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Tüzün Özdemir S, Akyol A. Effect of inhaler and topical lavender oil on pain management of arteriovenous fistula cannulation. J Vasc Access 2023; 24:465-474. [PMID: 34396816 DOI: 10.1177/11297298211031086] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The recurrent arteriovenous fistula (AVF) intervention in the treatment of hemodialysis induces pain in patients. Lavender oil has analgesic, antimicrobial, and calming effects. This oil is widely used in patients to reduce anxiety and stress associated with pain caused by analgesics. METHOD The present study is a randomized controlled and experimental clinical trial in which patients (n = 90) who underwent hemodialysis with AVFs were randomly divided into three groups. The intensity of pain was measured in all patients at three different stages during the insertion of arterial needles for hemodialysis: (1) The topical application of 100% lavender essential oil, (2) the inhaler application of 100% lavender essential oil, and (3) no intervention. The placebo (water) was applied to groups 1 and 2. RESULTS Our findings revealed that the mean pre-application pain scores in hemodialysis patients were 57.58 ± 20.28 in the working group, 48.53 ± 20.23 in the control group, 19.49 ± 15.66 in the post-application group, and 45.33 ± 25.52 in the control group (p < 0.005). The average pain scores after the application of lavender oil were 22.66 ± 15.35 in the inhaler lavender group, 16.33 ± 15.97 in the topical lavender group, and 45.33 ± 25.52 in the control group. CONCLUSIONS After inhaler and topical application of lavender oil, a significant decrease in the severity of pain was recorded for patients at the time of arterial insertion of needles.
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Affiliation(s)
| | - Asiye Akyol
- Department of Internal Medicine Nursing, Ege University, Faculty of Nursing, Izmir, Turkey
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Dam M, Weijs PJM, van Ittersum FJ, Hoekstra T, Douma CE, van Jaarsveld BC. Nocturnal Hemodialysis Leads to Improvement in Physical Performance in Comparison with Conventional Hemodialysis. Nutrients 2022; 15:nu15010168. [PMID: 36615825 PMCID: PMC9823778 DOI: 10.3390/nu15010168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
End-stage kidney disease patients treated with conventional hemodialysis (CHD) are known to have impaired physical performance and protein-energy wasting (PEW). Nocturnal hemodialysis (NHD) was shown to improve clinical outcomes, but the evidence is limited on physical performance and PEW. We investigate whether NHD improves physical performance and PEW. This prospective, multicenter, non-randomized cohort study compared patients who changed from CHD (2−4 times/week 3−5 h) to NHD (2−3 times/week 7−8 h), with patients who continued CHD. The primary outcome was physical performance at 3, 6 and 12 months, assessed with the short physical performance battery (SPPB). Secondary outcomes were a 6-minute walk test (6MWT), physical activity monitor, handgrip muscle strength, KDQOL-SF physical component score (PCS) and LAPAQ physical activity questionnaire. PEW was assessed with a dietary record, dual-energy X-ray absorptiometry, bioelectrical impedance spectroscopy and subjective global assessment (SGA). Linear mixed models were used to analyze the differences between groups. This study included 33 patients on CHD and 32 who converted to NHD (mean age 55 ± 15.3). No significant difference was found in the SPPB after 1-year of NHD compared to CHD (+0.24, [95% confidence interval −0.51 to 0.99], p = 0.53). Scores of 6MWT, PCS and SGA improved (+54.3 [95%CI 7.78 to 100.8], p = 0.02; +5.61 [−0.51 to 10.7], p = 0.03; +0.71 [0.36 to 1.05], p < 0.001; resp.) in NHD patients, no changes were found in other parameters. We conclude that NHD patients did not experience an improved SPPB score compared to CHD patients; they did obtain an improved walking distance and self-reported PCS as well as SGA after 1-year of NHD, which might be related to the younger age of these patients.
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Affiliation(s)
- Manouk Dam
- Amsterdam UMC, Nutrition and Dietetics, Amsterdam Cardiovascular Sciences, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Correspondence:
| | - Peter J. M. Weijs
- Amsterdam UMC, Nutrition and Dietetics, Amsterdam Cardiovascular Sciences, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Nutrition and Dietetics, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dr. Meurerlaan 8, 1067 SM Amsterdam, The Netherlands
| | - Frans J. van Ittersum
- Amsterdam UMC, Nephrology, Amsterdam Cardiovascular Sciences, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Tiny Hoekstra
- Amsterdam UMC, Nephrology, Amsterdam Cardiovascular Sciences, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Caroline E. Douma
- Spaarne Gasthuis Hoofddorp, Nephrology, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands
| | - Brigit C. van Jaarsveld
- Amsterdam UMC, Nephrology, Amsterdam Cardiovascular Sciences, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Chazot C, Jean G. Intérêts et limites de l’Hémodialyse Longue Nocturne. BULLETIN DE LA DIALYSE À DOMICILE 2022. [DOI: 10.25796/bdd.v5i3.67683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
L’hémodialyse (HD) Longue Nocturne (HDLN) intermittente permet de combiner dialyse et sommeil. Ses avantages cliniques sont une vitesse d’ultrafiltration réduite, un meilleur contrôle de la volémie avec amélioration de la tolérance des séances et des performances cardiaques, une phosphatémie et des moyennes molécules mieux épurées et une meilleure survie dans les études de cohortes. La qualité de vie n’est pas altérée par la longueur des séances et elle s’améliore quand elle n’est pas optimale lors du transfert de l’HD standard vers l’HDLN. La qualité du sommeil n’est parfois perturbée mais elle n’est pas une cause importante de sortie du programme. La pérennité d’un programme d’HDLN passe par les volontés conjointes médicales et managériales, la sélection des patients stables, le respect des horaires et de la durée de séances, indispensable à la dialyse de sommeil. Les autorités de santé doivent jouer un rôle pour permettre cette modalité dans des conditions financières acceptables. L’information au patient de l’existence de l’HDLN avant le stade de la dialyse est essentielle, aidée par le témoignage des pairs. Les sociétés savantes doivent soutenir la recherche et l’information aux néphrologues. Enfin les conditions architecturales favorisant l’intimité et le sommeil sont une clé de réussite du programme.
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Zhu F, Kaysen GA, Sarkar S, Finkelstein FO, Carter M, Levin NW, Hoenich NA. Evaluation of one year of frequent dialysis on fluid load and body composition using calf bioimpedance technique. Physiol Meas 2019; 40:055004. [PMID: 31035269 DOI: 10.1088/1361-6579/ab1d8f] [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
OBJECTIVE The primary aim of this study was to evaluate the effect of increased frequency of dialysis (FHD) on change in fluid status and body composition using segmental bioimpedance. APPROACH Twelve stable HD patients were switched from 3 times/week to 6 times/week HD (FHD). Systolic blood pressure (SBP), body mass and body mass index (BMI) were measured pre- and post-HD. Calf resistance (R 5) at 5 kHz was measured using a multifrequency bioimpedance device (Hydra 4200). Calf resistivity (ρ = R 5 * area/length), normalized resistivity (CNR = ρ/BMI) and calf extracellular volume (cECV) were calculated. Fat mass was measured by Futrex body composition analyzers (Futrex 6100, Futrex Tech, Inc.). All measurements were performed at baseline (BL) and monthly for up to one year. MAIN RESULTS Nine patients completed one year of FHD. Compared to BL, body weight and cECV decreased, and CNR increased significantly by the first month but did not change thereafter. SBP pre-HD decreased significantly by the end of the first month with further reduction until month 12. Additionally, antihypertensive medication decreased significantly from baseline by month 4 and remained stable from month 6 throughout the rest of the study. The post-HD CNR in five of nine patients reached the range of normal (>18.5 10-2 * Ohm * m3 kg-1 for males and >19.1 10-2 * Ohm * m3 kg-1 for females) after 1 year FHD. In patients who returned to 3 times/week dialysis, CNR decreased significantly in the first week, and this was associated with increases in body weight and SBP. SIGNIFICANCE Reduction of fluid overload with no alteration of body composition was observed in this study. Accordingly, improving fluid status was confirmed by reducing BP and use of antihypertensive drugs together with increase in CNR. Measurement of fluid status by CNR in hemodialysis patients is a new method to quantitatively assess hydration potentially creating a target for volume of fluid removal.
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Affiliation(s)
- Fansan Zhu
- Renal Research Institute, 315 East 62nd Street, New York, NY 10065, United States of America. Author to whom any correspondence should be addressed
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Jansz TT, Özyilmaz A, Grooteman MPC, Hoekstra T, Romijn M, Blankestijn PJ, Bots ML, van Jaarsveld BC. Long-term clinical parameters after switching to nocturnal haemodialysis: a Dutch propensity-score-matched cohort study comparing patients on nocturnal haemodialysis with patients on three-times-a-week haemodialysis/haemodiafiltration. BMJ Open 2018. [PMID: 29523566 PMCID: PMC5855195 DOI: 10.1136/bmjopen-2017-019900] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Nocturnal haemodialysis (NHD), characterised by 8-hour sessions ≥3 times a week, is known to improve clinical parameters in the short term compared with conventional-schedule haemodialysis (HD), generally 3×3.5-4 hours a week. We studied long-term effects of NHD and used patients on conventional HD/haemodiafiltration (HDF) as controls. DESIGN Four-year prospective follow-up of patients who switched to NHD; we compared patients with patients on HD/HDF using propensity score matching. SETTING 28 Dutch dialysis centres. PARTICIPANTS We included 159 patients starting with NHD any time since 2004, aged 56.7±12.9 years, with median dialysis vintage 2.3 (0.9-5.1) years. We propensity-score matched 100 patients on NHD to 100 on HD/HDF. PRIMARY AND SECONDARY OUTCOME MEASURES Control of hypertension (predialysis blood pressure, number of antihypertensives), phosphate (phosphate, number of phosphate binders), nutritional status and inflammation (albumin, C reactive protein and postdialysis weight) and anaemia (erythropoiesis-stimulating agent (ESA) resistance). RESULTS Switching to NHD was associated with a non-significant reduction of antihypertensives compared with HD/HDF (OR <2 types 2.17, 95% CI 0.86 to 5.50, P=0.11); and a prolonged lower need for phosphate binders (OR <2 types 1.83, 95% CI 1.10 to 3.03, P=0.02). NHD was not associated with significant changes in blood pressure or phosphate. NHD was associated with significantly higher albumin over time compared with HD/HDF (0.70 g/L/year, 95% CI 0.10 to 1.30, P=0.02). ESA resistance decreased significantly in NHD compared with HD/HDF, resulting in a 33% lower ESA dose in the long term. CONCLUSIONS After switching to NHD, the lower need for antihypertensives, phosphate binders and ESA persists for at least 4 years. These sustained improvements in NHD contrast significantly with the course of these parameters during continued treatment with conventional-schedule HD and HDF. NHD provides an optimal form of dialysis, also suitable for patients expected to have a long waiting time for transplantation or those convicted to indefinite dialysis.
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Affiliation(s)
- Thijs Thomas Jansz
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Akin Özyilmaz
- Dialysis Centre Groningen, Groningen, The Netherlands
- Division of Nephrology, Department of Internal Medicine, University Medical Centre, Groningen, The Netherlands
| | - Muriel P C Grooteman
- Department of Nephrology, VU University Medical Centre, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, VU University Medical Centre, Amsterdam, The Netherlands
| | - Tiny Hoekstra
- Department of Nephrology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Marieke Romijn
- Department of Nephrology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Michael L Bots
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Brigit C van Jaarsveld
- Department of Nephrology, VU University Medical Centre, Amsterdam, The Netherlands
- Diapriva Dialysis Centre, Amsterdam, The Netherlands
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Dam M, Neelemaat F, Struijk-Wielinga T, Weijs PJ, van Jaarsveld BC. Physical performance and protein-energy wasting in patients treated with nocturnal haemodialysis compared to conventional haemodialysis: protocol of the DiapriFIT study. BMC Nephrol 2017; 18:144. [PMID: 28460640 PMCID: PMC5412044 DOI: 10.1186/s12882-017-0562-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 04/20/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Poor physical performance and protein-energy wasting (PEW) are health issues of major concern in haemodialysis patients. The conventional haemodialysis (CHD) regime, three times per week 3-5 h, is subject of discussion because of high morbidity and mortality rates. When patients switch from CHD to longer dialysis sessions, i.e. nocturnal haemodialysis (NHD), improvement in protein intake and increase in body weight is seen. However, it is unclear whether physical performance and more important aspects of PEW, such as body composition, improve as well. Therefore, the aim of this study is to investigate whether physical performance improves and PEW decreases, when patients switch from CHD to NHD. A second aim is to assess the influence of NHD on the biomarkers fibroblast growth factor-23 and sclerostin which are thought to be associated with malnutrition and mortality in patients on haemodialysis. METHODS This study is a prospective multicentre cohort study with an inclusion aim of 50 patients: 25 patients in a control group (three times per week, 3-5 h CHD) and 25 patients in a nocturnal group (three times per week, 7-9 h NHD). Primary outcome is change in physical performance, measured by the Short Physical Performance Battery. Additional measurements are a 6-min walk test, handgrip strength, a physical activity questionnaire and physical activity monitoring. The secondary outcome of the study is PEW, which will be evaluated by body weight, dual-energy X-ray absorptiometry, bio-electrical impedance spectroscopy, mid-upper arm muscle circumference, subjective global assessment, visual analogue scale for appetite and dietary records. Laboratory measurements including fibroblast growth factor-23 and sclerostin, and quality of life assessed with the Kidney Disease Quality of Life-Short Form are also studied. In every patient, four repeated measurements will be performed during one year of follow-up. DISCUSSION This study will investigate whether physical performance improves and PEW decreases when patients switch from CHD to NHD, compared to a control group who continue treatment with CHD. Strengths of this study are the comparison with a conventional haemodialysis cohort, and the broad variety of objective measurements combined with patient-reported outcomes of physical performance and PEW. TRIAL REGISTRATION NTR4715 , Netherlands Trial Register. Registered 30 July 2014.
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Affiliation(s)
- Manouk Dam
- VU University Medical Centre, department of Nutrition and Dietetics, Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
| | - Floor Neelemaat
- VU University Medical Centre, department of Nutrition and Dietetics, Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - Trudeke Struijk-Wielinga
- VU University Medical Centre, department of Nutrition and Dietetics, Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - Peter J Weijs
- VU University Medical Centre, department of Nutrition and Dietetics, Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - Brigit C van Jaarsveld
- VU University Medical Centre, department of Nephrology, Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
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Noori N, Yan AT, Kiaii M, Rathe A, Goldstein MB, Bello O, Wald R. Nutritional status after conversion from conventional to in-centre nocturnal hemodialysis. Int Urol Nephrol 2017; 49:1453-1461. [PMID: 28456922 DOI: 10.1007/s11255-017-1595-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Recipients of conventional hemodialysis (CHD; 3-4 h/session, 3 times/week) experience volume expansion and nutritional impairment which may contribute to high mortality. Prolongation of sessions with in-centre nocturnal hemodialysis (INHD; 7-8 h/session, 3 times/week) may improve clinical outcomes by enhancement of ultrafiltration and uremic toxin removal. MATERIALS AND METHODS In this prospective cohort study, 56 adult patients who were receiving maintenance CHD for at least 90 days were assigned to CHD (patients who remained in CHD) and INHD (patients who switched to INHD) groups. Both groups were followed for 1 year divided into four 13-week quarters; post-dialysis weight and interdialytic weight gain (IDWG) were captured in each quarter. Repeated measures analysis of variance was used to calculate group main effect, time main effect or time-group interaction effect. RESULTS Conversion to INHD was associated with a mean (95% confidence interval) change in IDWG of 0.5 (0.08, 1.2) kg as compared to -0.3 (-0.9, 0.1) kg in the CHD group (p < 0.01). In the INHD group, post-dialysis weight (% of baseline pre-dialysis weight) decreased after conversion, reaching a nadir during the first 3 months (0.7%) and subsequently it gradually increased and returned to its baseline at the end of follow-up. A similar temporal trend was seen for serum creatinine but not serum N-terminal pro-brain natriuretic peptide (NT-proBNP) which is a marker of extracellular volume. The changes in serum albumin, prealbumin and hs-CRP were not different between the two groups. CONCLUSIONS Conversion to INHD was associated with greater IDWG and relatively stable body mass. We speculate that this gain in weight reflects an increase in lean body mass following the change in dialysis modality, which can be concluded from the parallel increase in serum creatinine and the lack of increase in NT-proBNP.
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Affiliation(s)
- Nazanin Noori
- Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada
| | - Andrew T Yan
- Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, ST. Michael's Hospital, Toronto, ON, Canada
| | - Mercedeh Kiaii
- Division of Nephrology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Andrea Rathe
- Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada
| | - Marc B Goldstein
- Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada.,Li Ka Shing Knowledge Institute, ST. Michael's Hospital, Toronto, ON, Canada
| | - Olugbenga Bello
- Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada. .,Li Ka Shing Knowledge Institute, ST. Michael's Hospital, Toronto, ON, Canada.
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Chazot C, Vo-Van C, Lorriaux C, Deleaval P, Mayor B, Hurot JM, Jean G. Even a Moderate Fluid Removal Rate during Individualised Haemodialysis Session Times Is Associated with Decreased Patient Survival. Blood Purif 2017; 44:89-97. [DOI: 10.1159/000464346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/18/2017] [Indexed: 11/19/2022]
Abstract
Background: Several studies report that fluid removal rate (FRR) above 10-13 mL/h/kg is associated with increased mortality in haemodialysis (HD) patients. Aim: The aims of this study are to assess the influence of moderate FRR on survival in a cohort of prevalent dialysis patients with various dialysis session times and to challenge the FRR thresholds associated with increased mortality risk reported previously. Methods: Interdialytic weight gain (IDWG) and FRR (calculated from ultrafiltration [UF], target weight, and session time prescriptions) were studied in 190 prevalent dialysis patients (female: 42%, mean age: 69.5 years, median vintage: 40.2 months, diabetes: 34.7%, loop diuretic prescription: 5.8%) and averaged during the final quarter of 2010. Patient survival was analysed using Kaplan-Meier and Cox-multivariate analyses. Results: The median IDWG, median session time, and median FRR were 2.33 kg (-0.54-4.57), 5.0 h (3.9-8.0 h), 6.8 mL/h/kg (1.3-16.7), respectively, and FRR was ≥10 mL/h/kg in 11.6% of the patients. The Kaplan-Meier analysis showed decreased patient survival when the FRR was above the median (6.8 mL/h/kg; p = 0.012). The FRR was found to be independently associated with increased mortality (hazard ratio 1.15 [95% CI 1.02-1.29]; p = 0.027) using stepwise Cox proportional hazard regression analysis, including age, vintage, gender, body mass index (BMI), serum albumin level, β2-microglobulin level, cardiovascular and diabetes history, and session time. Online haemodiafiltration did not change this result. The role of residual renal function was unlikely because 74% of the patients had a vintage of >18 months, a minority (5.8%) were prescribed loop diuretics (a surrogate of significant urine output) and β2-microglobulin level was not different in patients who were below or above the FRR median. Conclusion: We concluded that the FRR threshold above which there is an increased mortality is lower than what has been reported (7.8 mL/h/kg). It raises the question of the hazard of fluid removal and intermittence of standard HD.
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Leypoldt JK, Meijers BKI. Effect of Treatment Duration and Frequency on Uremic Solute Kinetics, Clearances and Concentrations. Semin Dial 2016; 29:463-470. [PMID: 27578429 DOI: 10.1111/sdi.12531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The kinetics of uremic solute clearances are discussed based on two categories of uremic solutes, namely those that are and those that are not derived directly from nutrient intake, particularly dietary protein intake. This review highlights dialysis treatments that are more frequent and longer (high-dose hemodialysis) than conventional thrice weekly therapy. It is proposed that the dialysis dose measures based on urea as a marker uremic solute, such as Kt/V and stdKt/V, be referred to as measures of dialysis inadequacy, not dialysis adequacy. For uremic solutes derived directly from nutrient intake, it is suggested that inorganic phosphorus and protein-bound uremic solutes be considered as markers in the development of alternative measures of dialysis dose for high-dose hemodialysis prescriptions. As the current gap in understanding the detailed kinetics of protein-bound uremic solutes, it is proposed that normalization of serum phosphorus concentration with a minimum (or preferably without a) need for oral-phosphorus binders be targeted as a measure of dialysis adequacy in high-dose hemodialysis. For large uremic solutes not derived directly from nutrient intake (middle molecules), use of extracorporeal clearances for β2 -microglobulin that are higher than currently available during thrice weekly therapy is unlikely to reduce predialysis serum β2 -microglobulin concentrations. High-dose hemodialysis prescriptions will lead to reductions in predialysis serum β2 -microglobulin concentrations, but such reductions are also limited by significant residual kidney clearance. Kinetic data regarding middle molecules larger than β2 -microglobulin are scarce; additional studies on such uremic solutes are of high interest to better understand improved methods for prescribing high-dose hemodialysis prescriptions to improve patient outcomes.
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Affiliation(s)
- John K Leypoldt
- Renal Therapeutic Area and Medical Affairs, Baxter Healthcare Corporation, Deerfield, Illinois.
| | - Björn K I Meijers
- Division of Nephrology, Department of Microbiology and Immunology, University Hospitals Leuven, Leuven, Belgium
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Wald R, Goldstein MB, Perl J, Kiaii M, Yuen D, Wald RM, Harel Z, Weinstein JJ, Jakubovic B, Leong-Poi H, Kirpalani A, Leipsic J, Dacouris N, Wolf M, Yan AT. The Association Between Conversion to In-centre Nocturnal Hemodialysis and Left Ventricular Mass Regression in Patients With End-Stage Renal Disease. Can J Cardiol 2015; 32:369-77. [PMID: 26386732 DOI: 10.1016/j.cjca.2015.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 06/26/2015] [Accepted: 07/05/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND In-centre nocturnal hemodialysis (INHD, 7-8 hours/session, 3 times/week) is an increasingly utilized form of dialysis intensification, though data on the cardiovascular benefits of this modality are limited. METHODS In this prospective cohort study, we enrolled 67 prevalent conventional hemodialysis (CHD, 4 hours/session, 3 times/week) recipients at 2 medical centres in Canada, of whom 37 converted to INHD and 30 remained on CHD. The primary outcome was the change in left ventricular mass (LVM) after 1 year as assessed by cardiac magnetic resonance imaging. Secondary outcomes included changes in serum phosphate concentration, phosphate binder burden, haemoglobin, erythropoiesis stimulating agent usage, and blood pressure. RESULTS Conversion to INHD was associated with a 14.2 (95% confidence interval [CI] 1.2-27.2) g reduction in LVM as compared with continuation on CHD. This result was maintained after adjustment for baseline imbalances between the groups and in ancillary analyses. There was a trend toward a larger drop in systolic blood pressure (9.8 [95% CI, -1.4-20.9] mm Hg) among INHD recipients with a significant reduction in the number of prescribed antihypertensive agents (0.7 [95% CI, 0.3-1.1] agents). Serum phosphate declined by 0.40 (95% CI, 0.16-0.63) mmol/L among INHD recipients without any difference in calcium-based phosphate binder requirements, as compared with those who remained on CHD. CONCLUSIONS Compared with continuation of CHD, conversion to INHD was associated with significant LVM regression and reduction in serum phosphate concentration at 1 year.
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Affiliation(s)
- Ron Wald
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
| | - Marc B Goldstein
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Jeffrey Perl
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Mercedeh Kiaii
- Division of Nephrology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Yuen
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Rachel M Wald
- Divisions of Cardiology and Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Ziv Harel
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Jordan J Weinstein
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Baruch Jakubovic
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Howard Leong-Poi
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Division of Cardiology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Anish Kirpalani
- Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jonathon Leipsic
- Department of Radiology and Division of Cardiology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Niki Dacouris
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Myles Wolf
- Division of Nephrology and Center for Translational Metabolism and Health - Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew T Yan
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Division of Cardiology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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Thumfart J, Müller D. Nocturnal intermittent hemodialysis. Pediatr Nephrol 2015; 30:749-57. [PMID: 25103600 DOI: 10.1007/s00467-014-2869-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
Abstract
Preemptive renal transplantation is the method of choice for end stage renal disease in childhood and adolescence. However, without preemptive transplantation, waiting time for kidney transplantation might exceed several years. The poor quality of life and the extremely high morbidity and mortality rates of dialysis patients have led to the development of intensified hemodialysis programs in which the modes of dialysis (short daily, nocturnal intermittent or daily nocturnal) are different. Such programs have been shown to significantly improve several uremia-associated parameters, such as blood pressure, phosphate control, anemia and growth retardation, in both adult and pediatric (children and adolescents) patients and lead to a reduction in medications, including phosphate binders, erythropoietin and antihypertensive agents. Fluid limitations and dietary restrictions can also be lifted. With respect to psychosocial rehabilitation and quality of life, nocturnal intermittent dialysis programs provide a reasonable compromise of all forms of intensified programs. Experiences and practical approaches of our own in-center nocturnal intermittent hemodialysis program in the light of the recent publications are described in this review.
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Affiliation(s)
- Julia Thumfart
- Department of Pediatric Nephrology, Charité, Augustenburger Platz 1, 13353, Berlin, Germany
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12
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Buitenwerf E, Risselada AJ, van Roon EN, Veeger NJGM, Hemmelder MH. Effect of nadroparin on anti-Xa activity during nocturnal hemodialysis. BBA CLINICAL 2015; 3:276-9. [PMID: 26672512 PMCID: PMC4661578 DOI: 10.1016/j.bbacli.2015.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/15/2015] [Accepted: 03/20/2015] [Indexed: 11/15/2022]
Abstract
Background Nadroparin is used during hemodialysis to prevent clotting of the extra corporeal system. During nocturnal hemodialysis patients receive an increased dosage of nadroparin compared to conventional hemodialysis. We tested whether the prescribed dosage regimen of nadroparin, according to Dutch guidelines, causes accumulation of nadroparin. Methods Anti-Xa levels were used as an indicator of nadroparin accumulation. Anti-Xa was measured photometrically in 13 patients undergoing nocturnal hemodialysis for 4 nights a week. Nadroparin was administered according to Dutch dosage guidelines. We assessed anti-Xa levels at 4 time points during 1 dialysis week: before the start of the first dialysis session of the week (baseline), prior to (T1) and after the last dialysis session of the week (T2) and before the first dialysis of the following week (T3). Results Patients received 71–95 IU/kg at the start of dialysis and another 50% of the initial dosage after 4 h with a total cumulative dosage of 128 ± 24 IU/kg. Anti-Xa levels increased from 0.017 at baseline to 0.019 at T1 (p = 0.03). Anti-Xa levels were 0.419 ± 0.252 IU/ml at T2 (p < 0.001 vs baseline and T1), whereas anti-Xa levels were not changed at T3 compared to baseline. Conclusion Dosing of nadroparin according to Dutch guidelines in patients on nocturnal hemodialysis does not lead to accumulation of nadroparin. We therefore consider the Dutch dosage guidelines for nadroparin an effective and safe strategy. General significance This article is the first to present data on anti-Xa activity during nocturnal hemodialysis which is a widely used and potentially dangerous therapy. Higher dosages of nadroparin are administered during nocturnal hemodialysis. Nadroparin can accumulate which leads to an increased bleeding risk. We examined accumulation of nadroparin during nocturnal hemodialysis by measuring anti-Xa levels. Accumulation of nadroparin does not occur during nocturnal hemodialysis. Dutch guidelines for dosage of nadroparin in nocturnal hemodialysis are safe.
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Affiliation(s)
- Edward Buitenwerf
- Department of Internal Medicine-Nephrology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
| | - Arne J Risselada
- Department of Pharmacy, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
| | - Eric N van Roon
- Department of Pharmacy, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
| | - Nic J G M Veeger
- Department of Epidemiology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine-Nephrology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
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Dialysis frequency versus dialysis time, that is the question. Kidney Int 2013; 85:1024-9. [PMID: 24336033 DOI: 10.1038/ki.2013.474] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 08/05/2013] [Accepted: 08/15/2013] [Indexed: 11/09/2022]
Abstract
We reviewed a number of prospective randomized and multiple retrospective cohort studies of different dialysis prescriptions: longer dialysis time, at a frequency of at least three times a week, or a frequency of daily hemodialysis with a shorter dialysis time. Interestingly, the retrospective analyses have generally found significant survival benefits in the intensive dialysis groups, whereas more modest effects were observed in the prospective randomized controlled trials. The reason for this discrepancy may be related to the retrospective nature of the studies and possible selection bias; for example, the patients who were prescribed more frequent dialysis may have had more difficulties with volume control or high blood pressure. In contrast, the randomized controlled trials of increased dialysis frequency, which have shown indirect and modest benefits in complex coprimary end points, have small sample sizes and are plagued with difficulties in recruitment and compliance with the randomly allocated more frequent dialysis. This review, which attempts to balance the potential benefits of more frequent dialysis with the burden on the patient's lifestyle, an increased risk of access malfunction, as well as societal costs of such intensive dialysis prescriptions, concludes in favor of the conventional three times per week dialysis (at a minimum) but at longer dialysis times than is currently prescribed based on the Kt/Vurea metric alone.
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