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Birinci M, Hakyemez ÖS, Korkmaz O, Bingöl İ, Ata N, Ülgü MM, Birinci Ş, Ayvalı MO, Başarır K, Azboy İ. Unseen Threefold Mortality After the First Ten Days in Hemodialysis Patients Following Joint Arthroplasty: A Nationwide Retrospective Cohort Study of 1,287 Arthroplasty Patients on Hemodialysis. J Arthroplasty 2024; 39:2205-2212. [PMID: 38522803 DOI: 10.1016/j.arth.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The study addresses the growing number of hemodialysis (HD) patients undergoing joint arthroplasty, who are at higher risk of complications and mortality. Previous research has often overlooked deaths after discharge. This study aimed to examine early outcomes in a large nationwide cohort of patients who underwent arthroplasty for elective and fracture-related reasons. METHODS Between 2016 and 2022, a study was conducted using the e-Nabız database of the Türkiye Ministry of Health, focusing on patients aged 18 years and above who underwent elective or fracture-related arthroplasty. This study included 1,287 patients reliant on dialysis who underwent total hip arthroplasty, total knee arthroplasty, or hemiarthroplasty (HA), with 7.7% of them receiving dialysis for the first time. Propensity score matching was used to create an equally sized group of non-dialysis-dependent patients, ensuring demographic balance in terms of age, sex, a comorbidity index, and surgery type. The primary objective was to compare mortality rates 10, 30, and 90 days after arthroplasty. RESULTS The first-time dialysis patients who underwent HA had significantly higher 30- and 90-day mortality rates compared to the chronic dialysis group (P = .040 and P < .001, respectively). Also, the HD patients consistently exhibited higher 90-day mortality rates across all surgery types. With total knee arthroplasty, HD patients had a mortality rate of 8.7%, in stark contrast to 0% among non-HD patients (P < .001). Similarly, with total hip arthroplasty, HD patients had a 12% mortality rate, while non-HD patients had a markedly lower rate of 2.7% (P = .008). In the case of HA, HD patients had a significantly elevated 90-day mortality rate of 31.9%, in contrast to 17.1% among non-HD patients (P < .001). CONCLUSIONS Joint arthroplasty has higher rates of mortality and complications among HD patients. Surgical decisions must be based on patients' overall health, necessitating collaboration among specialists. These patients should be closely monitored.
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Affiliation(s)
- Murat Birinci
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
| | - Ömer S Hakyemez
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
| | - Oğuzhan Korkmaz
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
| | - İzzet Bingöl
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara Oncology Training and Research Hospital, Health Sciences University, Ankara, Türkiye
| | - Naim Ata
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | - Mahir M Ülgü
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | | | - Mustafa O Ayvalı
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | - Kerem Başarır
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Haliç University, İstanbul, Türkiye
| | - İbrahim Azboy
- Department of Orthopaedics and Traumatology, School of Medicine, İstanbul Medipol University, İstanbul, Türkiye
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Djajakusumah TM, Hapsari P, Nugraha P, Muhammad A, Lukman K. Characteristics of Vascular Access Cannulation Complications in End Stage Kidney Disease Patients in West Java from 2018 to 2022: A Retrospective Observational Study. Int J Nephrol Renovasc Dis 2024; 17:47-58. [PMID: 38370010 PMCID: PMC10870994 DOI: 10.2147/ijnrd.s440467] [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] [Received: 11/12/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
Background End-stage kidney disease (ESKD) is associated with a tremendous financial burden. Data in Indonesia shows an increasing number of patients with ESKD taking hemodialysis as a routine procedure every year. Establishment and maintenance of vascular access are important in the management of ESKD. Vascular complications that often arise due to hemodialysis are common and one of the main reasons for hospitalization. Cannulation complications ranged from minor hematomas to acute bleeding from pseudoaneurysms that required emergency surgical procedures. This study aims to assess the different clinicopathological characteristics of ESKD patients with vascular access cannulation complications and the surgical management related to the complications. Materials and Methods This research is a retrospective observational study. The research subjects in this study were ESKD patients in the vascular and endovascular surgery division of the tertiary hospital in West Java, Indonesia. There were 121 study subjects. Clinicopathological characteristics of vascular cannulation complications and surgical management are extracted from the medical record. Results Three major vascular complications were ruptured pseudoaneurysms 64/121 (52.9%), impending rupture pseudoaneurysms 28/121 (23.1%), and pseudoaneurysms 21/121 (17.4%). Common surgical procedures were ligation of the draining vein 47/121 (38.8%), arterial primary repair 28/121 (23.1%), and arterial patch repair 18/121 (14.9%). There was a significant relationship between symptoms of bleeding in ruptured pseudoaneurysms and bulging masses in pseudoaneurysms (p = 0.001). There was a significant relationship between the diameter of the vascular mass, vascular defect size, and hematoma and the type of surgical procedure taken (p < 0.010). Conclusion Ruptured, impending rupture, and pseudoaneurysms are major complications of vascular access in ESKD patients, and there was a significant relationship between the carried-out surgical procedure and the size of the vascular mass, defect, and hematoma.
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Affiliation(s)
- Teguh Marfen Djajakusumah
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Putie Hapsari
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Prapanca Nugraha
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Arrayyan Muhammad
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Kiki Lukman
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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Takkavatakarn K, Jintanapramote K, Phannajit J, Praditpornsilpa K, Eiam-Ong S, Susantitaphong P. Incremental versus conventional haemodialysis in end-stage kidney disease: a systematic review and meta-analysis. Clin Kidney J 2024; 17:sfad280. [PMID: 38186889 PMCID: PMC10768771 DOI: 10.1093/ckj/sfad280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Indexed: 01/09/2024] Open
Abstract
Background Appropriate dialysis prescription in the transitional setting from chronic kidney disease to end-stage kidney disease is still challenging. Conventional thrice-weekly haemodialysis (HD) might be associated with rapid loss of residual kidney function (RKF) and high mortality. The benefits and risks of incremental HD compared with conventional HD were explored in this systematic review and meta-analysis. Methods We searched MEDLINE, Scopus and Cochrane Central Register of Controlled Trials up to April 2023 for studies that compared the impacts of incremental (once- or twice-weekly HD) and conventional thrice-weekly HD on cardiovascular events, RKF, vascular access complications, quality of life, hospitalization and mortality. Results A total of 36 articles (138 939 participants) were included in this meta-analysis. The mortality rate and cardiovascular events were similar between incremental and conventional HD {odds ratio [OR] 0.87 [95% confidence interval (CI)] 0.72-1.04 and OR 0.67 [95% CI 0.43-1.05], respectively}. However, hospitalization and loss of RKF were significantly lower in patients treated with incremental HD [OR 0.44 (95% CI 0.27-0.72) and OR 0.31 (95% CI 0.25-0.39), respectively]. In a sensitivity analysis that included studies restricted to those with RKF or urine output criteria, incremental HD had significantly lower cardiovascular events [OR 0.22 (95% CI 0.08-0.63)] and mortality [OR 0.54 (95% CI 0.37-0.79)]. Vascular access complications, hyperkalaemia and volume overload were not statistically different between groups. Conclusions Incremental HD has been shown to be safe and may provide superior benefits in clinical outcomes, particularly in appropriately selected patients. Large-scale randomized controlled trials are required to confirm these potential advantages.
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Affiliation(s)
- Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kavita Jintanapramote
- Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand
| | - Jeerath Phannajit
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Research Unit for Metabolic Bone Disease in CKD patients, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Research Unit for Metabolic Bone Disease in CKD patients, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Zhu L, Li XL, Shi R, Wang DG. Dialysis vintage is associated with a high prevalence and severity of unpleasant symptoms in patients on hemodialysis. Ren Fail 2023; 45:2201361. [PMID: 37191187 DOI: 10.1080/0886022x.2023.2201361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Background: The burden of physical and emotional symptoms caused by somatic illness is present in most dialysis patients. However, it's unclear how symptom burden varies among patients with different dialysis vintages. We sought to examine differences in the prevalence and severity of unpleasant symptoms in hemodialysis patients with diverse dialysis vintage cohorts.Methods: This cross-sectional study included patients on maintenance hemodialysis at the Second Hospital of Anhui Medical University. We used the Dialysis Symptom Index (DSI) to determine the associated unpleasant symptoms, which is a validated survey to assess symptom burden/severity (higher scores indicate more severe symptoms), over June 2022 - September 2022.Results: We studied 146 patients: 35 (24%) had a dialysis vintage of ≤12 months (group 1) and 111 (76%) had a dialysis vintage of >12 months (group 2). Concerning Group 1 patients, the prevalence and severity of unpleasant symptoms were significantly higher in Group 2, the most common individual symptoms included feeling tired or lack of energy and trouble falling asleep (i.e., 75-85% of patients in each group), with dialysis vintage being an independent influencing factor (adjusted OR, 0.19; 95% CI, 0.16 to 0.23). Lower hemoglobin levels, iron stores, and dialysis adequacy levels are correlated with longer dialysis vintage.Conclusion: We observed a high prevalence of unpleasant symptoms and symptom clusters in a diverse dialysis vintages hemodialysis cohort. Further studies are needed to accurately and routinely define the symptom burden of chronic patients with chronic kidney disease (CKD).
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Affiliation(s)
- Li Zhu
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
| | - Xun-Liang Li
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
| | - Rui Shi
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
| | - De-Guang Wang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
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Lai B, Shen L, Ye S, Shen X, Zhou D, Guo X, Zhou H, Pan Y, Tong J. Influence of continuity of care on self-management ability and quality of life in outpatient maintenance hemodialysis patients. Ther Apher Dial 2022; 26:1166-1173. [PMID: 35043556 PMCID: PMC9790337 DOI: 10.1111/1744-9987.13800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/26/2021] [Accepted: 12/02/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the effect of continuity of care on self-management ability and quality of life (QOL) in patients undergoing maintenance hemodialysis (MHD). METHODS One hundred patients were randomly assigned to the observation group and the control group. In the observation group, patients received a 12-month continuity of care. In the control group, patients were given with routine nursing. Evaluate the patients' self-management ability and QOL between two groups 1 week before discharge and 6 and 12 months outpatient MHD. RESULTS Observation group had higher Hemodialysis Self-Management Instrument (HD-SMI) scores and Kidney Disease Quality of Life-Short Form (KDQOL-SF™) scores than control group at 6 and 12 months outpatient MHD. But patients in observation group had a much lower systolic blood pressure than those in control group at 12 months outpatient MHD. CONCLUSIONS Our study suggested that continuity of care in the form of online education, telephone visit, and outpatient visit could improve self-management ability and QOL of patients undergoing MHD.
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Affiliation(s)
- Bihong Lai
- Department of Nursing, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Li Shen
- Department of Nursing, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Shuiying Ye
- Department of Nursing, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Xia Shen
- Department of Nursing, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Dongchi Zhou
- Department of NephrologyShanghai Pudong Hospital, Fudan University Pudong Medical CenterShanghaiChina
| | - Xiaocui Guo
- Department of Nursing, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Huaxian Zhou
- Department of Nursing, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Yangbin Pan
- Department of NephrologyShanghai Pudong Hospital, Fudan University Pudong Medical CenterShanghaiChina
| | - Jindong Tong
- Department of Vascular SurgeryShanghai Pudong Hospital, Fudan University Pudong Medical CenterShanghaiChina
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Worboys HM, Cooper NJ, Burton JO, Young HML, Waheed G, Fotheringham J, Gray LJ. Measuring quality of life in trials including patients on haemodialysis: methodological issues surrounding the use of the Kidney Disease Quality of Life Questionnaire. Nephrol Dial Transplant 2022; 37:2538-2554. [PMID: 35689670 PMCID: PMC9681926 DOI: 10.1093/ndt/gfac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Haemodialysis (HD) treatment causes a significant decrease in quality of life (QoL). When enrolled in a clinical trial, some patients are lost prior to follow-up because they die or they receive a kidney transplant. It is unclear how these patients are dealt with in the analysis of QoL data. There are questions surrounding the consistency of how QoL measures are used, reported and analysed. METHODS A systematic search of electronic databases for trials measuring QoL in HD patients using any variation of the Kidney Disease Quality of Life (KDQoL) Questionnaire was conducted. The review was conducted in Covidence version 2. Quantitative analysis was conducted in Stata version 16. RESULTS We included 61 trials in the review, of which 82% reported dropouts. The methods to account for missing data due to dropouts include imputation (7%) and complete case analysis (72%). Few trials (7%) conducted a sensitivity analysis to assess the impact of missing data on the study results. Single imputation techniques were used, but are only valid under strong assumptions regarding the type and pattern of missingness. There was inconsistency in the reporting of the KDQoL, with many articles (70%) amending the validated questionnaires or reporting only statistically significant results. CONCLUSIONS Missing data are not dealt with according to the missing data mechanism, which may lead to biased results. Inconsistency in the use of patient-reported outcome measures raises questions about the validity of these trials. Methodological issues in nephrology trials could be a contributing factor to why there are limited effective interventions to improve QoL in this patient group. PROSPERO REGISTRATION CRD42020223869.
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Affiliation(s)
- Hannah M Worboys
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicola J Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Hannah M L Young
- Leicester Diabetes Centre, University of Hospitals of Leicester NHS Trust, Leicester, UK
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Ghazala Waheed
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - James Fotheringham
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
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Asghar MS, Ahsan MN, Mal P, Tahir MJ, Yasmin F, Abbasher Hussien Mohamed Ahmed K. Assessment of quality of life determinants in hemodialysis patients of a developing country: A cross-sectional study during ongoing COVID-19 pandemic. Medicine (Baltimore) 2022; 101:e29305. [PMID: 35945800 PMCID: PMC9351511 DOI: 10.1097/md.0000000000029305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients of end-stage renal disease are prone to have a very low quality of life (QoL). Variety of factors influence the QoL among sufferers of chronic kidney disease comprising of type of dialysis, sufficiency/adequacy of dialysis, and associated burden of disease. We conducted this study amidst the pandemic to determine the associated factors for poor QoL in hemodialysis patients during the ongoing pandemic. PATIENTS AND METHODS This cross-sectional study was conducted in a hemodialysis unit of a tertiary care hospital. A total of 118 participants responded to the validated questionnaire of Quality of Life Index-dialysis version-III (QLI). Higher scores signify good QoL, total scores are further categorized into subgroups desirable, relatively desirable and undesirable. RESULTS The mean age of the participants was 57.36 ± 10.03 years and mean body mass index of 26.73 ± 5.54 kg/m2. The mean total QoL of the study population was found quite low (12.99 ± 5.89). Majority of respondents fell in undesirable category of QoL (49.2%). Total QoL (P = 0.004) and subscale health/functioning (P = 0.003) were significantly lower in females. All the subscales along with total QoL scores were found lower in twice-weekly dialyzed patients (P < 0.001). Marital status (P = 0.049) and twice-weekly dialysis (P < 0.001) were found significant with undesirable QoL. On multivariate analysis, significant determinants of undesirable QoL were twice-weekly dialysis (P = 0.001), catheter access (P = 0.034), phosphate (P = 0.005) and uric acid (P = 0.006). CONCLUSION Inadequate dialysis due to lesser frequency per week leading to poorly cleared toxic substances were most significant contributors of poor QoL in our study.
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Affiliation(s)
- Muhammad Sohaib Asghar
- Department of Internal Medicine, Dow University of Health Sciences–Ojha Campus, Karachi, Pakistan
| | - Muhammad Nadeem Ahsan
- Department of Nephrology, Dow University of Health Sciences–Ojha Campus, Karachi, Pakistan
| | - Pooran Mal
- Department of Nephrology, Liaquat University of Medical & Health Sciences, Karachi, Pakistan
| | | | - Farah Yasmin
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Khabab Abbasher Hussien Mohamed Ahmed
- University of Khartoum, Faculty of Medicine, Khartoum, Sudan
- *Correspondence: Khabab Abbasher Hussien Mohamed Ahmed, Al-Gama’a Avenue, P. O. Box 321, 11111, Khartoum, Sudan (e-mail: )
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Murea M, Patel A, Highland BR, Yang W, Fletcher AJ, Kalantar-Zadeh K, Dressler E, Russell GB. Twice-Weekly Hemodialysis With Adjuvant Pharmacotherapy and Transition to Thrice-Weekly Hemodialysis: A Pilot Study. Am J Kidney Dis 2022; 80:227-240.e1. [PMID: 34933066 DOI: 10.1053/j.ajkd.2021.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/04/2021] [Indexed: 01/27/2023]
Abstract
RATIONALE & OBJECTIVE Thrice-weekly hemodialysis (HD) is the most common treatment modality for kidney failure in the United States. We conducted a pilot study to assess the feasibility and safety of incremental-start HD in patients beginning maintenance HD. STUDY DESIGN Pilot study. SETTING & PARTICIPANTS Adults with estimated glomerular filtration rate (eGFR) ≥5 mL/min/1.73 m2 and urine volume ≥500 mL/d beginning maintenance HD at 14 outpatient dialysis units. EXPOSURE Randomized allocation (1:1 ratio) to twice-weekly HD and adjuvant pharmacologic therapy for 6 weeks followed by thrice-weekly HD (incremental HD group) or thrice-weekly HD (conventional HD group). OUTCOME The primary outcome was feasibility. Secondary outcomes included changes in urine volume and solute clearance. RESULTS Of 77 patients invited to participate, 51 consented to do so, representing 66% of eligible patients. We randomized 23 patients to the incremental HD group and 25 patients to the conventional HD group. Protocol-based loop diuretics, sodium bicarbonate, and patiromer were prescribed to 100%, 39%, and 17% of patients on twice-weekly HD, respectively. At a mean follow-up of 281.9 days, participant adherence was 96% to the HD schedule (22 of 23 and 24 of 25 in the incremental and conventional groups, respectively) and 100% in both groups to serial timed urine collection. The incidence rate ratio for all-cause hospitalization was 0.31 (95% CI, 0.08-1.17); and 7 deaths were recorded (1 in the incremental and 6 in the conventional group). At week 24, the incremental HD group had lower declines in urine volume (a difference of 51.0 [95% CI, -0.7 to 102.8] percentage points) and in the averaged urea and creatinine clearances (a difference of 57.9 [95% CI, -22.6 to 138.4] percentage points). LIMITATIONS Small sample size, time-limited twice-weekly HD. CONCLUSIONS It is feasible to enroll patients beginning maintenance HD into a randomized study of incremental-start HD with adjuvant pharmacotherapy who adhere to the study protocol during follow-up. Larger multicenter clinical trials are indicated to determine the efficacy and safety of incremental HD with longer twice-weekly HD periods. FUNDING Funding was provided by Vifor Inc. TRIAL REGISTRATION Registered at ClinicalTrials.gov, identifier NCT03740048.
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Affiliation(s)
- Mariana Murea
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
| | - Ashish Patel
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Benjamin R Highland
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Wesley Yang
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Alison J Fletcher
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology Hypertension, and Kidney Transplantation, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California-Irvine, Orange, California; Long Beach Veterans Affairs Healthcare System, Long Beach, California
| | - Emily Dressler
- Department of Biostatistics and Data Science, Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Gregory B Russell
- Department of Biostatistics and Data Science, Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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Soi V, Faber MD, Paul R. Incremental Hemodialysis: What We Know so Far. Int J Nephrol Renovasc Dis 2022; 15:161-172. [PMID: 35520631 PMCID: PMC9065374 DOI: 10.2147/ijnrd.s286947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Traditionally, patients that develop progressive chronic kidney disease in need of kidney replacement therapy are prescribed thrice weekly in-center hemodialysis sessions at the beginning of therapy. This empiric prescription is based on historic trials that were comprised of mostly prevalent patients. Incremental hemodialysis is the process of performing <3 sessions of dialysis per week or limiting dialysis dose by duration at the initial onset of treatment to provide a more gradual transition, mimicking the progressive nature of kidney disease. Adding clearance contributions from residual kidney function is the standard of care with peritoneal dialysis but has not routinely been employed with hemodialysis. Accounting for residual kidney function accompanied by improvement in adjuvant pharmacotherapy, such as newer potassium binding agents and dietary modification, can augment dialytic clearances and allow for an incremental approach. Utilizing incremental dialysis has been associated with both preserving residual kidney function as well as improving patient quality of life. Barriers to this approach include concerns regarding patient acceptance of dialysis prescription changes, adherence to therapy, and provider factors that would require a restructuring of the current thrice weekly hemodialysis rubric. Candidacy for incremental therapy has shown the best outcomes when urea clearances exceed 3 mL/min and urine volumes are >500 mL/day, although these measures have been deemed conservative. A significant amount of retrospective and registry data has been supportive of initiating incremental hemodialysis and several pilot studies have shown the feasibility of implementing such an approach. Larger, randomized control trials are needed to fully evaluate safety and efficacy to allow for more widespread acceptance of this patient-centered approach to chronic kidney disease.
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Affiliation(s)
- Vivek Soi
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA
- Wayne State University School of Medicine, Detroit, MI, USA
- Correspondence: Vivek Soi, Email
| | - Mark D Faber
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Ritika Paul
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA
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10
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Tang L, Fu Z. The effects of the transtheoretical model combined with nutritional intervention in hemodialysis patients. Am J Transl Res 2021; 13:7898-7905. [PMID: 34377268 PMCID: PMC8340176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the effects of the transtheoretical model combined with nutritional intervention (TTMNI) in hemodialysis (HD) patients. METHODS The clinical data of 100 HD patients recorded from October 2018 to October 2020 were retrospectively collected and divided into two groups according to the intervention method each patient underwent. Group A (n=49) underwent routine nursing intervention and group B (n=51) underwent TTMNI combined with routine nursing intervention. The two groups were compared before and after intervention in terms of their nutritional indices, Renal Adherence Attitudes Questionnaire (RAAQ) scores, their Renal Adherence Behavior Questionnaire (RABQ) scores, their Subjective Global Assessment (SGA) statuses, their anthropometric indicators such as their serum creatinine (SCr), blood urea nitrogen (BUN), mid-arm muscle circumference (MAMC), triceps skinfold (TSF), body mass index (BMI), urea clearance index (KT/V), and urea reduction ratios (URR%). RESULTS Compared with group A, group B showed higher transferrin (TRF), prealbumin (PA), and albumin (ALB) levels, higher RAAQ and RABQ scores, higher MAMC, TSF, and BMI levels and lower SGA scores, and lower SCr, and BUN levels (P<0.05). After the intervention, the attainment rate of target KT/V was 94.12% in group B, higher than the 63.27% in group A, and the patients with target URR% accounted for 96.07% in group B, higher than the 61.22% in group A (P<0.05). CONCLUSION TTMNI for HD patients is helps improve patients' nutritional statuses and their dietary compliance as well as their liver function, and it increases their dialysis attainment rate.
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Affiliation(s)
- Lihua Tang
- Hemodialysis Room, First People's Hospital of Fuzhou Fuzhou 344000, Jiangxi Province, China
| | - Zhihui Fu
- Hemodialysis Room, First People's Hospital of Fuzhou Fuzhou 344000, Jiangxi Province, China
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