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Wang L, Yang Y, Zhao Q. Retrospective analysis of predictive factors for AVF dysfunction in patients undergoing MHD. Medicine (Baltimore) 2024; 103:e37737. [PMID: 38640314 PMCID: PMC11029975 DOI: 10.1097/md.0000000000037737] [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: 10/17/2023] [Revised: 02/03/2024] [Accepted: 03/06/2024] [Indexed: 04/21/2024] Open
Abstract
To construct an early clinical prediction model for AVF dysfunction in patients undergoing Maintenance Hemodialysis (MHD) and perform internal and external verifications. We retrospectively examined clinical data from 150 patients diagnosed with MHD at Hefei Third People's Hospital from January 2014 to June 2023. Depending on arteriovenous fistula (AVF) functionality, patients were categorized into dysfunctional (n = 62) and functional (n = 88) cohorts. Using the least absolute shrinkage and selection operator(LASSO) regression model, variables potentially influencing AVF functionality were filtered using selected variables that underwent multifactorial logistic regression analysis. The Nomogram model was constructed using the R software, and the Area Under Curve(AUC) value was calculated. The model's accuracy was appraised through the calibration curve and Hosmer-Lemeshow test, with the model undergoing internal validation using the bootstrap method. There were 11 factors exhibiting differences between the group of patients with AVF dysfunction and the group with normal AVF function, including age, sex, course of renal failure, diabetes, hyperlipidemia, Platelet count (PLT), Calcium (Ca), Phosphorus, D-dimer (D-D), Fibrinogen (Fib), and Anastomotic width. These identified factors are included as candidate predictive variables in the LASSO regression analysis. LASSO regression identified age, sex, diabetes, hyperlipidemia, anastomotic diameter, blood phosphorus, and serum D-D levels as 7 predictive factors. Unconditional binary logistic regression analysis revealed that advanced age (OR = 4.358, 95% CI: 1.454-13.062), diabetes (OR = 4.158, 95% CI: 1.243-13.907), hyperlipidemia (OR = 3.651, 95% CI: 1.066-12.499), D-D (OR = 1.311, 95% CI: 1.063-1.616), and hyperphosphatemia (OR = 4.986, 95% CI: 2.513-9.892) emerged as independent risk factors for AVF dysfunction in MHD patients. The AUC of the predictive model was 0.934 (95% CI: 0.897-0.971). The Hosmer-Lemeshow test showed high consistency between the model's predictive results and actual clinical observations (χ2 = 1.553, P = .092). Internal validation revealed an AUC of 0.911 (95% CI: 0.866-0.956), with the Calibration calibration curve nearing the ideal curve. Advanced age, coexisting diabetes, hyperlipidemia, blood D-D levels, and hyperphosphatemia are independent risk factors for AVF dysfunction in patients undergoing MHD.
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Affiliation(s)
- Liqin Wang
- Hemodialysis Center, Hefei Third Clinical College (Hefei Third People’s Hospital), Anhui Medical University, Hefei, China
| | - Yanna Yang
- Department of Nephrology, Hefei Third Clinical College (Hefei Third People’s Hospital), Anhui Medical University, Hefei, China
| | - Qianqian Zhao
- Hemodialysis Center, Hefei Third Clinical College (Hefei Third People’s Hospital), Anhui Medical University, Hefei, China
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2
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Moll G, Lim WH, Penack O. Editorial: Emerging talents in alloimmunity and transplantation: 2022. Front Immunol 2024; 15:1393026. [PMID: 38558808 PMCID: PMC10978591 DOI: 10.3389/fimmu.2024.1393026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Guido Moll
- BIH Center for Regenerative Therapies (BCRT) and Berlin-Brandenburg School for Regenerative Therapies (BSRT), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
- Department of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wai H. Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Olaf Penack
- Department of Hematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
- BIH Biomedical Innovation Academy, Charité Universitätsmedizin Berlin, Berlin, Germany
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3
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Li L, Chen M, Zhou Y, Gao R, Wang Y, Zhang Y. Effect of hierarchical nursing model on complications of hemodialysis patients in ICU and its effect evaluation. Minerva Med 2023; 114:902-904. [PMID: 35671003 DOI: 10.23736/s0026-4806.22.08186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ling Li
- Department of Critical Care Medicine, Nanjing Tongren Hospital, Nanjing, China
| | - Min Chen
- Blood Purifying Center, Nanjing Tongren Hospital, Nanjing, China
| | - Yaqin Zhou
- Department of Nursing, Nanjing Tongren Hospital, Nanjing, China
| | - Ruifang Gao
- Department of Critical Care Medicine, Nanjing Tongren Hospital, Nanjing, China
| | - Yuanyuan Wang
- Department of Critical Care Medicine, Nanjing Tongren Hospital, Nanjing, China
| | - Yonghua Zhang
- Department of Critical Care Medicine, Nanjing Tongren Hospital, Nanjing, China -
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Li Y, Luo X, Yang M, Su B. Alleviation of Oxidative Stress during Hemodialysis Sessions by Hemodialysis Membrane Innovation: A Multidisciplinary Perspective. Blood Purif 2023; 52:905-916. [PMID: 37748453 DOI: 10.1159/000533656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/11/2023] [Indexed: 09/27/2023]
Abstract
Oxidative stress is prevalent in end-stage kidney disease patients receiving chronic hemodialysis and is associated with heavy cardiovascular disease burdens and increased mortality risks. Hemoincompatible hemodialysis membranes per se contribute to the activation of oxidative reactions and the generation of oxygen free radicals. Since the early 1990s, vitamin E-coated membranes have been extensively used in hemodialysis patients to reduce oxidative stress during hemodialysis sessions. However, the beneficial effects of vitamin E-coated membranes versus unmodified synthetic membranes on long-term patient-centered outcomes, such as survival, quality of life, and prevalence of cardiovascular diseases, remain controversial. Accordingly, novel antioxidant hemodialysis membranes were prepared to replace the use of vitamin E-coated membranes despite the translational research on these membranes unfortunately coming to a standstill. In this review, we first summarize the state-of-the-art on the use of vitamin E-coated membranes in hemodialysis patients to highlight their strengths and limitations. Then, we discuss the latest advances in fabricating antioxidant hemodialysis membranes and provide perspectives to bridge knowledge gaps between laboratorial investigations and clinical practice in fabricating antioxidant hemodialysis membranes.
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Affiliation(s)
- Yupei Li
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China,
| | - Xinyao Luo
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Yang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Nephrology, The First People's Hospital of Shuangliu District, Chengdu, China
| | - Baihai Su
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Materials, Sichuan University, Chengdu, China
- Med+ Biomaterial Institute of West China Hospital, Sichuan University, Chengdu, China
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Wójtowicz D, Stodolak-Zych E. Strategies to Mitigate Biofouling of Nanocomposite Polymer-Based Membranes in Contact with Blood. MEMBRANES 2023; 13:762. [PMID: 37755184 PMCID: PMC10536434 DOI: 10.3390/membranes13090762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023]
Abstract
An extracorporeal blood purification method called continuous renal replacement therapy uses a porous hollow-fiber polymeric membrane that is exposed to prolonged contact with blood. In that condition, like with any other submerged filtration membrane, the hemofilter loses its properties over time and use resulting in a rapid decline in flux. The most significant reason for this loss is the formation of a biofilm. Protein, blood cells and bacterial cells attach to the membrane surface in complex and fluctuating processes. Anticoagulation allows for longer patency of vascular access and a longer lifespan of the membrane. Other preventive measures include the modification of the membrane itself. In this article, we focused on the role of nanoadditives in the mitigation of biofouling. Nanoparticles such as graphene, carbon nanotubes, and silica effectively change surface properties towards more hydrophilic, affect pore size and distribution, decrease protein adsorption and damage bacteria cells. As a result, membranes modified with nanoparticles show better flow parameters, longer lifespan and increased hemocompatibility.
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Affiliation(s)
- Dominika Wójtowicz
- Department of Biomaterials and Composites, Faculty of Materials Science and Ceramics, AGH University of Krakow, Al. Mickiewicza 30, 30-059 Krakow, Poland;
- Clinical Department of Anaesthesiology and Intensive Care, University Hospital in Krakow, ul. Jakubowskiego 2, 30-688 Krakow, Poland
| | - Ewa Stodolak-Zych
- Department of Biomaterials and Composites, Faculty of Materials Science and Ceramics, AGH University of Krakow, Al. Mickiewicza 30, 30-059 Krakow, Poland;
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Han YC, Liu YT, Zhang H, Xu Y, Liu J, Chen H, Song N, Qin DL, Yang S. VDR alleviates endothelial cell injury in arteriovenous fistula through inhibition of P66Shc-mediated mitochondrial ROS. Sci Rep 2023; 13:11088. [PMID: 37422508 PMCID: PMC10329703 DOI: 10.1038/s41598-023-37510-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023] Open
Abstract
To investigate the effects and mechanism of Vitamin D receptor (VDR) signaling on arteriovenous fistula (AVF) endothelial cell injury. Venous tissues of AVF stenosis patients were collected and analyzed, vascular morphology, reactive oxygen species (ROS), and the expression of VDR, P66Shc, fibronectin (FN), collagen-1 (Col-1) were detected. In addition, human umbilical vein endothelial cells (HUVECs) was used in in vitro studies. HUVECs was incubated with transforming growth factor-beta (TGF-β, 50 ng/ml). Aditionally, paricalcitol, VDR overexpression plasmid and Pin1 inhibitor Juglone were used to investigate the regulatory mechanism of VDR in mitochondrial ROS. The parameters of ROS (e.g. MitoSox) and the expression of FN, Col-1 were tested. Moreover, the mitochondrial translocation of P66Shc was analyzed. The expression of VDR was obviously decreased in the venous tissues of AVF stenosis patients. On the contrary, the expression of P66Shc, P-P66Shc, FN, Col-1 and 8-OHdG were increased significantly in the venous tissues of AVF stenosis patients (P < 0.05). In line with this, the level of mitochondrial ROS and the expression of P66Shc, P-P66Shc, FN, Col-1 increased obviously in HUVECs cells under TGF-β condition. Both VDR over-expression plasmid and Pin1 inhibitor Juglone could alleviate TGF-β induced endothelial injury. Mechanistically, VDR overexpression plasmid and Juglone could inhibit the expression of Pin1, and then restrain P66Shc mitochondrial translocation, eventually reduce the level of mitochondrial ROS. Our research indicated that activation of VDR could alleviate venous endothelial cell dysfunction through inhibiting Pin1-mediated mitochondrial translocation of P66Shc and consequently reducing mitochondrial ROS. It suggested that VDR signaling might be an effective target for AVF stenosis treatment.
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Affiliation(s)
- Ya-Chun Han
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yu-Ting Liu
- Department of Nephrology, The Third Xiangya Hospital, Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan Province, China
| | - Hao Zhang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan Province, China
| | - Yong Xu
- Department of Nephrology, The Third Xiangya Hospital, Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan Province, China
| | - Jun Liu
- Department of Nephrology, The Third Xiangya Hospital, Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan Province, China
| | - Hong Chen
- Department of Nephrology, The Third Xiangya Hospital, Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan Province, China
| | - Na Song
- Department of Nephrology, The Third Xiangya Hospital, Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan Province, China
| | - Dong-Lu Qin
- Department of Cardiovascular, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shikun Yang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan Province, China.
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Dou J, Liu H, Ma Y, Wu YY, Tao XB. Prevalence of post-dialysis fatigue: a systematic review and meta-analysis. BMJ Open 2023; 13:e064174. [PMID: 37311633 DOI: 10.1136/bmjopen-2022-064174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVES The purpose of this study was to synthesise data on the prevalence of post-dialysis fatigue (PDF) among haemodialysis (HD) patients. DESIGN Systematic review and meta-analysis. DATA SOURCES China National Knowledge Infrastructure, Wanfang, Chinese Biological Medical Database, PubMed, EMBASE and Web of Science were searched from their inception to 1 April 2022. ELIGIBILITY CRITERIA We selected patients who must receive HD treatment for at least 3 months. Cross-sectional or cohort studies published in Chinese or English were eligible for inclusion. The main search terms used in the abstract were: "renal dialysis", "hemodialysis" and "post-dialysis", in combination with the word "fatigue". DATA EXTRACTION AND SYNTHESIS Two investigators independently performed data extraction and quality assessment. Data were pooled to estimate the overall prevalence of PDF among HD patients using the random-effects model. Cochran's Q and I2 statistics were adopted to evaluate heterogeneity. RESULT A total of 12 studies were included, with 2152 HD patients, of which 1215 were defined as having PDF. The overall prevalence of PDF in HD patients was 61.0% (95% CI: 53.6% to 68.3%, p<0.001, I2=90.0%). Subgroup analysis failed to explain the source of heterogeneity, but univariable meta-regression showed that a mean age of ≥50 years might be the source of heterogeneity. Egger's test revealed no publication bias among the studies (p=0.144). CONCLUSIONS PDF is highly prevalent among HD patients.
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Affiliation(s)
- Junkai Dou
- School of Nursing, Anhui University of Traditional Chinese Medicine-East Campus, Hefei, China
| | - Huan Liu
- Department of Nephrology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yuan Ma
- School of Nursing, Wannan Medical College, Wuhu, China
| | - Ying-Ying Wu
- School of Nursing, Wannan Medical College, Wuhu, China
| | - Xiu-Bin Tao
- Department of Nursing, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
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8
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Guo SS, Gou YL, Li JD, Zhang HF, Huang Y, Zheng XJ, Chen H, Sui Z. An analysis of the etiologies and economic indexes of inpatients with stage 5 chronic kidney disease in North China. Front Public Health 2022; 10:956463. [PMID: 36530683 PMCID: PMC9751047 DOI: 10.3389/fpubh.2022.956463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/29/2022] [Indexed: 12/04/2022] Open
Abstract
Objective The aim of this study was to analyze the epidemiological characteristics of the causes of chronic kidney disease (CKD) stage 5 patients in North China and to investigate the economic burden of those on hemodialysis (HD) or peritoneal dialysis (PD), as well as the associated influencing factors. Methods General clinical information, etiological categories, and hospitalization costs for HD or PD were collected from 1,515 patients hospitalized with stage 5 CKD at the Affiliated Hospital of Hebei University from 2016 to 2018. Logistic regression analysis was used to analyze the independent influencing factors affecting patients' financial burden. Results The highest rate of DN was found in patients aged 70 years or older (27.0%) and the highest incidence of primary glomerulopathy was found in patients aged <50 years (24.3%). Age, type of dialysis, and type of health insurance were independent influences on the total financial burden of patients, and the results of multifactorial logistic regression analysis showed that age [OR (95% CI): 1.009 (1.002, 1.020)] and type of dialysis [OR (95% CI): 1.746 (1.149, 2.659)] would increase the total financial burden. The type of health insurance would reduce the total financial burden [OR (95% CI): 0.222 (0.108, 0.418)]. Conclusion Chronic kidney disease, with its complex etiology and the heavy financial burden required for treatment, remains a more serious public health problem globally, and it is therefore necessary to further improve medical coverage for dialysis patients, increase management efforts, broaden pro-poor policies and increase the accessibility of medical services in low- and middle-income areas.
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Affiliation(s)
- Shan-Shan Guo
- Department of Nephrology, Affiliated Hospital of Hebei University, Baoding, China
| | - Yan-Li Gou
- Department of Nephrology, Affiliated Hospital of Hebei University, Baoding, China
| | - Jian-Dong Li
- Department of Nephrology, Affiliated Hospital of Hebei University, Baoding, China
| | - Hong-Fang Zhang
- Tianjin Beichen Center for Disease Control and Prevention, Tianjin, China
| | | | - Xi-Jie Zheng
- Department of Nephrology, Affiliated Hospital of Hebei University, Baoding, China
| | - Hang Chen
- Department of Nephrology, Affiliated Hospital of Hebei University, Baoding, China,*Correspondence: Hang Chen
| | - Zhun Sui
- Department of Nephrology, Peking University People‘s Hospital, Beijing, China,Zhun Sui
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Groth T, Stegmayr BG, Ash SR, Kuchinka J, Wieringa FP, Fissell WH, Roy S. Wearable and implantable artificial kidney devices for end-stage kidney disease treatment-Current status and review. Artif Organs 2022; 47:649-666. [PMID: 36129158 DOI: 10.1111/aor.14396] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a major cause of early death worldwide. By 2030, 14.5 million people will have end-stage kidney disease (ESKD, or CKD stage 5), yet only 5.4 million will receive kidney replacement therapy (KRT) due to economic, social, and political factors. Even for those who are offered KRT by various means of dialysis, the life expectancy remains far too low. OBSERVATION Researchers from different fields of artificial organs collaborate to overcome the challenges of creating products such as Wearable and/or Implantable Artificial Kidneys capable of providing long-term effective physiologic kidney functions such as removal of uremic toxins, electrolyte homeostasis, and fluid regulation. A focus should be to develop easily accessible, safe, and inexpensive KRT options that enable a good quality of life and will also be available for patients in less-developed regions of the world. CONCLUSIONS Hence, it is required to discuss some of the limits and burdens of transplantation and different techniques of dialysis, including those performed at home. Furthermore, hurdles must be considered and overcome to develop wearable and implantable artificial kidney devices that can help to improve the quality of life and life expectancy of patients with CKD.
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Affiliation(s)
- Thomas Groth
- Department Biomedical Materials, Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,International Federation for Artificial Organs, Painesville, Ohio, USA
| | - Bernd G Stegmayr
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | | | - Janna Kuchinka
- Department Biomedical Materials, Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Fokko P Wieringa
- IMEC, Eindhoven, The Netherlands.,Department of Nephrology, University Medical Centre, Utrecht, The Netherlands.,European Kidney Health Alliance, WG3 "Breakthrough Innovation", Brussels, Belgium
| | | | - Shuvo Roy
- University of California, California, San Francisco, USA
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Effectiveness of Comprehensive Nursing in Hemodialysis of Patients with Chronic Renal Failure and the Impact on Their Quality of Life. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1399650. [PMID: 35966748 PMCID: PMC9374554 DOI: 10.1155/2022/1399650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
Objective To assess the effectiveness of comprehensive nursing in patients with chronic renal failure undergoing hemodialysis and the impact on their quality of life. Methods The present study included 86 patients undergoing hemodialysis for chronic renal failure from January 2020 to October 2021 and randomly assigned them to receive either normal nursing or comprehensive nursing, with 43 cases in each group. Outcome measures included psychological status, treatment compliance, quality of life, and complications of the eligible patients. Results After the intervention, comprehensive nursing resulted in lower Self-Rating Anxiety Scale (SAS) scores and Self-Rating Depression Scale (SDS) scores and higher quality of life scores for patients versus routine nursing (P < 0.05). Comprehensive nursing was associated with a significantly higher overall patient compliance rate versus routine nursing (P < 0.05). Patients receiving comprehensive nursing had a lower risk of developing complications versus those given routine nursing (P < 0.05). Conclusion Comprehensive care increases treatment compliance and self-care capacity of patients undergoing hemodialysis for chronic renal failure, improves their quality of life, and lowers the risk of complications, indicating a high potential for clinical advancement.
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11
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van Lente JJ, Baig MI, de Vos WM, Lindhoud S. Biocatalytic membranes through aqueous phase separation. J Colloid Interface Sci 2022; 616:903-910. [DOI: 10.1016/j.jcis.2022.02.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/26/2022] [Accepted: 02/20/2022] [Indexed: 12/31/2022]
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12
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Li Y, Lu H, Sun Y. Correlation of NO and ET-1 Levels with Blood Pressure Changes in Hemodialysis Patients after Arteriovenous Fistula Surgery. Front Surg 2022; 9:905372. [PMID: 35651688 PMCID: PMC9149304 DOI: 10.3389/fsurg.2022.905372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Hemodialysis (HD) is the most common renal replacement therapy for patients with end-stage renal disease (ESRD) and can significantly reduce mortality and improve the quality of life of patients. The occurrence of intradialytic hypotension and intradialytic hypertension are important risk factors for death and disability during dialysis in patients with ESRD, yet their etiology remains unclear, and some studies suggest that nitric oxide (NO) and endothelin-1 (ET-1) may play an important role in these hemodynamic alterations. For this purpose we examined the changes in NO and ET-1 levels during hemodialysis in 30 patients on maintenance hemodialysis (MHD) after arteriovenous fistula surgery. Thirty dialysis patients were divided into group I (stable blood pressure during dialysis), group II (Intradialytic hypotension) and group III (Intradialytic hypertension) according to the change of blood pressure (BP) during hemodialysis, with 10 cases in each group. BP of MHD patients were measured Pre-dialysis (Pre-D), at 1 h of dialysis (1h-D), at 2 h of dialysis (Mid-D, 2h-D), at 3 h of dialysis (3h-D), and at the end of dialysis (Post-D); and blood samples were taken from the arterial end at Pre-D, Mid-D, and Post-D to measure NO and ET-1 levels. The results of the analysis showed that as dialysis proceeded and ended, the NO levels in the three groups gradually decreased, with significant differences compared with those before dialysis (p < 0.05); the ET-1 levels in group III gradually increased, with significant differences compared with those before dialysis (p < 0.05), while the increasing trend of ET-1 levels in group I and group II was not significant. The increasing trend of MAP in group I was not significant (p > 0.05); MAP in group II showed a gradual decrease and MAP in group III showed an increasing trend, and the difference between MAP after dialysis and before dialysis was significant (p < 0.05). Correlation analysis showed a significant positive correlation between ET-1 levels and MAP in Group III at Mid-D (r = 0.847, p = 0.002). This shows that serum ET-1 and NO levels are significantly higher than normal in MHD patients after arteriovenous endovascular fistula surgery, and both ET-1 and NO levels are changing during dialysis, and there may be a link between their changes and blood pressure changes. It is suggested that the blood pressure fluctuations that occur during dialysis in MHD patients may be related to endothelial cell dysfunction.
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13
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La Russa R, Fazio V, Ferrara M, Di Fazio N, Viola RV, Piras G, Ciano G, Micheletta F, Frati P. Proactive Risk Assessment Through Failure Mode and Effect Analysis (FMEA) for Haemodialysis Facilities: A Pilot Project. Front Public Health 2022; 10:823680. [PMID: 35400067 PMCID: PMC8987154 DOI: 10.3389/fpubh.2022.823680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Haemodialysis (HD) is one of the methods for renal replacement therapy in the management of advanced chronic kidney disease through an osmosis process that allows purification of blood in the dialysis machine. The complexity of the dialytic procedure often requires the presence of a multi-specialist, multi-disciplinary team. The dialysis process is an important target for clinical risk management. Failure Mode and Effect Analysis (FMEA) is a proactive technique, considered a purposeful and dynamic tool for clinical risk management. FMEA is noted in five phases that allow a preliminary assessment of a definite process through identification and classification of risk priorities. This study represents the first of a two-phase project where FMEA is applied to HD in the setting of San Feliciano Hospital. The dialysis center performs ~12,000 dialysis sessions per year. The dialysis process is divided into different stages. A total of 31 failure modes were identified in the whole dialysis stages; more than 2/3 of the failure modes were related to the only connecting of the patient to the dialysis machine. The first phase of the study clearly remarked that the most critical step of the dialytic process is represented by the connection between the patient and the machine, as expected. Indeed, in order to have the dialysis set up, an arteriovenous fistula must be surgically created prior to the procedure and it is one of the most important issues in the HD process because of the necessity of a constant revision of it. FMEA application to HD is a useful tool, easy to be implemented and it is likely to nimbly reveal the practical and potential solutions to the critical steps of the procedure.
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Affiliation(s)
- Raffaele La Russa
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Foggia, Italy
| | - Valentina Fazio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Michela Ferrara
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Foggia, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
- *Correspondence: Nicola Di Fazio
| | - Rocco Valerio Viola
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Gianluca Piras
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Paola Frati
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
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14
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Chen YA, Ou SM, Lin CC. Influence of Dialysis Membranes on Clinical Outcomes: From History to Innovation. MEMBRANES 2022; 12:membranes12020152. [PMID: 35207074 PMCID: PMC8876340 DOI: 10.3390/membranes12020152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 12/18/2022]
Abstract
Dialysis membranes were traditionally classified according to their material compositions (i.e., as cellulosic or synthetic) and on the basis of the new concept of the sieving coefficient (determined by the molecular weight retention onset and molecular weight cut-off). The advantages of synthetic polymer membranes over cellulose membranes are also described on the basis of their physical, chemical, and structural properties. Innovations of dialysis membrane in recent years include the development of medium cutoff membranes; graphene oxide membranes; mixed-matrix membranes; bioartificial kidneys; and membranes modified with vitamin E, lipoic acid, and neutrophil elastase inhibitors. The current state of research on these membranes, their effects on clinical outcomes, the advantages and disadvantages of their use, and their potential for clinical use are outlined and described.
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Affiliation(s)
- Yee-An Chen
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Shuo-Ming Ou
- Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Correspondence: (S.-M.O.); (C.-C.L.); Tel.: +886-2-2875-3103 (C.-C.L.); +886-2-2871-2121 (S.-M.O.); Fax: +886-2-2875-7858 (C.-C.L.)
| | - Chih-Ching Lin
- Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Correspondence: (S.-M.O.); (C.-C.L.); Tel.: +886-2-2875-3103 (C.-C.L.); +886-2-2871-2121 (S.-M.O.); Fax: +886-2-2875-7858 (C.-C.L.)
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15
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Erickson KF, Warrier A, Wang V. Market Consolidation and Innovation in US Dialysis. Adv Chronic Kidney Dis 2022; 29:65-75. [PMID: 35690407 DOI: 10.1053/j.ackd.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 11/11/2022]
Abstract
While patients with end-stage kidney disease have benefited from innovations in clinical therapeutics and care delivery, these changes have been primarily incremental and have not fundamentally transformed care delivery. Dialysis markets are highly concentrated, which may impede innovation. Unique features of the dialysis industry that have contributed to consolidation can help to explain links between consolidation and innovation. We discuss these unique features and then provide a framework for considering the effects of consolidation on innovation in dialysis that focuses on the following economic considerations: (1) industry characteristics, composition, and stage of consolidation, (2) innovation characteristics and relative profitability, (3) the role of government regulation, and (4) innovation from smaller providers and new entrants. We present examples of how these considerations have influenced the adoption of alternative dialysis technologies such as peritoneal dialysis and erythropoietin-stimulating agents, and we discuss how consolidated markets can both help and hinder recent policy initiatives to transform dialysis care delivery. Only by considering these important drivers of consolidation, future efforts can be successful in transforming end-stage kidney disease care.
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Affiliation(s)
- Kevin F Erickson
- Baylor College of Medicine, Section of Nephrology, Houston, TX; Baker Institute for Public Policy, Rice University, Houston, TX.
| | - Anupama Warrier
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Virginia Wang
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC; Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC
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16
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Lv H, Meng J, Chen Y, Yang F, Wang W, Wei G, Zhang J, Wang H, Wang M, Zhou L, Liu H. Impact of COVID-19 Pandemic on Elevated Anxiety Symptoms of Maintenance Hemodialysis Patients in China: A One-Year Follow-Up Study. Front Psychiatry 2022; 13:864727. [PMID: 35664473 PMCID: PMC9160521 DOI: 10.3389/fpsyt.2022.864727] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Recent studies have shown that coronavirus disease 2019 (COVID-19) aggravates anxiety in patients with maintenance hemodialysis (MHD), but it is still unclear how long this adverse effect will last. This study aims to investigate the impact of COVID-19 on the elevated anxiety symptoms of MHD patients 1 year after the outbreak. Assessment of elevated anxiety symptoms was performed on patients with MHD during early COVID-19 (February 17-February 29, 2020) and 1-year follow-up (March 1-March 13, 2021), and a total of 100 patients had completed face-to-face questionnaires at the first and 1-year follow-up. At the beginning of the outbreak, 40% of the patients with MHD had anxiety symptoms [self-rating anxiety scale (SAS) score ≥ 50], and 11% (SAS score: 60-69) and 2% (SAS score ≥ 70) of the patients had moderate and severe anxiety symptoms, respectively. Multivariate analysis shows that possibility of unaccompanied transfer, possibility of family members or themselves being infected in a hospital, added body temperature monitoring during dialysis, and increased medical procedures are the risk factors in elevated anxiety symptoms during early COVID-19. At the 1-year follow-up, the incidence of anxiety symptoms in the same group of patients declined to 28%, and all the patients had mild anxiety symptoms (SAS score: 50-59), which is significantly lower than that of the early COVID-19 pandemic with statistically significant difference (p = 0.003). Increased protective measures taken by the medical staves were the only risk factor in elevated anxiety symptoms during the 1-year follow-up. This study shows that COVID-19 has a direct impact on the deterioration of anxiety symptoms in patients with MHD. With the changes of the requirements for COVID-19 prevention and control, as well as the enhancement of propaganda and education of the pandemic and psychological care, the severity and risk factors of anxiety symptoms in the patients with MHD are changing. Thus, targeted interventions are suggested to improve the psychological endurance of the patients with MHD.
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Affiliation(s)
- Honghong Lv
- Department of Nephrology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China
| | - Junping Meng
- Department of Nephrology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China
| | - Yang Chen
- Department of Nephrology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China
| | - Feng Yang
- Department of Nephrology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China
| | - Wen Wang
- Department of Nephrology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China
| | - Guohua Wei
- Department of Nephrology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China
| | - Jiaojiao Zhang
- Department of Nephrology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China
| | - Huan Wang
- Department of Nephrology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China
| | - Mengqiu Wang
- Department of Nephrology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China
| | - Lu Zhou
- Department of Nephrology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China
| | - Hongbao Liu
- Department of Nephrology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China
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17
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Lee S, Sirich TL, Meyer TW. Improving Clearance for Renal Replacement Therapy. KIDNEY360 2021; 2:1188-1195. [PMID: 35355887 PMCID: PMC8786098 DOI: 10.34067/kid.0002922021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The adequacy of hemodialysis is now assessed by measuring the removal of a single solute, urea. The urea clearance provided by current dialysis methods is a large fraction of the blood flow through the dialyzer, and, therefore, cannot be increased much further. However, other solutes, which are less effectively cleared than urea, may contribute more to the residual uremic illness suffered by patients on hemodialysis. Here, we review a variety of methods that could be used to increase the clearance of such nonurea solutes. New clinical studies will be required to test the extent to which increasing solute clearances improves patients' health.
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Affiliation(s)
- Seolhyun Lee
- Department of Medicine, Stanford University, Palo Alto, California,Department of Medicine, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Tammy L. Sirich
- Department of Medicine, Stanford University, Palo Alto, California,Department of Medicine, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Timothy W. Meyer
- Department of Medicine, Stanford University, Palo Alto, California,Department of Medicine, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
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18
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Melchior P, Erlenkötter A, Zawada AM, Delinski D, Schall C, Stauss-Grabo M, Kennedy JP. Complement activation by dialysis membranes and its association with secondary membrane formation and surface charge. Artif Organs 2021; 45:770-778. [PMID: 33326619 DOI: 10.1111/aor.13887] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/06/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
Activation of the complement system may occur during blood-membrane interactions in hemodialysis and contribute to chronic inflammation of patients with end-stage renal disease. Hydrophilic modification with polyvinylpyrrolidone (PVP) has been suggested to increase the biocompatibility profile of dialysis membranes. In the present study we compared the complement activation of synthetic and cellulose-based membranes, including the polysulfone membrane with α-tocopherol-stabilized PVP-enriched inner surface of the novel FX CorAL dialyzer, and linked the results to their physical characteristics. Eight synthetic and cellulose-based dialyzers (FX CorAL, FX CorDiax [Fresenius Medical Care]; Polyflux, THERANOVA [Baxter]; ELISIO, SUREFLUX [Nipro]; xevonta [B. Braun]; FDX [Nikkisio Medical]) were investigated in the present study. Complement activation (C3a, C5a, and sC5b-9) was evaluated in a 3 hours ex vivo recirculation model with human blood. Albumin sieving coefficients were determined over a 4 hours ex vivo recirculation model with human plasma as a surrogate of secondary membrane formation. Zeta potential was measured as an indicator for the surface charge of the membranes. The FX CorAL dialyzer induced the lowest activation of the three complement factors (C3a: -39.4%; C5a: -57.5%; and sC5b-9: -58.9% compared to the reference). Highest complement activation was found for the cellulose-based SUREFLUX (C3a: +154.0%) and the FDX (C5a: +335.0% and sC5b-9: +287.9%) dialyzers. Moreover, the FX CorAL dialyzer had the nearest-to-neutral zeta potential (-2.38 mV) and the lowest albumin sieving coefficient decrease over time. Albumin sieving coefficient decrease was associated with complement activation by the investigated dialyzers. Our present results indicate that the surface modification implemented in the FX CorAL dialyzer reduces the secondary membrane formation and improves the biocompatibility profile. Further clinical studies are needed to investigate whether these observations will result in a lower inflammatory burden of hemodialysis patients.
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Affiliation(s)
- Pascal Melchior
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Ansgar Erlenkötter
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Biosciences - Biotechnology, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Adam M Zawada
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Dirk Delinski
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Christian Schall
- Process Technology, Filter Production, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Manuela Stauss-Grabo
- Global Medical Office, Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - James P Kennedy
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
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