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Xiong Y, You N, Qin S, Liao R, Yu Y. The role of hemodialysis access in intradialysis and interdialysis vital sign variabilities and the development of dialysis headache. Ren Fail 2024; 46:2411367. [PMID: 39378122 PMCID: PMC11463014 DOI: 10.1080/0886022x.2024.2411367] [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: 05/26/2024] [Revised: 09/03/2024] [Accepted: 09/26/2024] [Indexed: 10/10/2024] Open
Abstract
To determine the relationship of hemodialysis access with vital sign variability and hemodialysis-related headache (HRH). Adult outpatients receiving maintenance hemodialysis (MHD) were prospectively recruited, and 12 consecutive dialysis sessions were monitored. Intradialysis (hour-to-hour) and interdialysis (dialysis day-to-day) vital sign variabilities were assessed via three metrics: the difference between the maximum and minimum values, average real variability (ARV), and residuals. Multivariate logistic regression analysis was used to explore the factors triggering HRH. A total of 91 Chinese MHD patients (60.4% male) aged 58.5 ± 17.2 years were included, with 59 patients using radiocephalic arteriovenous fistulas (RCAVFs) and 32 patients using tunneled cuffed catheters (TCCs) for dialysis. The median dialysis vintage was 26.8 (12.0-44.7) months. Compared with the RCAVF group, the TCC group had significantly greater urea reduction (71.1 ± 9.3% vs. 61.7 ± 10.5%, p < 0.001) and clearance (1.5 (1.2-1.8) vs. 1.1 (1.0-1.4), p < 0.001) rates, higher intradialysis pulse variability and lower intradialysis diastolic blood pressure variability. Some of interdialysis variability indexes in pulse, systolic blood pressure (SBP), and SpO2 were significantly greater in the TCC group than that in the RCAVF group. Age (OR = 0.880, 95% CI = 0.785-0.986, p = 0.028), TCC use (OR = 22.257, 95% CI = 1.190-416.399, p = 0.038), intradialysis SBP-ARV (OR = 2.768, 95% CI = 1.069-7.171, p = 0.036), and blood sodium level (OR = 0.400, 95% CI = 0.192-0.832, p = 0.014) were shown to be independent risk factors for HRH. In conclusion, the use of TCCs has multifaceted effects on intradialysis and interdialysis vital sign variabilities and is independently associated with an increased risk of HRH.
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Affiliation(s)
- Yuqin Xiong
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, PR China
- Division of Nephrology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Nujia You
- Division of Nephrology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Shuoyue Qin
- College of Life Sciences, Sichuan University, Chengdu, Sichuan, PR China
| | - Ruoxi Liao
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Yang Yu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
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Gan Q, Zhang L, Fang Y, Yang L, Shi M, Xiao Z. Low pulse pressure and high serum complement C1q are risk factors for hemodialysis headache: A case-control study. Headache 2024; 64:285-298. [PMID: 38429985 DOI: 10.1111/head.14688] [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: 04/27/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Hemodialysis headache (HDH) is a common complication of dialysis that negatively affects the patient's quality of life. The etiology and triggering factors of HDH are not fully understood. This study aims to assess the prevalence and characteristics of HDH among patients undergoing hemodialysis across multiple centers in China. Furthermore, we conducted a case-control study at one hospital to identify risk factors associated with HDH. METHODS The study consisted of two phases including a cross-sectional observational study and a case-control study. Participants underwent neurological examinations and interviews. Demographic and medical information were collected from both medical records and patient files. Serum creatinine, uric acid, urea, estimated glomerular filtration rate (eGFR), plasma osmolarity, glucose, C1q, and a variety of electrolytes including potassium, sodium, chloride, calcium, magnesium, and phosphorus were measured before and after dialysis. Blood pressure variables including systolic blood pressure, diastolic blood pressure, pulse pressure (PP), and heart rate were monitored hourly. Serum levels of inflammatory factors, including tumor necrosis factor α (TNF-α), interleukin (IL)-1β, IL-4, IL-6, and IL-10 were quantified using a double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS The prevalence of HDH was 37.7% (183/485). HDH was characterized by a bilateral tightening headache of moderate intensity and duration of <2 h, occurring in different locations. The case-control study included 50 patients with HDH and 84 control patients, pre-dialysis PP was found to be lower in the HDH group than in the control group (mean ± standard deviation 51.5 ± 18.2 vs. 67.9 ± 14.9, p = 0.027). Furthermore, the pre-dialysis serum complement C1q level was significantly higher for the HDH group than the control group (median and interquartile range 201.5 [179.0-231.5] vs. 189.0 [168.9-209.0], p = 0.021). Pre-dialysis PP was associated with 5.1% decreased odds of HDH (odds ratio [OR] = 0.96; 95% confidence interval [CI], 0.93-0.99, p = 0.026), body weight was associated with a 5.4% decreased risk of HDH (OR = 0.95; 95% CI, 0.91-0.99, p = 0.013), and pre-dialysis C1q levels increased the odds of HDH by 1.9% (OR = 1.02; 95% CI, 1.01-1.03, p = 0.005). CONCLUSION Low PP, low body weight, and high blood complement C1q may be potential risk factors associated with HDH.
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Affiliation(s)
- Quan Gan
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lily Zhang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuting Fang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Liu Yang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ming Shi
- Department of Dialysis Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zheman Xiao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
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Gürsoy G, Karadağ S, Köse Ş, Şakacı T, Koçak SY, Döventaş YE, Oktar AÇ, Bayar MD. The role of calcitonin gene-related peptide and substance P in the pathogenesis of dialysis headache. Hemodial Int 2024; 28:85-91. [PMID: 37852938 DOI: 10.1111/hdi.13120] [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: 03/30/2023] [Revised: 08/31/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023]
Abstract
AIM The present study aims to establish the role of serum CGRP and SP levels in the disease pathophysiology in patients with dialysis headache not accompanied by primary or secondary headaches, and also whether there is a correlation between these vasoactive peptides and the severity of headache. METHOD This study was designed as prospective and multicenter. A total of 30 dialysis headache patients and 30 patients without headache as the control group in the Nephrology outpatient clinics which implement similar dialysis procedures were included in the study. Blood samples were taken from all the patients before hemodialysis, and post-hemodialysis samples were collected. CGRP and SP contents in serum samples were measured using the ELISA method with detection kits. RESULTS A total of 60 patients were included in the study with 17 female and 13 male patients in the dialysis headache group and 18 female and 12 male patients in the control group, and there were no significant differences in sex and age between the groups. CGRP levels in the headache group were found to be significantly higher compared with the control group both before and after hemodialysis. Furthermore, pre-hemodialysis CGRP levels were significantly higher than post-hemodialysis CGRP levels in both the headache and control groups. Serum SP levels in the headache group were found to be higher compared with the control group both before and after hemodialysis, there was no significant difference between the groups. Even though SP levels in both groups decreased after hemodialysis, there was again no significant difference between the groups. No correlation was found between the patients' severity of headache and serum CGRP and SP levels. CONCLUSION This study concludes that CGRP and SP, even though the latter is not statistically significant, play a role in the pathophysiology of the dialysis headache, and further studies with a larger and more specific patient population may reveal the relationship between the neuropeptides and dialysis headache more clearly.
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Affiliation(s)
- Gizem Gürsoy
- Department of Neurology, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Serhat Karadağ
- Department of Neurology, Haseki Research and Training Hospital, Istanbul, Turkey
| | - Şennur Köse
- Department of Neurology, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Tamer Şakacı
- Department of Neurology, Şişli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Sibel Yücel Koçak
- Department of Neurology, Bakırköy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | | | - Ayla Çulha Oktar
- Department of Neurology, Haseki Research and Training Hospital, Istanbul, Turkey
| | - Muhammet Duran Bayar
- Department of Neurology, Gaziosmanpaşa Research and Training Hospital, Istanbul, Turkey
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Xiong Y, You N, Liao R, Wu L, Liu Y, Ling Z, Yu Y. Association of intradialysis blood sodium level, blood pressure variability, and hydration status with hemodialysis-related headache: a prospective cohort study. J Headache Pain 2023; 24:166. [PMID: 38082228 PMCID: PMC10712180 DOI: 10.1186/s10194-023-01701-2] [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: 11/03/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To identify primary factors contributing to hemodialysis-related headache (HRH) in maintenance hemodialysis (MHD) patients. METHODS Adult outpatients receiving MHD were prospectively enrolled from a hemodialysis (HD) center of a tertiary hospital in China. Twelve dialysis sessions were successively monitored for each patient. HRH is defined as having at least three headache episodes that begin during HD and resolve within 72 h of HD session completion. Blood gas analysis during headache episodes and body composition analysis after dialysis were conducted. Hour-to-hour vital sign variability during dialysis was assessed using the metric of average real variability (ARV). Multivariable logistic regression analysis was conducted to explore the factors triggering HRH. RESULTS A total of 95 Chinese MHD patients were enrolled, with 92 patients (60.9% were males) included in the final analysis. The mean age of the 92 patients was 59.3 ± 17.5 years, and the median dialysis vintage was 27.1 (12-46.2) months. Among them, 12 patients (13%) complained of 42 headache attacks, and eight (8.7%) were diagnosed with HRH. For eight patients with HRH, headache occurred 100.3 ± 69.5 min after the start of dialysis, with a mean VAS score of 4.3 ± 1 points. The quality of headaches was dull (six patients), pulsating (one patient), or stabbing pain (one patient); all the headaches were bilateral, with one having concomitant vomiting. The intradialysis headache duration and the whole headache duration were 98.8 ± 68.1 and 120 (65-217.5) minutes, respectively. Younger age (OR = 0.844, 95% CI 0.719-0.991, p = 0.039), decreased blood sodium level (OR = 0.309 in the range of 133-142 mmol/L, 95% CI 0.111-0.856, p = 0.024), increased ARV of intradialysis systolic blood pressure (OR = 3.067, 95% CI 1.006-9.348, p = 0.049) and ratio of overhydration to dry weight (OR = 1.990, 95% CI 1.033-3.832, p = 0.040) were found to be independent risk factors for HRH. CONCLUSIONS This study suggested a significant attribution of blood sodium, hydration status and blood pressure variability to HRH.
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Affiliation(s)
- Yuqin Xiong
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
- Department of Nephrology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Nujia You
- Department of Nephrology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- China School of Nursing, Sichuan University, Chengdu, China
| | - Ruoxi Liao
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Ling Wu
- Department of Nephrology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- China School of Nursing, Sichuan University, Chengdu, China
| | - Yao Liu
- Department of Nephrology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- China School of Nursing, Sichuan University, Chengdu, China
| | - Ziying Ling
- Department of Nephrology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- China School of Nursing, Sichuan University, Chengdu, China
| | - Yang Yu
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China.
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China.
- Department of Nephrology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, Sichuan Province, China.
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Yang Y, Meng F, Zhu H, Zhang L, Lu G, Xiao S, He J, Yu S, Liu R. The applicability research of the diagnostic criteria for 10.2 Heamodialysis-related headache in the international classification of headache disorders-3 rd edition. J Headache Pain 2023; 24:19. [PMID: 36849915 PMCID: PMC9972802 DOI: 10.1186/s10194-023-01548-7] [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: 12/07/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Headache during hemodialysis (HDH) is prevalent but not negligible. Despite the high prevalence of dialysis headaches, they have rarely been studied. Therefore, this study aimed to evaluate the prevalence, risk factors, and clinical characteristics of HDH and reappraise the HDH diagnostic criteria in the International Classification of Headache Disorders 3 (ICHD-3). METHODS One hundred and fifty-four patients completed this randomized cross-sectional study. Consecutive patients who underwent haemodialysis were assessed using a semi-structured questionnaire. The patients were administered face-to-face questionnaires while undergoing dialysis. RESULTS This study included 154 patients. Before commencing dialysis, 3.24% (5/154) of the patients had migraine without aura, 1.29% (2/154) had menstrual-related migraine, 0.6% (1/154) had tension-type headaches, and 0.6% (1/154) had an unclassifiable headache. One case (0.6%) of headache resolved after dialysis treatment. HDH was diagnosed in 9.09% (14/154) of the patients. Headache after haemodialysis (HAH) was reported in 6.49% (10/154) of patients. The most prevalent features of HDH were frontal or temporal location, bilateral headaches, dull and throbbing nature, and moderate severity. HDH started at a mean of 2.33 ± 0.79 h after dialysis commenced. The average headache duration was 6.56 ± 1.57 h (median = 3.0 h), with 66.67% of the patients reporting a duration of ≤4 h. HDH was more prevalent in females than males (P = 0.01, P < 0.05). Female sex was a risk factor for HDH (P = 0.01,P < 0.05). CONCLUSIONS The diagnostic criteria for 10.2 HDH in ICHD-3 may miss several HAH. Therefore, ICHD-3 should be revised according to the literature and further studies.
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Affiliation(s)
- Ying Yang
- Chinese PLA Medical School, Fuxing Road 28, Haidian District, Beijing, 100853, PR China.,Department of Neurology, the First Medical Centre of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, PR China
| | - Fanchao Meng
- Chinese PLA Medical School, Fuxing Road 28, Haidian District, Beijing, 100853, PR China.,Department of Neurology, the First Medical Centre of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, PR China
| | - Hanyu Zhu
- Blood Purification Center, the First Medical Center of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, PR China
| | - Lei Zhang
- Blood Purification Center, the First Medical Center of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, PR China
| | - Guangshuang Lu
- Chinese PLA Medical School, Fuxing Road 28, Haidian District, Beijing, 100853, PR China.,Department of Neurology, the First Medical Centre of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, PR China.,The Lu'an Hospital Affiliated to Anhui Medical University, the Lu'an People's Hospital, Wanxi Road 21, Jinan District, Lu'an, 237000, PR China
| | - Shaobo Xiao
- Chinese PLA Medical School, Fuxing Road 28, Haidian District, Beijing, 100853, PR China.,Department of Neurology, the First Medical Centre of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, PR China
| | - Jiaji He
- Chinese PLA Medical School, Fuxing Road 28, Haidian District, Beijing, 100853, PR China.,Department of Neurology, the First Medical Centre of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, PR China
| | - Shengyuan Yu
- Chinese PLA Medical School, Fuxing Road 28, Haidian District, Beijing, 100853, PR China. .,Department of Neurology, the First Medical Centre of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, PR China.
| | - Ruozhuo Liu
- Chinese PLA Medical School, Fuxing Road 28, Haidian District, Beijing, 100853, PR China. .,Department of Neurology, the First Medical Centre of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, PR China.
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Gomes BT, Costa ALGD, Mazzali M. Dialysis headache: prevalence and clinical presentation in hemodialysis and kidney transplant patients. HEADACHE MEDICINE 2023. [DOI: 10.48208/headachemed.2022.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction
Headache is a common symptom among hemodialysis patients, with a prevalence around 70%. Dialysis headache is defined according to International Classification of Headache Disorders (ICHD-3) as a headache without specific characteristics, occurring during and caused by hemodialysis that spontaneously disappears within 72 hours after the dialysis session. There is no consensus on trigger factors or physiopathology.
Objective
To evaluate prevalence, clinical characteristics, and associated factors with dialysis headache.
Methods
Observational study with quantitative analysis. Study patients were divided into two groups: (HD) 25 hemodialysis patients and (Tx) 25 early post kidney transplant patients. A structured questionnaire was applied to all patients, including Hospital Anxiety and Depression Scale (HADS) and Epworth Sleepiness Scale. Laboratory data, blood pressure and body weight were analyzed before and after one dialysis session. Results: In group HD, eight patients (32%) had diagnosis of dialysis headache, with pulsating headache (n=6, 75%), photophobia (n=6, 75%), phonophobia (n=4, 50%), and nauseas or vomiting (n=6, 75%), with a mean pain score of 7.75 ± 1.58. Headache group had higher scores of anxieties (7.00 ± 3.93 vs. 3.82 ± 3.23, p=0.03) and sleepiness (9.13 ± 3.94 vs. 4.76 ± 3.85, p=0.01), lower levels of serum calcium (p=0.01), and higher systolic (p=0.02) and diastolic (p=0.02) blood pressure pre dialysis. In group Tx, five patients (20%) reported dialysis headache, with pulsating headache (n=4, 80%), nauseas or vomiting (n=4, 80%), with a mean pain score of 8.0 ± 1.41. Headache group had a higher score of sleepiness (9.20 ± 4.32 vs. 4.80 ± 4.51, p=0.029) and were younger (38.93 ± 14.43 vs. 54.02 ± 8.31, p=0.03).
Conclusion
Headache is frequent among hemodialysis patients and had similar symptoms of migraine. In this series dialysis headache was associated with higher scores of anxieties and sleepiness, higher blood pressure and lower calcium pre dialysis.
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Souza M, Lima KR, Fortes YML, Silva-Neto R, Filgueiras MC. Dialysis headache: A literature review in the last 30 years. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction
According to the International Classification of Headache Disorders (ICHD-3), dialysis headache has no specific characteristics occurring during and caused by haemodialysis. It resolves spontaneously within 72 hours after the haemodialysis session has ended.
Objective
To describe the prevalence, clinical features, associated symptoms and risk factors of dialysis headache.
Methods
Based on a literature search in the major medical databases and using the descriptors“dialysis headache”, “hemodialysis and headache” and “renal dialysis and headache”we included articles published between 1992 and 2022. Of the 492articles found, only 9 met the inclusion criteria and were analyzed.
Results
We describe 444 patients (53.1% men and 46.9% women) diagnosed with dialysis headache, corresponding to 24.8% of those who underwent hemodialysis.The age ranged from 15 to 75 years. Pain occurred predominantly from the third hour of hemodialysis (65.8%), lasting less than four hours (71.7%), located bilaterally (63.1%), pulsatile (58.5%) and moderate intensity (68.9%).The most frequent associated symptoms were photophobia or phonophobia (71.5%), vertigo (22.3%) and nausea and/or vomiting (16.5%).
Conclusion
This review showed a high prevalence of dialysis headache in patients undergoing hemodialysis and that the clinical characteristics, treatment and prevention are still poorly studied.
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SOUSA MELO E, PEDROSA RP, CARRILHO AGUIAR F, VALENTE LM, SAMPAIO ROCHA-FILHO PA. Dialysis headache: characteristics, impact and cerebrovascular evaluation. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:129-136. [DOI: 10.1590/0004-282x-anp-2021-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022]
Abstract
ABSTRACT Background: Headache is one of the most frequent symptoms that occur during hemodialysis sessions. Despite the high prevalence of dialysis headache, it has been little studied. Objective: To evaluate the characteristics, impact and factors associated with dialysis headache. The behavior of the cerebral vasculature was also compared between patients with and without dialysis headache. Methods: This was a cross-sectional study. Consecutive patients who underwent hemodialysis were assessed through a semi-structured questionnaire, the Headache Impact Test (HIT-6), the Hospital Anxiety and Depression Scale and the Short Form-36 Health Survey (SF-36). Transcranial Doppler ultrasonography was performed in the first and fourth hours of hemodialysis. Results: A total of 100 patients were included; 49 of them had dialysis headache. Women (OR=5.04; 95%CI 1.95-13.04), younger individuals (OR=1.05; 95%CI 1.01-1.08), individuals with higher schooling levels (OR=3.86; 95%CI 1.4-10.7) and individuals who had spent longer times on dialysis programs (OR=0.99; 95%CI 0.98-1) had more dialysis headache (logistic regression). Individuals with dialysis headache had worse quality of life in the domains of pain and general state of health (56.9 versus 76.4, p=0.01; 49.7 versus 60.2, p=0.03, respectively). Dialysis headache was associated with significantly greater impact on life (OR=24.4; 95%CI 2.6-226.6; logistic regression). The pulsatility index (transcranial Doppler ultrasonography) was lower among patients with dialysis headache than among those without them. Conclusions: Dialysis headaches occur frequently and are associated with worse quality of life and patterns of cerebral vasodilatation.
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Aoun MH, Hilal N, Beaini C, Sleilaty G, Hajal J, Boueri C, Chelala D. Effects of Caffeinated and Decaffeinated Coffee on Hemodialysis-Related Headache (CoffeeHD): A Randomized Multicenter Clinical Trial. J Ren Nutr 2021; 31:648-660. [PMID: 33715955 DOI: 10.1053/j.jrn.2021.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/30/2020] [Accepted: 01/23/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Historically, headache was reported in up to 76% of hemodialysis patients. Some authors suggested that headache resulted from caffeine withdrawal. This study aims to compare the incidence of headache and hypotension between patients drinking regular or decaffeinated coffee during dialysis. METHODS One-hundred fifty-six patients were enrolled in this randomized, double-blind, placebo-controlled, multicenter study. Patients with atrial fibrillation were excluded. Group A was given 80 mL of regular coffee and group B 80 mL of decaffeinated coffee (placebo) in the middle of the session for 12 consecutive sessions. Ultrafiltration rate was fixed to a maximum of 13 mL/kg/hour. The primary outcome was the incidence of headache during dialysis. RESULTS A total of 139 patients completed the trial (6.4% vs. 15.4% of withdrawal in Groups A and B, respectively). The number of sessions with headache was not significantly different between Group A and B (33.3% vs. 37.1% respectively, P = .522), nor the number of sessions with hypotension (27% vs. 26% respectively, P = .539). In a subgroup analysis, headache tended to be more frequent in Group B (P = .06) in 2 categories of patients: those with the highest potassium dialysate (K = 2) and the non-hypertensive patients. CONCLUSIONS Headache occurred in 35% of patients during their chronic hemodialysis sessions. Caffeine intake did not prevent headache occurrence in these patients.
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Affiliation(s)
- Mabel H Aoun
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon; Department of Nephrology, Saint-Georges Hospital, Ajaltoun, Lebanon.
| | - Najla Hilal
- Department of Nephrology, Saint-Georges Hospital, Ajaltoun, Lebanon
| | - Chadia Beaini
- Department of Nephrology, Bellevue Medical Center, Mansourieh, Lebanon
| | - Ghassan Sleilaty
- Department of Biostatistics and Clinical Research Center, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon; Department of Cardiovascular Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Joseph Hajal
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon; Department of Nephrology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Celine Boueri
- Department of Nephrology, Saint-Georges Hospital, Ajaltoun, Lebanon
| | - Dania Chelala
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon; Department of Nephrology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
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Hazim A, Adarmouch L, Eloury A, Aasfara J, Asly M, Slassi I. Hemodialysis-related headache: Still a challenge in 2020? Effect of conventional versus online hemodiafiltration from a study in Casablanca, Morocco. Artif Organs 2021; 45:602-607. [PMID: 33326637 DOI: 10.1111/aor.13886] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
Hemodialysis-related headache (HRH) is a well-known clinical event. It is considered as one of the most commonly reported neurological symptoms among hemodialysis patients. Its epidemiological, physiological, clinical, and therapeutic data remain scarce and are poorly studied. Our aim was to determine the frequency of HRH in the region of Casablanca, Morocco, to describe its clinical characteristics and to explore the hypothesis that renal replacement techniques, such as conventional versus online hemodiafiltration may have an association on clinical adverse effects like HRH. A descriptive, cross-sectional, and multicentric study was carried out among 100 chronic hemodialysis patients for at least 6 months. HRH was defined according to criteria published by the International Classification of Headache Disorder third edition beta version (ICHD3β) [1]. Two different HD-modalities (standard HD and OL-HDF) have been investigated in order to explore their impact on HRH. Headache was reported by 60% of the patients including 41.6% of hemodialysis-related headache. HRH had on average a duration of 7.4 hours, pulsatile among 38% of interviewed patients and of moderate intensity in 48% of cases. In total, 51.3% of patients undergoing conventional hemodialysis modality reported HRH compared to 12.5% undergoing online hemodiafiltration technique (OL-HDF) (P = .008). Hemodialysis-related headache remains a poorly studied clinical event despite its high prevalence. Its diagnosis, management, and especially its prevention remain a challenge for the neurologist and the nephrologist. Our results suggest that OL-HDF is a promising therapeutic and preventive tool to reduce the incidence of HRH.
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Affiliation(s)
- Asmaa Hazim
- Neurology Department, Faculty of Medicine, Cheikh Khalifa Ibn Zayed Hospital, Mohamed VI University of Health Sciences, Casablanca, Morocco
| | - Latifa Adarmouch
- Department of Public Health, Community Medicine and Epidemiology, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Aida Eloury
- Nephrology Department, Faculty of Medicine, Cheikh Khalifa Ibn Zayed Hospital, Mohamed VI University of Health Sciences, Casablanca, Morocco
| | - Jehanne Aasfara
- Neurology Department, Faculty of Medicine, Cheikh Khalifa Ibn Zayed Hospital, Mohamed VI University of Health Sciences, Casablanca, Morocco
| | - Mouna Asly
- Rehabilitation Department, Cheikh Khalifa Ibn Zayed Hospital, Mohamed VI University of Health Sciences, Casablanca, Morocco
| | - Ilham Slassi
- Neurology Department, Faculty of Medicine, Cheikh Khalifa Ibn Zayed Hospital, Mohamed VI University of Health Sciences, Casablanca, Morocco
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Martín-Rodríguez F, López-Izquierdo R, Portillo Rubiales RM, Fadrique Millán LN, Carbajosa Rodríguez V, Sanz-García A, Ortega Rabbione G, Polonio-López B, Villamor MÁC, Martín-Conty JL. Blood Biomarkers for Assessing Headaches in Healthcare Workers after Wearing Biological Personal Protective Equipment in a COVID-19 Field Hospital. J Pers Med 2021. [PMID: 33406767 DOI: 10.21203/rs.3.rs-55229/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) has led to a pandemic, which among other things, has highlighted biosafety as a key cornerstone in the management of disease transmission. The aim of this work was to analyze the role played by different blood biomarkers in predicting the appearance of headaches in healthcare workers wearing personal protective equipment (PPE) in a COVID-19 treatment unit. A prospective cohort study of 38 healthcare workers was performed during April 2020. Blood analysis, performed just before the start of a 4 hour shift, was carried out on all volunteers equipped with PPE. At the end of their shifts and after decontamination, they were asked if they had suffered from headache in order to obtain a binary outcome. The baseline creatinine value reflected a specific odds ratio of 241.36 (95% CI: 2.50-23,295.43; p = 0.019) and an area under the curve (AUC) value of 0.737 (95%CI: 0.57-0.90; p < 0.01). Blood creatinine is a good candidate for predicting the appearance of a de novo headache in healthcare workers after wearing PPE for four hours in a COVID-19 unit.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Advanced Clinical Simulation Centre, Faculty of Medicine, Universidad de Valladolid, Advanced Life Support Unit, Emergency Medical Services, 47005 Valladolid, Spain
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/ Dulzaina, 2, 47012 Valladolid, Spain
| | - Raquel M Portillo Rubiales
- C.S. de Tordesillas, Gerencia de Atención Primaria de Valladolid Oeste, Gerencia Regional de Salud de Castilla y León (SACYL), Crta. de Valladolid s/n, 47100 Tordesillas, Valladolid, Spain
| | - Laura N Fadrique Millán
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/ Dulzaina, 2, 47012 Valladolid, Spain
| | - Virginia Carbajosa Rodríguez
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/ Dulzaina, 2, 47012 Valladolid, Spain
| | - Ancor Sanz-García
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), C/ Diego de León 62, 28006 Madrid, Spain
| | - Guillermo Ortega Rabbione
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), C/ Diego de León 62, 28006 Madrid, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
| | - Miguel Ángel Castro Villamor
- C.S. Delicias I Gerencia de Atención Primaria de Valladolid Oeste, Gerencia Regional de Salud de Castilla y León (SACYL), Pª Juan Carlos I, 18, 47013 Valladolid, Spain
| | - José L Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
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12
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Martín-Rodríguez F, López-Izquierdo R, Portillo Rubiales RM, Fadrique Millán LN, Carbajosa Rodríguez V, Sanz-García A, Ortega Rabbione G, Polonio-López B, Castro Villamor MÁ, Martín-Conty JL. Blood Biomarkers for Assessing Headaches in Healthcare Workers after Wearing Biological Personal Protective Equipment in a COVID-19 Field Hospital. J Pers Med 2021; 11:27. [PMID: 33406767 PMCID: PMC7823801 DOI: 10.3390/jpm11010027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 01/10/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) has led to a pandemic, which among other things, has highlighted biosafety as a key cornerstone in the management of disease transmission. The aim of this work was to analyze the role played by different blood biomarkers in predicting the appearance of headaches in healthcare workers wearing personal protective equipment (PPE) in a COVID-19 treatment unit. A prospective cohort study of 38 healthcare workers was performed during April 2020. Blood analysis, performed just before the start of a 4 hour shift, was carried out on all volunteers equipped with PPE. At the end of their shifts and after decontamination, they were asked if they had suffered from headache in order to obtain a binary outcome. The baseline creatinine value reflected a specific odds ratio of 241.36 (95% CI: 2.50-23,295.43; p = 0.019) and an area under the curve (AUC) value of 0.737 (95%CI: 0.57-0.90; p < 0.01). Blood creatinine is a good candidate for predicting the appearance of a de novo headache in healthcare workers after wearing PPE for four hours in a COVID-19 unit.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Advanced Clinical Simulation Centre, Advanced Life Support Unit, Emergency Medical Services, Faculty of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain;
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/Dulzaina, 2, 47012 Valladolid, Spain; (L.N.F.M.); (V.C.R.)
| | - Raquel M. Portillo Rubiales
- C.S. de Tordesillas, Gerencia de Atención Primaria de Valladolid Oeste, Gerencia Regional de Salud de Castilla y León (SACYL), Crta. de Valladolid s/n, 47100 Tordesillas, Valladolid, Spain;
| | - Laura N. Fadrique Millán
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/Dulzaina, 2, 47012 Valladolid, Spain; (L.N.F.M.); (V.C.R.)
| | - Virginia Carbajosa Rodríguez
- Emergency Department, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), c/Dulzaina, 2, 47012 Valladolid, Spain; (L.N.F.M.); (V.C.R.)
| | - Ancor Sanz-García
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), C/Diego de León, 62, 28006 Madrid, Spain; (A.S.-G.); (G.O.R.)
| | - Guillermo Ortega Rabbione
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), C/Diego de León, 62, 28006 Madrid, Spain; (A.S.-G.); (G.O.R.)
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain; (B.P.-L.); (J.L.M.-C.)
| | - Miguel Ángel Castro Villamor
- C.S. Delicias I Gerencia de Atención Primaria de Valladolid Oeste, Gerencia Regional de Salud de Castilla y León (SACYL), Pª Juan Carlos I, 18, 47013 Valladolid, Spain;
| | - José L. Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain; (B.P.-L.); (J.L.M.-C.)
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Impact of Adverse Drug Reactions in Patients with End Stage Renal Disease in Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239101. [PMID: 33291233 PMCID: PMC7730015 DOI: 10.3390/ijerph17239101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) require specialized therapeutic interventions. The decreased renal function that modulates the physiology and presence of comorbidities is often associated with variations in the pharmacological response, thus increasing the risk of adverse drug events or reactions (ADE/ADRs) from co-administered drugs. METHODS A cross-sectional study to record comorbidities, drug-drug interactions (DDIs), ADE/ADRs in patients with chronic kidney disease of stage five in Greece. The study enrolled 60 patients of mean age 64.8 ± 12.9 years, undergoing hemodialysis three times a week. Demographic and social factors, comorbidities, laboratory test data, medication regimens, DDIs and the reporting of ADE/ADRs were analyzed. RESULTS Cardiovascular diseases and diabetes were the main comorbidities. In total, 50 different DDIs of various clinical significance were identified. CNS, GI-track, and musculoskeletal-system-related ADE/ADRs were most often reported by patients. ADE/ADRs as clinical outcome from DDIs were associated in 64% of the total identified DDIs. There was a positive trend between number of medications, ADE/ADRs report and DDIs. CONCLUSIONS The impact of ADE/ADRs in ESRD patients should be always considered. Guidelines as well as continuous training in the context of evidence-based clinical practice by healthcare personnel on therapy administration and prevention of adverse events are important.
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Morais EM, Moreira PR, Winkelmann ER. Movie watching during dialysis sessions reduces depression and anxiety and improves quality of life: A randomized clinical trial. Complement Ther Med 2020; 52:102488. [PMID: 32951737 DOI: 10.1016/j.ctim.2020.102488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/04/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Evaluate the effect of watching comedy movies as a complementary practice during dialysis on levels of anxiety, depression, quality of life, stress, laboratory findings and intra-dialysis complications. METHODS A randomized clinical trial was conducted involving the practice of presenting comedy movies during dialysis. The primary outcome was depression. The secondary outcomes were anxiety, quality of life, stress, laboratory findings and intra-dialysis complications.ResultsTwenty-six patients were in the control group and 35 were in the experimental group. Significant intra-group differences [6.0 to 3.0 (p <0.001) and 8.0 to 4.0 (p <0.001), respectively] and inter-group differences [5.0 vs. 3.0 (p = 0.016) and 7.0 vs. 4.0 (p = 0.017), respectively] were found regarding anxiety and depression scores, with improvements in the experimental group. The experimental group was also less likely to have intra-dialysis complications, such as hypertension (p = 0.003) and headache (p = 0.020), and reported significant improvements in different domains of quality of life [symptoms/problems (p = 0.003); effects of the disease (p = 0.008); pain (p = 0.027); general health state (p = 0.004); and social function (p = 0.036)]. No significant differences were found in salivary cortisol or the results of the biochemical exams, with the exception of a reduction in hematocrit in the control group.ConclusionsThe proposed complementary practice was associated with reductions in anxiety and depression scores and intra-dialysis complications (hypertension and headache) as well as improvements in quality of life in patients with chronic kidney disease.
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Affiliation(s)
- Edinara Moraes Morais
- Postgraduate Course in Integral Health Care, Regional University of Northwestern Rio Grande Do Sul (UNIJUÍ) and Cruz Alta University (UNICRUZ), Ijuí, Rio Grande Do Sul, Brazil
| | - Paulo Ricardo Moreira
- Postgraduate Course in Integral Health Care, Cruz Alta University (UNICRUZ), Rio Grande Do Sul, Brazil
| | - Eliane Roseli Winkelmann
- Postgraduate Course in Integral Health Care, Department of Health Sciences, Regional University of Northwestern Rio Grande Do Sul (UNIJUÍ), Ijuí, Rio Grande Do Sul, Brazil.
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