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Vongchaiudomchoke T, Aviphan K, Sanyakeun N, Wachiraphansakul N, Sawangduan V, Nochaiwong S, Ruengorn C, Noppakun K. Randomized Trial on the Effects of Dialysate Potassium Concentration on Intradialytic Hypertension. Kidney Int Rep 2023; 8:1323-1331. [PMID: 37441490 PMCID: PMC10334342 DOI: 10.1016/j.ekir.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/08/2023] [Accepted: 04/04/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Intradialytic hypertension is not an uncommon condition during chronic hemodialysis. It is associated with unfavorable cardiovascular outcomes, including hospitalization and mortality. Several small studies have demonstrated the contradictory effects of different dialysate potassium concentrations on intradialytic blood pressure. This study is a randomized crossover trial aiming to evaluate the effects of different dialysate potassium concentrations on intradialytic hypertension. Methods A 24-week, 2-treatment, 4-sequence, multicenter, double-blinded, randomized, crossover study was conducted at Maharaj Nakorn Chiang Mai Hospital and Lampang Hospital in Thailand among stable patients receiving chronic hemodialysis who experienced intradialytic hypertension >30% of their sessions over the past 3 months. Each participant was randomly assigned to 1 of 4 treatment sequences. During each intervention period, patients were dialyzed with dialysate potassium of either 2 mmol/l (D-K2) or 3 mmol/l (D-K3) for 4 weeks according to their preassigned sequence, separated by a 2-week washout period. The primary outcome was the incidence of intradialytic hypertension. Results Forty eligible patients were recruited. The mean age was 61.4 ± 14.2 years and the mean systolic blood pressure (SBP) was 146.6 ± 11.2 mm Hg. Of the 40 patients, 95.5% had hypertension and their average number of antihypertensive drugs was 2.8 ± 1.9. A total of 1380 dialysis sessions were included in the analysis (695 sessions for D-K2 and 685 sessions for D-K3). The incidence of intradialytic hypertension was not significantly different between different dialysate potassium concentrations (D-K2 54.7% vs. D-K3 53.1%, P = 0.788). The changes in SBP, diastolic blood pressure (DBP), and mean arterial pressure (MAP) were not different between the 2 dialysate potassium groups. Conclusion Dialysate potassium concentration of 2 or 3 mmol/l did not affect the incidence of intradialytic hypertension in patients receiving chronic hemodialysis who frequently developed intradialytic hypertension.
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Affiliation(s)
| | - Kanawat Aviphan
- Department of Internal Medicine, Lampang Hospital, Lampang, Thailand
| | - Nopparat Sanyakeun
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Kajohnsak Noppakun
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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Elsayed MM, Zeid MM, Hamza OMR, Elkholy NM. Dialysis recovery time: associated factors and its association with quality of life of hemodialysis patients. BMC Nephrol 2022; 23:298. [PMID: 36050656 PMCID: PMC9434841 DOI: 10.1186/s12882-022-02926-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/24/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Post-dialysis fatigue is a common and distressing complaint in patients on hemodialysis (HD). The dialysis recovery time (DRT) is a recent and reliable method of Post-dialysis fatigue assessment. We aimed to identify factors affecting the DRT and its relation with HD patients’ quality of life. Material and methods This is a cross-sectional study carried out on end-stage renal disease patients on regular HD. All participants underwent detailed history taking and complete physical examination, and data on dialysis and laboratory investigations were also collected. Patients were asked “How long does it take you to recover from a dialysis session?” to calculate the DRT. We used the Malnutrition-Inflammation Score (MIS) and KDQOL-36 questionnaire to assess patients’ nutritional status and quality of life, respectively. Results Two hundred and ten patients were screened and 191, with a median age of 47 years, completed the study. Patients had a median DRT of 300 minutes (range: 0.0–2880.0), with 55% of patients reporting a DRT of > 240 minutes and 22.5% of them reporting a DRT of < 30 minutes. Patients had a median MIS score of 7 (range: 0–17). There was a statistically significant negative relation between the DRT and symptom/ problem list (p < 0.001), effects of kidney disease (p < 0.001), burden of kidney disease (p < 0.001), SF-12 physical composite (p = 0.001), and SF-12 mental composite (p < 0.001) of KDQOL. The results of multivariate analyses showed that dialysate Na (p = 0.003), and the number of missed sessions (p < 0.001) were independently correlated with the DRT. Conclusions Decreased dialysate Na, and increased number of missed sessions were predictors of prolonged DRT. Patients with prolonged DRT were associated with poorer quality of life. Further randomized clinical trials are needed to assess strategies to minimize the DRT and, perhaps, enhance clinical outcomes. Trials registration ClinicalTrials.gov Identifier: NCT04727281. First registration date: 27/01/2021.
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Affiliation(s)
- Mohamed Mamdouh Elsayed
- Nephrology and Internal Medicine Department, Faculty of Medicine, Alexandria University, Alkhartoom square, El azareeta, Alexandria, 21131, Egypt.
| | - Montasser Mohamed Zeid
- Nephrology and Internal Medicine Department, Faculty of Medicine, Alexandria University, Alkhartoom square, El azareeta, Alexandria, 21131, Egypt
| | - Osama Mohamed Refai Hamza
- Nephrology and Internal Medicine Department, Faculty of Medicine, Alexandria University, Alkhartoom square, El azareeta, Alexandria, 21131, Egypt
| | - Noha Mohamed Elkholy
- Nephrology and Internal Medicine Department, Faculty of Medicine, Alexandria University, Alkhartoom square, El azareeta, Alexandria, 21131, Egypt
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Bellin EY, Hellebrand AM, Kaplan SM, Ledvina JG, Markis WT, Levin NW, Kaufman AM. Post-dialysis recovery time in ESRD patients receiving more frequent hemodialysis in skilled nursing facilities. Hemodial Int 2022; 26:424-434. [PMID: 35388580 PMCID: PMC9543222 DOI: 10.1111/hdi.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/26/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
Introduction Post‐dialysis recovery time (DRT) has an important relationship to quality of life and survival, as identified in studies of ESRD patients on conventional dialysis. ESRD patients are often discharged from hospitals to skilled nursing facilities (SNFs) where on‐site treatment using home hemodialysis technology is increasingly offered, but nothing is known about DRT in this patient population. Methods From November 4, 2019 to June 11, 2021, within a dialysis organization providing service across 12 states and 154 SNFs, patients receiving in‐SNF, more frequent dialysis (MFD) (modeled to deliver 14 treatment hours minimum per week and stdKt/V ≥2.0) were asked to describe their post‐dialysis recovery time following their previous treatment, within predefined categoric choices: 0–½, ½–1, 1–2, 2–4, 4–8, 8–12 h, by next morning, or not even by next morning. Patients reporting DRT following at least one full‐week treatment opportunity were included in a mixed model logistic regression of rapid recovery (DRT ≤2 h). Findings Two thousand three hundred and nine patients met the statistical modeling inclusion criteria, providing DRT on 108,876 dialysis sessions, while receiving mean (SD) 4.3 (0.96) weekly dialysis treatments. 2118 (92%) reported DRT ≤2 h. Results appeared biologically plausible, as lower odds of rapid DRT were observed for patients who were older, missed their previous treatment, or experienced intradialytic hypotension. Greater odds of rapid DRT were observed in patients receiving five dialyses in the previous week or having 160–179 mmHg pre‐hemodialysis systolic blood pressure. Rapid recovery was associated with reduced mortality or hospitalization. Discussion SNF dialysis patients receiving 5x per week MFD report rapid recovery time ≤2 h in 92% of dialyses despite advanced age, frailty, and comorbidities. Future studies will assess the practical ramifications of rapid DRT perception/experience on nursing home rehabilitation programs, which could impact patient health beyond the nursing home stay.
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Affiliation(s)
- Eran Y Bellin
- Departments of Epidemiology & Population Health and Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | | | - Nathan W Levin
- Internal Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA
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Watt J, Fitzpatrick J, Sozio SM, Jaar BG, Estrella MM, Tereshchenko LG, Monroy-Trujillo JM, Walsh M, Parekh RS. Association of abnormal electrocardiograph metrics with prolonged recovery time in incident hemodialysis patients. BMC Nephrol 2022; 23:46. [PMID: 35086494 PMCID: PMC8796483 DOI: 10.1186/s12882-022-02664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients receiving intermittent hemodialysis have variable times of recovery to feeling better after dialysis. QT prolongation, a precursor to clinical and subclinical cardiovascular events, may contribute to delayed recovery time. We hypothesized that abnormal electrocardiographic parameters indicating perturbations in ventricular action are associated with longer recovery times thus impacting a patient-centered quality of life. METHODS Among 242 incident in-center hemodialysis participants from the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, corrected QT interval (QTc), QRST angle and heart rate variance were measured on non-dialysis days using a standard 5-min electrocardiograph recording. Left ventricular hypertrophy (LVH) was defined using the Cornell voltage product. Recovery time was ascertained during a phone interview with a standardized validated questionnaire. Associations between QTc, QRST angle, heart rate variance, and LVH and natural log-transformed recovery time were examined using linear regression adjusted for participant characteristics and electrolytes. RESULTS Mean age was 55 (standard deviation 13) years, 55% were male, 72% were African American. Longer QTc interval was associated with increased recovery time (per 10 ms increase in QTc, recovery time increased by 6.2%; 95% confidence interval: 0.0-10.5). QRST angle, heart rate, heart rate variability and LVH were not significantly associated with recovery time. CONCLUSION Longer QTc intervals are associated with longer recovery time independent of serum electrolytes. This supports a relationship between a patient's underlying arrhythmic status and time to recovery after hemodialysis. Future studies will determine if maneuvers to reduce QTc improves recovery time and quality of life of patients on hemodialysis.
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Affiliation(s)
- Jacqueline Watt
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Fitzpatrick
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Nephrology Center of Maryland, Baltimore, MD, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, USA
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Larisa G Tereshchenko
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Michael Walsh
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rulan S Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
- Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
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Fitzpatrick J, Sozio SM, Jaar BG, Estrella MM, Segev DL, Shafi T, Monroy-Trujillo JM, Parekh RS, McAdams-DeMarco MA. Frailty, Age, and Postdialysis Recovery Time in a Population New to Hemodialysis. KIDNEY360 2021; 2:1455-1462. [PMID: 35373112 PMCID: PMC8786133 DOI: 10.34067/kid.0001052021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
Background Frailty, a phenotype characterized by decreased physiologic reserve and the inability to recover following confrontation with a stressor like hemodialysis, may help identify which patients on incident hemodialysis will experience longer postdialysis recovery times. Recovery time is associated with downstream outcomes, including quality of life and mortality. We characterized postdialysis recovery times among patients new to hemodialysis and quantified the association between frailty and hemodialysis recovery time. Methods Among 285 patients on hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, frailty was measured using the Fried phenotype. Self-reported recovery time was obtained by telephone interview. We estimated the association of frailty (intermediately frail and frail versus nonfrail) and postdialysis recovery time using adjusted negative binomial regression. Results Median time between dialysis initiation and study enrollment was 3.4 months (IQR, 2.7-4.9), and that between initiation and recovery time assessment was 11 months (IQR, 9.3-15). Mean age was 55 years, 24% were >65 years, and 73% were Black; 72% of individuals recovered in ≤1 hour, 20% recovered in 1-6 hours, 5% required 6-12 hours to recover, and <5% required >12 hours to recover. Those with intermediate frailty, frailty, and age ≤65 years had 2.56-fold (95% CI, 1.45 to 4.52), 1.72-fold (95% CI, 1.03 to 2.89), and 2.35-fold (95% CI, 1.44 to 3.85) risks, respectively, of longer recovery time independent of demographic characteristics, comorbidity, and dialysis-related factors. Conclusions In adults new to hemodialysis, frailty was independently associated with prolonged postdialysis recovery. Future studies should assess the effect of frailty-targeted interventions on recovery time to improve clinical outcomes.
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Affiliation(s)
- Jessica Fitzpatrick
- Department of Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen M. Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland
| | - Bernard G. Jaar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Nephrology Center of Maryland, Baltimore, Maryland
| | - Michelle M. Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California,Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Dorry L. Segev
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Tariq Shafi
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi,Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Rulan S. Parekh
- Department of Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada
| | - Mara A. McAdams-DeMarco
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Department of Surgery, Johns Hopkins University, Baltimore, Maryland
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Ozen N, Cepken T, Tosun B. Do biochemical parameters and intradialytic symptoms affect post-dialysis recovery time? A prospective, descriptive study. Ther Apher Dial 2021; 25:899-907. [PMID: 33497021 DOI: 10.1111/1744-9987.13624] [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] [Received: 08/03/2020] [Revised: 01/09/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022]
Abstract
The recovery time is defined as the time required to recover from the feelings of lassitude and fatigue. The daily activities of patients are affected by dialysis sessions, requiring significant time for patients to return to their routines. This situation implies a lower quality of life for HD patients. The aim of this study was to investigate the effects of biochemical parameters and intradialytic symptoms on post-dialysis recovery time in maintenance HD patients. This study was conducted at a private dialysis center during June and August 2019. Data were collected using the "Descriptive Characteristics Form" and the "Dialysis Symptom Index." "STROBE check-list" was used for the report of the study. The study was completed with 86 participants. The median post-dialysis recovery time was 240 min (interquartile range, 120-360 min), and female patients exhibit significantly higher recovery time than male patients. The median BMI was statistically significantly higher in patients whose post-dialysis recovery time was ≥240 min. Additional findings show that the post-dialysis recovery time was shortened by 0.230 times for male patients, while intradialytic hypotension (IDH) prolonged the median post-dialysis recovery time by 3.141 times. Factors underlying the IDH should be determined in order to eradicate the issue. The study was registered in ClinicalTrials.gov with the number NCT04274556.
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Affiliation(s)
- Nurten Ozen
- Florence Nightingale Hospital School of Nursing, Department of English Nursing, Demiroglu Bilim University, Istanbul, Turkey
| | - Tugba Cepken
- Private Koc Dialysis Center - Beylikduzu, Istanbul, Turkey
| | - Betul Tosun
- Department of Nursing, Hasan Kalyoncu University Faculty of Health Sciences, Gaziantep, Turkey
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Guedes M, Pecoits-Filho R, Leme JEG, Jiao Y, Raimann JG, Wang Y, Kotanko P, de Moraes TP, Thadhani R, Maddux FW, Usvyat LA, Larkin JW. Impacts of dialysis adequacy and intradialytic hypotension on changes in dialysis recovery time. BMC Nephrol 2020; 21:529. [PMID: 33287719 PMCID: PMC7720452 DOI: 10.1186/s12882-020-02187-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 11/25/2020] [Indexed: 11/22/2022] Open
Abstract
Background Dialysis recovery time (DRT) surveys capture the perceived time after HD to return to performing regular activities. Prior studies suggest the majority of HD patients report a DRT > 2 h. However, the profiles of and modifiable dialysis practices associated with changes in DRT relative to the start of dialysis are unknown. We hypothesized hemodialysis (HD) dose and rates of intradialytic hypotension (IDH) would associate with changes in DRT in the first years after initiating dialysis. Methods We analyzed data from adult HD patients who responded to a DRT survey ≤180 days from first date of dialysis (FDD) during 2014 to 2017. DRT survey was administered with annual KDQOL survey. DRT survey asks: “How long does it take you to be able to return to your normal activities after your dialysis treatment?” Answers are: < 0.5, 0.5-to-1, 1-to-2, 2-to-4, or > 4 h. An adjusted logistic regression model computed odds ratio for a change to a longer DRT (increase above DRT > 2 h) in reference to a change to a shorter DRT (decrease below DRT < 2 h, or from DRT > 4 h). Changes in DRT were calculated from incident (≤180 days FDD) to first prevalent (> 365-to- ≤ 545 days FDD) and second prevalent (> 730-to- ≤ 910 days FDD) years. Results Among 98,616 incident HD patients (age 62.6 ± 14.4 years, 57.8% male) who responded to DRT survey, a higher spKt/V in the incident period was associated with 13.5% (OR = 0.865; 95%CI 0.801-to-0.935) lower risk of a change to a longer DRT in the first-prevalent year. A higher number of HD treatments with IDH episodes per month in the incident period was associated with a 0.8% (OR = 1.008; 95%CI 1.001-to-1.015) and 1.6% (OR = 1.016; 95%CI 1.006-to-1.027) higher probability of a change to a longer DRT in the first- and second-prevalent years, respectively. Consistently, an increased in incidence of IDH episodes/months was associated to a change to a longer DRT over time. Conclusions Incident patients who had higher spKt/V and less sessions with IDH episodes had a lower likelihood of changing to a longer DRT in first year of HD. Dose optimization strategies with cardiac stability in fluid removal should be tested. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-020-02187-9.
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Affiliation(s)
- Murilo Guedes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Juliana El Ghoz Leme
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Yue Jiao
- Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA, 02451, USA
| | | | - Yuedong Wang
- University of California Santa Barbara, Santa Barbara, CA, USA
| | - Peter Kotanko
- Research Division, Renal Research Institute, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Franklin W Maddux
- Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA, 02451, USA
| | - Len A Usvyat
- Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA, 02451, USA
| | - John W Larkin
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil. .,Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA, 02451, USA.
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Yoowannakul S, Tangvoraphonkchai K, Davenport A. Patient-reported intra-dialytic symptoms and post-dialysis recovery times are influenced by psychological distress rather than dialysis prescription. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0211-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Duggal V, Hussein WF, Reiterman M, Sun SJ, Abra GE, Schiller B. The effect of blood flow rate on dialysis recovery time in patients undergoing maintenance hemodialysis: A prospective, parallel-group, randomized controlled trial. Hemodial Int 2019; 23:223-229. [PMID: 30834652 DOI: 10.1111/hdi.12741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION A majority of patients with end-stage renal disease (ESRD) on in-center hemodialysis (HD) require several hours to recover from an HD session. Patients and caregivers identify fatigue as a high priority for improvement. However, evidence for practical interventions to improve recovery time from conventional in-center HD is lacking. The effect of blood flow rate reduction on dialysis recovery time (DRT) is unknown. METHODS Multicenter, single-blinded, randomized, parallel-design controlled trial of blood flow rate reduction vs. usual care. One-hundred two patients with ESRD undergoing maintenance HD in 18 centers with baseline DRT of greater than 6 hours were included as subjects. The intervention was a blood flow rate reduction of 100 mL/min, to a minimum of 300 mL/min. The primary outcome was the between-group difference in change in DRT. Secondary outcomes were changes in London Evaluation of Illness (LEVIL) survey responses from baseline. FINDINGS Baseline median DRT was 720 (IQR 360-1013) minutes in controls and 720 (IQR 360-1106) minutes in the intervention group. DRT decreased in both groups. Mean change from baseline (95% confidence interval) at Week 4 in the study was -324 (-473, -175) minutes in the control group and -120 (-329, 90) minutes in the intervention group. The change from baseline was more profound in the control group (P = 0.05). Secondary outcomes of measures of quality of life reported on the LEVIL survey showed more improvement in patients' feelings of general well-being in the control group (P = 0.01). Differences between groups in pain, feeling washed out or drained, sleep quality, shortness of breath, and appetite were not statistically significant. DISCUSSION Blood flow rate reduction did not improve DRT over usual care. Though more work needs to be done to address patient-reported fatigue, a significant positive impact may not be achieved without substantial changes in dialysis prescription.
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Affiliation(s)
- Vishal Duggal
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA.,Medical Clinical Affairs, Satellite Healthcare, California, San Jose, USA
| | - Wael F Hussein
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA.,Medical Clinical Affairs, Satellite Healthcare, California, San Jose, USA
| | - Marc Reiterman
- Medical Clinical Affairs, Satellite Healthcare, California, San Jose, USA
| | - Sumi J Sun
- Medical Clinical Affairs, Satellite Healthcare, California, San Jose, USA
| | - Graham E Abra
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA.,Medical Clinical Affairs, Satellite Healthcare, California, San Jose, USA
| | - Brigitte Schiller
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA.,Medical Clinical Affairs, Satellite Healthcare, California, San Jose, USA
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