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Wefer F, Krüger L, Waldréus N, Köpke S. Non-pharmacological interventions to reduce thirst in patients with heart failure or hemodialysis: A systematic review and meta-analysis. Heart Lung 2024; 67:33-45. [PMID: 38653004 DOI: 10.1016/j.hrtlng.2024.04.012] [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: 01/18/2024] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Thirst is a frequent and burdening symptom in many patients, especially in patients with chronic heart failure (CHF) and/or receiving hemodialysis (HD). As drug therapies are not feasible, non-pharmacological strategies are needed to reduce thirst and thirst-related burden. OBJECTIVES To identify non-pharmacological interventions aiming to reduce thirst in patients with CHF and/ or HD, to describe intervention components, and to evaluate the effectiveness of these interventions. METHODS In February 2024, we completed a systematic search in MEDLINE via PubMed, Livivo, CINAHL, Cochrane Library and Web of Science. Two reviewers independently screened titles, abstracts, and full texts, performed critical appraisal and data extraction. We checked risk of bias with the checklists of the Joanna Briggs Institute and the Cochrane Risk of Bias tool and calculated meta-analyses for sufficiently homogeneous studies using fixed-effects models. RESULTS We included 15 intervention studies applying non-pharmacological interventions including chewing gum (n = 8), low-sodium diet (n = 2), acupressure (n = 1), frozen strawberries (n = 1), fluid timetables (n = 1), ice cubes and mouthwash (n = 1), and a psychological intervention (n = 1). Sample sizes varied between 11 and 88 participants. Eleven intervention studies showed a reduction of thirst as intervention effect. Meta-analyses for chewing gum showed no significant effect on thirst using a visual analogue scale (IV: -2,32 [-10.37,5.73]; p = 0.57) or the dialysis thirst inventory (IV: -0.26 [- 1.83, 1.30]; p = 0.74). Quality of studies was moderate to low. CONCLUSION Results indicate that various non-pharmacological interventions could be helpful to reduce thirst in patients with CHF or HD, but important uncertainty remains.
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Affiliation(s)
- Franziska Wefer
- Institute of Nursing Science, University of Cologne, Medical Faculty & University Hospital Cologne, Cologne, Germany; Heart and Diabetes Center NRW, Care Development, Care Directorate, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany.
| | - Lars Krüger
- Heart and Diabetes Center NRW, Care Development, Care Directorate, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Nana Waldréus
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden; Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Medical Faculty & University Hospital Cologne, Cologne, Germany
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Sivagnanam H, Senthilkumar PK, Velu KB, Anand M, Viswanathan R. Comparative Analysis of Tools for Assessment of Protein-Energy Wasting in Chronic Kidney Disease Patients on Maintenance Hemodialysis. Indian J Nephrol 2024; 34:453-460. [PMID: 39372618 PMCID: PMC11450822 DOI: 10.4103/ijn.ijn_57_23] [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: 02/16/2023] [Accepted: 06/02/2023] [Indexed: 10/08/2024] Open
Abstract
Background Patients with chronic kidney disease have muscle wasting, sarcopenia, and cachexia that contribute to frailty and morbidity. The present study assessed the prevalence of protein-energy wasting in dialysis-dependent chronic kidney disease population and evaluated the validity of various nutritional assessment tools in diagnosing protein-energy wasting. Materials and Methods All patients above 18 years undergoing dialysis for more than 3 months without any active infection or malignancy were included in our study. Data from anthropometric measurements, dietary assessment, and blood investigations were collected. Protein-energy wasting was assessed by the International Society of Renal Nutrition and Metabolism 2008 criteria. Diagnostic validity of the nutritional assessment tools to predict protein-energy wasting was estimated by area under the curve, sensitivity, specificity, and accuracy statistics. Results A total of 146 patients were studied. The prevalence of protein-energy wasting was 56.8%. Protein-energy wasting was significantly associated with socioeconomic status, hospitalization days, and catheter days. Normalized protein catabolism rate had the highest sensitivity (90.4%) for predicting protein-energy wasting. Malnutritional inflammatory score had the highest area under the curve (0.858), specificity (82.5%), and accuracy (82.2%). Mid-upper arm circumference, Dialysis Malnutrition Score, and albumin were also found to be significant predictors of protein-energy wasting. Conclusion Lack of advanced equipment in suburban and rural centers to detect protein-energy wasting in India can be overcome by using the various stand-alone and combination nutrition assessment tools which have been validated in the present study.
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Affiliation(s)
- Harish Sivagnanam
- Department of Nephrology, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India
| | - PK. Senthilkumar
- Department of Nephrology, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India
| | - Kannan Bhaba Velu
- Department of Nephrology, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India
| | - Murugesh Anand
- Department of Nephrology, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India
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Kato NP, Nagatomo Y, Kawai F, Kitai T, Mizuno A. Fluid Restriction for Patients with Heart Failure: Current Evidence and Future Perspectives. J Pers Med 2024; 14:741. [PMID: 39063995 PMCID: PMC11277838 DOI: 10.3390/jpm14070741] [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: 05/20/2024] [Revised: 06/20/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Fluid restriction has long been believed to benefit patients with heart failure by counteracting the activated renin-angiotensin aldosterone system and sympathetic nervous activity. However, its effectiveness remains controversial. In this paper, we summarized the current recommendations and reviewed the scientific evidence on fluid restriction in the setting of both acute decompensated heart failure and compensated heart failure. While a recent meta-analysis demonstrated the beneficial effects of fluid restriction on both all-cause mortality and hospitalization compared to usual care, several weaknesses were identified in the assessment of the methodological quality of the meta-analysis using AMSTAR 2. Further randomized controlled trials with larger sample sizes are needed to elucidate the benefits of fluid restriction for both clinical outcomes and patient-reported outcomes in patients with heart failure.
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Affiliation(s)
- Naoko P. Kato
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83 Linköping, Sweden
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan;
| | - Fujimi Kawai
- Library, Department of Academic Resources, St. Luke’s International University, Tokyo 104-0044, Japan;
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita 564-8565, Japan;
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan;
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Miskulin DC, Tighiouart H, Hsu CM, Weiner DE. Dialysate Sodium Lowering in Maintenance Hemodialysis: A Randomized Clinical Trial. Clin J Am Soc Nephrol 2024; 19:712-722. [PMID: 38349776 PMCID: PMC11168813 DOI: 10.2215/cjn.0000000000000431] [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: 10/14/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
Key Points Treatment to dialysate sodium 135 versus 138 mEq/L led to no difference in the rate of change in intradialytic hypotension, but symptoms were greater in the low arm. Use of a dialysate sodium concentration of 135 versus 138 mEq/L led to a small reduction in interdialytic weight gain, but had no effect on predialysis BP. Raising dialysate sodium concentration from 135 to 140 mEq/L reduced intradialytic hypotension and was associated with a marked increase in BP. Background Lowering dialysate sodium concentration may improve volume and BP control in patients on maintenance hemodialysis. Methods We randomized 42 participants 2:1 to dialysate sodium 135 versus 138 mEq/L for 6 months. This was followed by a 12-week extension phase in which sodium was increased to 140 mEq/L in low-arm participants. The primary outcome was intradialytic hypotension (IDH). Secondary outcomes included dialysis disequilibrium symptoms, emergency room visits/hospitalizations, interdialytic weight gain, and BP. Longitudinal changes across arms were analyzed using linear mixed regression. Results Treatment to dialysate sodium 135 versus 138 mEq/L was not associated with a difference in a change in the rate of IDH (mean change [95% confidence interval], 2.8 [0.8 to 9.5] versus 2.7 [1.1 to 6.2] events per 100 treatments per month); ratio of slopes 0.96 (0.26 to 3.61) or emergency room visits/hospitalizations (7.3 [2.3 to 12.4] versus 6.7 [2.9 to 10.6] events per 100 patient-months); difference 0.6 (−6.9 to 5.8). Symptom score was unchanged in the 135 mEq/L arm (0.7 [−1.4 to 2.7]) and decreased in the 138 mEq/L arm ([5.0 to 8.5 to 2.0]; difference 6.0 [2.1 to 9.8]). Interdialytic weight gain declined in the 135 mEq/L arm and was unchanged in the 138 mEq/L arm (−0.3 [−0.5 to 0.0] versus 0.3 [0.0 to 0.6] kg over 6 months; difference [−0.6 (−0.1 to −1.0)] kg). In the extension phase, raising dialysate sodium concentration from 135 to 140 mEq/L was associated with an increase in interdialytic weight gain (0.2 [0.1 to 0.3] kg) and predialysis BP (7.0 [4.8 to 9.2]/3.9 [2.6 to 5.1] mm Hg) and a reduction in IDH (odds ratio, 0.66 [0.45 to 0.97]). Conclusions Use of a dialysate sodium concentration of 135 as compared with 138 mEq/L was associated with a small reduction in interdialytic weight gain without affecting IDH or predialysis BP, but with an increase in symptoms. Raising dialysate sodium concentration from 135 to 140 mEq/L was associated with a reduction in IDH, small increase in interdialytic weight gain, and marked increase in predialysis BP. Clinical Trial registration number NCT03144817 .
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Affiliation(s)
- Dana C. Miskulin
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | - Caroline M. Hsu
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Daniel E. Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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Chhabra R, Davenport A. Is increased subjective thirst associated with greater interdialytic weight gains, extracellular fluid and dietary sodium intake? Artif Organs 2024; 48:91-97. [PMID: 37902178 DOI: 10.1111/aor.14657] [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: 06/29/2023] [Revised: 09/01/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Some previous studies have reported an effect of increasing subjective thirst and interdialytic weight gains (IDWG), and that this may be influenced by nonadherence to dietary sodium restrictions, whereas others reported no such association. As such we wished to review the effect of self-reported thirst on IDWGs and dietary sodium intake. METHODS Dialysis patients were asked to complete visual analogues thirst, distress thermometer (DT) scores and complete a sodium food frequency questionnaire (SFFQ). IDWG and pre and post dialysis volumes were measured with multifrequency bioelectrical impedance. RESULTS One hundred and eleven patients completed the questionnaires and had bioimpedance measurements: 63% male, mean age 63.8 ± 16.1 years, 33% diabetic with a median thirst score 3 (0-5) and SFFQ 52.0 ± 18, and IDWG 2.1 ± 1.3%. Thirst was associated with DT (r = 0.28, p = 0.004) and negatively with age (r = -0.31, p < 0.001), but not SFFQ, IDWG, extracellular water, or dialysate sodium, or dialysate to plasma gradient. Patients with higher thirst scores were younger (58.0 ± 15.2 vs. 69.4 ± 15.0 years, p < 0.001) with higher DT scores (5 [2-7] vs. 2 [0-5], p < 0.001). On multivariate logistic analysis, only age was associated with self-reported thirst (odds ratio 0.95, 95% confidence limits 0.92-0.98, p < 0.001). CONCLUSION We found that subjective thirst was greater for younger patients and those who reported higher levels of distress, but no association with IDWGs, dietary sodium intake, or dialysate sodium. However, most of our patients followed the dietary advice, as evidenced by the low SFFQ scores and % IDWGs. Whether thirst increases distress or distress increases subjective thirst remains to be determined.
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Affiliation(s)
- Roohi Chhabra
- UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
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Picó-Munyoz R, Tárrega A, Laguna L. Origins of thirstiness sensation and current food solutions. Compr Rev Food Sci Food Saf 2023; 22:4433-4450. [PMID: 37583300 DOI: 10.1111/1541-4337.13229] [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: 12/13/2022] [Revised: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
The sensation of thirstiness is the desire to drink water. In certain situations, the ingestion of liquid water can be restricted. As a result, thirstiness is not relieved, resulting in an uncomfortable and distressing situation. The present review describes thirstiness and hydration, the food products and beverages that cause thirstiness, and the beverages and food products currently available to quench thirstiness in individuals with restricted access to liquid ingestion. It also discusses how to measure the effectiveness of calming thirstiness. To diminish thirstiness distress, different alternatives to liquids are proposed. Individuals with swallowing disorders are given thickened water, individuals with restricted water ingestion are given ice cubes or ice popsicles of different flavors, and sportspeople are given energy gels. However, current beverage solutions seem not to relieve thirst fully, although some stimuli like iced water, flavors (especially lemon and mint), or acids seem to work better than plain stimuli and could be added to existing products. Therefore, there is still a need to incorporate these strategies into beverage and food formulations and to test their effectiveness.
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Affiliation(s)
- Ruth Picó-Munyoz
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
| | - Amparo Tárrega
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
| | - Laura Laguna
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
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Lamba J, Mittal S, Tewari S, Jain D, Tewari S, Duhan J, Sangwan P, Kumar V. Association of Apical Periodontitis with Different Stages of Chronic Kidney Disease Measured by Glomerular Filtration Rate and Systemic Markers: An Observational Study. J Endod 2023; 49:1472-1479. [PMID: 37640201 DOI: 10.1016/j.joen.2023.08.012] [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: 04/25/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The aim of this study was to assess the prevalence and severity of apical periodontitis (AP) in subjects with different stages of chronic kidney disease (CKD) and its association with systemic markers. METHODS In this cross-sectional study, 105 patients with CKD (n = 35 each in the early, predialysis, and hemodialysis groups) and 105 healthy controls were included. The prevalence, number of teeth with AP (endodontic burden [EB]), and the severity of AP were recorded. High- sensitivity C-reactive protein, blood urea, and serum creatinine levels were also recorded. Logistic regression was applied to determine the possible association between CKD and AP in the study population, and linear regression was performed to predict the effect of AP on systemic markers in CKD patients. RESULTS AP in at least 1 tooth was found in 75.2% of CKD patients and 40.9% of the controls (P < .05). CKD patients were 4 times more likely to have AP than controls (P < .05; odds ratio = 3.954; 95% confidence interval, 2.09-7.45). EB and the severity of AP were also significantly higher in CKD patients than the healthy controls (P < .05). Although higher values of EB and severe AP were observed with the progression of disease, the difference was not significant. The severity of AP was significantly associated with an increase in serum creatinine, blood urea, and a decrease in estimated glomerular filtration rate (P < .05) in CKD patients. CONCLUSIONS AP was significantly more prevalent in the CKD group. The association between the severity of AP and CKD markers suggests that AP could possibly alter the progression of CKD. However, these findings do not establish a cause-and-effect relationship.
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Affiliation(s)
- Jyoti Lamba
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Shweta Mittal
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India.
| | - Sanjay Tewari
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Deepak Jain
- Department of Medicine, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Shikha Tewari
- Department of Periodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Jigyasa Duhan
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Pankaj Sangwan
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Vinay Kumar
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
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Çiftçi B, Yıldız GN, Avşar G, Köse S, Aydın E, Doğan S, Çelik Ş. Development of the Thirst Discomfort Scale: A Validity and Reliability Study. Am J Crit Care 2023; 32:176-183. [PMID: 37121897 DOI: 10.4037/ajcc2023954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Thirst is a sensation associated with a dry mouth and the desire or craving to drink water. Surgical patients are among those hospitalized individuals who are at high risk of developing both osmotic and hypovolemic thirst. OBJECTIVES To develop a new measurement tool for evaluating the thirst-related discomfort of surgical patients and to assess its validity and reliability. METHODS The study population consisted of patients admitted to the surgical clinics of a research hospital in Turkey between January and March 2022. The new measurement tool was developed in several stages: a pilot implementation phase with 51 patients and the main implementation phase with 198 patients. Data were collected by means of face-to-face interviews with patients. Exploratory factor and confirmatory factor analyses were performed using IBM SPSS Statistics, version 22, and IBM SPSS Amos. RESULTS The final Thirst Discomfort Scale consisted of 12 items in 3 subdimensions. The Cronbach α values of the scale subdimensions ranged from 0.787 to 0.848, and the Cronbach α value for the scale as a whole was 0.886. The scale explained 66.237% of the total variance of the data. CONCLUSION The Thirst Discomfort Scale consisting of 12 items and 3 subdimensions is a valid and reliable measurement tool for evaluating thirst-related discomfort of surgical patients.
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Affiliation(s)
- Bahar Çiftçi
- Bahar Çiftçi is an assistant professor, Department of Fundamentals of Nursing, Atatürk University, Atateknokent, Erzurum, Turkey
| | - Güzel Nur Yıldız
- Güzel Nur Yıldız is an instructor, Department of Dialysis, Muş Alparslan University, Muş, Turkey
| | - Gülçin Avşar
- Gülçin Avşar is an associate professor, Department of Fundamentals of Nursing, Atatürk University, Atateknokent, Erzurum, Turkey
| | - Sema Köse
- Sema Köse is an instructor, Department of Nursing, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Esra Aydın
- Esra Aydın is an instructor, Department of Dialysis, Gümüşhane University, Gümüşhane, Turkey
| | - Sevgi Doğan
- Sevgi Doğan is a research assistant, Department of Fundamentals of Nursing, Atatürk University, Erzurum, Turkey
| | - Şeymanur Çelik
- Şeymanur Çelik is a research assistant, Department of Fundamentals of Nursing, Atatürk University, Erzurum, Turkey
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Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth. STUDY DESIGN A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. RESULTS From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. CONCLUSION There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.
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Nanayakkara S, Gao J. LIMITED EVIDENCE SUGGESTS THAT END STAGE KIDNEY DISEASE AND HEMODIALYSIS MAY IMPACT SALIVARY FLOW RATE AND COMPOSITION. J Evid Based Dent Pract 2022; 22:101757. [PMID: 36162886 DOI: 10.1016/j.jebdp.2022.101757] [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] [Indexed: 11/30/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Rodrigues RP, Vidigal MT, Vieira WA, Nascimento GG, Sabino-Silva R, Blumenberg C, Siqueira MF, Siqueira WL, Paranhos LR. Salivary changes in chronic kidney disease and in patients undergoing hemodialysis: a systematic review and meta-analysis. Journal of Nephrology. 2022 Mar 2:1-29. SOURCE OF FUNDING The work has been partially funded by CAPES-Finance Code 001. The authors have also acknowledged The Brazilian National Council for Scientific and Technological Development (CNPq) and Minas Gerais State Agency for Research and Development, Brazil (FAPEMIG) for the support. TYPE OF STUDY/DESIGN Systematic review with meta-analysis of data.
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Yang LY, Lee BO, Lee KN, Chen CA. Effects of Electrical Stimulation of Acupoints on Xerostomia for Patients Who Undergo Hemodialysis. Healthcare (Basel) 2022; 10:healthcare10030498. [PMID: 35326976 PMCID: PMC8954393 DOI: 10.3390/healthcare10030498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
Xerostomia plays a major role in higher interdialytic weight gain (IDWG), which causes cardiovascular complications in patients who undergo hemodialysis. However, few studies have determined a method to manage xerostomia. This study determines the effect of transcutaneous electrical acupoint stimulation (TEAS) on hemodialysis patients with xerostomia and the percentage of IDWG. The study was a single-blind and quasi-experimental study. There are 75 participants: 37 in the TEAS group and 38 in the contrast group. The TEAS group used 250 µs and 50 Hz and the contrast group used 50 µs and 2 Hz three times a week for 3 weeks to stimulate ST 6 and TE17 acupoints. The salivary flow rates, dry mouth, and %IDWG were determined before, during and one week after the program. Compared with the contrast group, the TEAS group showed a significantly improved salivary flow rate (mL/min) (F (2, 123) = 15.28, p < 0.0001), and patients recovered their normal salivary flow rate. However, the results show that both groups showed significant improvement in dry mouth after treatment. The TEAS group demonstrated no effect in terms of %IDWG, as expected. The results show that a TEAS program is an effective means of symptom management for xerostomia patients who undergo hemodialysis. A TEAS program can be used to manage symptoms for xerostomia patients who undergo hemodialysis.
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Affiliation(s)
- Li-Yu Yang
- College of Nursing, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (L.-Y.Y.); (B.-O.L.)
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (L.-Y.Y.); (B.-O.L.)
| | - Kai-Ni Lee
- Department of Nephrology, Tainan Sinlau Hospital, Tainan 701002, Taiwan;
| | - Chien-An Chen
- Department of Nephrology, Tainan Sinlau Hospital, Tainan 701002, Taiwan;
- Correspondence: ; Tel.: +886-6-2748316 (ext. 2100)
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Abstract
Patients on chronic hemodialysis are counseled to reduce dietary sodium intake to limit their thirst and consequent interdialytic weight gain (IDWG), chronic volume overload and hypertension. Low-sodium dietary trials in hemodialysis are sparse and mostly indicate that dietary education and behavioral counseling are ineffective in reducing sodium intake and IDWG. Additional nutritional restrictions and numerous barriers further complicate dietary adherence. A low-sodium diet may also reduce tissue sodium, which is positively associated with hypertension and left ventricular hypertrophy. A potential alternative or complementary approach to dietary counseling is home delivery of low-sodium meals. Low-sodium meal delivery has demonstrated benefits in patients with hypertension and congestive heart failure but has not been explored or implemented in patients undergoing hemodialysis. The objective of this review is to summarize current strategies to improve volume overload and provide a rationale for low-sodium meal delivery as a novel method to reduce volume-dependent hypertension and tissue sodium accumulation while improving quality of life and other clinical outcomes in patients undergoing hemodialysis.
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Affiliation(s)
- Luis M Perez
- Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Denver, CO, USA
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
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Simão DO, Júlia da Costa R, Fonseca Verneque BJ, Ferreira do Amaral J, Chagas GM, Duarte CK. Sodium and/or fluid restriction and nutritional parameters of adult patients with heart failure: A systematic review and meta-analysis of randomized controlled trial. Clin Nutr ESPEN 2021; 45:33-44. [PMID: 34620336 DOI: 10.1016/j.clnesp.2021.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/27/2021] [Accepted: 08/16/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Heart failure (HF) is a clinical syndrome resulting from the structural and/or functional impairment of blood supply to tissues. Congestion and edema associated with water retention are the main symptoms presented by patients. Fluid (FR) and sodium restriction are non-pharmacological measures indicated in clinical practice to mitigate this symptom, despite their low evidence level. AIM Assessing the impact of sodium and/or fluid restriction on nutritional parameters of adult patients with HF, based on systematic review with meta-analysis. METHODS The study was conducted in June 2020, on the following databases: EMBASE, PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science. Citations were also collected in the gray literature such as thesis banks and preprints. Randomized clinical trials conducted with patients in the age group 18 years, or older, who were hospitalized or under outpatient/clinical follow-up, and who were subjected to intervention based on fluid and/or sodium restriction in comparison to the control, were herein selected. RESULTS Although FR-based diets are effective in reducing liquid intake, they increase individuals' thirst sensation and body weight in comparison to non-FR diets. The association between this intervention and sodium restriction is also effective in reducing liquid intake as sodium intake decreases. However, the association of the most severe (<2000 mg/day) and moderate (2000-2400 mg/day) sodium restrictions with FR has reduced energy intake, although without evidence of weight change - only the most severe sodium restriction was capable of keeping individuals' thirst sensation. In addition, moderate sodium restrictions (2300 to 3000 mg/day) in association with FR were capable of decreasing urinary sodium excretion. On the other hand, prescriptions of severe or moderate sodium restriction (<2,400 mg/d) alone have reduced individuals' body weight and BMI, although they did not change their caloric intake. However, severe sodium restriction (<2,000 mg) has led to higher body weight than the low-sodium diet (2000 to 2,4000 mg/day). CONCLUSION Sodium restriction may not be an effective strategy because it adversely affects individuals' weight, a fact that suggests increased congestion. Weight-based FR is supported to bethe best way to individualize this non-pharmacological treatment and it does not appear to affect nutritional parameters capable of putting patients with HF at higher malnutrition risk.
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Affiliation(s)
- Daiane Oliveira Simão
- Unidade Multiprofissional e Reabilitação - Nutrição Clínica, Hospital Das Clínicas da Universidade Federal de Minas Gerais, Brazil
| | - Renata Júlia da Costa
- Departamento de Nutrição da Escola de Enfermagem da Universidade Federal de Minas Gerais, Brazil
| | | | - Joana Ferreira do Amaral
- Departamento de Nutrição Clínica e Social da Escola de Nutrição da Universidade Federal de Ouro Preto, Brazil
| | - Gicele Mendes Chagas
- Unidade Multiprofissional e Reabilitação - Nutrição Clínica, Hospital Das Clínicas da Universidade Federal de Minas Gerais, Brazil
| | - Camila Kümmel Duarte
- Departamento de Nutrição da Escola de Enfermagem da Universidade Federal de Minas Gerais, Brazil.
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Günen Yılmaz S, Yılmaz F. Evaluation of demographic and clinical risk factors for high interdialytic weight gain. Ther Apher Dial 2021; 26:613-623. [PMID: 34533275 DOI: 10.1111/1744-9987.13738] [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: 03/20/2021] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 11/27/2022]
Abstract
Xerostomia and hyposalivation are highly prevalent in hemodialysis (HD) patients and this is effective in increased fluid intake. The aim of this study is to determine the demographic and clinical risk factors associated with high interdialytic weight gain (IDWG) in nondiabetic HD patients. In total, 52 eligible HD patients were recruited in this cross-sectional study. Patients were divided into two groups according to % IDWG: Group 1: High IDWG (≥3%) and Group 2: normal IDWG (<3%). Plasma osmolarity (POsm), unstimulated salivary flow rate (USFR), xerostomia inventory (XI), and dialysis thirst inventory (DTI) were evaluated. The mean age of the patients was 53.7 ± 15.7 years. The prevalence of xerostomia was 53.8%, and hyposalivation was in 40.3% in the patients. High IDWG was positively correlated with XI and DTI while it was negatively correlated with POsm and USFR. The area under the receiver-operating characteristics curve for POsm for high IDWG was 0.661, with sensitivity of 63.8% and specificity of 72.7% for a cut-off point of 297.4 mOsm/L. Logistic regression analysis showed that advanced age odds ratio (OR: 1.215, p = 0.019), pill burden (OR: 1.162, p = 0.031), C-reactive protein (CRP; OR: 1.308, p = 0.042), and low POsm (OR: 0.768, p = 0.046) were independently related to high IDWG. The prevalence of xerostomia and thirst was higher in HD patients with high IDWG compared to the normal IDWG group. Age, CRP, low POsm, and pill burden were independently associated with high IDWG.
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Affiliation(s)
- Sevcihan Günen Yılmaz
- Department of Maxillofacial Radiology, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Fatih Yılmaz
- Department of Nephrology, Antalya Atatürk State Hospital, Antalya, Turkey
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15
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Yu IC, Liu CY, Fang JT. Effects of hemodialysis treatment on saliva flow rate and saliva composition during in-center maintenance dialysis: a cross-sectional study. Ren Fail 2021; 43:71-78. [PMID: 33327832 PMCID: PMC7751405 DOI: 10.1080/0886022x.2020.1857769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim To analyze changes in saliva flow rate and clinical measures from unstimulated whole saliva (UWS) among patients undergoing hemodialysis for end-stage kidney disease (ESKD). Background Chronic hemodialysis causes changes in blood chemistry as well as dry mouth, due to removal of excess fluids. UWS is used to examine saliva flow rate as an indicator of mouth dryness. Whether UWS can be used to measure changes in clinical variables following hemodialysis has not been explored. Design A cross-sectional quantitative study. Methods Patients with ESKD were recruited by purposive sampling (n = 100) between 1 January and 30 June 2015 from a hospital in northern Taiwan. UWS was collected 1-hour pre-dialysis (T1), mid-dialysis (T2), and 1-hour post-dialysis (T3). Saliva flow rate and clinical variables were analyzed. Results Saliva flow rate increased significantly from T1 to T3 (Wald χ2 = 10.40, p < .01). Changes in saliva from T1 to T3 included decreases in blood urea nitrogen and creatinine (Wald χ2 = 97.12, p < .001 and Wald χ2 = 36.98, p < .001, respectively). The pH and osmolality also decreased (p < .001 and p < .01, respectively). Changes in electrolytes included decreases in potassium and calcium (Wald χ2 = 6.71, p < .05 and Wald χ2 = 17.64, p < .01, respectively) and increases in chloride (Wald χ2 = 17.64, p < .001). Conclusion Our findings demonstrated saliva flow rate and several saliva components were altered during hemodialysis. The total volume of saliva secretion increased following dialysis, which can reduce xerostomia. Therefore, medical personnel could provide interventions of relieving dry mouth symptoms and increasing saliva flow rate before hemodialysis treatment.
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Affiliation(s)
- I-Chen Yu
- Department of Nursing, Chang Gung University of Science and Technology, Taiwan.,Department of Nephrology, Chang Gung Memorial Hospital in Linkou, Tao-Yuan, Taiwan
| | - Chieh-Yu Liu
- Department of Speech Language Pathology and Audiology, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ji-Tseng Fang
- Department of Nephrology, Chang Gung Memorial Hospital in Linkou, Tao-Yuan, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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16
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Laheij A, Rooijers W, Bidar L, Haidari L, Neradova A, de Vries R, Rozema F. Oral health in patients with end-stage renal disease: A scoping review. Clin Exp Dent Res 2021; 8:54-67. [PMID: 34459147 PMCID: PMC8874082 DOI: 10.1002/cre2.479] [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: 03/23/2021] [Accepted: 07/13/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES In patients with end stage, renal disease a high rate of morbidity and mortality is present. Studies suggest that end stage renal disease may affect oral health. Therefore, the aim of this study was to perform a scoping review on periodontal disease, dental caries, xerostomia, and hyposalivation in end stage renal disease patients. MATERIALS AND METHODS A literature search (in PubMed and Embase.com) was performed up to September 29, 2020, in collaboration with a medical information specialist. Included outcome variables were the community periodontal index, probing pocket depth, gingival index, bleeding on probing, decayed-missing-filled-teeth, carious-absent-obturated index, Xerostomia Inventory and the (un)stimulated whole salivary flow rate. RESULTS Forty three out of 1293 studies were included in the final review comprising 7757 end stage renal disease patients. The average age was 58.3 ± 29.4 years. 28.2%-78.8% of patients reported xerostomia and the (un)stimulated salivary flow rates were significantly lower. Higher community periodontal index scores were measured in end stage renal disease patients. More decayed-missing-filled-teeth were recorded, but no differences were found between groups. CONCLUSIONS Xerostomia and hyposalivation were highly prevalent in end stage renal disease patients. Patients have more deepened pockets, but an equal number of carious teeth compared to healthy controls.
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Affiliation(s)
- Alexa Laheij
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Netherlands
| | - Wietse Rooijers
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Netherlands
| | - Lela Bidar
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Netherlands
| | - Lema Haidari
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Netherlands
| | - Aegida Neradova
- Department of Nephrology, Dianet Amsterdam, and Amsterdam UMC, Netherlands
| | | | - Frederik Rozema
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, location AMC, Netherlands
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Bhuwania P, Veerappan I, Sethuraman R, Rajgopal A. Effect of intestinal dialysis using polyethylene glycol on fluid balance and thirst in maintenance hemodialysis patients: A comparative study. Ther Apher Dial 2021; 26:398-408. [PMID: 34219392 DOI: 10.1111/1744-9987.13707] [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: 02/23/2021] [Revised: 06/19/2021] [Accepted: 07/02/2021] [Indexed: 12/24/2022]
Abstract
High inter-dialytic weight gains (IDWG) and Hyperkalemia have been associated with adverse outcomes like poor quality of life and high mortality. Thirst remains an unsolved problem in hemodialysis (HD) patients. The aim of this study was to evaluate the effect of polyethylene glycol (PEG) based intestinal dialysis on IDWG, thirst and biochemical parameters. A prospective interventional evidenced based paired comparative single center study was conducted. Thirty-five anuric patients on weekly thrice HD were studied for four consecutive dialysis weeks. Before the mid-week dialysis day of week 3, Patients received 2 L PEG solution. The primary end points were change in mean relative IDWG and change in mean subjective thirst feeling as measured on visual analog scale (VAS) with secondary endpoints being change in small molecule clearance. There was significant reduction in IDWG after the therapy from 3 ± 0.81 L to 2.35 ± 0.72 (P = 0.002). The therapy also reduced the % IDWG BW from 5.1 ± 1.7% to 4.15 ± 1.6% (P = 0.017). No change in thirst was seen, that is, 6.16 ± 0.66, 6.14 ± 0.64, and 6.16 ± 0.65 (P = 0.986). A multivariate linear regression did not reveal any effect of age, gender, and co-morbidities on the reduction of IDWG and thirst. The therapy achieved a significant urea, creatinine, and potassium reduction of 8.23%, 8.13%, and 8.33% respectively with an increase in sodium levels by 0.86%. This modality reduced the IDWG, was found to be a potent treatment modality for hyperkalemia but did not affect thirst sensation even after consumption of 2 L solution.
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Affiliation(s)
- Puneet Bhuwania
- Department of Nephrology, KG Hospital and PG Institute, Coimbatore, Tamil Nadu, India
| | - Ilangovan Veerappan
- Department of Nephrology, KG Hospital and PG Institute, Coimbatore, Tamil Nadu, India
| | - Ramaswami Sethuraman
- Department of Nephrology, KG Hospital and PG Institute, Coimbatore, Tamil Nadu, India
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Impact d’une prise en charge par hypnose sur le vécu et l’observances des recommandations hydriques en hémodialyse : résultats d’un protocole à cas unique chez deux patients. PRAT PSYCHOL 2021. [DOI: 10.1016/j.prps.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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19
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Rootjes PA, Penne EL, Ouellet G, Dou Y, Thijssen S, Kotanko P, Raimann JG. Dextrose solution for priming and rinsing the extracorporeal circuit in hemodialysis patients: A prospective pilot study. Int J Artif Organs 2021; 44:906-911. [PMID: 34058888 PMCID: PMC8559183 DOI: 10.1177/03913988211020023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Excess sodium intake and consequent volume overload are major clinical problems in hemodialysis (HD) contributing to adverse outcomes. Saline used for priming and rinsing of the extracorporeal circuit is a potentially underappreciated source of intradialytic sodium gain. We aimed to examine the feasibility and clinical effects of replacing saline as the priming and rinsing fluid by a 5% dextrose solution. MATERIALS AND METHODS We enrolled non-diabetic and anuric stable HD patients. First, the extracorporeal circuit was primed and rinsed with approximately 200-250 mL of isotonic saline during 4 weeks (Phase 1), subsequently a similar volume of a 5% dextrose solution replaced the saline for another 4 weeks (Phase 2), followed by another 4 weeks of saline (Phase 3). We collected data on interdialytic weight gain (IDWG), pre- and post-dialysis blood pressure, intradialytic symptoms, and thirst. RESULTS Seventeen chronic HD patients (11 males, age 54.1 ± 18.7 years) completed the study. The average priming and rinsing volumes were 236.7 ± 77.5 and 245.0 ± 91.8 mL respectively. The mean IDWG did not significantly change (2.52 ± 0.88 kg in Phase 1; 2.28 ± 0.70 kg in Phase 2; and 2.51 ± 1.2 kg in Phase 3). No differences in blood pressures, intradialytic symptoms or thirst were observed. CONCLUSIONS Replacing saline by 5% dextrose for priming and rinsing is feasible in stable HD patients and may reduce intradialytic sodium loading. A non-significant trend toward a lower IDWG was observed when 5% dextrose was used. Prospective studies with a larger sample size and longer follow-up are needed to gain further insight into the possible effects of using alternate priming and rinsing solutions lowering intradialytic sodium loading. TRIAL REGISTRATION Identifier NCT01168947 (ClinicalTrials.gov).
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Affiliation(s)
- Paul A Rootjes
- Department of Nephrology, Northwest Clinics, Alkmaar, The Netherlands.,Department of Nephrology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Erik Lars Penne
- Department of Nephrology, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Yanna Dou
- The Nephrology Center, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | | | - Peter Kotanko
- Renal Research Institute, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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M NK, K N RS, H M T, Kamath G, D D. Prevalence of xerostomia in patients on haemodialysis: A systematic review and meta-analysis. Gerodontology 2021; 38:235-241. [PMID: 33432660 DOI: 10.1111/ger.12526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/04/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Haemodialysis is the most popular procedure of treating end-stage renal disease. But patients on haemodialysis report various symptoms including xerostomia that add to the physical as well as the psychological stress. Xerostomia is also considered to be one of the factors for interdialytic weight gain. This systematic review aims to find out the prevalence of xerostomia in patients on haemodialysis. The results would help the nephrologists to consider xerostomia, treat it appropriately and minimise the risks during haemodialysis. METHODS The search strategy was in line with the PRISMA guidelines. An online literature search of databases like PUBMED, SCOPUS, Wiley Online Library and the Cochrane library along with journal hand searches and scanning of references was done. The relevant articles were identified based on the inclusion and exclusion criteria. Full-text articles were obtained and scrutinised. Risk of bias assessment was carried out for the included articles. RESULTS Four articles satisfying the inclusion criteria were finalised. The pooled prevalence of xerostomia in patients on haemodialysis was 52.3%. The assessment of risk bias placed the articles at low risk. CONCLUSION With the limited number and variations of studies, the prevalence of xerostomia in haemodialysis patients was high. Ideal management approaches could be proposed if many more accurate estimates of prevalence of xerostomia in patients on haemodialysis are recorded in future.
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Affiliation(s)
- Nanditha Kumar M
- Department of Prosthodontics, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India
| | - Raghavendra Swamy K N
- Department of Prosthodontics, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India
| | - Thippeswamy H M
- Department of Public Health Dentistry, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India
| | - Giridhar Kamath
- Department of Prosthodontics, Sharavathi Dental College & Hospital, Rajiv Gandhi University of Health Sciences, Bengaluru, India
| | - Devananda D
- Department of Biochemistry, JSS Medical College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India
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Perez LM, Fang HY, Ashrafi SA, Burrows BT, King AC, Larsen RJ, Sutton BP, Wilund KR. Pilot study to reduce interdialytic weight gain by provision of low-sodium, home-delivered meals in hemodialysis patients. Hemodial Int 2020; 25:265-274. [PMID: 33150681 DOI: 10.1111/hdi.12902] [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: 07/31/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients with kidney failure undergoing maintenance hemodialysis (HD) therapy are routinely counseled to reduce dietary sodium intake to ameliorate sodium retention, volume overload, and hypertension. However, low-sodium diet trials in HD are sparse and indicate that dietary education and behavioral counseling are ineffective in reducing sodium intake. This study aimed to determine whether 4 weeks of low-sodium, home-delivered meals in HD patients reduces interdialytic weight gain (IDWG). Secondary outcomes included changes in dietary sodium intake, thirst, xerostomia, blood pressure, volume overload, and muscle sodium concentration. METHODS Twenty HD patients (55 ± 12 years, body mass index [BMI] 40.7 ± 16.6 kg/m2 ) were enrolled in this study. Participants followed a usual (control) diet for the first 4 weeks followed by 4 weeks of three low-sodium, home-delivered meals per day. We measured IDWG, hydration status (bioimpedance), standardized blood pressure (BP), food intake (3-day dietary recall), and muscle sodium (magnetic resonance imaging) at baseline (0 M), after the 4-week period of usual diet (1 M), and after the meal intervention (2 M). FINDINGS The low-sodium meal intervention significantly reduced IDWG when compared to the control period (-0.82 ± 0.14 kg; 95% confidence interval, -0.55 to -1.08 kg; P < 0.001). There were also 1 month (1 M) to 2 month (2 M) reductions in dietary sodium intake (-1687 ± 297 mg; P < 0.001); thirst score (-4.4 ± 1.3; P = 0.003), xerostomia score (-6.7 ± 1.9; P = 0.002), SBP (-18.0 ± 3.6 mmHg; P < 0.001), DBP (-5.9 ± 2.0 mmHg; P = 0.008), and plasma phosphorus -1.55 ± 0.21 mg/dL; P = 0.005), as well as a 0 M to 2 M reduction in absolute volume overload (-1.08 ± 0.33 L; P = 0.025). However, there were no significant changes in serum or tissue sodium (all P > 0.05). DISCUSSION Low-sodium, home-meal delivery appears to be an effective method for improving volume control and blood pressure in HD patients. Future studies with larger sample sizes are needed to examine the long-term effects of home-delivered meals on these outcomes and to assess cost-effectiveness.
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Affiliation(s)
- Luis M Perez
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Hsin-Yu Fang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Sadia-Anjum Ashrafi
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Brett T Burrows
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Alexis C King
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Ryan J Larsen
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Bradley P Sutton
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Kenneth R Wilund
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Flythe JE, Hilliard TS, Ikeler K, Keller S, Gipson DS, Grandinetti AC, Nordyke RJ, Perrone RD, Roy-Chaudhury P, Unruh M, West M, Bocell F, Hurst FP. Toward Patient-Centered Innovation: A Conceptual Framework for Patient-Reported Outcome Measures for Transformative Kidney Replacement Devices. Clin J Am Soc Nephrol 2020; 15:1522-1530. [PMID: 32276947 PMCID: PMC7536748 DOI: 10.2215/cjn.00110120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Individuals with dialysis-dependent kidney failure experience considerable disease- and treatment-related decline in functional status and overall well-being. Despite these experiences, there have been few substantive technological advances in KRT in decades. As such, new federal initiatives seek to accelerate innovation. Historically, integration of patient perspectives into KRT product development has been limited. However, the US Food and Drug Administration recognizes the importance of incorporating patient perspectives into the total product life cycle (i.e., from product conception to postmarket surveillance) and encourages the consideration of patient-reported outcomes in regulatory-focused clinical trials when appropriate. Recognizing the significance of identifying patient-reported outcome measures (PROMs) that capture contemporary patient priorities, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and US Food and Drug Administration, convened a workgroup to (1) develop a conceptual framework for a health-related quality of life PROM; (2) identify and map existing PROMs to the conceptual framework, prioritizing them on the basis of their supporting evidence for use in the regulatory environment; and (3) describe next steps for identifying PROMs for use in regulatory clinical trials of transformative KRT devices. This paper summarizes the proposed health-related quality-of-life PROM conceptual framework, maps and prioritizes PROMs, and identifies gaps and future needs to advance the development of rigorous, meaningful PROMS for use in clinical trials of transformative KRT devices.
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Affiliation(s)
- Jennifer E. Flythe
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Kourtney Ikeler
- American Institutes for Research, Chapel Hill, North Carolina
| | - San Keller
- American Institutes for Research, Chapel Hill, North Carolina
| | - Debbie S. Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Prabir Roy-Chaudhury
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- W.G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, North Carolina
| | - Mark Unruh
- School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Melissa West
- Kidney Health Initiative and American Society of Nephrology, Washington, DC
| | - Fraser Bocell
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Frank P. Hurst
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
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23
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Ozen N, Aydin Sayilan A, Mut D, Sayilan S, Avcioglu Z, Kulakac N, Ecder T, Akyolcu N. The effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms: A prospective, randomized controlled trial. Hemodial Int 2020; 25:94-103. [PMID: 32996239 DOI: 10.1111/hdi.12878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The major salivary glands can be stimulated by chewing gum to increase saliva flow and decrease xerostomia. The aim of this study was to investigate the effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms in hemodialysis (HD) patients. METHODS This prospective randomized controlled single-blind study was conducted with patients who had been treated for at least 6 months with sessions 3 days a week for 4 hours at two HD units. Patients were randomly allocated to chewing gum group or the control group. In the chewing gum group, gum was chewed for 10 minutes six times a day, and when the patients felt mouth dryness or were thirsty. In the nonchewing gum group, gum was not chewed. The patients were followed-up for 3 months. A total of three saliva samples were taken before starting treatment at the first, 12th, and 36th HD session. Data were collected with the "Visual Analogue Scale (VAS)," "Hemodialysis Patients Fluid Control Scale," "Dialysis Symptom Index," and "Hospital Anxiety and Depression Scale" at baseline, week 4, week 8, and week 12. FINDINGS The study was completed with a total of 44 patients consisting of 22 patients in the each group. The second and third month VAS values (xerostomia) of the patients in the chewing gum groups were statistically significantly lower than those in the control group (P = 0.014, P < 0.001, respectively). The third month salivary flow rate in the chewing gum group was higher than the values in the control group patients (P < 0.001). DISCUSSION It is anticipated that this study will raise nurses' awareness of dry mouth and encourage future studies on interventions to increase the salivary flow rate to prevent or treat dry mouth.
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Affiliation(s)
- Nurten Ozen
- Florence Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
| | - Aylin Aydin Sayilan
- Nursing Department, Kirklareli University School of Health Science, Kırklareli, Turkey
| | - Dilek Mut
- Department of Intensive Care Unit, Kirklareli State Hospital, Kirklareli, Turkey
| | - Samet Sayilan
- Department of Internal Medicine, Kirklareli State Hospital, Kirklareli, Turkey
| | - Zeynep Avcioglu
- Department of Quality Management Unit, Lüleburgaz State Hospital, Kirklareli, Turkey
| | - Nursen Kulakac
- Faculty of Health Science, Gumushane University, Gümüşhane, Turkey
| | - Tevfik Ecder
- Division of Nephrology, Department of Internal Medicine, Demiroglu Bilim University, İstanbul, Turkey
| | - Neriman Akyolcu
- Department of Nursing, Faculty of Health Sciences, Istinye University, İstanbul, Turkey
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Marshall MR, Vandal AC, de Zoysa JR, Gabriel RS, Haloob IA, Hood CJ, Irvine JH, Matheson PJ, McGregor DOR, Rabindranath KS, Schollum JBW, Semple DJ, Xie Z, Ma TM, Sisk R, Dunlop JL. Effect of Low-Sodium versus Conventional Sodium Dialysate on Left Ventricular Mass in Home and Self-Care Satellite Facility Hemodialysis Patients: A Randomized Clinical Trial. J Am Soc Nephrol 2020; 31:1078-1091. [PMID: 32188697 PMCID: PMC7217404 DOI: 10.1681/asn.2019090877] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Fluid overload in patients undergoing hemodialysis contributes to cardiovascular morbidity and mortality. There is a global trend to lower dialysate sodium with the goal of reducing fluid overload. METHODS To investigate whether lower dialysate sodium during hemodialysis reduces left ventricular mass, we conducted a randomized trial in which patients received either low-sodium dialysate (135 mM) or conventional dialysate (140 mM) for 12 months. We included participants who were aged >18 years old, had a predialysis serum sodium ≥135 mM, and were receiving hemodialysis at home or a self-care satellite facility. Exclusion criteria included hemodialysis frequency >3.5 times per week and use of sodium profiling or hemodiafiltration. The main outcome was left ventricular mass index by cardiac magnetic resonance imaging. RESULTS The 99 participants had a median age of 51 years old; 67 were men, 31 had diabetes mellitus, and 59 had left ventricular hypertrophy. Over 12 months of follow-up, relative to control, a dialysate sodium concentration of 135 mmol/L did not change the left ventricular mass index, despite significant reductions at 6 and 12 months in interdialytic weight gain, in extracellular fluid volume, and in plasma B-type natriuretic peptide concentration (ratio of intervention to control). The intervention increased intradialytic hypotension (odds ratio [OR], 7.5; 95% confidence interval [95% CI], 1.1 to 49.8 at 6 months and OR, 3.6; 95% CI, 0.5 to 28.8 at 12 months). Five participants in the intervention arm could not complete the trial because of hypotension. We found no effect on health-related quality of life measures, perceived thirst or xerostomia, or dietary sodium intake. CONCLUSIONS Dialysate sodium of 135 mmol/L did not reduce left ventricular mass relative to control, despite improving fluid status. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER The Australian New Zealand Clinical Trials Registry, ACTRN12611000975998.
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Affiliation(s)
- Mark R Marshall
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand;
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Medical Affairs, Baxter Healthcare (Asia) Pte Ltd., Singapore
| | - Alain C Vandal
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Janak R de Zoysa
- Department of Renal Medicine, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
- Waitemata Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ruvin S Gabriel
- Department of Cardiology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Imad A Haloob
- Department of Renal Medicine, Bathurst Base Hospital, New South Wales, Bathurst, Australia
| | - Christopher J Hood
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - John H Irvine
- Department of Nephrology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Philip J Matheson
- Department of Nephrology, Wellington Hospital, Capital & Coast District Health Board, Wellington, New Zealand
| | - David O R McGregor
- Department of Nephrology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Kannaiyan S Rabindranath
- Department of Nephrology, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand
| | - John B W Schollum
- Nephrology Service, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - David J Semple
- Department of Renal Medicine, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Zhengxiu Xie
- Middlemore Clinical Trials, Auckland, New Zealand; and
| | - Tian Min Ma
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand;
| | - Rose Sisk
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Joanna L Dunlop
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
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25
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Sugizaki CSDA, Braga CC, Freitas ATVDS, Peixoto MDRG. Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis. J Bras Nefrol 2020; 42:153-162. [PMID: 32187260 PMCID: PMC7427644 DOI: 10.1590/2175-8239-jbn-2019-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/18/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale's psychometric properties for patients on hemodialysis (HD). METHODS The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach's alpha was used to measure the scale's internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC). RESULTS The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale's internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001). CONCLUSION Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.
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Affiliation(s)
| | - Clarice Carneiro Braga
- Universidade Federal de Goiás, Faculdade de Nutrição, Programa
de Pós-Graduação em Nutrição e Saúde, Goiânia, GO, Brasil
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Bossola M, Calvani R, Marzetti E, Picca A, Antocicco E. Thirst in patients on chronic hemodialysis: What do we know so far? Int Urol Nephrol 2020; 52:697-711. [PMID: 32100204 DOI: 10.1007/s11255-020-02401-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/01/2020] [Indexed: 01/11/2023]
Abstract
Thirst has been defined as "the sensation that leads animal's and human's actions toward the goal of finding and drinking water" or as "any drive that can motivate water intake, regardless of cause". Thirst, together with xerostomia, is the main cause of poor adherence to fluid restriction and of excessive intake of fluids in patients on chronic hemodialysis, and consequently of high interdialytic weight gain. Interdialytic weight gain (IDWG) should be lower than 4.0-4.5% of dry weight. Unfortunately, many patients have an IDWG greater than this value and some have IDWG of 10-20%. High IDWG is associated with a higher risk of all-cause and cardiovascular death and increased morbidity, such as ventricular hypertrophy and major adverse cardiac and cerebrovascular events. In addition, high IDWG leads to supplementary weekly dialysis sessions with consequent deterioration of quality of life and increased costs. Thus, the knowledge of thirst in patients on chronic hemodialysis is essential to prompt its adequate management to limit IDWG in the routine clinical practice. The present review aims to describe the physiology of thirst in patients on chronic hemodialysis, as well as the prevalence, its measures, the associated variables, the consequences, and the strategies for its reduction.
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Affiliation(s)
- Maurizio Bossola
- Servizio Emodialisi, Dipartimento Di Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Riccardo Calvani
- Divisione Di Geriatria, Neuroscienza E Ortopedia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Marzetti
- Divisione Di Geriatria, Neuroscienza E Ortopedia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Picca
- Divisione Di Geriatria, Neuroscienza E Ortopedia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuela Antocicco
- Divisione Di Geriatria, Neuroscienza E Ortopedia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Effects of Phyllanthus emblica spray interventions on xerostomia after general anesthesia for gynecologic tracheal intubation: A randomised controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2019.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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28
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Yeter HH, Erten Y, Isler SC, Soysal F, Elbeg S, Unsal B. Could drug burden be associated with severe periodontitis in patients receiving haemodialysis? J Ren Care 2019; 45:239-247. [PMID: 31564070 DOI: 10.1111/jorc.12299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Periodontitis increases the risk of cardiovascular disease in the general population by triggering systemic inflammation. AIM To investigate the relationship between systemic inflammation and periodontitis, and clarify any association between severe periodontitis and the medications used by patients receiving haemodialysis. DESIGN A cross-sectional study. PARTICIPANTS The study was undertaken with 56 patients receiving haemodialysis. MEASUREMENTS Demographic and laboratory data and prescribed drugs regularly used by patients were recorded from hospital records. During the dialysis session, a validated Xerostomia Inventory score was completed. A complete dental/periodontal examination was also undertaken on all patients by the same periodontist. RESULTS In the study population, stage I periodontitis was determined in 41%, stage II periodontitis in 17%, stage III periodontitis in 21%, and stage IV periodontitis in 21%. Male gender, hypertension, coronary artery disease, β antagonists, calcium channel blockers, sodium polystyrene sulphonate, teeth brushing less than twice a day and high sensitive C-reactive protein > 8 mg/l were significantly associated with severe periodontitis. CONCLUSION Drugs, including β antagonists, calcium channel blockers, polystyrene sulphonate, co-morbid conditions and poor or insufficient oral care could facilitate an increase in the severity of periodontitis in patients receiving haemodialysis. Severe periodontitis also seems to be associated with cardiovascular disease and inflammation in patients with chronic renal disease.
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Affiliation(s)
- Hasan H Yeter
- Department of Nephrology, Gazi University, Ankara, Turkey
| | - Yasemin Erten
- Department of Nephrology, Gazi University, Ankara, Turkey
| | - Sila C Isler
- Department of Periodontology, Gazi University, Ankara, Turkey
| | - Fatma Soysal
- Department of Periodontology, Gazi University, Ankara, Turkey
| | - Sehri Elbeg
- Department of Biochemistry, Gazi University, Ankara, Turkey
| | - Berrin Unsal
- Department of Periodontology, Gazi University, Ankara, Turkey
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Affiliation(s)
- Maurizio Bossola
- Servizio Emodialisi Università Cattolica del Sacro Cuore Roma Italia
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
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Abstract
Disasters occur regularly, and frequently large numbers of patients treated with maintenance dialysis or with the recent onset of acute kidney injury are put at risk owing to the lack of access to dialysis care precipitating also a kidney failure disaster. The absence of necessary dialysis treatments can result in excessive emergency department visits, hospitalizations, morbidity, or an early death. Those with kidney failure are often evaluated in disaster medical locations or hospitals without nephrologists in attendance. Here we offer guidance for medical personnel evaluating such patients so that dialysis-dependent individuals can be properly assessed and managed with the need for urgent dialysis recognized. A disaster dialysis triage system is proposed. (Disaster Med Public Health Preparedness. 2019;13:782-790).
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31
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Pecoits-Filho R, Larkin JW, Poli-de-Figueiredo CE, Cuvello Neto AL, Barra AB, Canhada S, de Campos LG, Woehl J, Gonçalves PB, Han H, de Moraes TP, Raimann JG, Canziani MEF. Design and methodology of the impact of HemoDiaFIlTration on physical activity and self-reported outcomes: a randomized controlled trial (HDFIT trial) in Brazil. BMC Nephrol 2019; 20:98. [PMID: 30894141 PMCID: PMC6425582 DOI: 10.1186/s12882-019-1247-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/01/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND End stage renal disease (ESRD) patients require a renal replacement therapy (RRT) to filter accumulated toxins and remove excess water, which are associated with impaired physical function. Hemodialysis (HD) removes middle-molecular weight (MMW) toxins less efficiently compared to hemodiafiltration (HDF); we hypothesized HDF may improve physical function. We detailed the design and methodology of the HDFIT protocol that is testing whether changing from HD to HDF effects physical activity levels and various outcomes. METHODS HDFIT is a prospective, multi-center, unblinded, randomized control trial (RCT) investigating the impact of dialysis modality (HDF verses HD) on objectively measured physical activity levels, self-reported quality of life, and clinical/non-clinical outcomes. Clinically stable patients with HD vintage of 3 to 24 months without any severe limitation ambulation were recruited from sites throughout southern Brazil. Eligible patients were randomized in a 1:1 ratio to either: 1) be treated with high volume online HDF for 6 months, or 2) continue being treated with high-flux HD. This study includes run-in and randomization visits (baseline), 3- and 6-month study visits during the interventional period, and a 12-month observational follow up. The primary outcome is the difference in the change in steps per 24 h on dialysis days from baseline to the 6-month follow up in patients treated with HDF versus HD. Physical activity is being measured over one week at study visits with the ActiGraph ( www.actigraphcorp.com ). For assessment of peridialytic differences during the dialysis recovery period, we will analyze granular physical activity levels based on the initiation time of HD on dialysis days, or concurrent times on non-dialysis days and the long interdialytic day. DISCUSSION In this manuscript, we provide detailed information about the HDFIT study design and methodology. This trial will provide novel insights into peridialytic profiles of physical activity and various self-reported, clinical and laboratory outcomes in ESRD patients treated by high volume online HDF versus high-flux HD. Ultimately, this investigation will elucidate whether HDF is associated with patients having better vitality and quality of life, and less negative outcomes as compared to HD. TRIAL REGISTRATION Registered on ClinicalTrials.gov on 20 April 2016 ( NCT02787161 ).
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Affiliation(s)
- Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil.
| | - John W Larkin
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil.,Fresenius Medical Care North America, 920 Winter Street, Waltham, MA, 02451, USA
| | | | | | - Ana Beatriz Barra
- Fresenius Medical Care Brazil, R. Amoreira 891, Jaguariúna, São Paulo, 13820-000, Brazil
| | - Sinaia Canhada
- Fresenius Medical Care Brazil, R. Amoreira 891, Jaguariúna, São Paulo, 13820-000, Brazil
| | - Ludimila Guedim de Campos
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil
| | - Juliane Woehl
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil
| | - Priscila Bezerra Gonçalves
- Health Technology Graduate Program, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Hao Han
- Fresenius Medical Care North America, 920 Winter Street, Waltham, MA, 02451, USA
| | - Thyago Proença de Moraes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil
| | - Jochen G Raimann
- Research Division, Renal Research Institute, 315 East 62nd Street, 4th Floor, New York, NY, 10065, USA
| | - Maria Eugenia F Canziani
- Universidade Federal de São Paulo, R. Sena Madureira 1500, São Paulo, São Paulo, 04021-001, Brazil
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Mina RJL, Lerma MB, Litan PLB, Milano AAL, Mojica ADR, Malong‐Consolacion CP, Lerma EB, Macindo JRB, Torres GCS. Fluid distribution timetable on adherence to fluid restriction of patients with end‐stage renal disease undergoing haemodialysis: Single‐blind, Randomized‐Controlled Pilot Study. J Adv Nurs 2019; 75:1328-1337. [DOI: 10.1111/jan.13964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 11/09/2018] [Accepted: 01/08/2019] [Indexed: 01/01/2023]
Affiliation(s)
| | | | | | | | | | - Charito P. Malong‐Consolacion
- College of Nursing University of Santo Tomas Manila Philippines
- Faculty of Medicine and Surgery University of Santo Tomas Manila Philippines
- Artificial Kidney Unit University of Santo Tomas Hospital Manila Philippines
- Eminence Homecare Inc. Dialysis Center Quezon City General Hospital Quezon City Philippines
| | | | - John Rey B. Macindo
- Nursing Service Division AMOSUP Seamen's Hospital Manila Philippines
- Faculty of Management and Development Studies University of the Philippines – Open University Los Baños Philippines
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Garcia AKA, Fonseca LF, Furuya RK, Rabelo PD, Rossetto EG. Effect of chewing gum on thirst: an integrative review. Rev Bras Enferm 2019; 72:484-493. [PMID: 31017214 DOI: 10.1590/0034-7167-2018-0132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/06/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify and analyze the evidence on the effect of chewing gum on thirst in adults. METHOD Integrative review, guided by the question: "What is the scientific evidence about the effects of chewing gum on adult's thirst?" LILACS, PubMed, Scopus and Web of Science were the databases consulted. RESULTS Of a total of 2,414 articles found, 12 papers were selected whose publications varied between 1991 and 2016. The use of chewing gum resulted in increased salivary volume (five studies), xerostomia relief (seven studies), and thirst reduction (four studies). It was not possible to establish the number of chewing gums per day, being frequent the recommendation to use as desired. There was a predominance of studies with patients under dialysis and with cancer. CONCLUSION Chewing gum is an effective strategy to reduce thirst discomfort in adults.
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Yang L, Chen H, Su Y, Chin C. The effect of transcutaneous electrical nerve stimulation on increasing salivary flow rate in hemodialysis patients. Oral Dis 2018; 25:133-141. [PMID: 30076692 DOI: 10.1111/odi.12948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 07/26/2018] [Accepted: 07/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Li‐Yu Yang
- College of Nursing Kaohsiung Medical University Kaohsiung Taiwan
| | - Hsing‐Mei Chen
- Department of Nursing, College of Medicine National Cheng Kung University Tainan Taiwan
| | - Yi‐Ching Su
- College of Nursing Kaohsiung Medical University Kaohsiung Taiwan
| | - Chi‐Chun Chin
- College of Nursing Kaohsiung Medical University Kaohsiung Taiwan
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Bossola M, Pepe G, Vulpio C. The Frustrating Attempt to Limit the Interdialytic Weight Gain in Patients on Chronic Hemodialysis: New Insights Into an Old Problem. J Ren Nutr 2018; 28:293-301. [DOI: 10.1053/j.jrn.2018.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 01/10/2023] Open
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Bruzda-Zwiech A, Szczepańska J, Zwiech R. Xerostomia, thirst, sodium gradient and inter-dialytic weight gain in hemodialysis diabetic vs. non-diabetic patients. Med Oral Patol Oral Cir Bucal 2018; 23:e406-e412. [PMID: 29924756 PMCID: PMC6051689 DOI: 10.4317/medoral.22294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/23/2018] [Indexed: 11/22/2022] Open
Abstract
Background In hemodialysis (HD) patients, xerostomia and hyposalivation may intensify sensations of thirst, and contribute to the intake of fluids and excessive inter-dialytic weight gain (IWG). Since IWG is regarded to be higher in diabetic patients than in non-diabetics HD enhancing their mortality, it is crucial to define plausible underlying causes. Therefore, the study investigates factors contributing to the increased IWG in diabetic HD patients. Material and Methods The study included 97 HD patients (38 diabetics) receiving hemodialysis. All participants completed surveys comprising the Dialysis Thirst Inventory (DTI) and Xerostomia Inventory. Unstimulated whole saliva flow rate (USWFR) was measured, with USWFR below 0.1 mL/min being regarded as hyposalivation. Additionally, pre- and post-dialysis serum sodium concentration, sodium gradient and IWG were assessed. In diabetic HD patients, hemoglobin A1c (HbA1c) level was measured. Results Significantly higher scores were found in diabetic than non-diabetic HD patients with regard to DTI (21.2±7.7 vs. 17.1±6.2: Z=2.44, p=0.03) and xerostomia (40.5±6.1 vs. 29.9±14.4: Z=4.15, p=0.003). Hyposalivation was observed more often in diabetic HD patients (Z=2.23, p=0.04). IGW was significantly higher in participants with diabetes (Z=2.44, p=0.03), as was the pre-dialysis sodium serum (Z=3.4, p=0.008). High levels of HbA1c were associated with lower levels of serum sodium (r=-0.67 p<0.05). HbA1c positively correlated with pre-dialysis sodium gradient (r=0.66 p<0.05). However, multiple regression analysis found that the only predictors of increased IWG (>4.8 IWG%) in diabetic patients remained saliva flow rate and pre-dialysis sodium gradient. Conclusions Concomitant diabetes in hemodialysis patients appears to intensify subjective xerostomia and thirst sensation. It also leads to excessive IWG by the increase of pre-dialysis serum sodium gradient. Key words:Diabetes mellitus, hemodialysis, hyposalivation, inter-dialytic weight gain, sodium gradient.
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Affiliation(s)
- A Bruzda-Zwiech
- Department of Pediatric Dentistry Medical University of Lodz, Poland 92-213 Lodz, Pomorska 251,
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37
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Bacci MR, Adami F, Figueiredo FWS, Alves BCA, da Veiga GL, Fonseca FLA. Quality of life on hemodialysis and inflammation: a descriptive analysis. ACTA ACUST UNITED AC 2018; 51:e7355. [PMID: 29694512 PMCID: PMC5937730 DOI: 10.1590/1414-431x20187355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/09/2018] [Indexed: 01/26/2023]
Abstract
Chronic kidney disease (CKD) is highly prevalent worldwide. Patients with CKD on hemodialysis are more likely to present behavioral changes and worse quality of life as a result of their routine and complications. They also have higher levels of cytokines. The aim of this study is to assess the relationship between the inflammatory profile and quality of life measured by KDOQL-SF36 in hemodialysis outpatients. Patients older than 21 years of age and on routine hemodialysis for at least 6 months with treatment on a regular weekly basis were included and their anthropometric parameters and serum inflammatory markers were evaluated. Thirty patients consented to participate. Homocysteine (Hcy) levels were correlated with worse glomerular filtration rate (GFR; P=0.003) and creatinine (P=0.002). IL-6 was not correlated with worse nutritional status taking into account body mass index (BMI; kg/m2; P=0.83). On the other hand, TNF-alpha was positively correlated with albumin (P=0.008), nutritional status by BMI (P=0.04), and nutritional status by arm circumference area (P=0.04). IL-6 was correlated with activity limitation (P=0.02) and Hcy with work status (P=0.04). Hcy was correlated with nutritional status and inflammatory markers. In this population, the majority of the sections in KDOQL-SF36 were not correlated with cytokines levels.
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Affiliation(s)
- M R Bacci
- Departamento de Clínica Médica, Faculdade de Medicina ABC, Santo André, SP, Brasil
| | - F Adami
- Laboratório de Epidemiologia e Análises de Dados, Faculdade de Medicina ABC, Santo André, SP, Brasil
| | - F W S Figueiredo
- Laboratório de Epidemiologia e Análises de Dados, Faculdade de Medicina ABC, Santo André, SP, Brasil
| | - B C A Alves
- Laboratório de Análises Clínicas, Faculdade de Medicina ABC, Santo André, SP, Brasil
| | - G L da Veiga
- Laboratório de Análises Clínicas, Faculdade de Medicina ABC, Santo André, SP, Brasil
| | - F L A Fonseca
- Departamento de Clínica Médica, Faculdade de Medicina ABC, Santo André, SP, Brasil
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Colson A, Brinkley A, Braconnier P, Ammor N, Burnier M, Pruijm M. Impact of salt reduction in meals consumed during hemodialysis sessions on interdialytic weight gain and hemodynamic stability. Hemodial Int 2018; 22:501-506. [PMID: 29624853 DOI: 10.1111/hdi.12655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/11/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients on hemodialysis (HD) are advised to limit daily water- and salt intake to reduce interdialytic weight gain (IDWG). To counterbalance protein-losses, protein-rich meals are sometimes provided during HD sessions, but their salt content is not always taken into account. The aim of this study was to assess the influence of a lower salt content of meals provided during HD sessions on IDWG, blood pressure (BP), and hemodynamic stability during dialysis. METHODS This monocentric, interventional study was proposed to all the patients treated with three weekly HD sessions. The first two months of the study (high salt period), the patients continued to receive one sandwich containing 2.4 g of salt per session. Then, we reduced its salt content from 2.4 to 1.4 g, and patients received this "low-salt sandwich" at each dialysis session for four months. The mean values of IDWG, BP, and dry weight of the first two months were compared with those collected during the low salt periods (2-6 months). FINDINGS Forty out of 76 patients who initially agreed to participate were free of hospitalization, transplantation, and transfer to another center or death during the study period and were included in the final analysis (35% women). Median age was 63 years (range 28-90), 22.5% had a residual diuresis > 0.5 L/day. IDWG baseline decreased from 2.17 ± 0.98 to 2.03 ± 1 kg (P = 0.001) two months and to 2.09 ± 1.01 kg (P = 0.009) four months after we had lowered the salt content of the sandwich. The number of symptomatic intradialytic hypotension was also reduced (6.1% vs., respectively, 3.2% and 3.3% of HD sessions; P = 0.004). DISCUSSION IDWG was reduced and hemodynamic stability improved after the reduction of the salt content of perdialytic meals. This suggests that salt consumed during HD matters and might influence salt and water intake outside the dialysis unit.
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Affiliation(s)
- Arthur Colson
- Faculty of Medicine, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Anita Brinkley
- Service of Nephrology and Hypertension, University Hospital of Lausanne, Lausanne, Switzerland
| | - Philippe Braconnier
- Service of Nephrology and Hypertension, University Hospital of Lausanne, Lausanne, Switzerland
| | - Nadia Ammor
- Service of Nutrition and Endocrinology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital of Lausanne, Lausanne, Switzerland
| | - Menno Pruijm
- Service of Nephrology and Hypertension, University Hospital of Lausanne, Lausanne, Switzerland
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Jager DHJ, Bots CP, Forouzanfar T, Brand HS. Clinical oral dryness score: evaluation of a new screening method for oral dryness. Odontology 2018; 106:439-444. [PMID: 29356914 PMCID: PMC6153998 DOI: 10.1007/s10266-018-0339-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 01/20/2023]
Abstract
The purpose of this study was to explore the association of the clinical oral dryness score (CODS) with salivary flow rates, xerostomia inventory (XI), and bother index (BI). 147 patients were screened using CODS, which determined 10 features of oral dryness. Each feature contributed 1 point, and the total score varied from 0 to 10. Unstimulated (UWS), chewing-stimulated (CH-SWS) and acid-stimulated (A-SWS) whole salivary flows and the XI and BI were measured. Associations were explored with a bootstrapped Spearman rank correlation test (1000 × bootstrapping). Based on unstimulated salivary flow, 55 patients were classified as hyposalivators, 31 as low salivators, 48 as normosalivators and 13 as high salivators. Median CODS in the hyposalivation group was 5 (IQR 3–6) compared with 3 (IQR 2–5) in the low salivation group, 2 (IQR 1–4) in the normal salivation group and 2 (IQR 1–2.5) in the high salivation group. Significant associations between CODS and the other parameters were only found in the hyposalivation group between CODS and UWS (ρ(53) = − 0.513; p < 0.01), between CODS and CH-SWS (ρ(53) = − 0.453; p < 0.01), between CODS and A-SWS (ρ(53) = − 0.500; p < 0.01), CODS and XI (ρ(53) = 0.343; p < 0.001) and between CODS and BI (ρ(53) = 0.375; p = 0.01). In patients with hyposalivation, CODS is associated with unstimulated and stimulated salivary flow and XI and BI. CODS alone or a combination of CODS with a subjective measure, such as the XI or BI, could be recommended during routine clinical assessment to detect hyposalivation.
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Affiliation(s)
- Derk H Jan Jager
- Department of Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Boelelaan 1118, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Department of Oral Health Sciences, KU Leuven & University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.
| | - Casper P Bots
- Dutch Institute for Salivary Research, Tuinfluiter 5, 3752 NA, Bunschoten, The Netherlands
| | - Tim Forouzanfar
- Department of Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Boelelaan 1118, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Boelelaan 1118, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Oral Biochemistry, Academic Center for Dentistry Amsterdam (ACTA), Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
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Garcia AKA, Fonseca LF, Aroni P, Galvão CM. Strategies for thirst relief: integrative literature review. Rev Bras Enferm 2017; 69:1215-1222. [PMID: 27925100 DOI: 10.1590/0034-7167-2016-0317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/17/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: to analyze the strategies used to relieve the thirst of hospitalized patients. Method: an integrative review, for which the databases PubMed, LILACS, CINAHL and the group of references organized by the Group for Study and Research of Thirst were selected for the search of primary studies, with the keywords: thirst, ice, cold, intervention, nursing care, artificial saliva. Results: the review sample was composed of ten primary studies. The strategies found were: low temperature using frozen gauze, ice chips, and cold water, menthol associated with cold strategies, chewing gum, acupressure, and the use of a thin straw, substitute saliva, and early fluid ingestion. Conclusion: the temperature was presented as a predominant and effective strategy to relieve the thirst for surgical patients in intensive care and hemodialysis treatment.
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Affiliation(s)
- Aline Korki Arrabal Garcia
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem. Londrina-PR, Brasil
| | - Lígia Fahl Fonseca
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem. Londrina-PR, Brasil
| | - Patricia Aroni
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-Graduação em Enfermagem Fundamental. Ribeirão Preto-SP, Brasil
| | - Cristina Maria Galvão
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-Graduação em Enfermagem Fundamental. Ribeirão Preto-SP, Brasil
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Camacho-Alonso F, Cánovas-García C, Martínez-Ortiz C, De la Mano-Espinosa T, Ortuño-Celdrán T, Marcello-Godino JI, Ramos-Sánchez R, Sánchez-Siles M. Oral status, quality of life, and anxiety and depression in hemodialysis patients and the effect of the duration of treatment by dialysis on these variables. Odontology 2017; 106:194-201. [PMID: 28770414 DOI: 10.1007/s10266-017-0313-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
This study aimed is to evaluate the oral health status, quality of life, anxiety and depression among hemodialysis patients and to analyze the effect of the duration of dialysis on these variables. 120 patients on hemodialysis and 120 control subjects underwent oral examination, periodontal evaluation, xerostomia study using a Visual Analogue Scale (VAS), sialometry evaluation; quality of life (QOL) using the OHIP-14 questionnaire and anxiety/depression. Bleeding index, CPTIN, clinical attachment level, and probing depth were significantly higher in the hemodialysis group than the control group (p < 0.001). VAS scores were higher in patients on hemodialysis with significant differences in 6 of the 8 domains (p ≤ 0.05). Unstimulated whole saliva was significantly lower in hemodialysis patients than control subjects (p < 0.001). OHIP-14 scores showed significantly poorer QOL in patients on hemodialysis than control subjects (p = 0.042). Hemodialysis patients presented greater depression and anxiety than control (p < 0.001). Periodontal health was worse among the patients who had been in treatment >10 years, xerostomia and sialorrea was worse in patients treated for 5-9.9, and >10 years, QOL was worse in patients who had spent <1 year; depression and anxiety was greater among those treated for 1-2.9 years. In conclusion, Oral health, QOL, anxiety and depression are worse in patients on hemodialysis, and oral health deteriorates as the time spent in dialysis lengthens, but patients in treatment for <3 years presented the poorest QOL and the greatest anxiety and depression.
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Affiliation(s)
- F Camacho-Alonso
- Department of Oral Surgery, University of Murcia, Murcia, Spain. .,Clínica Odontológica Universitaria, Unidad Docente de Cirugía Bucal, Hospital Morales Meseguer (2 planta), Avda. Marqués de los Vélez s/n, 30008, Murcia, Spain.
| | | | | | | | | | | | | | - M Sánchez-Siles
- Department of Oral Medicine, University of Murcia, Murcia, Spain
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Yang G, Lin S, Wu Y, Zhang S, Wu X, Liu X, Zou C, Lin Q. Auricular Acupressure Helps Alleviate Xerostomia in Maintenance Hemodialysis Patients: A Pilot Study. J Altern Complement Med 2017; 23:278-284. [PMID: 28191857 DOI: 10.1089/acm.2016.0283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Guowen Yang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangzhou Hospital of Integrated Traditional and Western Medicine, Guangzhou, China
| | - Shaoqin Lin
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Yuchi Wu
- Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Shangpeng Zhang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiuqing Wu
- Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xusheng Liu
- Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Chuan Zou
- Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Qizhan Lin
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
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López-Pintor RM, López-Pintor L, Casañas E, de Arriba L, Hernández G. Risk factors associated with xerostomia in haemodialysis patients. Med Oral Patol Oral Cir Bucal 2017; 22:e185-e192. [PMID: 28160594 PMCID: PMC5359703 DOI: 10.4317/medoral.21612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/24/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To determine the prevalence of xerostomia and hyposalivation in Haemodialysis (HD) patients, to clarify risk factors, assess patient's quality of life, and to establish a possible correlation among interdialytic weight gain (IDWG) and xerostomia. MATERIAL AND METHODS This study was performed on a group of 50 HD patients. Data were collected using a questionnaire containing demographic and clinical variables, a visual analogue scale (VAS) for xerostomia, IDWG, and an oral health impact profile questionnaire (OHIP-14). Unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. RESULTS A total of 28 HD patients (56%) suffered xerostomia. Dry mouth was associated with hypertension (OR, 5.24; 95% CI, 1.11-24.89) and benzodiazepine consumption (OR, 5.96; 95% CI, 1.05-33.99). The mean xerostomia VAS and OHIP-14 scores were 31.74±14.88 and 24.38±11.98, respectively. No significant correlation was observed between IDWG% and VAS and OHIP total score. Nonetheless, a positive correlation between VAS level of thirst and IDWG% was found (r=0.48 p=0.0001). UWS and SWS means (determined in 30 patients) were 0.16±0.17 and 1.12±0.64, respectively. Decreased values of UWS and SWS were reported in 53.33% and 36.66% of HD patients. CONCLUSIONS Xerostomia in HD has a multifactorial aetiology due to accumulative risks as advanced age, systemic disorders, drugs, fluid intake restriction, and salivary parenchymal fibrosis and atrophy. Therefore, it is important to detect possible xerostomia risk factors to treat correctly dry mouth in HD patients and avoid systemic complications.
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Affiliation(s)
- R-M López-Pintor
- Departamento Estomatología III, Facultad de Odontología, Plaza Ramón y Cajal s/n, 28040 Madrid Spain,
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Martins PR, Fonseca LF, Rossetto EG. Developing and validating the Perioperative Thirst Discomfort Scale. Rev Esc Enferm USP 2017; 51:e03240. [DOI: 10.1590/s1980-220x2016029003240] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 03/21/2017] [Indexed: 11/22/2022] Open
Abstract
Abstract OBJECTIVE Developing and validating a scale to assess perioperative thirst discomfort. METHOD A methodological research conducted in 2014 and 2015 at the surgical center of a public hospital in the north of Paraná, Brazil. The scale was developed after literature review, followed by face and content validation, and reliability assessment through its internal consistency and inter-observer equivalence. RESULTS Seven items make up the scale: dry mouth; dry lips; thick tongue; thick saliva; dry throat, bad taste and desire to drink water. The content validity index for attributes and items was 0.98, and the reliability index was 1 for the scale attributes and items. Internal consistency assessed by Cronbach's alpha was 0.91 and inter-rater equivalence was 1, as measured by weighted kappa coefficient. CONCLUSION ThePerioperative Thirst Discomfort Scaleshowed high content and reliability indexes.
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Effects of mouthwash interventions on xerostomia and unstimulated whole saliva flow rate among hemodialysis patients: A randomized controlled study. Int J Nurs Stud 2016; 63:9-17. [DOI: 10.1016/j.ijnurstu.2016.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 11/23/2022]
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Zehm A, Mullin J, Zhang H. Thirst in Palliative Care #313. J Palliat Med 2016; 19:1009-10. [DOI: 10.1089/jpm.2016.0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Eftimovska-Otovic N, Stojceva-Taneva O, Grozdanovski R, Stojcev S. Clinical Effects of Standard and Individualized Dialysate Sodium in Patients on Maintenance Hemodialysis. Open Access Maced J Med Sci 2016; 4:248-52. [PMID: 27335595 PMCID: PMC4908740 DOI: 10.3889/oamjms.2016.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: The degree to which the dialysate prescription and, in particular, the dialysate sodium concentration influences blood pressure and interdialytic weight gain (IDWG) via changes in sodium flux, plasma volume or the other parameters is not well understood. The aim of the study was to investigate whether dialysis patients will have some beneficial effects of dialysate sodium set up according to serum sodium or sodium modeling. MATERIAL AND METHODS: Ninety-two nondiabetic subjects (52 men and 40 women) performed 12 consecutive hemodialysis (HD) sessions (4 weeks) with dialysate sodium concentration set up on 138 mmol/L (standard sodium – first phase), followed by 24 sessions (second phase) wherein dialysate sodium was set up according to individualized sodium. Variables of interest were: systolic, diastolic and mean blood pressure, pulse, IDWG, thirst score – (Xerostomia Inventory (XI) and Dialysis Thirst Inventory (DTI)) and side effects (occurrence of hypotension and muscle cramps). After the first phase, the subjects were divided into 3 groups: normotensive (N=76), hypertensive (N= 11) and hypotensive (N=5) based on the average pre-HD systolic BP during the whole period of the first phase. RESULTS: Sodium individualization resulted in significantly lower blood pressure (133.61 ± 11.88 versus 153.60 ± 14.26 mmHg; p=0.000) and IDWG (2.21 ± 0.93 versus 1.87 ± 0.92 kg; p=0.018) in hypertensive patients, whereas normotensive patients showed only significant decrease in IDWG (2.21 ± 0.72 versus 2.06 ± 0.65, p=0,004). Sodium profiling in hypotensive patients significantly increased IDWG (2.45 vs. 2.74, p= 0,006), and had no impact on blood pressure. Thirst score was significantly lower in normotensive patients with individualized-sodium HD and showed no change in the other two groups. During the second phase, hypotension occurred in only 1 case and muscle cramps in 10 normotensive patients. CONCLUSION: Individualized sodium resulted in clinical benefits in normotensive and hypertensive patients.
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Affiliation(s)
| | - Olivera Stojceva-Taneva
- University Clinic for Nephrology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Risto Grozdanovski
- Specialized Hospital for Nephrology and Dialysis "Diamed", Skopje, Republic of Macedonia
| | - Saso Stojcev
- General City Hospital "8th September", Skopje, Republic of Macedonia
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Determinants of thirst distress in patients on hemodialysis. Int Urol Nephrol 2016; 48:1525-32. [PMID: 27215556 DOI: 10.1007/s11255-016-1327-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/17/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Thirst sensation can induce nonadherence with fluid restriction in patients on hemodialysis (HD) and may lead to large interdialytic weight gain (IWG). This study aimed to evaluate thirst distress and its determinants and to explore fluid management strategies used by patients on HD. METHODS A cross-sectional study was conducted in a sample of 203 patients who were followed in three HD centers in Turkey, from January 2015 to June 2015. Data were collected by a personal information form, the Thirst Distress Scale (TDS) and the Visual Analogue Scale (VAS) for thirst and xerostomia. Data analysis was performed using descriptive statistics, Student's t test, the one-way analysis of variance, Pearson's correlation coefficients, and linear regression analysis. RESULTS The mean TDS score was 20.71 ± 8.34, which is a higher than moderate level of thirst distress. The significant determinants of thirst distress of the patients were the VAS thirst score (unstandardized β = 1.73, p < 0.001), the VAS xerostomia score (unstandardized β = 0.42, p < 0.001), and the IWG values (unstandardized β = 1.20, p = 0.003), after controlling for specific variables. The most common strategies used to reduce fluid intake or relieve thirst were avoiding salty foods (70.9 %), limiting salt on food (70.9 %), and spacing liquids over the entire day (57.6 %). CONCLUSIONS Patients with higher levels of thirst and xerostomia and those with a high IWG were more likely to have higher thirst distress. A greater understanding of thirst distress and its related factors could contribute to more effective interventions that improve health and well-being in patients on HD.
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Limeres J, Garcez JF, Marinho JS, Loureiro A, Diniz M, Diz P. Early tooth loss in end-stage renal disease patients on haemodialysis. Oral Dis 2016; 22:530-5. [PMID: 27038430 DOI: 10.1111/odi.12486] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 03/16/2016] [Accepted: 03/29/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This article sets out to evaluate the prevalence and aetiopathogenesis of edentulism in patients on haemodialysis. SUBJECTS AND METHODS The study group comprised 44 adult patients with end-stage renal disease (ESRD) on haemodialysis. A control group was formed of 44 individuals matched for age and sex and with a glomerular filtration rate >90 ml min(-1) . All participants underwent intra-oral examination, gathering information on dental and periodontal status, and a saliva sample was taken to determine saliva debit and its biochemical composition. RESULTS The average number of missing teeth was higher in ESRD patients than in controls (P = 0.018). Six (13.6%) fully edentulous individuals were detected in the study group and 1 (2.2%) in the control group. Some of the clinical and biochemical variables with statistically significant differences between the study group and the control group showed a significant relationship with the number of missing teeth, but the depth of the periodontal pockets presented the highest coefficient of determination (OR = 3511.1; 95%CI = 82.2-6834.3; P < 0.001; R(2) = 0.827). CONCLUSIONS Premature tooth loss is common in haemodialysis patients. Although the aetiology and pathogenesis of this finding has still not been fully clarified, it appears that severe periodontal disease may play a relevant role.
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Affiliation(s)
- J Limeres
- Special Needs Unit and OMEQUI Research Group, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain
| | - J F Garcez
- Instituto Superior de Ciências da Saúde-Norte (ISCS-N), Gandra, Portugal
| | - J S Marinho
- Stomatology Department. Instituto Portugués de Oncología Francisco Gentil (IPO), Porto, Portugal
| | - A Loureiro
- Nephrology Department. Instituto Portugués de Oncología Francisco Gentil (IPO), Porto, Portugal
| | - M Diniz
- Special Needs Unit and OMEQUI Research Group, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain
| | - P Diz
- Special Needs Unit and OMEQUI Research Group, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain
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