Short daily versus conventional hemodialysis quality of life: a cross-sectional multicentric study in Spain

Relationship Between Nutritional Parameters and Quality of Life in Patients With End-Stage Kidney Disease on In-Centre Haemodialysis in Al-Ahsa, Saudi Arabia

INTRODUCTION

Nutrition threatens the quality of life (QOL) in end-stage kidney disease (ESKD) patients on haemodialysis (HD). The aim of the study is to assess which nutritional parameters associate with the health-related QOL category score using Arabic translated, adapted, and validated version of the Kidney Disease Quality of Life Short-Form 36 (KDQOL-36).

METHODS

We carried out a cross-sectional study with a total of 60 ESKD patients in one haemodialysis centre in Al-Ahsa, Saudi Arabia. The health-related QOL of the five components of the KDQOL-36 are as follows: physical component score (PCS), mental component score (MCS), the burden of kidney disease (BKD), symptoms and problems of kidney disease (SPKD), and effects kidney disease (EKD) which were grouped into three categories (good, average and poor) based on the score.

RESULTS

Of the 60 HD patients, 43 (71.7%) were between 19 and 59 years old and 41 patients (68.3%) were males. This study revealed that high haemoglobin impact PCS, MCS, SPKD, and EKD in favour of poor health-related QOL, but normal haemoglobin impacts BKD in favour of good QOL. In addition, patients who had a normal serum albumin level had good scores for MCS, BKD, SPKD, and EKD. Also, there was a significant association between Kt/V value with EKD (p=0.001).

CONCLUSION

According to the findings of this study, patients with HD have poor health-related QOL outcomes than those with good nutritional status. This finding demonstrates the critical need for further articles to study this particular group of population.

Nutritional status in short daily hemodialysis versus conventional hemodialysis patients in China

PURPOSE

Malnutrition is the main determinant of mortality and morbidity in maintenance hemodialysis patients. In many countries except for China, it has been reported that short daily hemodialysis (SDHD) could improve nutritional status. We will report here the nutritional results obtained in the SDHD therapy period compared with conventional hemodialysis (cHD) therapy period in Chinese patients.

METHODS

This study compared 29 SDHD patients (SDHD group), each patient served as his own control, with 30 cHD patients (cHD group) serving as the parallel controls. The hematologic parameters, anthropometric measurements, modified quantitative subjective global assessment (MQSGA) score, weekly standard Kt/V (std Kt/V) and average daily intake of protein were measured at baseline (SDHD₀ or cHD₀ period), at 3 months (SDHD₁ or cHD₁ period) and at 6 months (SDHD₂ or cHD₂ period).

RESULTS

The average daily intake of protein, dry weight, body mass index, mid-arm circumference, mid-arm muscle circumference, serum albumin, prealbumin, cholesterol, hemoglobin, weekly std Kt/V values at SDHD₂ were higher than the corresponding values at SDHD₀ (p < 0.05, p < 0.05, p < 0.001, p < 0.05, p < 0.05, p < 0.05, p < 0.001, p < 0.05, p < 0.05, p < 0.001 and p < 0.001, respectively). Meanwhile, the average daily intake of protein, serum albumin, prealbumin, cholesterol, hemoglobin, weekly std Kt/V values at SDHD₂ were higher than the corresponding values at cHD₂ (p < 0.05, p < 0.001, p < 0.05, p < 0.05, p < 0.001 and p < 0.001, respectively), whereas the MQSGA score at SDHD₂ was lower than the score at SDHD₀ and cHD₀ (p < 0.05, respectively).

CONCLUSIONS

SDHD may improve the nutritional status compared with cHD in Chinese patients undergoing maintenance hemodialysis.

The impact of short daily hemodialysis on anemia and the quality of life in Chinese patients

Anemia is a frequent complication in hemodialysis patients. Compared to conventional hemodialysis (CHD), short daily hemodialysis (sDHD) has been reported to be effective in many countries except China. The aim of the present study was to determine whether sDHD could improve anemia and quality of life (QOL) for Chinese outpatients with end-stage renal disease. Twenty-seven patients (16 males/11 females) were converted from CHD to sDHD. All laboratory values were measured before conversion (baseline), at 3 months after conversion (sDHD1), and at 6 months after conversion (sDHD2). The patient's QOL was evaluated at baseline and 6 months after conversion using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Hemoglobin concentration increased significantly from 107.4±7.9 g/L at baseline to 114.4±6.8 g/L (P<0.05) at sDHD1, and 118.3±8.4 g/L (P<0.001) at sDHD2 (Student paired t-test). However, the dose requirement for erythropoietin decreased from 6847.8±1057.3 U/week at baseline to 5869.6±1094.6 U/week (P<0.05) at sDHD2. Weekly stdKt/V increased significantly from 2.05±0.13 at baseline to 2.73±0.20 (P<0.001) at sDHD1, and 2.84±0.26 (P<0.001) at sDHD2. C-reactive protein decreased from baseline to sDHD1 and sDHD2, but without statistically significant differences. Physical and mental health survey scores increased in the 6 months following conversion to sDHD. sDHD may increase hemoglobin levels, decrease exogenous erythropoietin dose requirements, and improve QOL in Chinese hemodialysis patients compared to CHD. A possible mechanism for improvement of clinical outcomes may be optimized management of uremia associated with the higher efficiency of sDHD.

International differences in hemodialysis delivery and their influence on outcomes

There are many variations in the delivery of hemodialysis. These variations include components of conventional dialysis, such as membrane type, dialysis dose, and session duration. In addition, alternative approaches to dialysis, such as hemodiafiltration, nocturnal hemodialysis, and short daily hemodialysis, also may be considered. For some of these practice variations, data exist to support one approach over another (eg, fistulas rather than grafts and catheters), but for many, no such data exist. Very few practice variations have been examined in randomized trials, and we are reliant predominantly on observational data. This review examines some practice variations in hemodialysis delivery, attempting to highlight which of these may be appropriate to consider when optimizing dialysis delivery in the clinic.

Vancomycin pharmacokinetics and pharmacodynamics during short daily hemodialysis

BACKGROUND AND OBJECTIVES

Short daily hemodialysis (SDHD) is an alternative to thrice-weekly HD because of its putative physiologic benefits. The purpose of this study was to investigate the effect of SDHD on the pharmacokinetics and pharmacodynamics of vancomycin.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Six noninfected adults who had anuria and were treated with SDHD were studied and received four dialysis sessions over 4 days. After completion of the first SDHD, each patient received vancomycin 15 mg/kg by intravenous infusion. Blood samples were collected over the ensuing 3 days during each subsequent inter- and intradialytic period. Pharmacokinetic parameters were determined. Serum concentration-time profiles were simulated for four vancomycin regimens with maintenance doses administered after every other SDHD. Area under the serum-concentration time curve (AUC) from 0 to 48 hours, 48 to 96 hours, and 96 to 144 hours were calculated, and Monte Carlo simulations were performed to determine the probability of target attainment at an AUC/minimum inhibitory concentration (MIC) ratio ≥800 for each 48-hour AUC at MICs ranging from 0.5 to 2.0 μg/ml.

RESULTS

Median (range) systemic clearance was 7.2 ml/min (5.3 to 10.0 ml/min), and dialytic clearance was 104 ml/min (94 to 106 ml/min). The steady-state volume of distribution was 55.4 L (34.8 to 77.2 L). At MICs ≤1 μg/ml, probability of target attainment was >90% for each 48-hour AUC when vancomycin was administered as a 20-mg/kg loading dose followed by 10 mg/kg after every other SDHD.

CONCLUSIONS

Vancomycin pharmacokinetic parameters in SDHD are consistent with data from thrice-weekly HD. A loading dose of 20 mg/kg followed by 10 mg/kg after every other SDHD provides adequate exposure for pathogens with MICs ≤1 μg/ml.