Intradialytic complications among patients on twice-weekly maintenance hemodialysis: an experience from a hemodialysis center in Eritrea

Association between illness perception and social alienation among maintenance hemodialysis patients: The mediating role of fear of progression

PURPOSE

This study aimed to investigate the mediating role of fear of progression on illness perception and social alienation among maintenance hemodialysis (MHD) patients.

BACKGROUND

MHD is frequently accompanied by increased pain and complications such as itchy skin, chronic fatigue, and muscle spasms. Cardiovascular disease rates are also elevated among MHD patients, which can heighten their anxiety regarding prognosis and treatment discomfort. This chronic fear may severely impact social functioning, leading patients to withdraw from interpersonal interactions and experience heightened helplessness and loneliness. Further investigation is necessary to understand the factors behind the high level of social alienation in MHD patients and their underlying mechanisms.

DESIGN

A cross-sectional study guided by the STROBE.

METHODS

A convenience sample of 230 MHD patients were enrolled from January to May 2023. Data including demographic and clinical characteristics, illness perception, fear of progression, and social alienation were collected. Descriptive analysis and Pearson correlations were conducted using IBM SPSS version 25.0. The mediating effect was analyzed using Model 4 of the PROCESS macro for SPSS, with the Bootstrap method employed to assess its significance.

RESULTS

The score of social alienation in MHD patients was high, with illness perception and fear of progression both significantly correlated with social alienation. In the mediating effects model, illness perception can predict social alienation in MHD patients, and fear of progression use plays a part in mediating the process by which illness perception affects social alienation. The Kappa Squared (κ2) value of 21.9%, suggests a medium effect size.

CONCLUSIONS

Illness perception directly predicts social alienation in MHD patients and exerts an indirect effect through the mediating role of fear of progression. Suggests that healthcare professionals should concentrate on MHD patients with high negative illness perceptions to alleviate their fear of progression, thereby decreasing the level of social alienation and enhancing their integration into society.

Institutional ethnography of hemodialysis care: Perspectives of multidisciplinary health care teams in Nepal

Background

Hemodialysis is the most commonly used renal replacement therapy for end-stage renal disease. The collaborative efforts of multidisciplinary teams comprising nephrologists, nurses, pharmacists, and dietitians play a crucial role in enhancing patient outcomes, improving the quality of care, and reducing treatment costs. However, various factors such as healthcare cost reduction, limited resources, profit-driven systems, organizational structure, and involvement in patient care decisions impact the provision of hemodialysis care by the multidisciplinary teams.

Objective

This study aimed to explore the institutional practices of multidisciplinary teams within a hemodialysis unit.

Methods

This institutional ethnography study was conducted between April 2019 to February 2020 in a hemodialysis unit of a public university hospital in Kathmandu, Nepal. Data were collected through face-to-face interviews with ten nurses (including supervisors and incharge), two nephrologists, two dietitians, two pharmacists, and two technicians. Additionally, 167 hours of observation, two focus groups with nurses, analysis of institutional texts, and field notes were conducted. Participants were purposively selected based on their ability to provide diverse information regarding institutional practices in hemodialysis care. Interviews were recorded and transcribed.

Results

The analyzed data were presented in: 1) the context of hemodialysis care, 2) textual practices: the ruling relations of hemodialysis care (staffing, protocol, job description), 3) hemodialysis decision, and 4) institutional support.

Conclusion

Hemodialysis care provided by multidisciplinary teams is constrained by limited resources, particularly in terms of physical space, dialysis machines, nurses, doctors, and dietitians. The hospital's cost-cutting policies lead to reduced investment in patient care equipment, particularly dialysis machines, which significantly impact the workload of nurses and technicians. Insufficient nurse staffing necessitates the provision of other renal care responsibilities, resulting in increased workload, reduced time available for hemodialysis care, and unfinished tasks. The absence of clear job descriptions for hemodialysis care places an additional burden on nurses, who are often required to fulfill the responsibilities of other healthcare teams. Doctors hold the authority in making care decisions, which are subsequently followed by other team members.

Epidemiology, Pathophysiology, and Clinical Perspectives of Intradialytic Hypertension

BACKGROUND

Individuals with end-stage renal disease on chronic hemodialysis (HD) may encounter numerous HD-associated complications, including intradialytic hypertension (IDHYPER). Although blood pressure (BP) follows a predictable course in the post-HD period, BP levels during the session may vary across the individuals. Typically, a decline in BP is noted during HD, but a significant proportion of patients exhibit a paradoxical elevation.

SUMMARY

Several studies have been conducted to understand the complexity of IDHYPER, but much remains to be elucidated in the future. This review article aimed to present the current evidence regarding the proposed definitions, the pathophysiologic background, the extent and clinical implications of IDHYPER, as well as the possible therapeutic options that have emerged from clinical studies.

KEY MESSAGES

IDHYPER is noted in approximately 15% of individuals undergoing HD. Several definitions have been proposed, with a systolic BP rise >10 mm Hg from pre- to post-dialysis in the hypertensive range in at least four out of six consecutive HD treatments being suggested by the latest Kidney Disease: Improving Global Outcomes. Concerning its pathophysiology, extracellular fluid overload is a crucial determinant, with endothelial dysfunction, sympathetic nervous system overdrive, renin-angiotensin-aldosterone system activation, and electrolyte alterations being important contributors. Although its association with ambulatory BP in the interdialytic period is controversial, IDHYPER is associated with adverse cardiovascular events and mortality. Moving to its management, the antihypertensive drugs of choice should ideally be nondialyzable with proven cardiovascular and mortality benefits. Finally, rigorous clinical and objective assessment of extracellular fluid volume is essential. Volume-overloaded patients should be instructed about the importance of sodium restriction, while physicians ought to alter HD settings toward a greater dry weight reduction. The use of a low-sodium dialysate and isothermic HD could also be considered on a case-by-case basis since no randomized evidence is currently available.

The effectiveness of intradialytic exercise in ameliorating fatigue symptoms in patients with chronic kidney failure undergoing hemodialysis: A systematic literature review and meta-analysis

Objective

Hemodialysis in patients with chronic kidney failure is an intervention serving as an alternative to kidney transplantation. In 2019, chronic kidney failure became the world's 6th leading cause of death. In Indonesia, kidney failure has an increasing number of cases every year and is the 10th highest cause of death. According to basic health research in 2018, the prevalence of chronic kidney failure was 3.4%, and 19.3% of patients 15 years of age and older underwent hemodialysis. This study analyzed the effectiveness of intradialytic exercise in ameliorating fatigue symptoms in patients with chronic kidney failure undergoing hemodialysis, in terms of exercise type, duration, time, and frequency.

Methods

All appropriate and eligible full-text articles published between January 2010 and October 2021 were screened and extracted from the databases PubMed, Scopus, ProQuest, Science Direct, CrossRef, Google Scholar, and Garuda Database for Research and Technology. The articles were critically reviewed, and two independent authors reviewed the risk of bias by using the JBI form. Data analysis was performed qualitatively to obtain an overview of the characteristics of intradialytic exercise and quantitatively through meta-analysis.

Results

Intradialytic exercise was found to effectively decrease fatigue by 81% in the intervention group. The most significant effect sizes were as follows: type of intradialytic exercise: aerobic exercise (146%); duration of intradialytic exercise: >20 min (100%); time of intradialytic exercise: first 2 h (127%); and exercise frequency: <12 sessions (120%).

Conclusion

The characteristics of intradialytic exercise that are considered effective in ameliorating fatigue are aerobic exercise lasting >20 min and performed in the first 2 h of hemodialysis, with a frequency of <12 sessions.

Using the Intelligent System to Improve the Delivered Adequacy of Dialysis by Preventing Intradialytic Complications

Acute kidney failure patients while detoxificated by hemodialysis (HD) mostly or continuously faced regular problems such as low blood pressure (hypotension), muscle cramps, nausea, or vomiting. Higher intradialytic symptom leads to low-quality HD treatment. Although more known therapeutic interventions are used to relieve the HD side effects, this study was designed to investigate how intelligent systems can make highly beneficial alterations in dialysis facilities and equipment to ease intradialytic complications and help the staff deliver high-quality treatment. A search was performed among relevant research articles based on nonpharmacological intervention methods considered to prevent adverse effects of renal replacement therapy until 2020 in the PubMed databases using the terms “intradialytic complications,” “intradialytic complication interventions,” “nonpharmacological interventions,” “intradialytic exercises,” and “adequacy calculation methods.” Studies included the prevalence of intradialytic complications, different strategies with the aim of preventing complications, the outcome of intradialytic exercises on dialysis symptoms, and dialysis dose calculation methods. The results showed the incidence of hypotension varying between 5% and 30%, fatigue, muscular cramps, and vomiting as the most common complications during dialysis, which greatly affect the outcome of HD sessions. To prevent hypotension, ultrafiltration profiling, sodium modeling, low dialysate temperature, and changing the position to Trendelenburg are some strategies. Urea reduction ratio (URR), formal urea kinetic modeling (FUKM), formal single-pool urea kinetics, and online clearance monitoring (OCM) are methods for calculating the delivered dose of dialysis in which OCM is a low-cost and accessible way to monitor regularly the quality of dialysis delivered. Integration of the chair and HD machine which is in direct contact with the patient provides an intelligent system that improves the management of the dialysis session to enhance the quality of healthcare service.

A Systematic Review of Potentially Effective Nonpharmacological Interventions for Reducing Fatigue among Iranian Patients Who Receive Hemodialysis

BACKGROUND AND PURPOSE

Fatigue control in hemodialysis (HD) patients requires a multidisciplinary approach. This study aimed to comprehensively review the available research literature regarding the nonpharmacological interventions used for reducing fatigue among Iranian HD patients.

METHODS

In this systematic review, an extensive search of the literature was conducted on PubMed, Web of Science, and Scopus databases, using the keywords related to the purpose. Also, the Persian equivalent of these keywords was searched in Iranian databases, such as Iranmedex and Scientific Information Database (SID) from the inception to June 16, 2020.

RESULTS

Of 2,761 articles, 25 studies were included in the review. Among a total of 1,748 Iranian HD patients with a mean age of 54.17 (SD = 12.27) years, 61.38% were male. Interventions such as educational-based programs (n = 5), nutrition-based programs (n = 2), massage therapy (n = 3), exercise-based programs (n = 4), relaxation technique (n = 3), combination of relaxation technique and inhalation aromatherapy (n = 1), energy therapy (reflexology and acupressure) (n = 3), and mind-guided imagery (n = 1) were effective in reducing fatigue in Iranian HD patients.

DISCUSSION/CONCLUSION

These simple, low-cost, and practical interventions can be used for the reduction of fatigue among HD patients by nurses. However, future well-designed studies are recommended to confirm the efficacy of these and other potentially effective interventions for reducing fatigue in HD patients.