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Zhang L, Zou L, Zhou L. Effectiveness of psychoeducational interventions on psychological distress and health-related quality of life among patients with maintenance hemodialysis: a systematic review and meta-analysis. Ren Fail 2024; 46:2331613. [PMID: 38561244 PMCID: PMC10986446 DOI: 10.1080/0886022x.2024.2331613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To examine the effectiveness of psychoeducational interventions on depression, anxiety, and health-related quality of life (HRQOL) for people undergoing maintenance hemodialysis (MHD). METHODS This review used systematic review and meta-analysis as the research design. Nine databases, including PubMed, Web of Science, Embase, CINAHL Complete, Cochrane Library, CNKI, WanFang, VIP, and Chinese Biomedical Literature Database, were searched from the inception to the 8th of July 2023. Two reviewers independently identified randomized controlled trials (RCT) examining the effects of psychoeducational interventions on MHD patients. RESULTS Fourteen studies involving 1134 MHD patients were included in this review. The results of meta-analyses showed that psychoeducational intervention had significant short-term (< 1 m) (SMD: -0.87, 95% CI: -1.54 to -0.20, p = 0.01, I2 = 91%; 481 participants), and medium-term (1-3 m) (SMD: -0.29, 95% CI: -0.50 to -0.08, p = 0.01, I2 = 49%; 358 participants) on anxiety in MHD patients, but the effects could not be sustained at longer follow-ups. Psychoeducational interventions can also have short-term (< 1 m) (SMD: -0.65, 95% CI: -0.91 to -0.38, p < 0.00001, I2 = 65%; 711 participants) and medium-term (1-3 m) (SMD: -0.42, 95% CI: -0.76 to -0.09, p = 0.01, I2 = 69%; 489 participants) effects in reducing depression levels in MHD patients. Psychoeducational interventions that use coping strategies, goal setting, and relaxation techniques could enhance the QOL in MHD patients in the short term (< 1 m) (SMD: 0.86, 95% CI: 0.42 to 1.30, p = 0.02, I2 = 86%; 241 participants). CONCLUSIONS Psychoeducational interventions have shown great potential to improve anxiety, depression, and quality of life in patients with MHD at the short- and medium-term follow-ups.Trial registration number: CRD42023440561.
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Affiliation(s)
- Liyuan Zhang
- Department of Orthopedics, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Jiangsu Province, China
| | - Li Zou
- Endocrinology department, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Jiangsu Province, China
| | - Lijuan Zhou
- Nursing department, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu Province, China
- Medical School, Nantong University, Nantong, Jiangsu Province, China
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Lu R, Fang Y, Wu W, Zeng X, Liu T, Qian Y, Xie Y, Zhou Y, Gu L. Hemodiafiltration with endogenous reinfusion for uremic toxin removal in patients undergoing maintenance hemodialysis: a pilot study. Ren Fail 2024; 46:2338929. [PMID: 38632963 PMCID: PMC11028005 DOI: 10.1080/0886022x.2024.2338929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To delineate the efficacy and safety profile of hemodiafiltration with endogenous reinfusion (HFR) for uremic toxin removal in patients undergoing maintenance hemodialysis (MHD). METHODS Patients who have been on MHD for a period of at least 3 months were enrolled. Each subject underwent one HFR and one hemodiafiltration (HDF) treatment. Blood samples were collected before and after a single HFR or HDF treatment to test uremic toxin levels and to calculate clearance rate. The primary efficacy endpoint was to compare uremic toxin levels of indoxyl sulfate (IS), λ-free light chains (λFLC), and β2-microglobulin (β2-MG) before and after HFR treatment. Secondary efficacy endpoints was to compare the levels of urea, interleukin-6 (IL-6), P-cresol, chitinase-3-like protein 1 (YKL-40), leptin (LEP), hippuric acid (HPA), trimethylamine N-oxide (TMAO), asymmetric dimethylarginine (ADMA), tumor necrosis factor-α (TNF-α), fibroblast growth factor 23 (FGF23) before and after HFR treatment. The study also undertook a comparative analysis of uremic toxin clearance between a single HFR and HDF treatment. Meanwhile, the lever of serum albumin and branched-chain amino acids before and after a single HFR or HDF treatment were compared. In terms of safety, the study was meticulous in recording vital signs and the incidence of adverse events throughout its duration. RESULTS The study enrolled 20 patients. After a single HFR treatment, levels of IS, λFLC, β2-MG, IL-6, P-cresol, YKL-40, LEP, HPA, TMAO, ADMA, TNF-α, and FGF23 significantly decreased (p < 0.001 for all). The clearance rates of λFLC, β2-MG, IL-6, LEP, and TNF-α were significantly higher in HFR compared to HDF (p values: 0.036, 0.042, 0.041, 0.019, and 0.036, respectively). Compared with pre-HFR and post-HFR treatment, levels of serum albumin, valine, and isoleucine showed no significant difference (p > 0.05), while post-HDF, levels of serum albumin significantly decreased (p = 0.000). CONCLUSION HFR treatment effectively eliminates uremic toxins from the bloodstream of patients undergoing MHD, especially protein-bound toxins and large middle-molecule toxins. Additionally, it retains essential physiological compounds like albumin and branched-chain amino acids, underscoring its commendable safety profile.
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Affiliation(s)
- Renhua Lu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Fang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wangshu Wu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaojun Zeng
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tingting Liu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Qian
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuanyuan Xie
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yijun Zhou
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Leyi Gu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Hu H, Chau PH, Choi EPH. Physical activity, exercise habits and health-related quality of life in maintenance hemodialysis patients: a multicenter cross-sectional study. J Nephrol 2024:10.1007/s40620-024-01935-6. [PMID: 38658480 DOI: 10.1007/s40620-024-01935-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Although exercise has the potential to yield numerous benefits for maintenance hemodialysis patients, the relationship between physical activity, exercise habits, and health-related quality of life (HRQOL) has not been thoroughly investigated. This study aimed to characterize the physical activity, exercise habits, and HRQOL of maintenance hemodialysis patients while examining the associations between these factors. METHODS A convenience sampling was used to recruit 827 patients from 74 dialysis units in China. The structured questionnaire included sociodemographics, the International Physical Activity Questionnaire, exercise habits, and the Kidney Disease Quality of Life Short Form 1.3. An independent samples t-test, multivariable logistic regression analysis, and multivariable linear regression analysis were used. RESULTS The physical activity levels of 69% of participants were found to be below the recommendation of the World Health Organization. Despite 62.4% of participants reporting regular exercise, 73.8% reported light exercise intensity, and 92.6% engaged in walking or jogging. Participants' HRQOL was higher in the low-intensity exercise group compared with the moderate-to-hard-intensity exercise group. Moderate-to-high physical activity was associated with better HRQOL in 13 of the 19 domains and regular exercise was linked to higher HRQOL in four of the 19 domains. CONCLUSIONS This study identified a low level of physical activity, light exercise intensity, and walking as the primary exercise type among the participants. A significant correlation was found between higher physical activity levels, regular exercise, and better HRQOL for maintenance hemodialysis patients. It is advisable to implement strategies to enhance physical activity levels and design exercise programs for maintenance hemodialysis patients based on their real-world physical activity levels and exercise habits.
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Affiliation(s)
- Huagang Hu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong
- School of Nursing, Medical College, Soochow University, Box 203, 1 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Pui Hing Chau
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong
| | - Edmond Pui Hang Choi
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong.
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Li C, Sun W, Xu L, Chen C, Fang L, Tang Y, Zhang Q, Shi H, Liu T. Cerebral blood flow changes in maintenance hemodialysis patients with restless legs syndrome and their clinical significance:a cross-sectional case-control study. BMC Neurol 2024; 24:128. [PMID: 38627680 PMCID: PMC11020200 DOI: 10.1186/s12883-024-03636-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE Restless legs syndrome (RLS) stands as a prevalent neurological complication within maintenance hemodialysis (MHD) patients. However, the alterations in cerebral blood flow (CBF) among MHD-RLS patients remain uncharted. Through the utilization of the arterial spin labeling (ASL) technique, we evaluated the fluctuations in CBF within distinct brain regions and analyzed the risk factors for the development of RLS in MHD patients in the context of the clinic. METHODS Thirty-one MHD patients with concomitant RLS (MHD-RLS group) and thirty-one non-RLS patients matched based on age, gender, as well as cognitive function (MHD-nRLS group) were included. Through image preprocessing and data analysis, the changes in CBF values in distinct brain regions were obtained, and the CBF values of brain regions with substantial differences between the two groups were correlated with the RLS scores. Furthermore, the differences in baseline data were compared, and through the utilization of multifactorial logistic regression, the independent risk factors for the development of RLS were examined. RESULTS Compared with the MHD-nRLS group, the MHD-RLS group had increased CBF in the right superior temporal gyrus, reduced CBF in the right hippocampus, left middle frontal gyrus, inferior frontal gyrus of right triangle, middle frontal gyrus of left orbit, left precentral gyrus, and left precuneus. Only left precentral gyrus CBF were negatively correlated with RLS scores after correction for dialysis duration(r = -0.436, P = 0.016). Accordingly, multifactorial regression analysis by stepwise method yielded that the left precentral gyrus CBF values(OR: 0.968, 95%CI: 0.944-0.993, P = 0.012) remained an independent risk factor for RLS in MHD patients. In addition, the results showed that hemodialysis duration (OR: 1.055, 95%CI: 1.014-1.098, P = 0.008) and serum iron levels (OR: 0.685, 95%CI: 0.551-0.852, P = 0.001) were also risk factors for the development of RLS. CONCLUSION Patients afflicted with MHD-RLS exhibit alterations in CBF across several brain regions. Notably, the left precentral gyrus might serve as a pivotal region influencing the onset of RLS among MHD patients. Furthermore, extended hemodialysis duration and a relative insufficiency in serum iron levels independently contribute as risk factors for RLS development within the MHD patient population.
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Affiliation(s)
- Chen Li
- Department of Nephrology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
- Graduate College, Dalian Medical University, Dalian, China
| | - Wei Sun
- Graduate College, Dalian Medical University, Dalian, China
- Department of Radiology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
| | - Linfang Xu
- Hemodialysis Center, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
| | - Cheng Chen
- Department of Nephrology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
| | - Li Fang
- Department of Nephrology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
| | - Yushang Tang
- Department of Nephrology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
| | - Qiaoyang Zhang
- Department of Psychology, The Affiliated Changzhou No. 2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
| | - Haifeng Shi
- Department of Radiology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China.
| | - Tongqiang Liu
- Department of Nephrology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China.
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Li J, Zhao Z, Ren G, Zhang L, Wang T. Pulmonary tumor embolism in a maintenance hemodialysis patient with hepatocellular carcinoma. CEN Case Rep 2024; 13:121-124. [PMID: 37490240 PMCID: PMC10982258 DOI: 10.1007/s13730-023-00810-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023] Open
Abstract
Patients with chronic kidney disease are already at an increased risk for pulmonary embolism, since loss of renal function rendered a procoagulant state. Further, malignant tumor is a well-established risk factor for pulmonary thromboembolism. Alternatively, occlusion of the pulmonary vasculature by tumor cells per se and associated thrombi may mimic thromboembolic disease. By comparison, however, report of pulmonary tumor embolism (PTE) in patients on maintenance hemodialysis (MHD) is exceedingly rare. A less vigilant clinician may have otherwise treated this situation as fluid overload or thromboembolic disorder. We herein described in an MHD patient such an unusual case of PTE, which was diagnosed by contrast-enhanced CT and PET/CT. As such, our work may expand the knowledge reserve of dialysis staffs about this rare complication of malignancy.
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Affiliation(s)
- Jing Li
- Department of Nephrology, The First Hospital of HeBei Medical University, No.89 East DongGang Road, ShiJiaZhuang, 050030, People's Republic of China
| | - ZhiPeng Zhao
- Department of Nephrology, The First Hospital of HeBei Medical University, No.89 East DongGang Road, ShiJiaZhuang, 050030, People's Republic of China
- Graduate School of HeBei Medical University, No.386 East ZhongShan Boulevard, ShiJiaZhuang, 050030, People's Republic of China
| | - GuangWei Ren
- Department of Nephrology, The First Hospital of HeBei Medical University, No.89 East DongGang Road, ShiJiaZhuang, 050030, People's Republic of China
| | - LiHong Zhang
- Department of Nephrology, The First Hospital of HeBei Medical University, No.89 East DongGang Road, ShiJiaZhuang, 050030, People's Republic of China
| | - Tao Wang
- Department of Nephrology, The First Hospital of HeBei Medical University, No.89 East DongGang Road, ShiJiaZhuang, 050030, People's Republic of China.
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Zhou X, Jiang H, Zhou YP, Wang XY, Ren HY, Tian XF, Zhang QQ. Mediating role of social support in dysphoria, despondency, and quality of life in patients undergoing maintenance hemodialysis. World J Psychiatry 2024; 14:409-420. [PMID: 38617988 PMCID: PMC11008395 DOI: 10.5498/wjp.v14.i3.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/30/2023] [Accepted: 01/23/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Dysphoria and despondency are prevalent psychological issues in patients undergoing Maintenance Hemodialysis (MHD) that significantly affect their quality of life (QOL). High levels of social support can significantly improve the physical and mental well-being of patients undergoing MHD. Currently, there is limited research on how social support mediates the relationship between dysphoria, despondency, and overall QOL in patients undergoing MHD. It is imperative to investigate this mediating effect to mitigate dysphoria and despondency in patients undergoing MHD, ultimately enhancing their overall QOL. AIM To investigate the mediating role of social support in relationships between dysphoria, despondency, and QOL among patients undergoing MHD. METHODS Participants comprised 289 patients undergoing MHD, who were selected using a random sampling approach. The Social Support Rating Scale, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and QOL Scale were administered. Correlation analysis was performed to examine the associations between social support, dysphoria, despondency, and QOL in patients undergoing MHD. To assess the mediating impact of social support on dysphoria, despondency, and QOL in patients undergoing MHD, a bootstrap method was applied. RESULTS Significant correlations among social support, dysphoria, despondency, and quality in patients undergoing MHD were observed (all P < 0.01). Dysphoria and despondency negatively correlated with social support and QOL (P < 0.01). Dysphoria and despondency had negative predictive impacts on the QOL of patients undergoing MHD (P < 0.05). The direct effect of dysphoria on QOL was statistically significant (P < 0.05). Social support mediated the relationship between dysphoria and QOL, and this mediating effect was significant (P < 0.05). Similarly, the direct effect of despondency on QOL was significant (P < 0.05). Moreover, social support played a mediating role between despondency and QOL, with a significant mediating effect (P < 0.05). CONCLUSION These findings suggest that social support plays a significant mediating role in the relationship between dysphoria, despondency, and QOL in patients undergoing MHD.
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Affiliation(s)
- Xiang Zhou
- Department of Nephrology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Research Center for Kidney Disease, Urumqi 832000, Xinjiang Uygur Autonomous Region, China
| | - Hong Jiang
- Department of Nephrology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Research Center for Kidney Disease, Urumqi 832000, Xinjiang Uygur Autonomous Region, China
| | - Yi-Peng Zhou
- Department of Nephrology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Research Center for Kidney Disease, Urumqi 832000, Xinjiang Uygur Autonomous Region, China
| | - Xiao-Yu Wang
- Department of Nephrology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Research Center for Kidney Disease, Urumqi 832000, Xinjiang Uygur Autonomous Region, China
| | - Hai-Yan Ren
- Department of Endocrinology and Metabolism, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 832000, Xinjiang Uygur Autonomous Region, China
| | - Xue-Fei Tian
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Qing-Qing Zhang
- Department of Nephrology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Research Center for Kidney Disease, Urumqi 832000, Xinjiang Uygur Autonomous Region, China
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Wang Y, Qin Y, Huang X, Liu W. MSCTA imaging analysis of autologous arteriovenous fistula dysfunction in maintenance hemodialysis patients. Am J Transl Res 2024; 16:955-963. [PMID: 38586097 PMCID: PMC10994794 DOI: 10.62347/yegn9292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/03/2023] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To observe the multi-slice spiral CT angiography (MSCTA) imaging features of arteriovenous fistula dysfunction in patients undergoing maintenance hemodialysis and analyze the significance of the imaging examination. METHODS Altogether 90 patients with end-stage renal disease treated by maintenance hemodialysis in General Hospital of China Resources & Wisco from June 2020 to February 2023 were divided into a normal function group (n=68) and a dysfunction group (n=22) according to the function of autogenous arteriovenous fistula. The clinical data of the two groups were recorded. The MSCTA was performed in each patient, and the manifestations of arteriovenous fistula dysfunction were analyzed. Additionally, the vascular access stenosis, vascular access lumen stenosis, arteriovenous diameter, blood flow, and hemodynamic indices were tested, and the value of MSCTA in predicting arteriovenous fistula function was analyzed by Logistic regression. RESULTS The degree of vascular access stenosis and vascular access lumen stenosis in the normal group were less than those in the dysfunctional group (P<0.05). The arteriovenous diameter, blood flow, blood flow velocity at anastomotic vein end, dialysis adequacy (spKt/V), and von Willebrand factor (vWF) function in the normal group were larger than those in the dysfunction group, and the radial artery shear force was lower than in the dysfunction group, with statistical significance (P<0.05). Among the arteriovenous fistula dysfunction, there were 3 patients with anastomotic + outflow vein stenosis, 4 patients with outflow vein stenosis, 9 patients with inflow artery + anastomosis + outflow vein stenosis, and 6 patients with superior vena cava stenosis. Logistic regression analysis showed that slow blood flow velocity at the venous end of anastomosis and high shear force of radial artery were influencing factors of arteriovenous fistula dysfunction, and the area under ROC curve of blood flow velocity at the venous end of anastomosis plus shear force of radial artery was 0.93, with a sensitivity of 0.87 and a specificity of 0.85. CONCLUSION MSCTA can be used to evaluate the dysfunction of autologous arteriovenous fistula in patients undergoing maintenance hemodialysis, and provide important reference information for the formulation of the next best clinical treatment plan.
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Affiliation(s)
- Yingjie Wang
- Department of Radiology, General Hospital of China Resources and Wisco Affiliated to Wuhan University of Science and TechnologyWuhan 430080, Hubei, China
- School of Medicine, Wuhan University of Science and TechnologyWuhan 430065, Hubei, China
| | - Yanlei Qin
- Department of Radiology, General Hospital of China Resources and Wisco Affiliated to Wuhan University of Science and TechnologyWuhan 430080, Hubei, China
| | - Xiaolu Huang
- Department of Radiology, General Hospital of China Resources and Wisco Affiliated to Wuhan University of Science and TechnologyWuhan 430080, Hubei, China
| | - Weihong Liu
- Department of Radiology, General Hospital of China Resources and Wisco Affiliated to Wuhan University of Science and TechnologyWuhan 430080, Hubei, China
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Li Y, Xing T, Xu R, Liu Y, Zhong X, Liu Y, Tan R. Single-pool model urea clearance index is associated with sarcopenia and nutritional status in patients undergoing maintenance hemodialysis: a cross-sectional study. BMC Nephrol 2024; 25:80. [PMID: 38443824 PMCID: PMC10916151 DOI: 10.1186/s12882-024-03510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/18/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The single-pool model urea clearance index (single-pool Kt/Vurea; spKt/V) is the most commonly used method for dialysis adequacy assessment. However, only a few studies have examined the relationship between spKt/V values and parameters related to sarcopenia and nutritional status. This study aimed to evaluate whether the spKt/V is an indicator of sarcopenia and nutritional status in patients undergoing maintenance hemodialysis (MHD). METHODS A total of 142 patients were included in this single-center, cross-sectional study. Venous blood samples were collected shortly before the hemodialysis session. The adequacy of dialysis in patients receiving MHD was assessed using spKt/V. Sarcopenia was identified according to the Asian Working Group for Sarcopenia (2019) definition. Receiver operating characteristic curve and area under the curve were used to evaluate the predictive value of spKt/V in sarcopenia. Univariate and multivariate binary logistic regression analyses were used to determine the association between spKt/V and sarcopenia and nutritional status. RESULTS The mean spKt/V level was 1.3 ± 0.2, the prevalence of sarcopenia was 15.5% in patients on MHD. The best cutoff value of spKt/V in sarcopenia was 1.45 for both sexes, 1.33 and 1.45 for men and women, respectively (P < 0.05). The multivariate binary logistic regression shown that the spKt/V was independently positively associated with sarcopenia (OR = 122.88, 95% CI = 0.64-0.87, P = 0.002). Grouping spKt/V by the best cutoff value, when spKt/V ≥ 1.45, the OR of sarcopenia was 11.75 (95% CI = 3.16-43.67, P < 0.001). Subgroup analyses showed that when spKt/V ≥ 1.33 in men and spKt/V ≥ 1.45 in woman, the OR of sarcopenia was 9.73 (95% CI = 2.25-42.11, P = 0.002) and 14.52 (95% CI = 1.06-199.67, P = 0.045), respectively. CONCLUSIONS The present study showed that spKt/V was an important influencing factor of sarcopenia and malnutrition in Asian patients on MHD.
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Affiliation(s)
- Yan Li
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Tingting Xing
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Rong Xu
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Yan Liu
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
- Department of Clinical Nutrition, Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Xiaoshi Zhong
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Yun Liu
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
- Department of Clinical Nutrition, Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Rongshao Tan
- Department of Clinical Nutrition, Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.
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Zhang Q, Liu Q, Zhang L, Jin Y, Xiang X, Huang X, Mai J, Zhao T, Cui W. The mediating effect of family resilience between coping styles and caregiver burden in maintenance hemodialysis patients: a cross-sectional study. BMC Nephrol 2024; 25:83. [PMID: 38443869 PMCID: PMC10916256 DOI: 10.1186/s12882-024-03520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Primary caregivers of hemodialysis patients suffer from varying degrees of stress from their patients. Caring for hemodialysis patients can expose caregivers to many problems, leading to an increased burden of care and even impacting the quality of care. The purpose of our study was to examine whether family resilience could be a mediating variable moderating the relationship between patient coping styles and caregiver burden. METHODS The study was a cross-sectional and descriptive-analytical study that interviewed 173 pairs of hemodialysis patients and their caregivers at a blood purification center in a public hospital in China. The Brief Coping Styles Scale (Chinese version) was used to assess individuals' coping styles for disease and treatment. From the caregiver's perspective, the Family Resilience Assessment Scale (Chinese version) was used to understand the resilience of families, and the Zarit Caregiver Burden Scale was used to capture the caregiver's subjective experience of burden. Statistical analyses were conducted using SPSS version 23 and Amos version 26 to analyze the relationships between variables to examine for correlation and construct mediated effects models. RESULTS Coping styles showed a significant positive correlation with family resilience (r = 0.347, P < 0.01) and a negative correlation with caregiver burden (r = -0.379, P < 0.01). A significant negative correlation was found between family resilience and caregiver burden (r = -0.503, P < 0.01). In the mediation model, patient coping styles directly impacted caregiver burden significantly (95% CI [-0.372, -0.058]), and coping styles indirectly impacted caregiver burden by family resilience in a significant way (95% CI [-0.275, -0.098]). CONCLUSIONS Patient coping styles directly affect caregiver burden. Family resilience is a mediating variable between patients' coping styles and the burden on caregivers.
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Affiliation(s)
- Qianjun Zhang
- School of Nursing, College of Medicine, Shantou University, Shantou, China
| | - Qiaoling Liu
- School of Nursing, College of Medicine, Shantou University, Shantou, China
- Department of Nursing, Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, China
| | - Li Zhang
- Department of Office, First People's Hospital of Foshan, Foshan, China.
| | - Yabin Jin
- Department of Office, First People's Hospital of Foshan, Foshan, China.
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, China.
| | - Xia Xiang
- Department of Nursing, First People's Hospital of Foshan, Foshan, China
| | - Xuefang Huang
- Hemodialysis Center, First People's Hospital of Foshan, Foshan, China
| | - Jiezhen Mai
- Department of Hepatopancreatic Surgery, First People's Hospital of Foshan, Foshan, China
| | - Tingfen Zhao
- College of Nursing, Zunyi Medical University, Zhuhai, China
| | - Wen Cui
- College of Nursing, Zunyi Medical University, Zhuhai, China
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Nobayashi H, Kanzaki G, Bamba H, Shibata Y, Fujimoto T, Matsuo N, Maruyama Y, Yokoo T. Early diagnosis leading to improvement of critical illness polyneuropathy associated with severe Staphylococcus aureus infection in a patient on hemodialysis. CEN Case Rep 2024; 13:26-31. [PMID: 37120491 PMCID: PMC10834894 DOI: 10.1007/s13730-023-00794-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023] Open
Abstract
Critical illness polyneuropathy (CIP) is a very rare complication of sepsis and multi-organ failure. Herein, we report the first case of CIP reported in a patient on maintenance hemodialysis, who improved with rehabilitation. A 55-year-old male patient was emergently admitted with fever and altered consciousness and diagnosed with bacterial meningitis based on cerebral spinal fluid and cranial magnetic resonance imaging findings. Methicillin-susceptible Staphylococcus aureus was detected in blood and cerebral spinal fluid cultures. Despite treatment with appropriate antibiotics, blood cultures were positive for 9 days and serum C-reactive protein (CRP) levels were persistently elevated. Magnetic resonance imaging of hands and feet to determine infection origin revealed osteomyelitis in several fingers and toes, which required the amputation of 14 necrotic fingers and toes. Thereafter, blood cultures became negative and CRP levels declined. However, flaccid paralysis was noted in both upper and lower extremities during sepsis treatment. Nerve conduction studies showed peripheral axonal disorder in motor and sensory nerves, and CIP was determined as the cause of paralysis based on the fulfillment of all four CIP diagnostic criteria. The patient's muscle strength improved with early and appropriate medical treatment and physical therapy, and he was discharged home 147 days after admission. Prolonged high-level inflammation is a cause of CIP. Patients on hemodialysis, who are potentially immunosuppressed and vulnerable to infection, are at high risk for CIP. In patients on maintenance hemodialysis who develop flaccid paralysis during treatment for severe infection, CIP should be considered for early diagnosis and intervention.
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Affiliation(s)
- Hiroki Nobayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Go Kanzaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Harui Bamba
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Yuriko Shibata
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Toshinari Fujimoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Nanae Matsuo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Yukio Maruyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
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11
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Liu Y, Du Q, Jiang Y. Prevalence of restless legs syndrome in maintenance hemodialysis patients: A systematic review and meta-analysis. Sleep Med 2024; 114:15-23. [PMID: 38147712 DOI: 10.1016/j.sleep.2023.11.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Restless legs syndrome is associated with quality of life and risk of death in maintenance hemodialysis patients. Although relevant meta-analyses have been conducted, epidemiological studies of restless legs syndrome have increased in recent years. OBJECTIVE Our aim was to systematically assess the prevalence of restless legs syndrome in maintenance hemodialysis patients and to evaluate the effect of different geographic regions, genders, study designs, and years of publication on the prevalence of restless legs syndrome. METHODS PubMed, Web of Science, EMBASE, The Cochrane Library, China Knowledge Resource Integrated Database, Wanfang Database, Weipu, and Chinese Biomedical Database were searched before March 16, 2023 for the published literature. Two investigators independently performed literature screening, data extraction for eligible studies, and risk of bias assessment. A random-effects model using the stata 15.0 software was used to assess the pooled prevalence of restless legs syndrome. RESULTS Fifty-seven articles were included in this meta-analysis, and the pooled prevalence of restless legs syndrome in 12,573 maintenance hemodialysis patients was 24.0 % (95 % CI: 21.0%-26.0 %). Maintenance hemodialysis patients from the Americas region and females had severe symptoms of restless legs syndrome, and the prevalence of restless legs syndrome increased from year to year. The prevalence of restless legs syndrome was higher in maintenance hemodialysis patients in cross-sectional studies and cohort studies compared to case-control studies. CONCLUSIONS Maintenance hemodialysis patients have a significantly higher prevalence of restless legs syndrome. These findings may provide some reference value for hospital nursing staff to focus on the management and treatment of restless legs syndrome in maintenance hemodialysis patients.
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Affiliation(s)
- Yaxin Liu
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Qiufeng Du
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Yunlan Jiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China.
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12
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Xu Y, Ling S, Liu Z, Luo D, Qi A, Zeng Y. The ability of phase angle and body composition to predict risk of death in maintenance hemodialysis patients. Int Urol Nephrol 2024; 56:731-737. [PMID: 37542595 PMCID: PMC10808255 DOI: 10.1007/s11255-023-03708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/08/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the ability of phase angle and body composition to identify risk factors for mortality among patients receiving maintenance hemodialysis (MHD) treatment. METHODS In this retrospective study, we examined the causes of death in 43 MHD patients who were treated at our hemodialysis center between January 2016 and December 2021 and compared the patients to 71 patients who survived during the same period. Body composition was measured using direct segmental multi-frequency bioelectrical impedance to obtain phase angle, fat-free mass (FFM), extracellular water/total body water (ECW/TBW), and waist circumference (WC). Laboratory data were also collected. Phase angle cut-off value-associated variables were identified using ROC analysis. The ability of body composition variables to identify risk factors for death in MHD patients was evaluated. RESULTS We found that cardiovascular disease was the most common cause of death among MHD patients. ROC curve analysis revealed that the optimal cut-off value for phase angle as a predictor of death risk in MHD patients was 4.50°. Additionally, lower phase angle, increased age, longer dialysis vintage, lower KT/V, and hypoproteinemia were identified as significant risk factors for death in MHD patients. CONCLUSION In conclusion, our findings suggest that cardiovascular disease is the leading cause of death among MHD patients and that lower phase angle, increased age, longer dialysis duration, and hypoproteinemia can be used to predict the risk of mortality in this patient population. The underlying mechanism by which lower phase angle can be used to predict the prognosis of MHD patients warrants further investigation.
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Affiliation(s)
- Yuanzhao Xu
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, 518000, Guangdong, China
| | - Shuyi Ling
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, 518000, Guangdong, China
| | - Zheyan Liu
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, 518000, Guangdong, China
| | - Denggui Luo
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, 518000, Guangdong, China
| | - Airong Qi
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, 518000, Guangdong, China.
| | - Youjia Zeng
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, 518000, Guangdong, China.
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13
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Wang Y, Qiu Y, Ren L, Jiang H, Chen M, Dong C. Social support, family resilience and psychological resilience among maintenance hemodialysis patients: a longitudinal study. BMC Psychiatry 2024; 24:76. [PMID: 38279114 PMCID: PMC10811847 DOI: 10.1186/s12888-024-05526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 01/16/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Psychological distress is common in maintenance hemodialysis patients, and high psychological resilience can promote psychological well-being. The current research focuses on psychological resilience protective factors such as family resilience and social support. However, the trajectories of psychological resilience, family resilience, and social support over time and their longitudinal relationships in maintenance hemodialysis patients have not been fully explored yet. Therefore, this study aims to explore the longitudinal relationship between these factors. METHODS Patients who received regular hemodialysis treatment for more than three months at dialysis centers of three tertiary hospitals in Zhejiang, China, were recruited from September to December 2020. A total of 252 patients who met the inclusion and exclusion criteria completed three follow-up surveys, including social support, family resilience, and psychological resilience assessments. A repeated measures ANOVA was used to explore differences in their respective scores at different time points. The cross-lagged analysis was performed in AMOS using the maximum likelihood method to examine the the reciprocal predictive relationships between these factors. RESULTS Social support and psychological resilience remained relatively stable over time, whereas family resilience indicated a little increasing trend. According to the cross-lagged analysis, higher T1 social support predicted higher family resilience at T2 [β = 0.123, 95% CI (0.026-0.244)]. Further, the effects of T2 social support to T3 family resilience [β = 0.194, 95%CI (0.039-0.335)] and psychological resilience [β = 0.205, 95%CI (0.049-0.354)] were significant. Finally, the effects of T2 family resilience to T3 social support [β = 0.122, 95%CI (0.010-0.225)] and psychological resilience [β = 0.244, 95%CI (0.119-0.359)] were also significant. CONCLUSIONS The study showed that the directionality of the relationship appears to be from social support or family resilience to patients' psychological resilience but not vice versa. This finding reminds healthcare professionals to emphasize the vital role of social and family resources in providing appropriate support and interventions for maintenance hemodialysis patients to promote psychological resilience and mental health development.
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Affiliation(s)
- Yuxin Wang
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, 325035, China
| | - Yuan Qiu
- Zhejiang Tourism and Health College, Zhoushan, China
| | - Liya Ren
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, 325035, China
| | - Hao Jiang
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, 325035, China
| | - Meijia Chen
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Chaoqun Dong
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, 325035, China.
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14
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Lv W, Liao H, Wang X, Yu S, Peng Y, Li X, Fu P, Yuan H, Chen Y. A machine learning-based assistant tool for early frailty screening of patients receiving maintenance hemodialysis. Int Urol Nephrol 2024; 56:223-235. [PMID: 37227677 DOI: 10.1007/s11255-023-03640-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/13/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE To develop an assistant tool based on machine learning for early frailty screening in patients receiving maintenance hemodialysis. METHODS This is a single-center retrospective study. 141 participants' basic information, scale results and laboratory findings were collected and the FRAIL scale was used to assess frailty. Then participants were divided into the frailty group (n = 84) and control group (n = 57). After feature selection, data split and oversampling, ten commonly used binary machine learning methods were performed and a voting classifier was developed. RESULTS The grade results of Clinical Frailty Scale, age, serum magnesium, lactate dehydrogenase, comorbidity and fast blood glucose were considered to be the best feature set for early frailty screening. After abandoning models with overfitting or poor performance, the voting classifier based on Support Vector Machine, Adaptive Boosting and Naive Bayes achieved a good screening performance (sensitivity: 68.24% ± 8.40%, specificity:72.50% ± 11.81%, F1 score: 72.55% ± 4.65%, AUC:78.38% ± 6.94%). CONCLUSION A simple and efficient early frailty screening assistant tool for patients receiving maintenance hemodialysis based on machine learning was developed. It can provide assistance on frailty, especially pre-frailty screening and decision-making tasks.
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Affiliation(s)
- Wenmei Lv
- Department of Nephrology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hualong Liao
- Department of Applied Mechanics, College of Architecture and Environment, Sichuan University, Chengdu, 610065, Sichuan, China
| | - Xue Wang
- Department of Nephrology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Shaobin Yu
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yuan Peng
- Department of Nephrology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xianghong Li
- Department of Nephrology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ping Fu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Huaihong Yuan
- Department of Nephrology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Yu Chen
- Department of Applied Mechanics, College of Architecture and Environment, Sichuan University, Chengdu, 610065, Sichuan, China.
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15
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Beigh A, Mazumder MA. Successful treatment of a brachial artery pseudoaneurysm in a brachiobasilic arteriovenous fistula using ultrasound-guided manual compression. J Ultrasound 2023; 26:955-957. [PMID: 36260216 PMCID: PMC10632190 DOI: 10.1007/s40477-022-00701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/16/2022] [Indexed: 10/24/2022] Open
Abstract
Pseudoaneurysm is a well-recognized complication seen in arteriovenous fistula (AVF) which usually involves the venous segments. Ultrasound-guided manual compression (UGMC) is a non-invasive and effective treatment for the management of pseudoaneurysms involving the venous segment. Pseudoaneurysm of the arterial segment of AVF is rare complication which usually needs surgical intervention. We report the first successful treatment case of a brachial artery pseudoaneurysm in a brachiobasilic arteriovenous fistula using ultrasound-guided manual compression. The patient presented with a 30 × 30 mm pulsatile swelling below the cubital fossa after second session of hemodialysis using an AVF created 8 weeks earlier. Ultrasound doppler demonstrated a brachial artery pseudoaneurysm in the non-transposed brachiobasilic fistula. Complete occlusion of the cavity with thrombus formation was accomplished after 55 min of compression and the psuedoaneurysm did not recur. UGMC can be an alternative treatment option for select cases of arterial segment pseudoaneurysm in AVF.
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Affiliation(s)
- Aadil Beigh
- Khyber Medical Institute, Khayam Chowk, Srinagar, Jammu and Kashmir, India
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Amari Y, Morimoto S, Yurugi T, Oyama Y, Nakajima F, Shimizu S, Ichihara A. Characteristics of Month-by-Month Blood Pressure Variability in Patients on Hemodialysis. Kidney Blood Press Res 2023; 48:761-776. [PMID: 37926094 DOI: 10.1159/000534967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION Poor prognosis in hemodialysis (HD) patients is due to the increased prevalence of cardiovascular diseases among them. We previously reported that higher visit-by-visit blood pressure variability is associated with increased cardiovascular mortality in HD patients. This present study aimed to investigate the characteristics of month-by-month blood pressure variability (MMBPV) in these patients. METHODS A total of 324 maintenance HD patients, who could be followed up for 60 months, were recruited. We used standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM) in pre- and post-dialysis systolic blood pressure (pre- and post-SD, pre- and post-CV, and pre- and post-VIM) as an index of MMBPV. We investigated (1) the reproducibility of MMBPV, (2) relationship between these values and background factors, and (3) association between these values and mortality. RESULTS MMBPV (pre- and post-SD, pre- and post-CV, and pre- and post-VIM) showed significant reproducibility (intraclass correlation, 0.483 [p < 0.001], 0.553 [p < 0.001], 0.450 [p < 0.001], 0.518 [p < 0.001], 0.456 [p < 0.001], and 0.522 [p < 0.001], respectively). High pre-VIM was associated with high interdialytic weight gain and poor nutritional status. High post-VIM was associated with glucose intolerance, high interdialytic weight gain, and poor nutritional status and associated with high rate of cardiovascular deaths independent of other factors (hazard ratio: 1.104, 95% confidence interval: 1.011-1.207, p = 0.028). CONCLUSION These data suggested that pre- and post-VIM in HD patients are reproducible and associated with various background factors, and especially post-VIM is independently correlated with cardiovascular mortality. Further studies are necessary to confirm the mechanism of increased post-VIM and clarify whether reducing post-VIM can improve the prognosis of HD patients.
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Affiliation(s)
- Yoshifumi Amari
- Department of Nephrology, Moriguchi Keijinkai Hospital, Osaka, Japan
| | - Satoshi Morimoto
- Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Takatomi Yurugi
- Department of Nephrology, Moriguchi Keijinkai Hospital, Osaka, Japan
| | - Yasuo Oyama
- Department of Nephrology and Dialysis, Neyagawa Keijinkai Clinic, Osaka, Japan
| | - Fumitaka Nakajima
- Department of Nephrology and Dialysis, Kadoma Keijinkai Clinic, Osaka, Japan
| | - Satoru Shimizu
- School of Arts and Sciences, Tokyo Woman's Christian University, Tokyo, Japan
| | - Atsuhiro Ichihara
- Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan
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Bai Y, Liang S, Vachharajani TJ, An N, Xu M, Zhou Z, Li H. Feasibility and safety of guidewire-balloon entrapment technique for recanalization of thoracic central vein occlusion in hemodialysis patients. J Vasc Access 2023; 24:1438-1444. [PMID: 35443827 DOI: 10.1177/11297298221092745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the feasibility and safety of Guidewire-Balloon Entrapment Technique (GBET) for the recanalization of thoracic central vein occlusions (TCVOs) in hemodialysis patients. METHODS A retrospective observational study was conducted using data from 28 patients who required the establishment or maintenance of hemodialysis access and were treated with GBET for the recanalization of right-sided TCVOs from January 2017 to April 2021. Of the patients, 27 required tunneled cuffed catheter (TCC) placement or exchange, and 1 had an outflow tract occlusion of the Brescia-Cimino radio cephalic arteriovenous fistula (AVF). RESULTS A total of 26 patients successfully underwent TCC exchange and placement using GBET; 1 patient underwent successful recanalization of an occlusion of the outflow tract of the right Brescia-Cimino AVF; and 1 patient underwent successful TCC placement in the left internal jugular vein (LIJV) after the failure of TCC placement in the right internal jugular vein (RIJV). The success rate for GBET was 27/28 (96.43%), and there were no major complications. CONCLUSION GBET is a safe and effective method for the recanalization of right-sided TCVOs, especially for TCC exchange and placement, and can be used as a safe and easy approach for TCVO recanalization.
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Affiliation(s)
- Yafei Bai
- Department Blood Purification Center of Hainan Provincial Hospital, Hainan Medical University Affiliated Hainan Hospital, China
| | - Shuntian Liang
- Department of Comprehensive Intervention of Southern Medical University of China, Guangzhou, Guangdong, China
| | - Tushar J Vachharajani
- Department of Kidney Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Na An
- Department Blood Purification Center of Hainan Provincial Hospital, Hainan Medical University Affiliated Hainan Hospital, China
| | - Mingzhi Xu
- Department Blood Purification Center of Hainan Provincial Hospital, Hainan Medical University Affiliated Hainan Hospital, China
| | - Zhongxin Zhou
- Department of Comprehensive Intervention of Southern Medical University of China, Guangzhou, Guangdong, China
| | - Hong Li
- Department Blood Purification Center of Hainan Provincial Hospital, Hainan Medical University Affiliated Hainan Hospital, China
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Chen D, Xiao C, Xiao W, Lou L, Gao Z, Li X. Prediction model for cognitive impairment in maintenance hemodialysis patients. BMC Neurol 2023; 23:367. [PMID: 37828422 PMCID: PMC10568884 DOI: 10.1186/s12883-023-03407-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
PURPOSE To explore the risk factors for cognitive impairment in patients undergoing maintenance hemodialysis (MHD) and construct a predictive model for cognitive impairment. METHODS A total of 146 patients with end-stage renal disease (ESRD) undergoing MHD were recruited at our hospital between December 2021 and April 2022. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and scores of < 26 were considered indicative of cognitive impairment. Risk factors were identified using a multivariate logistic regression model, and a receiver operating characteristic curve was applied to construct the prediction model. Cognitive impairment risk was categorized using a multifactorial prediction model based on the weight of evidence. RESULTS 46 patients with cognitive impairment were identified, with a prevalence of 31.5% in ESRD patients undergoing MHD. Multivariate logistic regression analyses indicated that the following factors were associated with an increased risk of cognitive impairment in patients undergoing MHD: aged 55.0-64.0 years (OR:6.24; 95%CI:1.81-21.48; P = 0.001), aged 65.0-74.0 years (OR:16.10; 95%CI:4.03-64.37; P < 0.001), aged ≥ 75.0 years (OR:90.22; 95%CI:16.86-482.86; P < 0.001), duration of dialysis ≥ 5 years (OR:3.99; 95%CI:1.58-10.04; P = 0.003), and current smoker (OR:4.61; 95%CI:1.46-14.57; P = 0.009). The predictive value of the constructed model based on the aforementioned factors for cognitive impairment was 84% (95%CI,77-91%). The prevalence of cognitive impairment for patients at low, moderately low, moderately high, and high risk was 0% (95%CI:0-17%), 10% (95%CI:3-22%), 32% (95%CI:16-52%), and 65% (95%CI:50-78%), respectively. CONCLUSIONS This study constructed a multifactorial prediction model with a high predictive value for cognitive impairment in patients with ESRD undergoing MHD.
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Affiliation(s)
- Ding Chen
- Department of Nephrology, Air Force Medical Center, PLA, No.30, Fucheng Road, Haidian District, Beijing, 100037, China
| | - Chang Xiao
- Department of Nephrology, Air Force Medical Center, PLA, No.30, Fucheng Road, Haidian District, Beijing, 100037, China
| | - Wangyan Xiao
- Department of Nephrology, Air Force Medical Center, PLA, No.30, Fucheng Road, Haidian District, Beijing, 100037, China
| | - Linjing Lou
- Department of Nephrology, Air Force Medical Center, PLA, No.30, Fucheng Road, Haidian District, Beijing, 100037, China
| | - Zhuo Gao
- Department of Nephrology, Air Force Medical Center, PLA, No.30, Fucheng Road, Haidian District, Beijing, 100037, China
| | - Xinlun Li
- Department of Nephrology, Air Force Medical Center, PLA, No.30, Fucheng Road, Haidian District, Beijing, 100037, China.
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Zhao Z, Li J, Yang L, Ren G, Zhang L, Wang T. Hemophagocytic lymphohistiocytosis and histiocytic necrotizing lymphadenitis secondary to hemodialysis catheter-related bloodstream infection caused by Corynebacterium Striatum. BMC Nephrol 2023; 24:294. [PMID: 37803308 PMCID: PMC10559591 DOI: 10.1186/s12882-023-03356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND We herein described the coexistence of hemophagocytic lymphohistiocytosis (HLH) and histiocytic necrotizing lymphadenitis, alternatively known as the Kikuchi disease (KD), secondary to hemodialysis catheter-related bloodstream infection (BSI) caused by Corynebacterium striatum. CASE PRESENTATION A patient on maintenance hemodialysis had developed persistent fever and Corynebacterium striatum was subsequently identified from the culture of both catheter tip and peripheral blood. During mitigation of the BSI, however, his fever was unabated and ensuing workup further found thrombocytopenia, hyperferritinemia, hypertriglyceridemia, low NK cell activity and a surge in serum CD25 levels. Moreover, biopsy of the bone marrow and lymph node detected histopathological evidence of hemophagocytosis and KD, respectively. Upon these abnormalities, the title-bound diagnosis was considered and the patient was eventually recovered from the treatment of dexamethasone instead of antibiotics. Consistently, aberrations in his serum CD25 levels and NK cell activity had subsided two months after discharge. CONCLUSIONS Arguably, this encounter offered a unique chance to unravel the principal pathogenic cascade in immunobiology that made the three entities one disease continuum. As such, our work may add new understandings of HLH and/or KD secondary to severe infections in general and excessive release of cytokines in particular among patients with kidney diseases. The resultant early diagnosis is crucial to initiate appropriate treatment and improve the survival of patients with these challenging and potentially life-threatening disorders.
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Affiliation(s)
- ZhiPeng Zhao
- Graduate School of HeBei Medical University, No.361 East ZhongShan Boulevard, ShiJiaZhuang, 050011, China
- Department of Nephrology, the First Hospital of HeBei Medical University, No.89 DongGang Road, ShiJiaZhuang, 050030, China
| | - Jing Li
- Department of Nephrology, the First Hospital of HeBei Medical University, No.89 DongGang Road, ShiJiaZhuang, 050030, China
| | - Liu Yang
- Department of Hematology, the First Hospital of HeBei Medical University, No.89 DongGang Road, ShiJiaZhuang, 050030, China
| | - GuangWei Ren
- Department of Nephrology, the First Hospital of HeBei Medical University, No.89 DongGang Road, ShiJiaZhuang, 050030, China
| | - LiHong Zhang
- Department of Nephrology, the First Hospital of HeBei Medical University, No.89 DongGang Road, ShiJiaZhuang, 050030, China
| | - Tao Wang
- Department of Nephrology, the First Hospital of HeBei Medical University, No.89 DongGang Road, ShiJiaZhuang, 050030, China.
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Wang P, Wang Z, Li ZX, Ma SH, Li Y, Li H, Yang C, Yu M, Wang J, An YC, Li M. Efficacy and safety of Tongdutiaoshen acupuncture on insomnia in maintenance hemodialysis patients: A randomized clinical trial protocol. Contemp Clin Trials Commun 2023; 35:101196. [PMID: 37583470 PMCID: PMC10423895 DOI: 10.1016/j.conctc.2023.101196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 08/17/2023] Open
Abstract
Background Patients undergoing maintenance hemodialysis (MHD) experience insomnia frequently. Poor sleep quality impairs the quality of life and adversely affects long-term outcomes. Currently, the treatment of insomnia in patients undergoing MHD is mainly based on medication, although it has severe side effects and poor compliance in patients. Therefore, developing complementary and alternative therapies with higher efficacies is important. This study explores the clinical efficacy and safety of Tongdutiaoshen acupuncture in treating insomnia in patients with MHD. Methods This randomized controlled trial (RCT) will be performed at Beijing Luhe Hospital, affiliated with Capital Medical University in China. We will strictly adhere to the Standards for Reporting Interventions in Clinical Trials of Acupuncture (2010). A total of 110 MHD patients with insomnia will be randomly allocated in a 1:1 ratio to the drug control (DC) or Tongdutiaoshen acupuncture (TA) group. Patients in the control group will be administered estazolam tablets (1 mg/day) for four weeks, followed by a 4-week follow-up period. Based on the background therapy provided for the DC group, the TA group will be administered the interventional cohort three times a week for four weeks in a row, followed by a 4-week follow-up period. The primary endpoints will include the Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAM-A), TCM Insomnia Syndrome Score, and clinical response rate, which will be evaluated on days 0, 14, 28, and 56. Secondary endpoints will include sleep data monitoring and related laboratory indices, which will be evaluated on days 0, 28, and 56, respectively. Discussion This study is designed based on a rigorous methodology to evaluate the efficacy and safety of Tongdutiaoshen acupuncture for insomnia in patients undergoing hemodialysis. The findings of this trial will be published in peer-reviewed journals as reliable evidence. Trial registration Chinese Clinical Trial Registry ChiCTR2200061967. Registered on July 07, 2022.
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Affiliation(s)
- Pei Wang
- Center of Traditional Chinese Medicine, Beijing Luhe Hospital Affiliated to Capital Medical University, No.82, Xinhua South Street, Tongzhou Distract, Beijing, 101149, China
| | - Zheng Wang
- Center of Traditional Chinese Medicine, Beijing Luhe Hospital Affiliated to Capital Medical University, No.82, Xinhua South Street, Tongzhou Distract, Beijing, 101149, China
| | - Zhong-xin Li
- Kidney Center, Beijing Luhe Hospital Affiliated to Capital Medical University, No.82, Xinhua South Street, Tongzhou Distract, Beijing, 101149, China
| | - Si-hui Ma
- Kidney Center, Beijing Luhe Hospital Affiliated to Capital Medical University, No.82, Xinhua South Street, Tongzhou Distract, Beijing, 101149, China
| | - Yan Li
- Kidney Center, Beijing Luhe Hospital Affiliated to Capital Medical University, No.82, Xinhua South Street, Tongzhou Distract, Beijing, 101149, China
| | - Huan Li
- Department of Psychiatry, Beijing Luhe Hospital Affiliated to Capital Medical University, No.82, Xinhua South Street, Tongzhou Distract, Beijing, 101149, China
| | - Chao Yang
- Department of Psychiatry, Beijing Luhe Hospital Affiliated to Capital Medical University, No.82, Xinhua South Street, Tongzhou Distract, Beijing, 101149, China
| | - Man Yu
- Center of Traditional Chinese Medicine, Beijing Luhe Hospital Affiliated to Capital Medical University, No.82, Xinhua South Street, Tongzhou Distract, Beijing, 101149, China
| | - Jiao Wang
- Center of Traditional Chinese Medicine, Beijing Luhe Hospital Affiliated to Capital Medical University, No.82, Xinhua South Street, Tongzhou Distract, Beijing, 101149, China
| | - Yan-chen An
- Center of Traditional Chinese Medicine, Beijing Luhe Hospital Affiliated to Capital Medical University, No.82, Xinhua South Street, Tongzhou Distract, Beijing, 101149, China
| | - Min Li
- Center of Traditional Chinese Medicine, Beijing Luhe Hospital Affiliated to Capital Medical University, No.82, Xinhua South Street, Tongzhou Distract, Beijing, 101149, China
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Peng X, Feng S, Zhang P, Sang S, Zhang Y. Analysis of influencing factors of anxiety and depression in maintenance hemodialysis patients and its correlation with BDNF, NT-3 and 5-HT levels. PeerJ 2023; 11:e16068. [PMID: 37750080 PMCID: PMC10518163 DOI: 10.7717/peerj.16068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/20/2023] [Indexed: 09/27/2023] Open
Abstract
Objective The aim of this study is to examine the factors that contribute to anxiety and depression in individuals undergoing maintenance hemodialysis (MHD), as well as their association with serum levels of brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and serotonin (5-HT). Methods In May 2020 and June 2022, 120 MHD patients who received MDH treatment at our hospital were enrolled. The control group was composed of 60 healthy adults (>18) who completed the physical examination at the same time. The serum levels of BDNF, NT-3, and 5-HT in patients and clinical data of MHD patients with different degrees of anxiety and depression were compared. The Pearson correlation was used to evaluate the correlation between anxiety and depression scores and serum BDNF, NT-3,5-HT levels in patients with MHD. Multivariate analysis was employed to analyze the risk factors of anxiety and depression in MHD patients. Results The incidence of anxiety and depression in 120 MHD patients was 34.17% (41/120) and 64.17% (77/120), respectively. The levels of serum NT-3 and 5-HT in the anxiety group were higher than those in the non-anxiety and control group, and the levels of serum NT-3 in the non-anxiety group were higher than those in the control group (P < 0.05). The levels of serum BDNF, NT-3 and 5-HT in the depressed group were higher than those in the non-depressed group and control group, and the levels of serum NT-3 in the non-depressed group were higher than those in the control group (P < 0.05). SAS score was positively correlated with serum NT-3 and 5-HT levels, while the SDS score was negatively correlated with serum BDNF and positively correlated with serum NT-3 and 5-HT levels. Female, rural household registration, and restless leg syndrome were independent risk variables for anxiety in patients with MHD (P < 0.05). Rural household registration, economic deterioration, fatigue, insomnia, and vascular pain were independent variables of depression risk in patients with MHD. Conclusion Anxiety and depression in patients with MHD are closely related to the levels of serum BDNF, NT-3, and 5-HT. Female, rural household registration, more than eight dialysis times/month, insomnia, and restless leg syndrome are the risk factors for anxiety in patients with MHD. Rural household registration, economic deterioration, fatigue, insomnia, and vascular pain are the risk factors for depression in patients with MHD. The clinical implication of these findings suggests that these indexes may perhaps serve as biological indicators of anxiety and depression amongst patients undergoing MHD. Such investigation can hence contribute to early detection, monitoring, and potentially enable the depiction of novel therapeutic strategies for managing these adverse states.
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Affiliation(s)
- Xiaoyan Peng
- Department of Hemodialysis Center, Second Affiliated Hospital of Nantong University (First People’s Hospital), Nantong, China
| | - Sujuan Feng
- Department of Hemodialysis Center, Second Affiliated Hospital of Nantong University (First People’s Hospital), Nantong, China
| | - Poxuan Zhang
- Department of Hemodialysis Center, Second Affiliated Hospital of Nantong University (First People’s Hospital), Nantong, China
| | - Shengmei Sang
- International Guests Ward, Second Affiliated Hospital of Nantong University (First People’s Hospital), Nantong, China
| | - Yi Zhang
- Department of Science and Technology, Second Affiliated Hospital of Nantong University (First People’s Hospital), Nantong, China
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Xiong L, Chen QQ, Cheng Y, Lan YS, Yang JB, Wen XQ, Xie X, Kang T, Wu WH, Ou S. The relationship between coronary artery calcification and bone metabolic markers in maintenance hemodialysis patients. BMC Nephrol 2023; 24:238. [PMID: 37582785 PMCID: PMC10428586 DOI: 10.1186/s12882-023-03286-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND To study the influencing factors for coronary artery calcification (CAC) in maintenance hemodialysis (MHD) patients and the relationship between CAC and bone metabolism markers and to attempt to find a reliable marker linking vascular calcification and bone metabolism in MHD patients. METHODS A total of 123 patients were enrolled. CAC was assessed by multislice spiral computed tomography (MSCT), and the CAC score (CACS) was evaluated using the Agaston method. Routine laboratory parameters, including triglycerides (TG), total cholesterol (TC), glucose (Glu), calcium (Ca), phosphorus (P), magnesium (Mg), etc., were measured. Serum markers of bone metabolism, such as alkaline phosphatase(ALP), calcitonin (CT), 25-hydroxy vitamin D [25-(OH)D], intact parathyroid hormone (iPTH), total type I procollagen amino-terminal peptide (tPINP), N-terminal mid-fragment of osteocalcin (N-MID OC), and β-type I collagen crosslinked carboxyl-terminal peptide (β-CTX), were also measured. RESULTS Among 123 MHD patients, 37 patients (30.08%) did not have CAC, and 86 patients (69.92%) had CAC, including 41 patients (47.67%) with mild calcification and 45 patients (52.33%) with moderate to severe calcification. Age, Body Mass Index(BMI), the prevalence of hypertension and diabetes mellitus, TC, Glu, P, and Ca×P in the calcification group were higher than those in the noncalcification group, whereas Mg, iPTH, tPINP, N-MID OC, and β-CTX were lower than those in the noncalcified group (P < 0.05). Compared with the mild calcification group (0 0.05). A logistic regression model was used to evaluate the influencing factors for CAC. The results showed that age, BMI, TC, Glu, P, and Ca×P were risk factors for CAC and its severity in MHD patients, whereas diabetes mellitus, Mg, and N-MID OC were protective factors for CAC in MHD patients. In addition, N-MID OC was a protective factor for the severity of CAC. After adjusting for the corresponding confounding factors, the results of the risk factors were consistent, and N-MID OC was still an independent protective factor for CAC and its severity. CONCLUSIONS Elevated serum P and Ca×P were independent risk factors for CAC in MHD patients, and serum Mg may be an independent protective factor for CAC. CAC was closely related to abnormal bone metabolism and bone metabolic markers in MHD patients. Relatively low bone turnover can promote the occurrence and development of CAC. N-MID OC may be a reliable bone metabolic marker linking vascular calcification and bone metabolism in MHD patients.
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Affiliation(s)
- Lin Xiong
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, 25th Taiping Street, Luzhou, 646000, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
| | - Qi-Qi Chen
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, 25th Taiping Street, Luzhou, 646000, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
| | - Yong Cheng
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China;, China
| | - Yong-Shu Lan
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China;, China
| | - Jian-Bo Yang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China;, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, Sichuan, China
| | - Xiang-Qiong Wen
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, 25th Taiping Street, Luzhou, 646000, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
| | - Xin Xie
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, 25th Taiping Street, Luzhou, 646000, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
| | - Ting Kang
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, 25th Taiping Street, Luzhou, 646000, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
| | - Wei-Hua Wu
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, 25th Taiping Street, Luzhou, 646000, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
| | - Santao Ou
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, 25th Taiping Street, Luzhou, 646000, Sichuan, China.
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China.
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Liu J, Zhang H, Diao Z, Guo W, Huang H, Zuo L, Liu W. Epidemiological analysis of death among patients on maintenance hemodialysis: results from the beijing blood purification quality Control and Improvement Center. BMC Nephrol 2023; 24:236. [PMID: 37582779 PMCID: PMC10426135 DOI: 10.1186/s12882-023-03271-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/16/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND China has the largest number of patients on maintenance hemodialysis (MHD) worldwide. Despite continuous improvements in hemodialysis techniques, patients on MHD have a higher mortality rate than the general population. Understanding the characteristics of death in this population can better promote clinical practice, thereby improving patients' survival. METHODS We collected demographic and clinical data for patients on MHD registered in the Beijing Blood Purification Quality Control and Improvement Center database from 2014 to 2020. The annual mortality rate was calculatedand the primary cause of end-stage renal disease (ESRD), dialysis vintage, and cause of death among deceased patients were analyzed. RESULTS (1) 24,363 patients on MHD were included, of which 6,065 patients died from 2014 to 2020. The annual mortality rate fluctuated between 7.4% and 8.0%. The median age of death was 70.0 (60.8-79.0) years and the male to female ratio was 1.27:1 (2). The top three primary causes of ESRD in deceased patients were chronic glomerulonephritis (CGN), diabetic nephropathy (DN), and hypertensive nephropathy (HN). Comparison of the annual mortality rate showed DN > HN > CGN (3). The median dialysis vintage of deceased patients was 3.7 (1.8-6.9) years, which slowly increased annually. Patients with diabetes had a shorter dialysis vintage than patients without diabetes (3.4 vs. 4.1 years, Z = 8.3, P < 0.001) (4). The major causes of death were cardiovascular disease (20.2%), sudden death (18.1%), infection (17.9%), and cerebrovascular disease (12.6%). Proportions of death from cardiovascular disease, infection, and sudden death were higher in patients with diabetes (22.2%, 20.2%, and 20.0%) than patients without diabetes (18.4%, 15.8%, and 16.3%). Sudden death was the leading cause of death in young (18-44 years; 27.0%) and middle aged (45-64 years; 20.8%) patients, whereas infection was the leading cause of death in patients aged ≥ 75 years (24.5%). CONCLUSION The annual mortality rate of patients on MHD in Beijing was relatively stable from 2014 to 2020. Sudden death was more likely to occur in young and middle-aged patients, and more patients aged ≥ 75 years died from infections.
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Affiliation(s)
- Jing Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Huixian Zhang
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zongli Diao
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wang Guo
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongdong Huang
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Peking University, Beijing, China.
| | - Wenhu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Hu H, Wu C, Kwok JYY, Ho MH, Chau PH, Lok KYW, Choi EPH. Effects of Different Exercises on Physical Function, Dialysis Adequacy, and Health-Related Quality of Life in Maintenance Hemodialysis Patients: A Systematic Review and Network Meta-Analysis. Am J Nephrol 2023; 54:379-390. [PMID: 37536298 DOI: 10.1159/000532109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Clinical guidelines recommend exercise training for patients undergoing maintenance hemodialysis (MHD). However, the effectiveness of different types of exercise remains uncertain. OBJECTIVES The aims of the study were to compare and rank the effect of different types of exercise on walking capacity, cardiorespiratory fitness, dialysis adequacy, and health-related quality of life (HRQOL) in patients undergoing MHD. METHODS Eight databases (four English and four Chinese) were searched from inception to January 1, 2022. Randomized controlled trials evaluating the efficacy of different exercises for patients undergoing MHD were included. Two independent reviewers screened the literature, extracted data, assessed the risk of bias, and evaluated the certainty of evidence. A frequentist random-effect network meta-analysis was conducted. RESULTS Ninety trials with 4,084 participants comparing 15 types of exercise were included, reporting on the six-minute walking test (45 trials), peak oxygen uptake (22 trials), dialysis adequacy (30 trials), and HRQOL (23 trials). Network meta-analysis showed that the most effective intervention for walking capacity was intradialytic aerobic exercise combined with blood flow restriction with a mean difference and 95% confidence interval of 97.35 (11.89-182.81), for peak oxygen uptake it was non-intradialytic combined aerobic and resistance exercise with a value of 4.35 (2.25-6.44), for dialysis adequacy it was intradialytic combined aerobic and resistance exercise with a value of 0.17 (0.06-0.28), for the physical component summary of HRQOL it was intradialytic aerobic exercise with a value of 4.93 (2.31-7.54), and for the mental component summary of HRQOL it was non-intradialytic combined aerobic and resistance exercise with a value of 6.36 (0.45-12.27). Ultimately, intradialytic combined aerobic and resistance exercise could improve all the above outcomes compared to usual care. CONCLUSIONS This study concluded that intradialytic combined aerobic and resistance exercise is optimal for MHD patients due to its significant positive effects on multiple outcomes. Walking capacity can be further enhanced by combining blood flow restriction with exercise. For improving dialysis adequacy, intradialytic exercise proves to be more effective than non-intradialytic exercise. Further well-designed clinical trials are needed to investigate the effects of exercise with varying durations, intensities, and frequencies.
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Affiliation(s)
- Huagang Hu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China,
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China,
| | - Chanchan Wu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jojo Yan Yan Kwok
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Pui Hing Chau
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kris Yuet Wan Lok
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Edmond Pui Hang Choi
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Mao Y, Xu L, Xu J, Tang Y, Liu T. Application Value of Limb Ischemic Preconditioning in Preventing Intradialytic Hypotension during Maintenance Hemodialysis. Kidney Blood Press Res 2023; 48:535-544. [PMID: 37497943 PMCID: PMC10614484 DOI: 10.1159/000531855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION The aim of this study was to investigate the efficacy and safety of limb ischemia preconditioning (LIPC) in the treatment of intradialytic hypotension (IDH) in patients with maintenance hemodialysis (MHD). METHODS This was a single-center, prospective, and randomized controlled case study. A total of 38 patients with MHD who met the inclusion criteria from September 2021 to August 2022 were selected from the Blood Purification Center of our hospital. They were randomly divided into the LIPC group (n = 19) and the control group (n = 19). For patients in the LIPC group, the femoral artery blood flow was blocked with an LIPC instrument for 5 min (pressurized to 200 mm Hg) before each dialysis, and they were reperfused for 5 min. The cycle was repeated five times, with a total of 50 min for 12 weeks. The control group was pressurized to 20 mm Hg with an LIPC instrument, and the rest was the same as the LIPC group. The blood pressure of 0 h, 1 h, 2 h, 3 h, 4 h, and body weight before and after hemodialysis were measured in the two groups during hemodialysis, the incidence of IDH and the changes of serum troponin I (TNI) and creatine kinase isoenzyme MB (CK-MB) levels before and after the intervention were observed, and the ultrafiltration volume and ultrafiltration rate were recorded. RESULTS At the 8th and 12th week after intervention, the MAP in the LIPC group was higher than that in the control group (103.28 ± 12.19 mm Hg vs. 93.18 ± 11.11 mm Hg, p = 0.04; 101.81 ± 11.36 mm Hg vs. 91.81 ± 11.92 mm Hg, p = 0.047). The incidence of IDH in the LIPC group was lower than that in the control group (36.5% vs. 43.1%, p = 0.01). The incidence of clinical treatment in IDH patients in the LIPC group was lower than that in the control group (6.3% vs. 12.4%, p = 0.00). The incidence of early termination of hemodialysis in the LIPC group was lower than that in the control group (1.6% vs. 3.8%, p = 0.01). The levels of TNI and CK-MB in the LIPC group after the intervention were lower than those in the control group (322.30 ± 13.72 ng/dL vs. 438.50 ± 24.72 ng/dL, p = 0.00; 159.78 ± 8.48 U/dL vs. 207.00 ± 8.70 U/dL, p = 0.00). The changes of MAP before and after the intervention were negatively correlated with the changes of TNI and CK-MB before and after the intervention (r = -0.473, p = 0.04; r = -0.469, p = 0.04). There were no differences in dry body mass and ultrafiltration rate between the two groups before and after the LIPC intervention (p > 0.05). Multiple linear regression analysis shows that TNI is the main influencing factor of ΔMAP. No LIPC-related adverse events were found during the study period. CONCLUSION LIPC can effectively reduce the incidence of IDH in patients with MHD and may be associated with the alleviation of myocardial damage.
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Affiliation(s)
- Yaqin Mao
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China,
- Graduate School, Dalian Medical University, Dalian, China,
| | - Linfang Xu
- Blood Purification Center, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Juntian Xu
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
- Graduate School, Dalian Medical University, Dalian, China
| | - Yushang Tang
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
- Blood Purification Center, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Tongqiang Liu
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
- Blood Purification Center, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
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Yang S, Diao Z, Liu W, Guo W. Effect of dialytic phosphate reduction rate on mortality in maintenance hemodialysis patients: a matched case-control study. BMC Nephrol 2023; 24:167. [PMID: 37308828 DOI: 10.1186/s12882-023-03199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/14/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Phosphates, similar to urea, are small molecular substances that can be cleared during dialysis. Dialytic phosphate reduction rate (PRR) may, to some extent, be related to the relative amount of phosphates cleared during dialysis. However, few studies have evaluated the associations between PRR and mortality in maintenance hemodialysis (MHD) patients. In this study, we investigated the association between PRR and clinical outcomes in MHD patients. METHODS This was a retrospective, matched case-control study. Data were collected from the Beijing Hemodialysis Quality Control and Improvement Center. Patients were divided into four groups according to PRR quartile. Age, sex, and diabetes were matched between the groups. The primary outcome was all-cause death, and the secondary outcome was cardiocerebrovascular death. RESULTS The study cohort comprised 4063 patients who were divided into four groups according to the PRR quartile: group PRR1 (< 48.35%), group PRR2 (48.35% - 54.14%), group PRR3 (54.14% - 59.14%), and group PRR4 (≥ 59.14%). We enrolled 2172 patients (543 in each study group) by case-control matching. The all-cause death rates were as follows: group PRR1: 22.5% (122/543), group PRR2: 20.1% (109/543), group PRR3: 19.3% (105/543), and group PRR4: 19.3% (105/543). No significant differences in all-cause and cardiocerebrovascular death rates according to the Kaplan-Meier survival curves were found between the groups (log-rank test, P > 0.05). Multivariable Cox regression analysis revealed no significant differences in all-cause and cardiocerebrovascular death rates between the four groups (P = 0.461; adjusted hazard ratio, 0.99; 95% confidence interval, 0.97 - 1.02 versus P = 0.068; adjusted hazard ratio, 0.99; 95% confidence interval, 0.97 - 1.00, respectively). CONCLUSIONS Dialytic PRR was not significantly associated with all-cause death and cardiocerebrovascular death in MHD patients.
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Affiliation(s)
- Shuixiu Yang
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
- Blood Purification Center, Guiyang Public Health Clinical Center, Guiyang, 550001, Guizhou, China
| | - Zongli Diao
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Wenhu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Wang Guo
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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Xiao P, Wang ZH, Lu Y, Zhang S, Jin YX, Liu X, Jiang ZL, Liu SX. Association between corrected serum calcium levels after dialysis and post-dialysis fatigue risk: a hospital-based case-control study. Eur J Med Res 2023; 28:173. [PMID: 37183248 PMCID: PMC10184336 DOI: 10.1186/s40001-023-01131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/28/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE Post-dialysis fatigue (PDF) is an important problem in patients undergoing maintenance hemodialysis (MHD); however, evidence of the association between serum calcium after dialysis and the risk of PDF is limited and controversial. We explored this association among patients receiving MHD. METHODS We carried out a case-control study of patients in the dialysis unit of Dalian Municipal Central Hospital between December 2019 and January 2020, including 340 patients with PDF and 270 patients without PDF. PDF was assessed by a \validated self-administered questionnaire. Clinical variables were tested for multicollinearity using variance inflation factor analysis. Corrected serum calcium levels were categorized into three groups, with the lowest tertile used as the reference category. The odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for PDF risk were estimated using an unconditional logistic regression model. RESULT After adjusting for potential confounders, corrected serum calcium levels showed a significant positive association with the risk of PDF (ORT3vs.T1 = 1.61, 95% CI = 1.01-2.58). Notably, after stratification by age, corrected serum calcium was also positively associated with the risk of PDF in patients aged ≥ 65 years (ORT3vs.T1 = 4.25, 95% CI 1.66-11.46). Furthermore, a significant linear trend and interaction were also observed (P < 0.05). DISCUSSION Higher corrected serum calcium levels after dialysis might increase the risk of PDF among MHD patients. However, further studies are warranted to confirm these findings.
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Affiliation(s)
- Ping Xiao
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Zhi-Hong Wang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Yan Lu
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Shuang Zhang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Yu-Xin Jin
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Xin Liu
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Zhen-Li Jiang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Shu-Xin Liu
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China.
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China.
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China.
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He X, Liu Y. Effects of arteriovenous fistulas and central venous catheters on the cardiac function and prognosis of patients on maintenance hemodialysis. Pak J Med Sci 2023; 39:780-784. [PMID: 37250573 PMCID: PMC10214819 DOI: 10.12669/pjms.39.3.7151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/20/2022] [Accepted: 02/28/2023] [Indexed: 11/02/2023] Open
Abstract
Objective To investigate the effects of arteriovenous fistulas (AVFs) and central venous catheters (CVCs) on the left ventricular function (LVF) and prognosis of maintenance hemodialysis (MHD) patients. Methods This retrospective cohort study included 270 patients (139 with AVF and 131 with CVC) undergoing dialysis with newly established vascular access in the blood purification center of Nanhua hospital, University of South China, from January 2019 to April 2021. Dialysis efficiencies, LVF indexes, and one-year prognoses were compared. Results At six and twelve months after the establishment of vascular access, the mean urea clearances (Kt/V) and urea reduction ratio (URR) between the AVF- and the CVC-group were similar (P>0.05). The mean LVF values between the two groups were also similar before the establishment of vascular access (P>0.05), but the mean values of left ventricular end diastolic diameter (LVEDd), interventricular septal thickness (IVSTd), and left ventricular posterior wall thickness (LVPWT) in the AVF-group were higher than those in the CVC-group one year later, and mean early (E) and late (A) diastolic mitral velocities, E/A, and ejection fraction (EF) were lower than those in the CVC-group (P<0.05). The incidence of left ventricular hypertrophy and systolic dysfunction in the AVF-group was higher than that in the CVC-group (P<0.05). The hospitalization rate of AVF-group (23.02%) was lower than that of the CVC-group (49.61%) (P<0.05). Conclusion Both AVF and CVC can achieve appropriate dialysis effects in MHD patients. AVF has a negative impact on cardiac function while CVC has a high hospitalization rate.
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Affiliation(s)
- Xufeng He
- Xufeng He Nanhua Hospital, University of South China, Health School of Nuclear Industry, Hengyang 421002, Hunan Province, P.R. China
| | - Yang Liu
- Yang Liu, Department of Hemodialysis Room, Nanhua hospital, University of South China, Hengyang 421002, Hunan Province, P.R. China
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Wang X, Xia F, Wang G. Mediating effect of anxiety and depression between family function and hope in patients receiving maintenance hemodialysis: a cross-sectional study. BMC Psychol 2023; 11:130. [PMID: 37098642 PMCID: PMC10127155 DOI: 10.1186/s40359-023-01169-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 04/27/2023] Open
Abstract
OBJECTIVES This study aimed to explore the levels of hope in patients receiving maintenance hemodialysis (MHD), and whether anxiety and depression mediate the relationship between family function and hope. METHODS The family APGAR index, hospital anxiety and depression scale, and Herth hope index were recorded using the self-reported questionnaires completed by 227 MHD patients. RESULTS The family function can directly predict hope, positively predict hope through depression (β = 0.052, p = 0.001), and positively predict hope through the chain mediating of anxiety and depression (β = 0.087, p = 0.001), according to chain mediation analysis. The total effect size was 28.31%. The total indirect effect value was 0.139, and the total effect value was 0.491. CONCLUSIONS Our findings suggest that family function had a direct impact on MHD patients' hope, and that lowering anxiety and depression can help to feel more hopeful.
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Affiliation(s)
- Xuefen Wang
- Nursing Department, Renmin Hospital of Wuhan University, Wuhan City, 430060, Hubei Province, China
| | - Fuhai Xia
- Nursing Department, Renmin Hospital of Wuhan University, Wuhan City, 430060, Hubei Province, China.
| | - Guoqing Wang
- Hemodialysis Center, Renmin Hospital of Wuhan University, Wuhan City, 430060, Hubei Province, China
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Wen J, Fang Y, Su Z, Cai J, Chen Z. Mental health and its influencing factors of maintenance hemodialysis patients: a semi-structured interview study. BMC Psychol 2023; 11:84. [PMID: 36978141 PMCID: PMC10054072 DOI: 10.1186/s40359-023-01109-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Maintenance hemodialysis (MHD) is a commonly used renal replacement therapy for end-stage renal disease patients. MHD patients have undergone multiple physiological stressors, which may cause physical problems and affect their mental health; however, few qualitative studies have been done on the mental health of MHD patients. Such qualitative research becomes the basis for further quantitative research and is critical to validating its results. Therefore, the current qualitative study used a semi-structured interview format, and aimed to explore the mental health and its influencing factors of MHD patients who are not receiving intervention treatment to determine how best to ameliorate their mental health. METHODS Based on the application of Grounded Theory, semi-structured face-to-face interviews were conducted with 35 MHD patients, following consolidated criteria for reporting qualitative studies (COREQ) guidelines. Two indicators (emotional state and well-being) were used to assess MHD patients' mental health. All interviews were recorded, after which two researchers independently performed data analyses using NVivo. RESULTS Acceptance of disease, complications, stress and coping styles, and social support were found to be the influencing factors of MHD patients' mental health. High acceptance of disease, healthy coping styles, and high social support were positively correlated with mental health. In contrast, low acceptance of disease, multiple complications, increased stress, and unhealthy coping styles were negatively correlated with mental health. CONCLUSION One's acceptance of the disease played a more significant role than other factors in affecting MHD patients' mental health.
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Affiliation(s)
- Junjun Wen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 101408, China
- Hemodialysis Center, Zhanlanlu Hospital, Beijing, 100044, China
| | - Yuan Fang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
| | - Zhongyan Su
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 101408, China
| | - Jimin Cai
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 101408, China
| | - Zhiyan Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.
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Wei S, Jiao J, Yu Y, Tian X, Yang X, Feng S, Li Y, Zhang P, Bai M. Long-term arteriovenous fistula prognosis for maintenance hemodialysis patients who accepted PIRRT by using arteriovenous fistula. Int J Artif Organs 2023; 46:195-201. [PMID: 36945121 DOI: 10.1177/03913988231162384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Maintenance hemodialysis (MHD) patients are often admitted to the hospital for severe morbidities. Prolonged intermittent renal replacement therapy (PIRRT) is required during the hospital staying. There are controversial opinions on the use of arteriovenous fistula (AVF) as vascular access for PIRRT in MHD patients. METHODS Patients with AVF who accepted PIRRT in our center between January 2014 and June 2021 were retrospectively screened. AVF dysfunction and patient mortality were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of AVF dysfunction. RESULTS About 162 patients were included in our present study. Twenty-six experienced AVF dysfunction, of whom 53.8%, 19.2%, and 27.0% had percutaneous transluminal balloon angioplasty, surgical revision, and AVF reconstruction, respectively. The accumulated AVF dysfunction rates were 11.8%, 16.2%, and 21.0% in 1, 2, and 3 years, respectively. Multivariate analysis revealed that smoking (HR 2.750, 95% CI 1.181-6.402, p = 0.019), higher platelet (PLT, HR 1.009, 95% CI 1.000-1.017, p = 0.047), higher prothrombin activity (PTA, HR 1.039, 95% CI 1.012-1.066, p = 0.004), and lower diastolic blood pressure (DBP, HR 0.963, 95% CI 0.932-0.996, p = 0.026) were independent risk factors for AVF dysfunction. During the follow-up period, 37 patients died. CONCLUSIONS Overall, the use of AVF for PIRRT might not dramatically increase the incidence of AVF dysfunction. And, Smoking, lower DBP, higher PLT, and higher PTA were associated with increased AVF dysfunction.
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Affiliation(s)
- Suijiao Wei
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
- Xi'an Medical University, Xi'an, Shaanxi, China
| | - Jing Jiao
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
- Xi'an Medical University, Xi'an, Shaanxi, China
| | - Yan Yu
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiujuan Tian
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaoxia Yang
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shidong Feng
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yajuan Li
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Peng Zhang
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ming Bai
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
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Tang X, Wang L, Ni S, Wu M, Hu S, Zhang L. Feasibility and effect of emotional freedom therapy on sleep quality in patients with end-stage renal disease receiving maintenance hemodialysis: A pilot study. Geriatr Nurs 2023; 51:112-120. [PMID: 36940505 DOI: 10.1016/j.gerinurse.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/22/2023]
Abstract
OBJECTIVE To explore the feasibility and efficacy of emotional freedom therapy (EFT) in improving sleep quality and managing negative emotions in end-stage renal disease patients on maintenance hemodialysis. METHODS Between May 2021 and February 2022, 66 maintenance hemodialysis patients with sleep problems were recruited and randomized into an intervention and control group. The intervention group underwent a 12-week intervention of EFT. Two groups' hospital anxiety depression scale (HADS) scores, Pittsburgh sleep quality index (PSQI), and interdialysis weight gain (IDWG) before and one week after the formal intervention were collected and compared. Feasibility analysis was performed using a feasibility questionnaire and in-depth interviews with patients. RESULTS Before the intervention, there was no statistical difference in the anxiety, depression, PSQI scores and IDWG between the two groups. After balancing the effects of gender and pre-intervention scores, two-way ANCOVA results showed that there were statistically significant differences between the two groups after the intervention in terms of anxiety, depression, sleep quality, sleep duration, daytime dysfunction and PSQI total score. However, interactions effect for IDWG was statistically significant. Simple effects analysis revealed a difference in post-intervention IDWG between the intervention and control groups for patients over 65 (p < 0.05). Most patients agreed or strongly agreed that the EFT was easy to schedule and they did not experience difficulties during learning the EFT process (respectively 75% and 71.88%). And 75% of the participants were willing to continue practicing EFT. Qualitative content analysis identified five prominent categories related to feasibility and acceptability: affirmation, benefits, communication, support and trust. CONCLUSION EFT can relieve anxiety and depression, enhance sleep quality, and improve the physical condition of patients with end-stage renal disease receiving maintenance hemodialysis. As well, the EFT intervention is practicable, acceptable, and perceived as being beneficial to the patient.
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Affiliation(s)
- Xin Tang
- Department of Nursing, Medical College of Hunan Normal University, Changsha 410013, PR China; Hemodialysis Center, Lukou District Hospital of Traditional Chinese Medicine, Zhuzhou, Hunan 412000, PR China
| | - Li Wang
- Department of Nursing, Medical College of Hunan Normal University, Changsha 410013, PR China
| | - Siyao Ni
- Department of Nursing, Medical College of Hunan Normal University, Changsha 410013, PR China
| | - Mengyu Wu
- Department of Nursing, Medical College of Hunan Normal University, Changsha 410013, PR China
| | - Shengnan Hu
- Department of Nursing, Medical College of Hunan Normal University, Changsha 410013, PR China
| | - Liuyi Zhang
- Department of Nursing, Medical College of Hunan Normal University, Changsha 410013, PR China.
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Fan Z, Feng Y, Zang L, Guo Y, Zhong XY. Association of circulating MtDNA with CVD in hemodialysis patients and in vitro effect of exogenous MtDNA on cardiac microvascular inflammation. BMC Cardiovasc Disord 2023; 23:74. [PMID: 36755219 PMCID: PMC9906832 DOI: 10.1186/s12872-023-03104-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) patients sustain a fairly high prevalence of cardiovascular disease (CVD). Microvascular inflammation is an early manifestation of CVD, and the released mitochondrial DNA (MtDNA) has been proposed to be a crucial integrator of inflammatory signals. Herein, the aim of this study was to determine the relationship between CVD, microvessel, and circulating MtDNA in the settings of uremia. METHODS Forty-two maintenance hemodialysis (MHD) patients and 36 health controls were enrolled in this study. Plasma cell-free MtDNA was detected by TaqMan-based qPCR assay. CVD risk markers including high-sensitive C-reactive protein (Hs-CRP), monocyte chemoattractant protein-1 (MCP-1), fibrinogen, and erythrocyte sedimentation rate (ESR) were measured by standard assays. Ten-year CVD risk was calculated from the Framingham risk score (FRS) model. In vitro study, human cardiac microvascular endothelial cells (HCMECs) were incubated with normal or uremic serum, with or without exogenous MtDNA. Intracellular toll-like receptor 9 (TLR9), adhesion molecule 1 (ICAM-1), MCP-1 and tumor necrosis factor-α (TNF-α) and cytosolic MtDNA were detected by qPCR. RESULTS Plasma MtDNA in MHD patients was significantly higher than healthy controls (4.74 vs. 2.41 × 105 copies/mL; p = 0.000). Subsequently, the MHD patients were classified into two groups based on the MtDNA median (4.34 × 105 copies/mL). In stratified analyses, the levels of Hs-CRP (5.02 vs. 3.73 mg/L; p = 0.042) and MCP-l (99.97 vs. 64.72 pg/mL; p = 0.008) and FRS (21.80 vs. 16.52; p = 0.016) in the high plasma MtDNA group were higher than those in the low plasma MtDNA group. In vitro study, we found that exogenous MtDNA aggravated uremic serum-induced microvascular inflammation (ICAM-1 and TNF-α) in HCMECs (all p < 0.05). Besides, the addition of MtDNA to the medium resulted in a further increase in cytosolic MtDNA and TLR9 levels in uremic serum-treated cells (all p < 0.05). In patients with MHD, MtDNA levels in plasma were significantly reduced after a single routine hemodialysis (pre 4.47 vs. post 3.45 × 105 copies/mL; p = 0.001) or hemodiafiltration (pre 4.85 vs. post 4.09 × 105 copies/mL; p = 0.001). These two approaches seem similar in terms of MtDNA clearance rate (21.26% vs. 11.94%; p = 0.172). CONCLUSIONS Overall, the present study suggests that MtDNA released into the circulation under the uremic toxin environment may adversely affect the cardiovascular system by exacerbating microvascular inflammation, and that reducing circulating MtDNA might be a future therapeutic strategy for the prevention of MHD-related CVD.
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Affiliation(s)
- Zhen Fan
- Department of Geriatrics, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan China
| | - Ya Feng
- grid.414880.1Department of Nephrology, Clinical Medical College, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan China
| | - Li Zang
- grid.414880.1Department of Nephrology, Clinical Medical College, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan China
| | - Yi Guo
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, West Section 2, Yihuan Road, Qingyang District, Chengdu, 610072, Sichuan, China.
| | - Xiao-yi Zhong
- grid.417298.10000 0004 1762 4928Department of Nephrology, Xinqiao Hospital, Army Medical University (Third Military Medical University), No. 83 Xinqiao Zhengjie, Shapingba District, Chongqing, 400037 China
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Jauwerissa R, Marbun MBH, Nugroho P, Rinaldi I, Suhardjono S, Shatri H, Laksmi PW, Hasan I. Factors Associated with Sarcopenia in Maintenance Hemodialysis Patients: A Cross-Sectional Study. Acta Med Indones 2023; 55:26-32. [PMID: 36999268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND Sarcopenia is associated with worse outcomes in maintenance hemodialysis (MHD) patients. Differences in criteria and methods used to diagnose sarcopenia, results in a wide range of prevalence. Factors associated with sarcopenia in MHD have not been well-studied. This study aimed to investigate the prevalence and factors associated with sarcopenia in the MHD population. METHODS Observational cross-sectional study was done with 96 MHD patients aged ≥18 years old, with dialysis vintage ≥120 days at Cipto Mangunkusumo Hospital March-May 2022. Descriptive, bivariate, and logistic regression analysis were done to find sarcopenia's prevalence and association with Simplify Creatinine Index (SCI), type 2 diabetes (DM), Interleukin-6 (IL-6), nutritional status, physical activity, and phosphate serum level. Asian Working Group for Sarcopenia (AWGS) 2019 criteria used to diagnose sarcopenia, Hand Grip Strength (HGS) to identify muscle strength, Bioimpedance Spectroscopy (BIS) to calculate muscle mass, and 6-meter walk test to evaluate physical performance. RESULTS The prevalence of sarcopenia was 54.2%. Factors with a significant association in bivariate analysis were phosphate serum level (p=0.008), SCI (p=0.005) and low physical activity (International Physical Activity Questionnaire) (p-0.006). Logistic regression analysis found higher phosphate serum level and high physical activity protective of sarcopenia (OR 0.677;CI95% 0.493-0.93 and OR 0.313;CI95% 0.130-0.755 respectively). CONCLUSION The prevalence of sarcopenia in the MHD population was 54.2%. Phosphate serum level, SCI, and physical activity were significantly correlated with sarcopenia. Both high phosphate level and high physical activity were protective against sarcopenia.
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Affiliation(s)
- Ria Jauwerissa
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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Ye W, Wang L, Wang Y, Wang C, Zeng J. Depression and anxiety symptoms among patients receiving maintenance hemodialysis: a single center cross-sectional study. BMC Nephrol 2022; 23:417. [PMID: 36585621 PMCID: PMC9804950 DOI: 10.1186/s12882-022-03051-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To investigate depression and anxiety and related factors among patients receiving maintenance hemodialysis (MHD). METHODS This cross-sectional study included patients underwent MHD in 3/2022 at Jinshan Hospital affiliated to Fudan University. Depression and anxiety levels of patients were assessed using Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. SF-36 was used to assess patients' quality of life. Multiple linear regression analysis was used to determine the variables associated with the scores of BDI/BAI. RESULTS A total of 103 patients were included, 71 cases (68.93%) and 38 cases (36.89%) with depression and anxiety, respectively. The scores of almost all domains of the SF-36 showed a declining trend with increasing depression or anxiety among patients on MHD. Higher Charlson Comorbidity Index (CCI) (β =0.066, 95%CI: 0.016-0.116, P = 0.010), lower educational status (β = - 0.139, 95%CI: - 0.243- -0.036, P = 0.009), and number of oral medications (β =0.177, 95%CI: 0.031-0.324, P = 0.018) were significantly associated with higher BDI scores. Longer dialysis duration (β =0.098, 95%CI: 0.003-0.193, P = 0.044) and number of oral medications (β =4.714, 95%CI: 1.837-7.590, P = 0.002) were significantly associated with higher BAI scores. CONCLUSIONS Depression and anxiety may be likely to occur among patients undergoing MHD and impact their quality of life. Higher CCI, lower educational status and usage of multiple oral medications may be associated with depression, whereas longer dialysis duration and multiple oral medications may be associated with anxiety in MHD patients.
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Affiliation(s)
- Wei Ye
- grid.8547.e0000 0001 0125 2443Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Lizhen Wang
- grid.8547.e0000 0001 0125 2443Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Yu Wang
- grid.8547.e0000 0001 0125 2443Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Chengjun Wang
- grid.8547.e0000 0001 0125 2443Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Jingyi Zeng
- grid.415108.90000 0004 1757 9178Department of Nephrology, Fujian Provincial Hospital, Fuzhou, 350001 China
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Zhou X, Kong Y, Ma Z, Liu T, Wan T, Zhang W, Zhao P, Wang Y, Ma L, Wang G, Wang X, Liang Y, Du X, Ning Y, Deng R, Tang Y, Hu W, Wang J. Evaluation of malnutrition and inflammation after total parathyroidectomy in patients on maintenance dialysis. Int Urol Nephrol 2022. [PMID: 36510041 DOI: 10.1007/s11255-022-03436-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the effect of total parathyroidectomy (tPTx) on malnutrition and inflammation in patients on maintenance dialysis (MHD) having secondary hyperparathyroidism (SHPT). METHODS Twenty-five patients on MHD having SHPT who were being treated with tPTx were selected, and changes in their general condition (dry body mass), parathyroid hormone (PTH) and calcium levels, nutrition state (hemoglobin, hematocrit, serum albumin, and total iron binding capacity), and inflammatory status [serum C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and the malnutrition-inflammation score (MIS)] were observed at 12, 24, and 36 months postoperatively. RESULTS Compared with the preoperative period, the dry body mass increased at 12, 24, and 36 months postoperatively (P < 0.01), hemoglobin, hematocrit, and serum albumin increased significantly (P < 0.01), whereas calcium, phosphorus, and PTH levels decreased significantly (P < 0.01). Serum CRP, IL-6, and TNF-α levels were significantly decreased at 12, 24, and 36 months after surgery (P < 0.01). Furthermore, MIS was reduced as well but to a lesser extent (P < 0.01). CONCLUSION tPTx effectively reduced MIS in maintenance dialysis patients, and the alleviated malnutrition and improved inflammatory status may contributed to improving the quality of life of patients on MHD with SHPT.
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Cancarevic I, Nassar M, Daoud A, Ali H, Nso N, Sanchez A, Parikh A, Ul Hosna A, Devanabanda B, Ahmed N, Soliman KM. Mortality rate of COVID-19 infection in end stage kidney disease patients on maintenance hemodialysis: A systematic review and meta-analysis. World J Virol 2022; 11:352-361. [PMID: 36188740 PMCID: PMC9523330 DOI: 10.5501/wjv.v11.i5.352] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/20/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been the most talked-about disease of the past few years. Patients with significant comorbidities have been at particular risk of adverse outcomes. This study looked at the outcomes and risk factors for adverse outcomes among patients on chronic hemodialysis for end-stage renal disease, a group of patients known to be particularly susceptible to infectious complications.
AIM To assess outcomes and risk factors for adverse outcomes of COVID-19 infection among patients on chronic hemodialysis.
METHODS We searched PubMed/MEDLINE, EMBASE, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Web of Science databases for relevant terms and imported the results into the Covidence platform. From there, studies were assessed in two stages for relevance and quality, and data from studies that satisfied all the requirements were extracted into a spreadsheet. The data was then analyzed descriptively and statistically.
RESULTS Of the 920 studies identified through the initial database search, only 17 were included in the final analysis. The studies included in the analysis were mostly carried out during the first wave. We found that COVID-19 incidence among patients on hemodialysis was significant, over 10% in some studies. Those who developed COVID-19 infection were most likely going to be hospitalized, and over 1 in 5 died from the infection. Intensive care unit admission rate was lower than the infection lethality rate. Biochemical abnormalities and dyspnea were generally reported to be associated with adverse outcomes.
CONCLUSION This systematic review confirms that patients on chronic hemodialysis are very high-risk individuals for COVID-19 infections, and a significant proportion was infected during the first wave. Their prognosis is overall much worse than in the general population, and every effort needs to be made to decrease their exposure.
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Affiliation(s)
- Ivan Cancarevic
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Ahmed Daoud
- Department of Medicine, Kasr Alainy Medical School, Cairo University, Cairo 11562, Egypt
| | - Hatem Ali
- Department of Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Angelica Sanchez
- Department of Medicine, Universidad Autonoma de Santo Domnigo, Santo Domingo 10105, Dominican Republic
| | - Avish Parikh
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Asma Ul Hosna
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Bhavana Devanabanda
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Nazakat Ahmed
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Karim M Soliman
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
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Lu W, Jiang G. Hemoperfusion in Maintenance Hemodialysis Patients. Blood Purif 2022; 51:1-9. [PMID: 35952627 DOI: 10.1159/000525952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022]
Abstract
The accumulation of protein-bound uremic toxins and medium-large molecule toxins in maintenance hemodialysis (MHD) patients is one of the causes of long-term dialysis-related complications. Hemoperfusion can remove these uremic toxins and reduce the complications of MHD patients. Upon a review of the Chinese and international literature, combined with practical experience of clinical diagnosis and treatment, the Shanghai Medical Association Society of Nephrology reached a consensus on the clinical applications of hemoperfusion in MHD patients. This consensus included four aspects: selection of appropriate patients, treatment frequency, treatment methods, and adverse reactions and precautions and provided guidelines for the rational and standardized treatment of hemoperfusion in MHD patients.
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Affiliation(s)
- Wei Lu
- Renal Division, Department of Internal Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gengru Jiang
- Renal Division, Department of Internal Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Centre for Rare Disease, Shanghai, China
- Shanghai Medical Association Society of Nephrology, Shanghai, China
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Lu H, Wu H, Yang Y, Feng X, Ma X, Xie Y, Xie D, Wang W, Lo ECM, Ye W. Relationship between chronic periodontitis and inflammatory cytokines in patients undergoing maintenance hemodialysis. Clin Oral Investig 2022; 26:6699-6709. [PMID: 35861756 DOI: 10.1007/s00784-022-04629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/12/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate the correlation between serum and gingival crevicular fluid (GCF) levels of inflammatory cytokines and the association with periodontal parameters in patients with maintenance hemodialysis (MHD) and healthy control. MATERIALS AND METHODS Patients who were undergoing MHD were enrolled as the MHD group. Healthy individuals who underwent oral examination were selected as the control group after matching for the MHD group. All participants underwent a full-mouth periodontal evaluation, and the levels of eight inflammatory cytokines, including IL-1β, IL-17, IL-6, IL-8, and tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase-8 (MMP-8), and C-reactive protein (CRP), in the GCF and serum were measured. RESULTS A total of 63 MHD patients and 75 healthy persons were included. The prevalence of moderate/severe periodontitis was significantly higher in the MHD group than in the control group (88.9 vs. 66.7%, P < 0.05). The GCF levels of CRP, TNF-α, MCP-1, and MMP-8 were higher in patients in the MHD group with moderate/severe periodontitis than in the control group (P < 0.05). Serum CRP, MCP-1, TNF-α, and MMP-8 levels were positively correlated with the GCF CRP levels (P < 0.05). The GCF and serum CRP levels were positively correlated with the periodontal clinical parameters (P < 0.05). CONCLUSIONS Serum CRP, MCP-1, TNF-α, and MMP-8 may relate with the GCF CRP levels. The GCF and serum CRP levels correlated positively with the periodontal clinical parameters, including the VPI, PPD, and CAL, indicating that CRP may play an important role between periodontitis and ESRD. CLINICAL RELEVANCE The present study indicated that GCF and serum CRP levels correlated positively with the periodontal clinical parameters, and the CRP levels may be selected as an indicator to evaluate the severity of inflammation and the effectiveness, prognosis of periodontal treatment in ESRD patients.
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Affiliation(s)
- Haixia Lu
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, 639 Zhizaoju Road, Shanghai, China
| | - Hongyu Wu
- Department of Endodontics, Shanghai Stomatological Hospital, Fudan University; Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, 356 Beijingdong Road, Shanghai, China
| | - Yuanmeng Yang
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, 639 Zhizaoju Road, Shanghai, China
| | - Xiping Feng
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, 639 Zhizaoju Road, Shanghai, China
| | - Xiaoxin Ma
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, 639 Zhizaoju Road, Shanghai, China
| | - Yingxin Xie
- Department of Nephrology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, China
| | - Danshu Xie
- Department of Nephrology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, China
| | - Wenji Wang
- Department of Nephrology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, China
| | - Edward Chin Man Lo
- Dental Public Health, Faculty of Dentistry, University of Hong Kong, 34 Hospital Road, Hong Kong, China
| | - Wei Ye
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, 639 Zhizaoju Road, Shanghai, China.
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Wand O, Nacasch N, Fadeela A, Shashar M, Grupper A, Benchetrit S, Erez D, Shitrit P, Cohen-Hagai K. Humoral response and breakthrough infections with SARS-CoV-2 B.1.617.2 variant in vaccinated maintenance hemodialysis patients. J Nephrol 2022; 35:1479-1487. [PMID: 35175577 PMCID: PMC8852959 DOI: 10.1007/s40620-022-01245-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/01/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Breakthrough COVID-19 may occur in vaccinated people, and may result from declining vaccine effectiveness or highly transmittable SARS-CoV-2 variants, such as the B.167.2 (delta) variant. We investigated risk factors and outcomes for infection with the delta variant among vaccinated hemodialysis patients. METHODS Patients on maintenance hemodialysis who received two doses of the BNT162b2 (Pfizer-BioNTech) vaccine were analysed according to having developed COVID-19 (study group) or not (control group), in a retrospective, observational, comparative study. We compared risk-factors for developing breakthrough COVID-19 and assessed clinical outcomes, including 30-day mortality rates. RESULTS Twenty-four cases of breakthrough SARS-CoV-2 infection were compared to 91 controls without infection. Breakthrough infection was associated with chronic immunosuppressive treatment, hematological malignancies, and low antibody levels against SARS-CoV-2 spike protein. All COVID-19 cases occurred at least 5 months after vaccination, and most were caused by the B.1.617.2 variant (at least 23/24 cases). COVID-19 was categorized as severe or critical disease in 11/24 patients (46%), and 54% required hospitalization and COVID-19-directed treatment. The source of infection was nosocomial in 6/24 cases (25%), and healthcare-related in 3/24 (12.5%). Mortality rate was 21%. Overall mortality was significantly higher in patients who developed COVID-19 than in controls (odds ratio for all-cause mortality 7.6, 95% CI 1.4-41, p = 0.002). CONCLUSIONS Breakthrough COVID-19 with the B.1.617.2 variant can occur in vaccinated hemodialysis patients and is associated with immunosuppression and weaker humoral response to vaccination. Infections may be nosocomial and result in significant morbidity and mortality.
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Affiliation(s)
- Ori Wand
- Department of Pulmonology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Nacasch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Ayman Fadeela
- Corona and Respiratory Viruses Laboratory, Meir Medical Center, Kfar Saba, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ayelet Grupper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center Tel Aviv, Tel Aviv, Israel
| | - Sydney Benchetrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Daniel Erez
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Pnina Shitrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infection Control Unit, Meir Medical Center, Kfar Saba, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.
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Feng J, Lu X, Li H, Wang S. High neutrophil-to-lymphocyte ratio is a significant predictor of depressive symptoms in maintenance hemodialysis patients: a cross-sectional study. BMC Psychiatry 2022; 22:313. [PMID: 35505395 PMCID: PMC9063198 DOI: 10.1186/s12888-022-03963-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is one of the most important psychiatric disorders in chronic kidney disease patients who undergo maintenance hemodialysis (MHD). Previous studies have shown that low-grade inflammation is involved in the progression of depressive symptoms. The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker that is inexpensive and easy to measure. However, the association between NLR and depression symptoms in MHD patients has not been examined. METHODS In this single-center, cross-sectional study, we included 160 patients undergoing MHD. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. NLR was calculated as the ratio of neutrophils to lymphocytes. Multinomial logistic regression and multivariate linear regression analyses were used to examine the association between NLR and depressive symptoms in MHD patients. RESULTS Depressive symptoms were detected in 36.7% of the 160 MHD patients. Multinomial logistic regression showed that NLR was a significant predictor of mild (odds ratio [OR]: 1.383, 95% confidence interval [CI]: 1.015-1.884, p = 0.04) and moderate/moderately severe depressive symptoms (OR: 1.441, 95% CI: 1.017-2.042, p = 0.04) in MHD patients, adjusted for age, sex, Kt/V, dialysis duration, history of kidney transplantation, history of hypertension, and Charlson comorbidity index score. In addition, multivariate linear regression analysis showed that NLR was an independent influencing factor for PHQ-9 score in MHD patients, after adjusting for confounding factors. CONCLUSIONS These findings suggest that NLR can be used as a biomarker for predicting depressive symptoms in MHD patients.
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Affiliation(s)
- Jianan Feng
- grid.411607.5Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing, 100020 China
| | - Xiangxue Lu
- grid.411607.5Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing, 100020 China
| | - Han Li
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing, 100020, China.
| | - Shixiang Wang
- grid.411607.5Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing, 100020 China
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Liu Y, Hu J, Tang R, Guo H, Chen Q, Qiu J, Liu Y, Tan R, Zhong X. Association between the blood manganese (Mn) and hemoglobin in patients undergoing maintenance hemodialysis. J Trace Elem Med Biol 2022; 71:126947. [PMID: 35176578 DOI: 10.1016/j.jtemb.2022.126947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Manganese (Mn) and iron metabolism are closely related. Iron metabolism disorders often lead to anemia in patients undergoing maintenance hemodialysis (MHD). Here, we aimed to investigate the relationship between blood Mn and hemoglobin (Hb) in patients undergoing MHD. METHODS Patients undergoing MHD in September 2019 were included in a cross-sectional study. Clinical and demographic data and blood samples were collected before hemodialysis sessions, and blood levels of Mn were measured by inductively coupled plasma mass spectrometry. Both multivariable linear and binary logistic regression analyses were performed to study the relationship between the blood Mn and Hb. RESULTS A total of 144 patients undergoing MHD were enrolled in the study. The patients had a mean age of 64.33 ± 13.39 years, median vintage of 33.50 (16.25-57.50) months. Among them, 66 were females (45.8%). The median blood Mn level was 13.55 µg/L (IQR:9.92-17.48). Ninety-nine patients were anemic (68.8%). The mean Hb level was 99.83 ± 19.68 g/L. The patient group with high blood Mn had a high proportion of females, and these patients had high levels of RBC, hemoglobin, Hct, UIBC, serum TCHOL, and serum LDL, yet short dialysis vintage, low prevalence of anemia, low levels of serum ferritin, serum iron, and TSAT. Following adjustment for confounding factors, we found that low blood Mn level was independently associated with lower Hb level and anemia in patients undergoing MHD by multivariate linear and multivariate binary logistic regression, respectively, in different models. CONCLUSION Whilst our study showed that high levels of blood Mn were independently associated with high hemoglobin in patients undergoing MHD, further multicenter studies with large sample sizes are still required.
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Affiliation(s)
- Yun Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong Province 510220, China
| | - Jianguang Hu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong Province 510220, China
| | - Ruiying Tang
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, Guangdong Province 510220, China
| | - Haonan Guo
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong Province 510220, China
| | - Qiongmei Chen
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong Province 510220, China
| | - Jingxian Qiu
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou, Guangdong Province 510220, China
| | - Yan Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong Province 510220, China; Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou, Guangdong Province 510220, China
| | - Rongshao Tan
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou, Guangdong Province 510220, China
| | - Xiaoshi Zhong
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong Province 510220, China.
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Wei K, Song G, Xi L, Chen J, Sun C, Chen P, Wei Y, Wang L, Kong X, Li Y, Xu D, Jia X. Association of plasma neutrophil gelatinase-associated lipocalin and thoracic aorta calcification in maintenance hemodialysis patients with and without diabetes. BMC Nephrol 2022; 23:156. [PMID: 35459121 PMCID: PMC9026670 DOI: 10.1186/s12882-022-02773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neutrophil gelatinase-associated lipocalin (NGAL) is not only a bone-derived factor involved in metabolism, but also a biomarker of kidney disease and cardiovascular pathophysiology. We conducted this cross-sectional observational study to explore relationships between plasma NGAL and thoracic aorta calcification (TAC) in maintenance hemodialysis (MHD) patients with and without diabetes. Methods Plasma NGAL was measured by ELISA, TAC was evaluated via computed tomography scan using a 3D quantification method or chest radiography aortic arch calcification score. Spearman correlation, Logistic regression and Partial correlation analysis were used to describe the correlations between NGAL and TAC. Results Plasma NGAL levels were lower in MHD patients with diabetes compared to those without diabetes (49.33(42.37, 55.48) vs 56.78(44.37, 674.13) ng/mL, P = 0.026). In MHD patients without diabetes, lg (NGAL) was positively correlated with ARC value(R = 0.612, P = 0.003) analyzed by Spearman correlation; for partial correlation analysis, lg (NGAL) was positively correlated with ARC value, after adjusting for age and sex (R = 0.550, P = 0.015), adjusting for age, sex and CHD (R = 0.565, P = 0.015), adjusting for age, sex, CHD and Alb (R = 0.536, P = 0.027), or adjusting for age, sex, CHD, Alb, and dialyzer membrane (polysulfone) (R = 0.590, P = 0.016); however, when adjusting for age, sex, CHD, Alb and Ca, the correlation between lg (NGAL) and ARC value disappeared. Positive correlation were found between NGAL and Ca (R = 0.644, P < 0.001), Ca and ACR (R = 0.534, P = 0.013) in Spearman coefficient analysis. Conclusion There were positive correlations among plasma NGAL, serum Ca and ARC in MHD patients without diabetes; which suggests that NGAL is possibly a participant in cardiovascular calcification, in non-diabetic MHD. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02773-z.
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Affiliation(s)
- Kai Wei
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Gesheng Song
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
| | - Linhe Xi
- Department of Plastic and Reconstruction, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
| | - Juan Chen
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Chuancai Sun
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Ping Chen
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Yong Wei
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Li Wang
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Xianglei Kong
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Yang Li
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Dongmei Xu
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Xiaoyan Jia
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China. .,Shandong Provincial Insititute of Nephrology, Jinan, China.
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Wu Y, Huang B, Zhang W, Farhan KAA, Ge S, Wang M, Zhang Q, Zhang M. The interaction analysis between advanced age and longer dialysis vintage on the survival of patients receiving maintenance hemodialysis. J Int Med Res 2022; 50:3000605221088557. [PMID: 35414284 PMCID: PMC9014717 DOI: 10.1177/03000605221088557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To compare the all-cause mortality of aged and younger patients undergoing maintenance hemodialysis (MHD) over the long or short term, and to identify independent risk factors. Methods We performed a retrospective cohort study using the medical records of 181 patients undergoing MHD. We compared the clinical characteristics and laboratory data of survivors and participants who died, according to their age and the duration of MHD. Binary stepwise logistic regression was used to identify independent risk factors for all-cause mortality. Results Cardiovascular and cerebrovascular diseases were the principal causes of mortality. The number of aged participants with hypertensive nephropathy as their primary kidney disease was significantly higher than the number of younger participants. The proportion with chronic glomerulonephritis was significantly higher for participants undergoing long-term MHD. Logistic regression analysis revealed that low body mass index, single-pool Kt/V, serum albumin, platelet count, and total iron-binding capacity; and high intact parathyroid hormone and N terminal pro B type natriuretic peptide were independent risk factors for all-cause mortality. Conclusions Aged patients are more susceptible to hypertensive nephropathy than younger patients. In addition, the survival of patients with chronic glomerulonephritis undergoing MHD is superior to that of those with hypertensive or diabetic nephropathy.
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Affiliation(s)
- Yong Wu
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bihong Huang
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Weichen Zhang
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | | | - Siyao Ge
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengjing Wang
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qian Zhang
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Minmin Zhang
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
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Yavuz D, Karagöz Özen DS, Demirağ MD. COVID-19: mortality rates of patients on hemodialysis and peritoneal dialysis. Int Urol Nephrol 2022. [PMID: 35381932 DOI: 10.1007/s11255-022-03193-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/20/2022] [Indexed: 11/13/2022]
Abstract
Objective Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection might have a higher mortality rate in patients with end-stage renal disease due to immunosuppression. This study investigates the mortality rates of SARS-CoV-2 infection and the factors affecting mortality among patients who were on maintenance hemodialysis and continuous ambulatory peritoneal dialysis. Materials and methods A total of 200 patients, including 157 maintenance hemodialysis and 43 continuous ambulatory peritoneal dialysis patients followed in our hospital, were included in the study. The patients' sociodemographic characteristics, comorbidities, history of SARS-CoV-2 infection in the previous year, death event, source of death (SARS-CoV-2 or not), presence of hospitalization due to SARS-CoV-2 infection, need for intensive care unit, need for ventilatory support in intensive care unit were obtained from the clinical file records. Results 85 of the 200 patients had a history of SARS-Cov-2 infection during the last 12 months. Forty-two (49.5%) patients with SARS-CoV-2 infection were hospitalized. Patients with SARS-CoV-2 had longer dialysis time, increased mortality, and significantly higher comorbidities such as coronary artery disease, congestive heart failure. Besides, heart failure and hypertension were the determining factors in the risk factor analysis for SARS-CoV-2 infection. In dialysis patients, the mortality rate in the last year, due to all causes, including SARS-CoV-2 infection, was 23% while the mortality rate due to "SARS-CoV-2 infection only" was 13%) (p > 0.05). Our findings are important in guiding clinical decision-making and informing the public and health authorities about the risk of death associated with COVID-19 in this patient group.
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Zhao X, Zhu L, Jin W, Yang B, Wang Y, Ni M, Zhao Y, Gan L, Zuo L. Echocardiographic left ventricular hypertrophy and geometry in Chinese chronic hemodialysis patients: the prevalence and determinants. BMC Cardiovasc Disord 2022; 22:55. [PMID: 35172749 DOI: 10.1186/s12872-022-02506-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background To investigate the prevalence of left ventricular hypertrophy (LVH) and explore left ventricular geometry in maintenance hemodialysis (MHD) patients, and to explore the risk factors of LVH which is an important predictor of cardiovascular events. Methods The subjects were patients who are on MHD for more than 3 months in Peking University People's Hospital from March 2015 to February 2017. Demographic and clinical data were retrospectively collected. Left ventricular mass was measured by echocardiography. LVH is defined by Left ventricular mass index (LVMI) > 115 g/m2 for men and > 95 g/m2 in women. LVMI and relative wall thickness were used to determine left ventricular geometry. Logistic regression was used to analyze the risk factors of LVH. Results Altogether, 131 patients including 77 males were enrolled. The median age was 60 (47, 69) years, with a median dialysis vintage of 48 (18, 104) months. There were 80 patients with LVH, the prevalence rate was 61.1%, and 66.3% of them were moderate to severe LVH. We found that (1) most of the patients were concentric hypertrophy; (2) one-third of the patients were concentric remodeling; (3) only 4 cases with normal geometry. The pre-dialysis serum sodium level and time average pre-dialysis systolic blood pressure (SBP) were independent risk factors of LVH. Conclusion LVH is prevalent in MHD patients. Concentric hypertrophy and concentric remodeling are the most common geometric patterns. Attention should be paid to long-term pre-dialysis SBP management and pre-dialysis sodium control as they might be potentially modifiable risk factors for LVH.
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Liu B, Yang Q, Zhao L, Shui H, Si X. Vitamin D receptor gene polymorphism predicts left ventricular hypertrophy in maintenance hemodialysis. BMC Nephrol 2022; 23:32. [PMID: 35033017 PMCID: PMC8761333 DOI: 10.1186/s12882-021-02640-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/13/2021] [Indexed: 01/04/2023] Open
Abstract
Background To verify that the single nucleotide polymorphisms (SNP) of vitamin D receptor (VDR) may lead to genetic susceptibility to left ventricular hypertrophy (LVH), the present study was designed to study four SNPs of VDR associated with LVH in maintenance hemodialysis (MHD) patients of Han nationality. Methods 120 MHD patients were recruited at Department of Nephrology, Zhongnan Hospital of Wuhan University to analyze the expression of genotype, allele and haplotype of Fok I, Bsm I, Apa I and Taq I in blood samples, and to explore their correlation with blood biochemical indexes and ventricular remodeling. Results The results showed that the risks of CVD included gender, dialysis time, heart rate, SBP, glycated hemoglobin, calcium, iPTH and CRP concentration. Moreover, LAD, LVDd, LVDs, IVST and LVMI in B allele of Bsm I increased significantly. Fok I, Apa I and Taq I polymorphisms have no significant difference between MHD with LVH and without LVH. Further study showed that VDR expression level decreased significantly in MHD patients with LVH, and the B allele was positively correlated with VDR Expression. Conclusion VDR Bsm I gene polymorphism may predict cardiovascular disease risk of MDH patients, and provided theoretical basis for early detection and prevention of cardiovascular complications.
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Affiliation(s)
- Bingman Liu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Qingqing Yang
- Department of Nephrology, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Liangyu Zhao
- Department of Nephrology, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Hua Shui
- Department of Nephrology, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Xiaoyun Si
- Department of Nephrology, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuchang District, Wuhan, 430071, China.
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Feng Z, Wang X, Zhang L, Apaer R, Xu L, Ma J, Li X, Che H, Tang B, Xiong Y, Xia Y, Xiao J, Su X, Wang Y, Dou X, Chen J, Mei L, Xue Z, Kong Y, Li S, Zhang H, Lin T, Wen F, Fu X, Tao Y, Fu L, Li Z, Huang R, Ye Z, He C, Shi W, Liang X, Ke G, Liu S. Pharmacokinetics and Pharmacodynamics of Sacubitril/Valsartan in Maintenance Hemodialysis Patients with Heart Failure. Blood Purif 2022; 51:270-279. [PMID: 34753147 DOI: 10.1159/000519643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/14/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Heart failure (HF) is one of the main comorbidities in patients receiving maintenance hemodialysis (HD). Sacubitril/valsartan (SAC/VAL) is widely used in HF patients with reduced ejection fraction (HFrEF) or HF mid-range ejection fraction (HFmrEF). However, the pharmacokinetic (PK) and pharmacodynamic properties of SAC/VAL in HD patients with HF remain uncertain. OBJECTIVES This study aimed to analyze the efficacy and PK properties of SAC/VAL in HD patients with HFrEF or HFmrEF. METHODS HD patients with HFrEF or HFmrEF were treated with SAC/VAL 50 or 100 mg twice a day (BID) and the concentrations of valsartan and LBQ657 (active metabolite of SAC) were determined by high-performance liquid chromatography-tandem mass spectrometry during HD and on the days between HD sessions (interval days). N-terminal-pro B-type natriuretic peptide and high-sensitivity troponin T were measured, and left ventricular ejection fraction (LVEF) was evaluated by echocardiography. RESULTS The mean maximum plasma concentrations (Cmax) of LBQ657 and VAL on the interval days were 15.46 ± 6.01 and 2.57 ± 1.23 mg/L, respectively. Compared with previous values in patients with severe renal impairment and healthy volunteers, these levels both remained within the safe concentration ranges during treatment with SAC/VAL 100 mg BID. Moreover, SAC/VAL significantly improved LVEF in HD patients with HFrEF or HFmrEF (p < 0.05). CONCLUSIONS HD did not remove the SAC metabolite LBQ657 or VAL in patients with HF. However, SAC/VAL 100 mg BID was safe and effective in patients undergoing HD.
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Affiliation(s)
- Zhonglin Feng
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xipei Wang
- Department of Medical Sciences, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Li Zhang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rizvangul Apaer
- Department of Nephrology, The First People's Hospital of Kashgar Prefecture, Kashgar Prefecture, China
| | - Lixia Xu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianchao Ma
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinyi Li
- Guangdong Pharmaceutical University, Guangzhou, China
| | - Huimin Che
- Guangdong Pharmaceutical University, Guangzhou, China
| | - Bin Tang
- Department of Nephrology, Zhongshan City People's Hospital, Zhongshan, China
| | - Yuwang Xiong
- Department of Nephrology, Zhongshan City People's Hospital, Zhongshan, China
| | - Yubin Xia
- Department of Nephrology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jie Xiao
- Department of Nephrology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoyan Su
- Department of Nephrology, Tunghua Hospital of Sun-Yat Sen University, Dongguang, China
| | - Yamei Wang
- Department of Nephrology, Tunghua Hospital of Sun-Yat Sen University, Dongguang, China
| | - Xianrui Dou
- Department of Nephrology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, China
| | - Jinzhong Chen
- Department of Nephrology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, China
| | - Lifan Mei
- Department of Nephrology, Boai Hospital of Zhongshan, Zhongshan, China
| | - Zhiqiang Xue
- Department of Nephrology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Yuanyuan Kong
- Department of Nephrology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Sijia Li
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong Zhang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ting Lin
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Feng Wen
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xia Fu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yiming Tao
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lei Fu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhuo Li
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Renwei Huang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiming Ye
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chaosheng He
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Shi
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinling Liang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guibao Ke
- Department of Nephrology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Nephrology, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, China
| | - Shuangxin Liu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Zhou Q, Zhang H, Yin L, Li G, Liang W, Chen G. Characterization of the gut microbiota in hemodialysis patients with sarcopenia. Int Urol Nephrol 2021; 54:1899-1906. [PMID: 34845594 PMCID: PMC9262794 DOI: 10.1007/s11255-021-03056-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/11/2021] [Indexed: 10/28/2022]
Abstract
PURPOSE Maintenance hemodialysis (MHD) patients are at high risk of sarcopenia. Gut microbiota affects host metabolic and may act in the occurrence of sarcopenia importantly. This study aimed to study the characterization of the gut microbiota in MHD patients with sarcopenia, and to further reveal the complex pathophysiology of sarcopenia in MHD patients. METHODS Fecal samples and clinical data were collected from 30 MHD patients with sarcopenia, and 30 age-and-sex-matched MHD patients without sarcopenia in 1 general hospital of Jiangsu Province from December 2020 to March 2021. 16S rRNA sequencing technology was used to analyze the genetic sequence of the gut microbiota for evaluation of the diversity, species composition, and differential microbiota of the two groups. RESULTS Compared to MHD patients without sarcopenia, the ACE index of patients with sarcopenia was lower (P = 0.014), and there was a structural difference in the β-diversity between the two groups (P = 0.001). At the genus level, the relative abundance of Tyzzerella_4 in the sarcopenia group was significantly higher than in the non-sarcopenia group (P = 0.039), and the relative abundance of Megamonas (P = 0.004), Coprococcus_2 (P = 0.038), and uncultured_bacterium_f_Muribaculaceae (P = 0.040) decreased significantly. CONCLUSION The diversity and structure of the gut microbiota of MHD patients with sarcopenia were altered. The occurrence of sarcopenia in MHD patients may be influenced by gut microbiota.
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Affiliation(s)
- Qifan Zhou
- Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Hailin Zhang
- Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China.
| | - Lixia Yin
- Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Guilian Li
- The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Wenxue Liang
- Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Guanjie Chen
- The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
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Luo D, Luo Y, Zou Y, Xu Y, Fu B, Yang D, Yang J, Xu C, Ling S, Li S, Qi A. Non-high-density lipoprotein cholesterol may predict the cardio-cerebrovascular risk in patients on maintenance hemodialysis. Lipids Health Dis 2021; 20:159. [PMID: 34774042 PMCID: PMC8590291 DOI: 10.1186/s12944-021-01546-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Non-high-density lipoprotein cholesterol (non-HDL-C) may be an independent risk factor for cardio-cerebrovascular disease (CVD); however, the cutoff level in patients on maintenance hemodialysis (MHD) is unknown. Methods This was a retrospective multicenter study of MHD patients treated at 10 dialysis centers in Guangdong Province from July 1, 2016, to April 1, 2017. Laboratory test data were collected and CVD complications and outcomes recorded. Results In total, 1288 eligible patients were included in this study; the non-HDL-C interquartile range was 2.76 (2.24–3.45) mmol/L. Over a median follow-up time of 24 months, 141 patients developed CVD. The non-HDL-C level was a principal risk factor for such events (P < 0.05; 95% confidence interval 0.800–0.842). The maximum Youden index was 0.549 and the best cutoff > 3.39 mmol/L. Conclusion Higher baseline non-HDL-C levels may increase the CVD risk in MHD patients. Thus, non-HDL-C effectively predicts CVD.
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Affiliation(s)
- Denggui Luo
- The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yueming Luo
- The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yanhong Zou
- The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yuanzhao Xu
- The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Bo Fu
- The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Dong Yang
- The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jun Yang
- The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Cai Xu
- The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Shuyi Ling
- The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Shunmin Li
- The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.
| | - Airong Qi
- The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.
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