Patient-reported symptoms during dialysis: the effect of pre-dialysis extracellular water and change in extracellular water post-dialysis
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Abstract Background Quality of life for haemodialysis (HD) patients may be affected by symptoms during dialysis treatments, and patient groups have highlighted the need to improve post-dialysis fatigue and dialysis-related symptoms. As changes in extracellular water (ECW) may lead to cramps and other symptoms, we wished to determine whether there was an association between ECW and intra-dialytic symptoms. Methods We reviewed the hospital records of HD patients who completed a self-reported intra-dialytic symptom questionnaire, using a visual analogue scale, who had contemporaneous pre- and postdialysis bioimpedance ECW measurements adjusted to height (aECW). Results We studied dialysis sessions of 506 patients, 314 (62.1%) male, 226 (44.7%) diabetic, mean age 64.6 ± 15.7 years, weight 69.9 ± 17.4 kg, and duration of dialysis treatment 26 (9.6–60.1) months. We divided patients into three groups according to pre-dialysis aECW, and total dialysis symptom scores were greater for those in the lower tertile (25 (10–41) vs middle 18 (8.5–34) vs upper 20 (7–31), p < 0.05). Only feeling cold, dizziness, and low blood pressure were statistically different between the three pre-dialysis aECW groups, and there was no difference in post-dialysis recovery times. We analysed the effect of the fall in aECW pre-to post-dialysis. Patients in the group with the greatest fall in aECW did not report more intra-dialytic symptoms or longer recovery times. Conclusion We found that patients starting dialysis with lower relative ECW were more likely to report intra-dialytic symptoms than those with greater amounts of fluid to remove, and most commonly reported symptoms were associated with intra-vascular volume depletion.Keywords:
Nephrology
Dialysis adequacy
Background: An increasing number of patients with chronic kidney disease (CKD) impact an increased need for hemodialysis. Inadequate hemodialysis affects morbidity in patients with CKD. Determination of the urea removal index can be accomplished by several invasive and non-invasive methods. The purpose of this study was to compare the urea reduction ratio (URR) and dialysis efficiency (Kt/V) calculated automatically by hemodialysis machines to assess the adequacy of hemodialysis in patients with CKD.Methods: A cross-sectional analysis study was conducted on 58 CKD patients with age ≥18 years, conventional 5-hour hemodialysis sessions twice weekly, using single use-hollow fiber dialyzers, and who had been receiving hemodialysis for ≥6 months in the hemodialysis unit at Wangaya Hospital from April 2022 to May 2022. Study data were obtained from medical records then described and analyzed using the statistical package for the social sciences (SPSS) program.Results: The mean of URR was 70.74±10.04, while the mean of Kt/V delivered by machine was 1.27±0.19. More hemodialysis patients received adequate hemodialysis based on URR parameters compared to Kt/V parameters (84.5% versus 1.7%). There was no significant difference between age, sex, body mass index (BMI), comorbidities, vascular access and duration of dialysis with adequacy hemodialysis. There was a significant difference between URR and Kt/V in the evaluation adequacy of hemodialysis (p=0.000). In addition, there was a positive correlation between URR and Kt/V in the evaluation adequacy of hemodialysis (r=0.592, p=0.000).Conclusions: The URR is a more accurate parameter, but the Kt/V delivered by machine can help the URR demonstrate the adequacy of haemodialysis patients with CKD.
Dialysis adequacy
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Nephrology
Renal replacement therapy
Dialysis Therapy
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<i>Background:</i> Some patients who reach end-stage renal disease refuse to start dialysis at the time suggested by their nephrologist and delay it. Whether this delay may affect health-related quality of life (HRQoL), clinical and biological parameters at dialysis onset, and then survival and hospitalization during dialysis is unknown. <i>Methods:</i> We considered all adult patients who began dialysis in Lorraine (France) in 2005–2006 having previously been followed by a nephrologist. Clinical and biological characteristics at dialysis onset were collected from medical records, and nephrologists were interviewed about compliance with the recommended starting date. HRQoL was measured using the French version of the ‘Kidney Disease Quality of Life’ V36 questionnaire. Mortality and total duration of hospitalization during the first year of dialysis were recorded as part of the end-stage renal disease French registry. The effects of delaying dialysis on survival and on duration of hospitalization were determined using log-rank test and polychotomous logistic regression, respectively. <i>Results:</i> Of 541 patients, 88 (16.3%) declined to initiate dialysis at the time recommended by the nephrologist and delayed it. Compared with patients who were compliant with the advice, noncompliers had more comorbidities, poorer clinical and biological profiles at dialysis start, and a higher risk of beginning dialysis in emergency circumstances with greater decline in the ‘burden of kidney disease’ dimension of HRQoL. However, there were no differences in survival or duration of hospitalization during dialysis. <i>Conclusion:</i> Despite a negative effect on clinical and biological parameters at initiation, delaying dialysis did not impact on survival during treatment.
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Introduction : Studies have shown when hemodialysis treatment is sufficiently effective, complications of uremic syndrome, additional treatment costs and hospitalization length are reduced. Several methods have been proposed to improve hemodialysis adequacy. Objectives : In this study, the effects of the synchronic use of the stepwise profile dialysis fluid flow rate with increased blood flow rate (BFR) were studied on hemodialysis adequacy. Patients and Methods : This is a cross-over clinical trial study conducted on 34 hemodialysis patients selected from a hemodialysis center of Qazvin University of Medical Sciences, Qazvin, Iran. The patients were randomly allocated into two groups (n= 17 patients in each group) in two sequences. In the first sequence, the subjects received four routine hemodialysis sessions in group one and four hemodialysis sessions with the stepwise profile of the fluid flow rate with increased BFR in group two. In the second sequence, the treatment methods were exchanged. Hemodialysis sessions were performed in both sequences, consecutively. Each session was at least three hours. Hemodialysis adequacy was measured using Kt/V software on the hemodialysis machines after each session. Results : The mean score of dialysis adequacy was 0.89 in the routine method and 1.26 in the profile with increased BFR. There was a statistically significant difference between the methods (t= -7.9, df = 33, P < 0.001). Conclusion : The results of the study suggest that the stepwise profile of the dialysis fluid flow rate with increased BFR should be used synchronously to improve hemodialysis adequacy.
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The prevalence and incidence of Chronic Renal Failure [CRF] is increasing in the world. The main way for treatment of End-Stage Kidney Disease [ESKD] - that leads from CRF - is hemodialysis. One of the most important criteria for the evaluation of hemodialysis treatment process is the measure of dialysis adequacy. Dialysis adequacy is considered to the best therapeutic indicator for patient's clinical results and the best index for the assessment of the dialysis adequacy is the urea clearance. Although adherence accurate diet by patients is complement for hemodialysis and it is recommended for effectively control of symptoms of uremic syndrome and preventing longterm complications, many of these patients do not keep diet and fluid restriction and result in non-adequate dialysis, therefore, in order to improve dialysis adequacy, education, justify and emend patient’s attitude about diet necessity of following dialysis period times precisely and on time refers are very important. Due to the complexity of the treatment and care of hemodialysis patients, as well as the needs for adequate dialysis implement for to achieve effective treatment for these patients, by designing and run an educational program based on Health Education Models, dialysis adequacy can be improved.
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The aim of this study was to assess the factors associated with dialysis adequacy in ESRD patients on maintenance hemodialysis in Rwanda. A descriptive cross-sectional study was conducted. A sample size of 66 hemodialysis patients was selected using purposive sampling strategy. An interview scheduled guide was used to collect data. Dialysis adequacy was calculated using kt/v Daugirdas & Schneditz formula. The mean hemodialysis adequacy was 1.26± 0.34. Most participants [41(62%)] had optimal hemodialysis adequacy of equal or greater than to 1.2, 19 (29%) had near optimal hemodialysis adequacy (0.8 - 1.2 kt/v) and only 6 (9%) had less than optimal hemodialysis adequacy (kt/v <0.8). Factors associated with hemodialysis adequacy were hospital settings (p = .010), age (p = .007), BMI (p =.004) and blood pressure level ((p = .018). Moreover, mode of transport and type of drinking water was significantly associated with hemodialysis adequacy (p = 0.032 and 0.030 respectively). In conclusion, the level of hemodialysis adequacy was low in 38% of ESRD patients with associated factors predominantly demographics. Therefore, further research inquiry is needed on additional factors which include technical aspects to establish their association with hemodialysis adequacy. Â
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Objective:To evaluate the effects of individualized hemodialysis on lowering the hemodialysis complications.Methods:All together312times of hemodialysis in20chronic renal failure patients were investiˉgated.The clinical effects of two different dialysis methods which included routine dialysis and individualized dialysis were compared.Results:There were a few influences on plasma osmotic pressure and serum natrium in individualized hemodialysis group with good effects and fewer complications.Conclusion:Individualized dialysis could effectively prevent the dialysis complications,promote the dialysis quality together with ensuring the dialysis effects.
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STARRT recently demonstrated that many patients experience suboptimal dialysis starts (defined as initiation as an inpatient and/or with a central venous catheter), even when followed by a nephrologist for >12 months (NDT 2011). However, STARRT did not identify the factors associated with suboptimal initiation of dialysis. The objectives of this study were to extend the results of STARRT by ascertaining the factors leading to suboptimal initiation of dialysis in patients who were referred at least 12 months prior to commencement of dialysis. At each of the three Toronto centers, charts of consecutive incident RRT patients were identified from 1 January 2009 to 31 December 2010, with predetermined data extracted. A total of 436 incident RRT patients were studied; 52.4% were followed by a nephrologist for >12 months prior to the initiation of dialysis. Suboptimal starts occurred in 56.4% of these patients. No attempt at arteriovenous fistula (AVF) or arteriovenous graft (AVG) prior to initiation was made in 65% of these starts. Factors contributing to suboptimal starts despite early referral included patient-related delays (31.25%), acute-on-chronic kidney disease (31.25%), surgical delays (16.41%), late decision-making (8.59%) and others (12.50%). The percentage of optimal starts with early referral among 14 nephrologists ranged from 33 to 72%. Most patients started dialysis in a suboptimal manner, despite an extended period of pre-dialysis care. Nephrologists should take responsibility for suboptimal initiation of dialysis despite early referral and test methods that attempt to prevent this.
Nephrology
Central venous catheter
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