Rationale: Endotoxin contamination in conventionally purified water poses serious risks to hemodialysis patients, leading to complications such as inflammation and sepsis. Addressing these risks is essential for enhan...Rationale: Endotoxin contamination in conventionally purified water poses serious risks to hemodialysis patients, leading to complications such as inflammation and sepsis. Addressing these risks is essential for enhancing patient safety and meeting global dialysis water quality standards. Advanced filtration technologies, such as titanium dioxide (TiO₂)-based nanoparticle filters, offer a promising approach to improve water purification processes in renal care. Objectives: This study aimed to develop and evaluate the effectiveness of a TiO₂-based nanoparticle microporous filtration system for hemodialysis water purification. The objectives included analyzing the system’s performance in reducing chemical contaminants (calcium, magnesium, aluminum, and lead) and microbiological contaminants (total viable count [TVC] and endotoxin units [EU]) across multiple renal centers. Methods: Water samples from three renal centers (RC1, RC2, and RC3) were analyzed pre- and post-filtration. TiO₂ nanoparticles were synthesized using the sol-gel method and characterized via Fourier Transform Infrared (FTIR) spectroscopy and Scanning Electron Microscopy with Energy Dispersive X-ray analysis (SEM/EDX). The microporous filter, fabricated with TiO₂ nanoparticles, silicon dioxide, and polyethylene glycol (PEG), was tested for its ability to remove contaminants. Analytical techniques included spectroscopy for chemical analysis and microbiological assays for contaminant quantification. Results: Post-treatment analysis revealed significant reductions in chemical contaminants, with removal efficiencies averaging 78% for calcium, 80% for magnesium, 81% for aluminum, and 76.6% for lead across all centers. Microbiological contamination was also substantially reduced, with 78–80% removal of TVC and 76–84.6% reduction in EU levels. FTIR analysis confirmed the presence of hydroxyl groups critical for adsorption, while SEM/EDX characterization revealed a crystalline structure with a particle size of 1.45 nm, pore size of 4.11 μm, filter height of 2.56 mm, and bulk density of 0.58 g/cm³. Conclusion: The TiO₂-based nanoparticle filtration system demonstrated high efficacy in removing chemical and microbiological contaminants, significantly improving water quality for hemodialysis. These results highlight its potential as a practical solution for renal centers, especially in resource-constrained settings. Further studies are needed to evaluate its long-term performance and feasibility for widespread adoption. Recommendation: Renal centers should consider adopting TiO2-based nanoparticle filters to address persistent water quality challenges. Pilot implementations across diverse settings can provide insights into operational feasibility. Additional research should explore scalability, maintenance requirements, and cost-effectiveness to optimize integration into healthcare systems. Significance Statement: This study introduces a practical and innovative solution to improve hemodialysis water purification. By effectively reducing both chemical and microbiological contaminants, the TiO2-based filtration system has the potential to enhance patient safety and outcomes, particularly in settings where maintaining high water quality standards remains challenging.展开更多
Objectives:This study was conducted to determine the effect of multidisciplinary nursing intervention(MNI)on interdialytic weight gain(IDWG)and quality of life(QoL)among chronic hemodialysis patients.Materials and Met...Objectives:This study was conducted to determine the effect of multidisciplinary nursing intervention(MNI)on interdialytic weight gain(IDWG)and quality of life(QoL)among chronic hemodialysis patients.Materials and Methods:Quantitative research approach with randomized-controlled,single-blind trial was conducted among 120 chronic hemodialysis patients in Institute of Medical Sciences and SUM Hospital Bhubaneswar,Odisha,India from February 2023 to February 2024.Participants were randomly assigned into the experimental group(n1=65)and control group(n2=55)by block randomization methods.The experimental group received the intervention phase up to the 6th week,along with the usual treatment,and the control group received only standard treatment up to the end of the study.After that,they received the diet chart plan and fluid distribution timetable.Results:Significant improvements were found in IDWG and QoL for the experimental group.The experimental group exhibited a sharp decline in weight gain within the group(F=20.05,P<0.001)between the group(F=13.02,P<0.001),interaction effects between the groups across the time point(F=5.67,P<0.005).Kidney disease QoL scores(KDQOL^(™)36)increased from 49.38±9.56 to 58.63±6.04 in the experimental group,compared to an increase from 50.84±9.25 to 52.04±8.02 in the control group.Conclusion:This trial showed that MNIs significantly reduced IDWG and improved KDQOL^(™)36 scores,with the experimental group outperforming the control,highlighting the intervention’s effectiveness.展开更多
Background:Hemodialysis(HD) per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR) exercise in HD patients,identification of possible risk factors related to the...Background:Hemodialysis(HD) per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR) exercise in HD patients,identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model.The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise(RE) with BFR on this molecule.Methods:Two hundred and six HD patients volunteered for this study(all with a glomerular filtration rate of <15 mL/min/1.73 m2).The RE+BFR session consisted of 50% arterial occlusion pressure during 50 min sessions of HD(intradialytic exercise).RE repetitions included concentric and eccentric lifting phases(each lasting 2 s) and were supervised by a strength and conditioning specialist.Results:Several variables were associated with elevated levels of D-dimer,including higher blood glucose,citrate use,recent cardiovascular events,recent intercurrents,higher inflammatory status,catheter as vascular access,older patients(>70 years old),and HD vintage.Furthermore,RE+BFR significantly increases D-dimer after 4 h.Patients with borderline baseline D-dimer levels(400-490 ng/mL) displayed increased risk of elevating D-dimer over the normal range(≥500 ng/mL).Conclusion:These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE+BFR.D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE+BFR.展开更多
I read with great interest the article“Concerns on the application of blood flow restriction resistance exercise and thrombosis risk in hemodialysis patients”by Correa et al.1 The study presents complementary data f...I read with great interest the article“Concerns on the application of blood flow restriction resistance exercise and thrombosis risk in hemodialysis patients”by Correa et al.1 The study presents complementary data from a previous randomized controlled trial,2 exploring the application of intradialytic blood flow restriction exercise for hemodialysis patients.展开更多
BACKGROUND Poor sleep quality is common among hemodialysis patients and can significantly impact their well-being.This study aimed to evaluate the effectiveness of a structured nursing intervention program in improvin...BACKGROUND Poor sleep quality is common among hemodialysis patients and can significantly impact their well-being.This study aimed to evaluate the effectiveness of a structured nursing intervention program in improving sleep quality in middleaged and elderly hemodialysis patients.AIM To evaluate the impact of nursing intervention on sleep quality in hemodialysis patients.METHODS This cross-sectional study was conducted in a tertiary hospital,the First Affiliated Hospital of Nanchang University,in 2023.This study included 105 middle-aged and elderly hemodialysis patients aged≥45 years who underwent maintenance hemodialysis for at least 3 mo,utilizing the Pittsburgh Sleep Quality Index(PSQI)to identify poor sleepers.Those identified underwent a 12-wk nursing intervention program focusing on education,relaxation techniques,and counseling.Post-intervention,sleep quality was reassessed using the PSQI.RESULTS The study found that 68.6%of hemodialysis patients were poor sleepers.Following the 12-wk nursing intervention program,there was a significant decrease in the mean global PSQI score from 8.9±3.2 to 5.1±2.7(P<0.001),indicating improved sleep quality.This demonstrated the effectiveness of the structured nursing intervention in enhancing sleep quality for middle-aged and elderly hemodialysis patients.CONCLUSION The structured nursing intervention program focusing on sleep hygiene education,relaxation techniques,and counseling effectively improved sleep quality among middle-aged and elderly hemodialysis patients.The significant decrease in the mean global PSQI score post-intervention indicates the positive impact of tailored nursing interventions in addressing poor sleep quality in this patient population.These findings emphasize the importance of implementing targeted nursing interventions to enhance the quality of life for hemodialysis patients by addressing the prevalent issue of poor sleep quality.展开更多
Objective:To investigate the difference in serum ferritin levels between deceased and surviving regular hemodialysis patients with COVID-19.Methods:We conducted a systematic search across four databases following the ...Objective:To investigate the difference in serum ferritin levels between deceased and surviving regular hemodialysis patients with COVID-19.Methods:We conducted a systematic search across four databases following the PRISMA statement guidelines.Studies reporting ferritin levels and mortality of regular hemodialysis patients with COVID-19 were included.Employing the random-effects model,we performed a meta-analysis to determine the mean difference in serum ferritin levels between the studied groups,along with their corresponding 95%confidence intervals.The meta-analysis was carried out using Review Manager 5.4 and Stata 16.Results:A total of 1013 patients from seven studies were included in this study.Our meta-analysis showed higher mean serum ferritin in the deceased compared to surviving regular hemodialysis patients with COVID-19,with a mean difference of 449.43 ng/mL[95%CI(244.07,654.80),P<0.0001;I2=58%,P=0.003].Conclusions:Our study found a higher mean of serum ferritin levels in the deceased compared to surviving regular hemodialysis patients with COVID-19.展开更多
Dear Editor,We report a rare case of endogenous endophthalmitis caused by Candida albicans in a patient with chronic renal failure concomitant hemodialysis.A 71-year-old man with a history of hypertension and 2-year c...Dear Editor,We report a rare case of endogenous endophthalmitis caused by Candida albicans in a patient with chronic renal failure concomitant hemodialysis.A 71-year-old man with a history of hypertension and 2-year chronic renal failure on hemodialysis via a native arteriovenous fistula(AVF)was presented to the local hospital due to fever 3wk ago.No pathogens were detected through blood culture on admission,and his fever gradually subsided with intravenous ceftriaxone sodium.After a week of fever,he experienced progressive blurred vision in both eyes,accompanied by pain and headaches.Subsequent magnetic resonance imaging(MRI)of the brain revealed sinusitis.He had not undergone any previous eye surgeries or trauma.展开更多
BACKGROUND Diabetic kidney disease(DKD)is a prevalent complication of diabetes that often requires hemodialysis for treatment.In the field of nursing,there is a growing recognition of the importance of humanistic care...BACKGROUND Diabetic kidney disease(DKD)is a prevalent complication of diabetes that often requires hemodialysis for treatment.In the field of nursing,there is a growing recognition of the importance of humanistic care,which focuses on the holistic needs of patients,including their emotional,psychological,and social well-being.However,the application of humanistic nursing in the context of hemodialysis for DKD patients remains relatively unexplored.AIM To explore the experience of humanistic nursing in hemodialysis nursing for DKD patients.METHODS Ninety-six DKD patients treated with hemodialysis from March 2020 to June 2022 were included in the study and divided into the control cluster(48 cases)and the study cluster(48 cases)according to different nursing methods;the control cluster was given routine nursing and the study cluster was given humanized nursing.The variances of negative emotion mark,blood glucose,renal function,the incidence of complications,life mark and nursing satisfaction before and after nur-sing were contrasted between the two clusters.RESULTS No significant difference in negative emotion markers between the two clusters were observed before nursing(P>0.05),and the negative emotion markers of the two clusters decreased after nursing.The Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale markers were lower in the study cluster than the control cluster.The healing rate of patients in the study cluster was significantly higher than the control cluster(97.92%vs 85.42%,P<0.05).Blood glucose parameters were not significantly different between the groups prior to nursing(P>0.05).However,after nursing,blood urea nitrogen and serum creatinine(SCr)levels in the study cluster were lower than those in the control cluster(P<0.05).The incidence rate of complications was significantly lower in the study group compared to the control cluster(6.25%vs 20.83%,P<0.05).There was no significant difference in the life markers between the two clusters before nursing.While the life markers increased after nursing for both groups,the 36-item health scale markers in the study cluster were higher than those within the control cluster(P<0.05).Finally,the nursing satisfaction rate was 93.75% in the study cluster,compared to 75% in the control cluster(P<0.05).CONCLUSION In hemodialysis for DKD patients,the implementation of humanistic nursing achieved ideal results,effectively reducing patients’psychological negative emotion markers so that they can actively cooperate with the diagnosis and nursing,facilitate the control of blood glucose and the maintenance of residual renal function,reduce the occurrence of complications,and finally enhance the life quality and nursing satisfaction of patients.It is worthy of being widely popularized and applied.展开更多
BACKGROUND Pulmonary hypertension is a serious complication in the treatment of maintenance hemodialysis patients,which seriously affects the quality of life of patients and threatens their life safety.Prevention,trea...BACKGROUND Pulmonary hypertension is a serious complication in the treatment of maintenance hemodialysis patients,which seriously affects the quality of life of patients and threatens their life safety.Prevention,treatment and improvement of pulmonary hypertension are of great significance to improve the quality of life of patients.AIM To investigate the intervention and control of pedal-powered bicycle in maintaining quality of life and pulmonary hypertension in hemodialysis patients.METHODS 73 patients with maintenance hemadialysis combined with pulmonary arterial hypertension at a hemodialysis center in a certain hospital from May 2021 to May 2022 are selected.Patients are divided into two groups,37 cases in the control group(group C)and 36 cases in the intervention group(group I).Patients are divided into two groups,group C is treated with oral administration of betaglandin sodium combined with routine nursing care.Based on group C,group I conducts power cycling exercises.RESULTS After treatment,group I patients had higher muscle strength,36-Item Short Form Health Survey scores,and Kidney Disease Targets Areas scores;The 6-minute walk distance test index level was higher and the Borg score was lower;The group I had lower systolic blood pressure,greater vital capacity,higher positive emotion,lower systolic pulmonary artery pressure index level,higher arterial partial oxygen pressure level,lower pulmonary vascular resistance index level,and higher blood oxygen saturation level[158.91±11.89 vs 152.56±12.81,1795.01±603.18 vs 1907.20±574.15,24.00(22.00,29.00)vs 24.00(22.00,28.00),P<0.001].CONCLUSION Aerobic exercise combined with Western medicine treatment can effectively improve patients'pulmonary hypertension,alleviate their negative emotions,and enable them to achieve a higher level of quality of life.展开更多
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 signif...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.展开更多
BACKGROUND Gastrointestinal symptoms are common in patients with uremia undergoing hemodialysis,and these symptoms seriously affect patients'prognosis.AIM To assess the occurrence and factors influencing gastroint...BACKGROUND Gastrointestinal symptoms are common in patients with uremia undergoing hemodialysis,and these symptoms seriously affect patients'prognosis.AIM To assess the occurrence and factors influencing gastrointestinal symptoms in patients with uremia undergoing hemodialysis.METHODS We retrospectively selected 98 patients with uremia who underwent regular hemo-dialysis treatment in the blood purification center of our hospital from December 2022 to December 2023.The gastrointestinal symptoms and scores of each dimension were evaluated using the Gastrointestinal Symptom Grading Scale(GSRS).Patients were divided into gastrointestinal symptoms and no gastrointestinal symptom groups according to whether they had gastrointestinal symptoms.The factors that may affect gastrointestinal symptoms were identified by single-factor analysis.Multiple logistic regression analysis was performed to identify independent risk factors for gastrointestinal symptoms.RESULTS Gastrointestinal symptoms included indigestion,constipation,reflux,diarrhea,abdominal pain,and eating disorders,and the total average GSRS score was 1.35±0.47.This study showed that age,number of tablets,dialysis time,glucocorticoid,parathyroid hormone(PTH),combined diabetes mellitus and C-reactive protein(CRP)were independent risk factors for gastrointestinal symptoms in patients with uremia undergoing hemodialysis,whereas body mass index(BMI),hemoglobin(Hb),and urea clearance index were independent protective factors(P<0.05).CONCLUSION Gastrointestinal symptoms are mostly mild in patients with uremia undergoing hemodialysis,most commonly including dyspepsia,eating disorders,and gastroesophageal reflux.The independent influencing factors mainly include the BMI,age,number of pills taken,dialysis time,urea clearance index,Hb,use of glucocorticoids,and thyroid hormone level.PTH,CRP,and diabetes are clinically related factors influencing the occurrence of gastrointestinal symptoms,and targeted prevention can be performed.展开更多
Objective:This study aimed to evaluate the effects of foot reflexology on fatigue and sleep quality in school-aged children receiving hemodialysis.Methods:A quasi-experimental pretest-posttest design was utilized.Thir...Objective:This study aimed to evaluate the effects of foot reflexology on fatigue and sleep quality in school-aged children receiving hemodialysis.Methods:A quasi-experimental pretest-posttest design was utilized.Thirty children of ages 6-12 undergoing in-center hemodialysis were recruited.The Pittsburgh Sleep Quality Index(PSQI)and Inventory of Fatigue Symptom(IFS)scales were administered at baseline.Participants then received 30 min of foot reflexology massage before hemodialysis sessions 3 days per week for 12 weeks.Posttest administration of the sleep and fatigue scales occurred after the intervention period.Results:Reflexology massage led to significant improvements in sleep quality components,including duration(0%-30%normal sleepers),efficiency(0%-50%>85%),latency(50%-0%>60 min),disturbances,and daytime dysfunction.The mean PSQI score decreased from 18.2 to 9.7(P<0.05).Fatigue severity substantially decreased,with the mean IFS score improving from 105.7 to 64.1(P<0.05).Conclusion:Foot reflexology is an effective nursing intervention for reducing fatigue and improving sleep quality in children on hemodialysis,warranting integration into routine care.展开更多
Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conduc...Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method.The data of patients on MHD were collected using the general information questionnaire,Physical Activity Rating Scale,Exercise Benefits/Barriers Scale(EBBS),and Exercise Self-Efficacy Scale(ESES).The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models.Results:Patients on MHD had a low exercise volume score of 13.71±0.68 points and a medium EBBS score of 63.36±0.40 points.Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects,including low monthly household income per capita(odds ratio[OR]=86.741,95%confidence interval[CI][1.164-6.465],P=0.042),primary underlying disease of diabetic nephropathy(OR=45.993,95%CI[1.353-1.564],P=0.033),the belief that“fatigue in lower extremities hinders exercise”(OR=4.697,95%CI[1.127-19.585],P=0.034),and the belief that“physical exercise bringing optimistic and positive life attitude”(OR=0.074,95%CI[0.007-0.830],P=0.035).Conclusions:Since patients on MHD had low physical exercise volume,the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD.Therefore,feasible and effective intervention measures can be formulated based on ESES in clinical nursing.展开更多
Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guid...Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guided cannulation may improve successful cannulation and reduce complications associated with unnecessary punctures. The study aims to conduct the meta-analyze to examine the effectiveness of renal nurse-performed US-guided cannulation to improve successful cannulation and reduce AVF-related complications in difficult AVF access. Design: A meta-analysis of randomised controlled trials. Methods: A systemic search was performed on electronic databases including CINAHL Plus, Web of Science, and PubMed from inception to October 2023. Risk ratios (RR) and standardized mean differences (SMD) were estimated using random-effect models for considerable homogeneity, and the Scottish Intercollegiate Guidelines Network (SIGN) methodology was adopted for critical appraisal. Results: Four RCTs were included. The results showed US-guided AVF cannulation had a significant effect in improving successful cannulation (RR: 0.19, 95% CI: 0.06 to 0.63, p = 0.007), and was favorable in reducing cannulation-associated complications (RR: 0.44, 95% CI: 0.10 to 1.93, p = 0.28), compared with blind needle cannulation. Conclusion: US-guided cannulation performed by renal nurses has the potential to improve successful cannulation, and fewer complications in hemodialysis patients with difficult arteriovenous access. Relevance to Clinical Practice: The results suggest the value of further training for renal nurses in US-guided cannulation, and broader implementation of US-guided cannulation to improve patient outcomes. Future studies could explore the optimal nursing training and longer-term benefits of US-guided cannulation by renal nurses in difficult AVF access. Patient or Public Contribution: No Patient or Public Contribution as this is a meta-analysis using the secondary data published in the RCTs.展开更多
BACKGROUND Primary hyperparathyroidism is typically caused by a single parathyroid adenoma.Ectopic parathyroid adenomas occur as well,with cases involving various sites,including the mediastinum,presenting in varying ...BACKGROUND Primary hyperparathyroidism is typically caused by a single parathyroid adenoma.Ectopic parathyroid adenomas occur as well,with cases involving various sites,including the mediastinum,presenting in varying frequencies.Secondary hyperparathyroidism develops in the context of chronic kidney disease,primarily due to vitamin D deficiency,hypocalcemia,and hyperphosphatemia.It is frequently diagnosed in patients undergoing dialysis.This article presents a rare case of hyperparathyroidism involving multiple hyperplastic parathyroid glands with pulmonary seeding in a 50-year-old female patient undergoing hemodialysis(HD).CASE SUMMARY The patient had a history of parathyroidectomy 10 years prior but developed recurrent hyperparathyroidism with symptoms of pruritus and cough with sputum during a period of routine dialysis.Radiographic imaging revealed multiple nodules in both lungs,with the largest measuring approximately 1.35 cm.Surgical histopathology confirmed the presence of hyperplastic parathyroid glands within the pulmonary tissue.After tumor resection surgery via videoassisted thoracic surgery with wedge resection,the patient was discharged in stable condition and in follow-up her symptoms showed improvement.CONCLUSION This article describes hyperparathyroidism presenting as pulmonary nodules in a patient undergoing postparathyroidectomy HD,highlighting diagnostic challenges and a positive outcome from tumor resection surgery.展开更多
Objective:The study assessed the quality of life(QoL)and coping strategies of patients on hemodialysis in selected hospitals in Ilorin,Kwara State.Methods:The study was a descriptive cross-sectional design using a qua...Objective:The study assessed the quality of life(QoL)and coping strategies of patients on hemodialysis in selected hospitals in Ilorin,Kwara State.Methods:The study was a descriptive cross-sectional design using a quantitative strategy.A multistage sampling technique was adopted to select 80 participants.The data were collected using an adapted questionnaire including four sections:sociodemographic characteristics,hemodialysis stressor scale consisting of four stressors,Jaloweic Coping Scale consisting of eight coping strategies,and QoL consisting of four items.The data were analyzed using SPSS version 23.Results:Findings from the study revealed that 50%of the participants were between the ages of 18 and 39 years,40%of the participants have been on hemodialysis for 1-2 years,whereas 52.5%had hypertension as a comorbidity.A total of 12.5%,63.8%,and 23.8%of the respondents were categorized as experiencing low,moderate,and high stress due to hemodialysis,respectively.QoL of the respondents revealed that 49.4%had no problem in self-care dimension.Average monthly income(χ^(2)=16.36,P=0.04)was observed to be significantly associated with coping strategies,whereas religion(χ^(2)=11.14,P=0.03)and frequency of hemodialysis(χ^(2)=10.26,P=0.04)were significantly associated with coping helpfulness.Conclusion:All participants experienced stress at varying degrees.Hemodialysis results in marked changes in the quality of patients’life,since it includes a number of modifications and restrictions,which affects patients’health functioning.This study revealed a wide range of information on the psychological and physiological stressors of people under hemodialysis.展开更多
It consists of a retrospective study with twenty-two individuals diagnosed with DRC: fourteen HD and eight CAPD, followed up in the dialysis center of Antonio Pedro University Hospital (HUAP) of Fluminense Federal Uni...It consists of a retrospective study with twenty-two individuals diagnosed with DRC: fourteen HD and eight CAPD, followed up in the dialysis center of Antonio Pedro University Hospital (HUAP) of Fluminense Federal University (UFF), between 2015 and 2017. Fifteen healthy control (HC) subjects were included, without diagnosed CKD. Patients with HIV positive, hepatitis A, B, and C, pregnant, cancer, smokers, alcoholics and those exposed to X-rays in the last 3 months, were excluded. Objectives: As oxidative stress and endothelial dysfunction may be linked to the higher prevalence of CVD in CKD patients, we measured the activities of the antioxidants enzymes: SOD and GPx and total NO levels in the plasma and serum of end-stage CKD patients undergoing dialysis therapy, comparing with the HC group. Methods: Quantification of NO levels was performed by fluorometric kit, while activities of SOD and GPx were determined using kinetic methods. Results: We found higher plasma SOD activity in HD (8.58 U/ml) and CAPD (10.14 U/ml), compared to C (3.73 U/ml) group, while GPx activity was decreased in HD (115.38 nmol/h/ml) and CAPD (122.76 nmol/h/ml) groups compared to HC group (275.83 nmol/h/ml). Total serum NO concentration was decreased in HD (14.09 pmol/μl) and CAPD (10.26 pmol/μl), compared to non-CKD patients (49.65 pmol/μl). Conclusion: Decreased total serum NO and GPx activities may lead to endothelial dysfunction and consequently a higher prevalence of CVD in CKD patients.展开更多
Introduction: Following the COVID-19 pandemic, vaccination has been proposed in several countries as the main preventive measure despite very limited data, particularly in dialysis patients. We conducted this study to...Introduction: Following the COVID-19 pandemic, vaccination has been proposed in several countries as the main preventive measure despite very limited data, particularly in dialysis patients. We conducted this study to assess the immunological response to vaccination in Senegalese hemodialysis patients. Patients and Methods: We conducted a prospective study, in two dialysis centers in Dakar from March 30<sup>th</sup> to August 30<sup>th</sup>, 2021 including patients on hemodialysis for >6 months, vaccinated against SARS-CoV-2 according to the vaccination schedule recommended by WHO. A vaccine response was considered positive when seroconversion was observed after one dose of vaccine. The clinical efficacy of immunization was defined as the absence of new COVID-19 infection in patients who received a complete vaccination. Results: Among the 81 patients included in the study, 7.4% had anti-Spike IgM antibodies before their first vaccination. Seroprevalence of IgM antibodies was 38.3% one month after the first vaccine dose (at M1) and 8.6% one month after the second dose (at M4). Anti-Spike IgG antibodies were present in 40.3% of patients before vaccination, in 90.1% at M1, and in 59.7% at M4. Among patients previously infected with SARS-CoV-2, 10.2% had IgM antibodies at M0, 31.6% at M1, and 10.5% at M4 post-vaccination. Similarly, seroprevalences of IgG antibodies in this subgroup were 31.5%, 61.3%, and 50.0% respectively at M0, M1, and M4 post-vaccination. A comparison of seroconversion rates between M0 and M4 showed significant differences only for IgG in COVID-19 naive patients. Mean duration in dialysis and the existence of previous COVID-19 infection were associated with patients’ vaccinal response after the two doses. Age, gender and the use of immunosuppressive treatment did not influence post-vaccinal antibody production. Conclusion: Vaccination against COVID-19 in Senegalese hemodialysis patients induced a low seroconversion rate but it was well tolerated. Moreover, the induced protection was neither strong nor durable, particularly in patients with longer duration in dialysis.展开更多
Background: Neutrophile to lymphocyte ratio (NLR) is a well-established marker of inflammation. It has been reported to be high in chronic kidney disease (CKD) and it is described as a prognosis factor in hemodialysis...Background: Neutrophile to lymphocyte ratio (NLR) is a well-established marker of inflammation. It has been reported to be high in chronic kidney disease (CKD) and it is described as a prognosis factor in hemodialysis patients. However, limited data are available about the normal range of NLR in healthy adults as well as CKD patients including hemodialysis black Africans in Sub-Saharan countries. We sought to study NLR in healthy and advanced CKD in a single Cameroonian health facility. Methods: Blood samples were obtained from blood donors, CKD stage 4 and non-dialysis stage 5, and hemodialysis patients for more than 6 months. Patients with confounding factors such as positive CRP, infection, and recent use of steroids were excluded. RNL means standard deviations (SDs), and 95% confidence intervals (95% CI) were determined. RNL range was defined as percentiles P2.5 to P97.5. Results: A total of 102 participants were included. Mean age was 40.45 ± 9.97 years and 58.8% were male. Age and sex distribution were similar in the three groups. Leucopenia and neutropenia were common in all the groups. Means NLR was 1.29 ± 0.57 (95% CI 1.08 - 1.49) range between 0.55 to 2.67;2.31 ± 1.3 (95% CI 1.75 - 2.88) with range between 0.69 to 4.31 and 2.14 ± 0.98 (95% CI 1.85 - 2.44) with range between 0.77 to 4.32 respectively in controls, CKD, and hemodialysis participants. NLR was comparable in CKD and hemodialysis patients (p = 0.99). Compared to controls, NLR was significantly elevated in CKD (p = 0.043) and hemodialysis patients (p Conclusion: Our data suggest that the normal range for NLR in adult nongeriatric healthy and advanced CKD patients including those on chronic hemodialysis may vary between 0.55 to 2.67 and 0.69 to 4.32 respectively.展开更多
Background: Wnt signalling inhibitors (Dickkopf-1 and Sclerostin) signalling play a role in vascular development and may contribute to calcification. Aim: To investigate the association between Dickkopf-1 and sclerost...Background: Wnt signalling inhibitors (Dickkopf-1 and Sclerostin) signalling play a role in vascular development and may contribute to calcification. Aim: To investigate the association between Dickkopf-1 and sclerostin serum concentrations in children undergoing maintenance hemodialysis with intimal medial thickness and peak systolic velocity of the main arteries. Patients and Methods: A study was conducted on 40 children undergoing maintenance hemodialysis and controls of the same age and sex. The study measured the initial medial thickness (IMT) and peak systolic velocity (PSV) of the main vessels (carotid, ulnar, and femoral). Dickkopf-1 and sclerostin serum levels in both groups were assessed, and a routine investigation was performed. Results: The findings indicate that the levels of serum Dickkopf-1 and Sclerostin were significantly higher in the hemodialysis group 2540.65 (2215.4 - 2909.2 pg/ml) and 1.17 (0.85 - 2.03 ng/ml)respectively (P = 0.001), compared to their control group it was 1110.45 (885.45 - 1527.65 pg/ml) and 0.28 (0.25 - 0.32 ng/ml)) respectively P = 0.001. Additionally, there was a significant increase in intima-media thickness (IMT) with a decrease in peak systolic velocity (PSV) in the main blood vessels, including the carotid, ulnar, and femoral arteries. A significant correlation was also observed between Dickkopf-1 and sclerostin levels and IMT of the carotid, ulnar, and femoral arteries. Conclusion: Wnt signalling inhibitors (Dickkopf-1 and Sclerostin) exert effects beyond the bone and significantly contribute to early vascular calcification in pediatric patients undergoing maintenance hemodialysis.展开更多
文摘Rationale: Endotoxin contamination in conventionally purified water poses serious risks to hemodialysis patients, leading to complications such as inflammation and sepsis. Addressing these risks is essential for enhancing patient safety and meeting global dialysis water quality standards. Advanced filtration technologies, such as titanium dioxide (TiO₂)-based nanoparticle filters, offer a promising approach to improve water purification processes in renal care. Objectives: This study aimed to develop and evaluate the effectiveness of a TiO₂-based nanoparticle microporous filtration system for hemodialysis water purification. The objectives included analyzing the system’s performance in reducing chemical contaminants (calcium, magnesium, aluminum, and lead) and microbiological contaminants (total viable count [TVC] and endotoxin units [EU]) across multiple renal centers. Methods: Water samples from three renal centers (RC1, RC2, and RC3) were analyzed pre- and post-filtration. TiO₂ nanoparticles were synthesized using the sol-gel method and characterized via Fourier Transform Infrared (FTIR) spectroscopy and Scanning Electron Microscopy with Energy Dispersive X-ray analysis (SEM/EDX). The microporous filter, fabricated with TiO₂ nanoparticles, silicon dioxide, and polyethylene glycol (PEG), was tested for its ability to remove contaminants. Analytical techniques included spectroscopy for chemical analysis and microbiological assays for contaminant quantification. Results: Post-treatment analysis revealed significant reductions in chemical contaminants, with removal efficiencies averaging 78% for calcium, 80% for magnesium, 81% for aluminum, and 76.6% for lead across all centers. Microbiological contamination was also substantially reduced, with 78–80% removal of TVC and 76–84.6% reduction in EU levels. FTIR analysis confirmed the presence of hydroxyl groups critical for adsorption, while SEM/EDX characterization revealed a crystalline structure with a particle size of 1.45 nm, pore size of 4.11 μm, filter height of 2.56 mm, and bulk density of 0.58 g/cm³. Conclusion: The TiO₂-based nanoparticle filtration system demonstrated high efficacy in removing chemical and microbiological contaminants, significantly improving water quality for hemodialysis. These results highlight its potential as a practical solution for renal centers, especially in resource-constrained settings. Further studies are needed to evaluate its long-term performance and feasibility for widespread adoption. Recommendation: Renal centers should consider adopting TiO2-based nanoparticle filters to address persistent water quality challenges. Pilot implementations across diverse settings can provide insights into operational feasibility. Additional research should explore scalability, maintenance requirements, and cost-effectiveness to optimize integration into healthcare systems. Significance Statement: This study introduces a practical and innovative solution to improve hemodialysis water purification. By effectively reducing both chemical and microbiological contaminants, the TiO2-based filtration system has the potential to enhance patient safety and outcomes, particularly in settings where maintaining high water quality standards remains challenging.
基金correspondence:Prof.Rashmimala PRADHAN,Department of Medical Surgical Nursing,SUM Nursing College,Faculty of Nursing,Siksha‘O’Anusandhan(Deemed to be University),Bhubaneswar,Odisha,India.E-mail:rashmimalapradhan@soa.ac.in。
文摘Objectives:This study was conducted to determine the effect of multidisciplinary nursing intervention(MNI)on interdialytic weight gain(IDWG)and quality of life(QoL)among chronic hemodialysis patients.Materials and Methods:Quantitative research approach with randomized-controlled,single-blind trial was conducted among 120 chronic hemodialysis patients in Institute of Medical Sciences and SUM Hospital Bhubaneswar,Odisha,India from February 2023 to February 2024.Participants were randomly assigned into the experimental group(n1=65)and control group(n2=55)by block randomization methods.The experimental group received the intervention phase up to the 6th week,along with the usual treatment,and the control group received only standard treatment up to the end of the study.After that,they received the diet chart plan and fluid distribution timetable.Results:Significant improvements were found in IDWG and QoL for the experimental group.The experimental group exhibited a sharp decline in weight gain within the group(F=20.05,P<0.001)between the group(F=13.02,P<0.001),interaction effects between the groups across the time point(F=5.67,P<0.005).Kidney disease QoL scores(KDQOL^(™)36)increased from 49.38±9.56 to 58.63±6.04 in the experimental group,compared to an increase from 50.84±9.25 to 52.04±8.02 in the control group.Conclusion:This trial showed that MNIs significantly reduced IDWG and improved KDQOL^(™)36 scores,with the experimental group outperforming the control,highlighting the intervention’s effectiveness.
基金supported by a grant provided by the Coordenacao de Aperfeicoamento de Pessoal de Nível Superior-Brazil-Finance Code 001 and National Council for Scientific and Technological Developmentfinanced in part by the Conselho Nacional de Desenvolvimento Científico e Tecnológico and Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior-Brasil--Finance Code 001funded by the Fundacao de Apoio à Pesquisa do Distrito Federal with grants from demanda espontanea-Edital 09/2022
文摘Background:Hemodialysis(HD) per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR) exercise in HD patients,identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model.The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise(RE) with BFR on this molecule.Methods:Two hundred and six HD patients volunteered for this study(all with a glomerular filtration rate of <15 mL/min/1.73 m2).The RE+BFR session consisted of 50% arterial occlusion pressure during 50 min sessions of HD(intradialytic exercise).RE repetitions included concentric and eccentric lifting phases(each lasting 2 s) and were supervised by a strength and conditioning specialist.Results:Several variables were associated with elevated levels of D-dimer,including higher blood glucose,citrate use,recent cardiovascular events,recent intercurrents,higher inflammatory status,catheter as vascular access,older patients(>70 years old),and HD vintage.Furthermore,RE+BFR significantly increases D-dimer after 4 h.Patients with borderline baseline D-dimer levels(400-490 ng/mL) displayed increased risk of elevating D-dimer over the normal range(≥500 ng/mL).Conclusion:These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE+BFR.D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE+BFR.
文摘I read with great interest the article“Concerns on the application of blood flow restriction resistance exercise and thrombosis risk in hemodialysis patients”by Correa et al.1 The study presents complementary data from a previous randomized controlled trial,2 exploring the application of intradialytic blood flow restriction exercise for hemodialysis patients.
文摘BACKGROUND Poor sleep quality is common among hemodialysis patients and can significantly impact their well-being.This study aimed to evaluate the effectiveness of a structured nursing intervention program in improving sleep quality in middleaged and elderly hemodialysis patients.AIM To evaluate the impact of nursing intervention on sleep quality in hemodialysis patients.METHODS This cross-sectional study was conducted in a tertiary hospital,the First Affiliated Hospital of Nanchang University,in 2023.This study included 105 middle-aged and elderly hemodialysis patients aged≥45 years who underwent maintenance hemodialysis for at least 3 mo,utilizing the Pittsburgh Sleep Quality Index(PSQI)to identify poor sleepers.Those identified underwent a 12-wk nursing intervention program focusing on education,relaxation techniques,and counseling.Post-intervention,sleep quality was reassessed using the PSQI.RESULTS The study found that 68.6%of hemodialysis patients were poor sleepers.Following the 12-wk nursing intervention program,there was a significant decrease in the mean global PSQI score from 8.9±3.2 to 5.1±2.7(P<0.001),indicating improved sleep quality.This demonstrated the effectiveness of the structured nursing intervention in enhancing sleep quality for middle-aged and elderly hemodialysis patients.CONCLUSION The structured nursing intervention program focusing on sleep hygiene education,relaxation techniques,and counseling effectively improved sleep quality among middle-aged and elderly hemodialysis patients.The significant decrease in the mean global PSQI score post-intervention indicates the positive impact of tailored nursing interventions in addressing poor sleep quality in this patient population.These findings emphasize the importance of implementing targeted nursing interventions to enhance the quality of life for hemodialysis patients by addressing the prevalent issue of poor sleep quality.
文摘Objective:To investigate the difference in serum ferritin levels between deceased and surviving regular hemodialysis patients with COVID-19.Methods:We conducted a systematic search across four databases following the PRISMA statement guidelines.Studies reporting ferritin levels and mortality of regular hemodialysis patients with COVID-19 were included.Employing the random-effects model,we performed a meta-analysis to determine the mean difference in serum ferritin levels between the studied groups,along with their corresponding 95%confidence intervals.The meta-analysis was carried out using Review Manager 5.4 and Stata 16.Results:A total of 1013 patients from seven studies were included in this study.Our meta-analysis showed higher mean serum ferritin in the deceased compared to surviving regular hemodialysis patients with COVID-19,with a mean difference of 449.43 ng/mL[95%CI(244.07,654.80),P<0.0001;I2=58%,P=0.003].Conclusions:Our study found a higher mean of serum ferritin levels in the deceased compared to surviving regular hemodialysis patients with COVID-19.
基金the National Natural Science Foundation of China(No.82171072)the Guangdong Basic and Applied Basic Research Foundation(No.2021A1515010921).
文摘Dear Editor,We report a rare case of endogenous endophthalmitis caused by Candida albicans in a patient with chronic renal failure concomitant hemodialysis.A 71-year-old man with a history of hypertension and 2-year chronic renal failure on hemodialysis via a native arteriovenous fistula(AVF)was presented to the local hospital due to fever 3wk ago.No pathogens were detected through blood culture on admission,and his fever gradually subsided with intravenous ceftriaxone sodium.After a week of fever,he experienced progressive blurred vision in both eyes,accompanied by pain and headaches.Subsequent magnetic resonance imaging(MRI)of the brain revealed sinusitis.He had not undergone any previous eye surgeries or trauma.
基金Supported by 2021 Wuxi Nursing Association Nursing Scientific Research Project Fund,No.Q202106.
文摘BACKGROUND Diabetic kidney disease(DKD)is a prevalent complication of diabetes that often requires hemodialysis for treatment.In the field of nursing,there is a growing recognition of the importance of humanistic care,which focuses on the holistic needs of patients,including their emotional,psychological,and social well-being.However,the application of humanistic nursing in the context of hemodialysis for DKD patients remains relatively unexplored.AIM To explore the experience of humanistic nursing in hemodialysis nursing for DKD patients.METHODS Ninety-six DKD patients treated with hemodialysis from March 2020 to June 2022 were included in the study and divided into the control cluster(48 cases)and the study cluster(48 cases)according to different nursing methods;the control cluster was given routine nursing and the study cluster was given humanized nursing.The variances of negative emotion mark,blood glucose,renal function,the incidence of complications,life mark and nursing satisfaction before and after nur-sing were contrasted between the two clusters.RESULTS No significant difference in negative emotion markers between the two clusters were observed before nursing(P>0.05),and the negative emotion markers of the two clusters decreased after nursing.The Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale markers were lower in the study cluster than the control cluster.The healing rate of patients in the study cluster was significantly higher than the control cluster(97.92%vs 85.42%,P<0.05).Blood glucose parameters were not significantly different between the groups prior to nursing(P>0.05).However,after nursing,blood urea nitrogen and serum creatinine(SCr)levels in the study cluster were lower than those in the control cluster(P<0.05).The incidence rate of complications was significantly lower in the study group compared to the control cluster(6.25%vs 20.83%,P<0.05).There was no significant difference in the life markers between the two clusters before nursing.While the life markers increased after nursing for both groups,the 36-item health scale markers in the study cluster were higher than those within the control cluster(P<0.05).Finally,the nursing satisfaction rate was 93.75% in the study cluster,compared to 75% in the control cluster(P<0.05).CONCLUSION In hemodialysis for DKD patients,the implementation of humanistic nursing achieved ideal results,effectively reducing patients’psychological negative emotion markers so that they can actively cooperate with the diagnosis and nursing,facilitate the control of blood glucose and the maintenance of residual renal function,reduce the occurrence of complications,and finally enhance the life quality and nursing satisfaction of patients.It is worthy of being widely popularized and applied.
基金Zhejiang Province Medicine and Health Science and Technology Programme,No.2019RC092 and No.2020KY394the Public Welfare Project of Zhejiang Provincial Department of Science and Technology,No.LGF19H170003.
文摘BACKGROUND Pulmonary hypertension is a serious complication in the treatment of maintenance hemodialysis patients,which seriously affects the quality of life of patients and threatens their life safety.Prevention,treatment and improvement of pulmonary hypertension are of great significance to improve the quality of life of patients.AIM To investigate the intervention and control of pedal-powered bicycle in maintaining quality of life and pulmonary hypertension in hemodialysis patients.METHODS 73 patients with maintenance hemadialysis combined with pulmonary arterial hypertension at a hemodialysis center in a certain hospital from May 2021 to May 2022 are selected.Patients are divided into two groups,37 cases in the control group(group C)and 36 cases in the intervention group(group I).Patients are divided into two groups,group C is treated with oral administration of betaglandin sodium combined with routine nursing care.Based on group C,group I conducts power cycling exercises.RESULTS After treatment,group I patients had higher muscle strength,36-Item Short Form Health Survey scores,and Kidney Disease Targets Areas scores;The 6-minute walk distance test index level was higher and the Borg score was lower;The group I had lower systolic blood pressure,greater vital capacity,higher positive emotion,lower systolic pulmonary artery pressure index level,higher arterial partial oxygen pressure level,lower pulmonary vascular resistance index level,and higher blood oxygen saturation level[158.91±11.89 vs 152.56±12.81,1795.01±603.18 vs 1907.20±574.15,24.00(22.00,29.00)vs 24.00(22.00,28.00),P<0.001].CONCLUSION Aerobic exercise combined with Western medicine treatment can effectively improve patients'pulmonary hypertension,alleviate their negative emotions,and enable them to achieve a higher level of quality of life.
基金Supported by the Natural Science Foundation Project of Xinjiang Uygur Autonomous Region,No.2021D01C143.
文摘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.
文摘BACKGROUND Gastrointestinal symptoms are common in patients with uremia undergoing hemodialysis,and these symptoms seriously affect patients'prognosis.AIM To assess the occurrence and factors influencing gastrointestinal symptoms in patients with uremia undergoing hemodialysis.METHODS We retrospectively selected 98 patients with uremia who underwent regular hemo-dialysis treatment in the blood purification center of our hospital from December 2022 to December 2023.The gastrointestinal symptoms and scores of each dimension were evaluated using the Gastrointestinal Symptom Grading Scale(GSRS).Patients were divided into gastrointestinal symptoms and no gastrointestinal symptom groups according to whether they had gastrointestinal symptoms.The factors that may affect gastrointestinal symptoms were identified by single-factor analysis.Multiple logistic regression analysis was performed to identify independent risk factors for gastrointestinal symptoms.RESULTS Gastrointestinal symptoms included indigestion,constipation,reflux,diarrhea,abdominal pain,and eating disorders,and the total average GSRS score was 1.35±0.47.This study showed that age,number of tablets,dialysis time,glucocorticoid,parathyroid hormone(PTH),combined diabetes mellitus and C-reactive protein(CRP)were independent risk factors for gastrointestinal symptoms in patients with uremia undergoing hemodialysis,whereas body mass index(BMI),hemoglobin(Hb),and urea clearance index were independent protective factors(P<0.05).CONCLUSION Gastrointestinal symptoms are mostly mild in patients with uremia undergoing hemodialysis,most commonly including dyspepsia,eating disorders,and gastroesophageal reflux.The independent influencing factors mainly include the BMI,age,number of pills taken,dialysis time,urea clearance index,Hb,use of glucocorticoids,and thyroid hormone level.PTH,CRP,and diabetes are clinically related factors influencing the occurrence of gastrointestinal symptoms,and targeted prevention can be performed.
文摘Objective:This study aimed to evaluate the effects of foot reflexology on fatigue and sleep quality in school-aged children receiving hemodialysis.Methods:A quasi-experimental pretest-posttest design was utilized.Thirty children of ages 6-12 undergoing in-center hemodialysis were recruited.The Pittsburgh Sleep Quality Index(PSQI)and Inventory of Fatigue Symptom(IFS)scales were administered at baseline.Participants then received 30 min of foot reflexology massage before hemodialysis sessions 3 days per week for 12 weeks.Posttest administration of the sleep and fatigue scales occurred after the intervention period.Results:Reflexology massage led to significant improvements in sleep quality components,including duration(0%-30%normal sleepers),efficiency(0%-50%>85%),latency(50%-0%>60 min),disturbances,and daytime dysfunction.The mean PSQI score decreased from 18.2 to 9.7(P<0.05).Fatigue severity substantially decreased,with the mean IFS score improving from 105.7 to 64.1(P<0.05).Conclusion:Foot reflexology is an effective nursing intervention for reducing fatigue and improving sleep quality in children on hemodialysis,warranting integration into routine care.
文摘Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method.The data of patients on MHD were collected using the general information questionnaire,Physical Activity Rating Scale,Exercise Benefits/Barriers Scale(EBBS),and Exercise Self-Efficacy Scale(ESES).The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models.Results:Patients on MHD had a low exercise volume score of 13.71±0.68 points and a medium EBBS score of 63.36±0.40 points.Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects,including low monthly household income per capita(odds ratio[OR]=86.741,95%confidence interval[CI][1.164-6.465],P=0.042),primary underlying disease of diabetic nephropathy(OR=45.993,95%CI[1.353-1.564],P=0.033),the belief that“fatigue in lower extremities hinders exercise”(OR=4.697,95%CI[1.127-19.585],P=0.034),and the belief that“physical exercise bringing optimistic and positive life attitude”(OR=0.074,95%CI[0.007-0.830],P=0.035).Conclusions:Since patients on MHD had low physical exercise volume,the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD.Therefore,feasible and effective intervention measures can be formulated based on ESES in clinical nursing.
文摘Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guided cannulation may improve successful cannulation and reduce complications associated with unnecessary punctures. The study aims to conduct the meta-analyze to examine the effectiveness of renal nurse-performed US-guided cannulation to improve successful cannulation and reduce AVF-related complications in difficult AVF access. Design: A meta-analysis of randomised controlled trials. Methods: A systemic search was performed on electronic databases including CINAHL Plus, Web of Science, and PubMed from inception to October 2023. Risk ratios (RR) and standardized mean differences (SMD) were estimated using random-effect models for considerable homogeneity, and the Scottish Intercollegiate Guidelines Network (SIGN) methodology was adopted for critical appraisal. Results: Four RCTs were included. The results showed US-guided AVF cannulation had a significant effect in improving successful cannulation (RR: 0.19, 95% CI: 0.06 to 0.63, p = 0.007), and was favorable in reducing cannulation-associated complications (RR: 0.44, 95% CI: 0.10 to 1.93, p = 0.28), compared with blind needle cannulation. Conclusion: US-guided cannulation performed by renal nurses has the potential to improve successful cannulation, and fewer complications in hemodialysis patients with difficult arteriovenous access. Relevance to Clinical Practice: The results suggest the value of further training for renal nurses in US-guided cannulation, and broader implementation of US-guided cannulation to improve patient outcomes. Future studies could explore the optimal nursing training and longer-term benefits of US-guided cannulation by renal nurses in difficult AVF access. Patient or Public Contribution: No Patient or Public Contribution as this is a meta-analysis using the secondary data published in the RCTs.
文摘BACKGROUND Primary hyperparathyroidism is typically caused by a single parathyroid adenoma.Ectopic parathyroid adenomas occur as well,with cases involving various sites,including the mediastinum,presenting in varying frequencies.Secondary hyperparathyroidism develops in the context of chronic kidney disease,primarily due to vitamin D deficiency,hypocalcemia,and hyperphosphatemia.It is frequently diagnosed in patients undergoing dialysis.This article presents a rare case of hyperparathyroidism involving multiple hyperplastic parathyroid glands with pulmonary seeding in a 50-year-old female patient undergoing hemodialysis(HD).CASE SUMMARY The patient had a history of parathyroidectomy 10 years prior but developed recurrent hyperparathyroidism with symptoms of pruritus and cough with sputum during a period of routine dialysis.Radiographic imaging revealed multiple nodules in both lungs,with the largest measuring approximately 1.35 cm.Surgical histopathology confirmed the presence of hyperplastic parathyroid glands within the pulmonary tissue.After tumor resection surgery via videoassisted thoracic surgery with wedge resection,the patient was discharged in stable condition and in follow-up her symptoms showed improvement.CONCLUSION This article describes hyperparathyroidism presenting as pulmonary nodules in a patient undergoing postparathyroidectomy HD,highlighting diagnostic challenges and a positive outcome from tumor resection surgery.
文摘Objective:The study assessed the quality of life(QoL)and coping strategies of patients on hemodialysis in selected hospitals in Ilorin,Kwara State.Methods:The study was a descriptive cross-sectional design using a quantitative strategy.A multistage sampling technique was adopted to select 80 participants.The data were collected using an adapted questionnaire including four sections:sociodemographic characteristics,hemodialysis stressor scale consisting of four stressors,Jaloweic Coping Scale consisting of eight coping strategies,and QoL consisting of four items.The data were analyzed using SPSS version 23.Results:Findings from the study revealed that 50%of the participants were between the ages of 18 and 39 years,40%of the participants have been on hemodialysis for 1-2 years,whereas 52.5%had hypertension as a comorbidity.A total of 12.5%,63.8%,and 23.8%of the respondents were categorized as experiencing low,moderate,and high stress due to hemodialysis,respectively.QoL of the respondents revealed that 49.4%had no problem in self-care dimension.Average monthly income(χ^(2)=16.36,P=0.04)was observed to be significantly associated with coping strategies,whereas religion(χ^(2)=11.14,P=0.03)and frequency of hemodialysis(χ^(2)=10.26,P=0.04)were significantly associated with coping helpfulness.Conclusion:All participants experienced stress at varying degrees.Hemodialysis results in marked changes in the quality of patients’life,since it includes a number of modifications and restrictions,which affects patients’health functioning.This study revealed a wide range of information on the psychological and physiological stressors of people under hemodialysis.
文摘It consists of a retrospective study with twenty-two individuals diagnosed with DRC: fourteen HD and eight CAPD, followed up in the dialysis center of Antonio Pedro University Hospital (HUAP) of Fluminense Federal University (UFF), between 2015 and 2017. Fifteen healthy control (HC) subjects were included, without diagnosed CKD. Patients with HIV positive, hepatitis A, B, and C, pregnant, cancer, smokers, alcoholics and those exposed to X-rays in the last 3 months, were excluded. Objectives: As oxidative stress and endothelial dysfunction may be linked to the higher prevalence of CVD in CKD patients, we measured the activities of the antioxidants enzymes: SOD and GPx and total NO levels in the plasma and serum of end-stage CKD patients undergoing dialysis therapy, comparing with the HC group. Methods: Quantification of NO levels was performed by fluorometric kit, while activities of SOD and GPx were determined using kinetic methods. Results: We found higher plasma SOD activity in HD (8.58 U/ml) and CAPD (10.14 U/ml), compared to C (3.73 U/ml) group, while GPx activity was decreased in HD (115.38 nmol/h/ml) and CAPD (122.76 nmol/h/ml) groups compared to HC group (275.83 nmol/h/ml). Total serum NO concentration was decreased in HD (14.09 pmol/μl) and CAPD (10.26 pmol/μl), compared to non-CKD patients (49.65 pmol/μl). Conclusion: Decreased total serum NO and GPx activities may lead to endothelial dysfunction and consequently a higher prevalence of CVD in CKD patients.
文摘Introduction: Following the COVID-19 pandemic, vaccination has been proposed in several countries as the main preventive measure despite very limited data, particularly in dialysis patients. We conducted this study to assess the immunological response to vaccination in Senegalese hemodialysis patients. Patients and Methods: We conducted a prospective study, in two dialysis centers in Dakar from March 30<sup>th</sup> to August 30<sup>th</sup>, 2021 including patients on hemodialysis for >6 months, vaccinated against SARS-CoV-2 according to the vaccination schedule recommended by WHO. A vaccine response was considered positive when seroconversion was observed after one dose of vaccine. The clinical efficacy of immunization was defined as the absence of new COVID-19 infection in patients who received a complete vaccination. Results: Among the 81 patients included in the study, 7.4% had anti-Spike IgM antibodies before their first vaccination. Seroprevalence of IgM antibodies was 38.3% one month after the first vaccine dose (at M1) and 8.6% one month after the second dose (at M4). Anti-Spike IgG antibodies were present in 40.3% of patients before vaccination, in 90.1% at M1, and in 59.7% at M4. Among patients previously infected with SARS-CoV-2, 10.2% had IgM antibodies at M0, 31.6% at M1, and 10.5% at M4 post-vaccination. Similarly, seroprevalences of IgG antibodies in this subgroup were 31.5%, 61.3%, and 50.0% respectively at M0, M1, and M4 post-vaccination. A comparison of seroconversion rates between M0 and M4 showed significant differences only for IgG in COVID-19 naive patients. Mean duration in dialysis and the existence of previous COVID-19 infection were associated with patients’ vaccinal response after the two doses. Age, gender and the use of immunosuppressive treatment did not influence post-vaccinal antibody production. Conclusion: Vaccination against COVID-19 in Senegalese hemodialysis patients induced a low seroconversion rate but it was well tolerated. Moreover, the induced protection was neither strong nor durable, particularly in patients with longer duration in dialysis.
文摘Background: Neutrophile to lymphocyte ratio (NLR) is a well-established marker of inflammation. It has been reported to be high in chronic kidney disease (CKD) and it is described as a prognosis factor in hemodialysis patients. However, limited data are available about the normal range of NLR in healthy adults as well as CKD patients including hemodialysis black Africans in Sub-Saharan countries. We sought to study NLR in healthy and advanced CKD in a single Cameroonian health facility. Methods: Blood samples were obtained from blood donors, CKD stage 4 and non-dialysis stage 5, and hemodialysis patients for more than 6 months. Patients with confounding factors such as positive CRP, infection, and recent use of steroids were excluded. RNL means standard deviations (SDs), and 95% confidence intervals (95% CI) were determined. RNL range was defined as percentiles P2.5 to P97.5. Results: A total of 102 participants were included. Mean age was 40.45 ± 9.97 years and 58.8% were male. Age and sex distribution were similar in the three groups. Leucopenia and neutropenia were common in all the groups. Means NLR was 1.29 ± 0.57 (95% CI 1.08 - 1.49) range between 0.55 to 2.67;2.31 ± 1.3 (95% CI 1.75 - 2.88) with range between 0.69 to 4.31 and 2.14 ± 0.98 (95% CI 1.85 - 2.44) with range between 0.77 to 4.32 respectively in controls, CKD, and hemodialysis participants. NLR was comparable in CKD and hemodialysis patients (p = 0.99). Compared to controls, NLR was significantly elevated in CKD (p = 0.043) and hemodialysis patients (p Conclusion: Our data suggest that the normal range for NLR in adult nongeriatric healthy and advanced CKD patients including those on chronic hemodialysis may vary between 0.55 to 2.67 and 0.69 to 4.32 respectively.
文摘Background: Wnt signalling inhibitors (Dickkopf-1 and Sclerostin) signalling play a role in vascular development and may contribute to calcification. Aim: To investigate the association between Dickkopf-1 and sclerostin serum concentrations in children undergoing maintenance hemodialysis with intimal medial thickness and peak systolic velocity of the main arteries. Patients and Methods: A study was conducted on 40 children undergoing maintenance hemodialysis and controls of the same age and sex. The study measured the initial medial thickness (IMT) and peak systolic velocity (PSV) of the main vessels (carotid, ulnar, and femoral). Dickkopf-1 and sclerostin serum levels in both groups were assessed, and a routine investigation was performed. Results: The findings indicate that the levels of serum Dickkopf-1 and Sclerostin were significantly higher in the hemodialysis group 2540.65 (2215.4 - 2909.2 pg/ml) and 1.17 (0.85 - 2.03 ng/ml)respectively (P = 0.001), compared to their control group it was 1110.45 (885.45 - 1527.65 pg/ml) and 0.28 (0.25 - 0.32 ng/ml)) respectively P = 0.001. Additionally, there was a significant increase in intima-media thickness (IMT) with a decrease in peak systolic velocity (PSV) in the main blood vessels, including the carotid, ulnar, and femoral arteries. A significant correlation was also observed between Dickkopf-1 and sclerostin levels and IMT of the carotid, ulnar, and femoral arteries. Conclusion: Wnt signalling inhibitors (Dickkopf-1 and Sclerostin) exert effects beyond the bone and significantly contribute to early vascular calcification in pediatric patients undergoing maintenance hemodialysis.
