scholarly journals Why and how should we promote home dialysis for patients with end-stage kidney disease during and after the coronavirus 2019 disease pandemic? A French perspective

2021 ◽  
Author(s):  
Guy Rostoker ◽  
Belkacem Issad ◽  
Hafedh Fessi ◽  
Ziad A. Massy
Keyword(s):  
Kidney Disease ◽  
Scientific Data ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
Health Crisis ◽  
Home Dialysis ◽  
Objective Information ◽  
Home Haemodialysis ◽  
Renal Replacement Therapies ◽  
End Stage

AbstractThe health crisis induced by the pandemic of coronavirus 2019 disease (COVID-19) has had a major impact on dialysis patients in France. The incidence of infection with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first wave of the COVID-19 epidemic was 3.3% among dialysis patients—13 times higher than in the general population. The corresponding mortality rate was high, reaching 21%. As of 19th April, 2021, the cumulative prevalence of SARS-CoV-2 infection in French dialysis patients was 14%. Convergent scientific data from France, Italy, the United Kingdom and Canada show that home dialysis reduces the risk of SARS-CoV-2 infection by a factor of at least two. Unfortunately, home dialysis in France is not sufficiently developed: the proportion of dialysis patients being treated at home is only 7%. The obstacles to the provision of home care for patients with end-stage kidney disease in France include (i) an unfavourable pricing policy for home haemodialysis and nurse visits for assisted peritoneal dialysis (PD), (ii) insufficient training in home dialysis for nephrologists, (iii) the small number of administrative authorizations for home dialysis programs, and (iv) a lack of structured, objective information on renal replacement therapies for patients with advanced chronic kidney disease (CKD). We propose a number of pragmatic initiatives that could be simultaneously enacted to improve the situation in three areas: (i) the provision of objective information on renal replacement therapies for patients with advanced CKD, (ii) wider authorization of home dialysis networks and (iii) price increases in favour of home dialysis procedures.

Arrhythmias in dialysis patients

2021 ◽  
Vol 4 (57) ◽  
pp. 8-11
Author(s):  
Szymon Warwas ◽  
Marta Jagosz ◽  
Beata Średniawa ◽  
Michał Mazurek ◽  
Ewa Jędrzejczyk-Patej
Keyword(s):  
Cardiovascular Diseases ◽  
Sudden Cardiac Death ◽  
Kidney Disease ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
Common Cause ◽  
Conduction Disturbances ◽  
End Stage

The most common cause of death among dialysis patients with end-stage kidney disease are cardiovascular diseases. It is estimated that 18-27% of all deaths in dialysis patients are sudden cardiac deaths due to arrhythmias and conduction disturbances. The most common arrhythmias in dialysis patients, often leading to sudden death, are not ventricular arrhythmias but bradyarrhythmias. The article below discusses the most common arrhythmias in dialysis patients and methods of preventing sudden cardiac death in this group of patients.

scholarly journals A Randomized Controlled Trial to Evaluate and Assess the Effect of Comprehensive Pre-End Stage Kidney Disease Education on Home Dialysis Use in Veterans, Rationale and Design

2021 ◽  
Author(s):  
Ashutosh M. Shukla ◽  
Jennifer Hale-Gallardo ◽  
Tatiana Orozco ◽  
Ivette Freytes ◽  
Sergio Romero ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Controlled Trial ◽  
End Stage Kidney Disease ◽  
Patient Centered ◽  
Advanced Chronic Kidney Disease ◽  
Home Dialysis ◽  
Clinical Patient ◽  
Randomized Controlled ◽  
The Us ◽  
End Stage

Abstract Background Informed dialysis selection and greater home dialysis use are the two long-desired, underachieved targets of advanced chronic kidney disease care in the US healthcare system. Observational institutional studies have shown that comprehensive pre-end stage kidney disease (ESKD) disease education (CPE) can improve both these outcomes. However, lack of validated protocols, well-controlled studies, and systemic models have limited wide-spread adoption of CPE in the US. We hypothesized that a universal CPE and patient-centered initiation of renal replacement therapy can improve multiple clinical, patient-centered and health service outcomes in advanced chronic kidney disease (CKD) and ESKD.Methods Trial to Evaluate and Assess the effects of CPE on Home dialysis in Veterans (TEACH-VET) is a mixed method randomized controlled trial aimed to evaluate the effects of a system-based approach for providing CPE to all Veterans with advanced CKD across a regional healthcare System. The study will randomize 544 Veterans with non-dialysis stage 4 and 5 CKD in a 1:1 allocation stratified by their annual family income and the stage of CKD to an intervention (CPE) arm or control arm. Intervention arm will receive a two-phase CPE in an intent-to-teach manner. Control arm will receive usual clinical care supplemented by resources for the freely-available kidney disease information. Participants will be followed after intervention/control for the duration of the study or until 90-days post-ESKD, whichever occurs earlier.Results The primary outcome will assess the proportion of Veterans using home dialysis at 90-days post-ESKD, and secondary outcomes will include post-intervention/control CKD knowledge, confidence in dialysis decision and home dialysis selection. Qualitative arm of the study will use semi-structured interviews to in-depth assess Veterans’ satisfaction with the intervention, preference for delivery, and barriers and facilitators to home dialysis selection and use. Several post-ESKD clinical, patient-centered and health services outcomes will be assessed 90-days post-ESKD as additional secondary outcomes.Conclusion The results will provide evidence regarding the need and efficacy of a system-based, patient-centered approach towards universal CPE for all patients with advanced CKD. If successful, this may provide a blueprint for developing such programs across the similar healthcare infrastructures throughout the country.Trial registration: NCT04064086

scholarly journals Dysfunction of natural killer cells in end-stage kidney disease on hemodialysis

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kei Nagai
Keyword(s):  
Oxidative Stress ◽  
Kidney Disease ◽  
Nk Cells ◽  
Natural Killer ◽  
Nk Cell ◽  
Cell Number ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
Activating Receptors ◽  
End Stage

AbstractNatural killer (NK) cells are known to play an important role in defense against infection and tumors. Although there is no clear consensus, most studies have shown that the number and cytotoxicity of NK cells decreases in end-stage kidney disease (ESKD) patients undergoing hemodialysis. Uremic patients chronically suffer from oxidative stress, which could be responsible for downregulation of the activating receptors on NK cells and modulation of ligand expression for activating receptors. Theoretically, the reduced number of NK cells and decreased function might increase susceptibility to viral infections and cancer development in patients with ESKD. There is emerging evidence that NK cell numbers may be an outcome predictor in renal transplantation; however, the clinical significance of NK cell dysfunction in dialysis patients requires clarification. In this review, I describe NK cell number, cytotoxic activity, and activating mechanisms in the context of uremia and oxidative stress, which is anticipated to assist in elucidating the mechanisms underlying immunodeficiency in dialysis patients.

scholarly journals Epidemiology of COVID-19 Infection in Hospitalized End-Stage Kidney Disease Patients in a Predominantly African-American Population

2021 ◽  
pp. 1-9
Author(s):  
José E. Navarrete ◽  
David C. Tong ◽  
Jason Cobb ◽  
Frederic F. Rahbari-Oskoui ◽  
Darya Hosein ◽  
...  
Keyword(s):  
African American ◽  
Kidney Disease ◽  
Peripheral Vascular ◽  
C Reactive Protein ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
Reactive Protein ◽  
History Of ◽  
End Stage ◽  
D Dimer

<b><i>Background:</i></b> End-stage kidney disease patients on dialysis are particularly susceptible to COVID-19 infection due to comorbidities, age, and logistic constraints of dialysis making social distancing difficult. We describe our experience with hospitalized dialysis patients with COVID-19 and factors associated with mortality. <b><i>Methods:</i></b> From March 1, 2020, to May 31, 2020, all dialysis patients admitted to 4 Emory Hospitals and tested for COVID-19 were identified. Sociodemographic information and clinical and laboratory data were obtained from the medical record. Death was defined as an in-hospital death or transfer to hospice for end-of-life care. Patients were followed until discharge or death. <b><i>Results:</i></b> Sixty-four dialysis patients with COVID-19 were identified. Eighty-four percent were African-American. The median age was 64 years, and 59% were males. Four patients were on peritoneal dialysis, and 60 were on hemodialysis for a median time of 3.8 years, while 31% were obese. Fever (72%), cough (61%), and diarrhea (22%) were the most common symptoms at presentation. Thirty-three percent required admission to intensive care unit, and 23% required mechanical ventilation. The median length of stay was 10 days, while 11 patients (17%) died during hospitalization and 17% were discharged to a temporary rehabilitation facility. Age &#x3e;65 years (RR 13.7, CI: 1.9–100.7), C-reactive protein &#x3e;100 mg/dL (RR 8.3, CI: 1.1–60.4), peak D-dimer &#x3e;3,000 ng/mL (RR 4.3, CI: 1.03–18.2), bilirubin &#x3e;1 mg/dL (RR 3.9, CI: 1.5–10.4), and history of peripheral vascular disease (RR 3.2, CI: 1.2–9.1) were associated with mortality. Dialysis COVID-19-infected patients were more likely to develop thromboembolic complications than those without COVID-19 (RR 3.7, CI: 1.3–10.1). <b><i>Conclusion:</i></b> In a predominantly African-American population, the mortality of end-stage kidney disease patients admitted with COVID-19 infection was 17%. Age, C-reactive protein, D-dimer, bilirubin, and history of peripheral vascular disease were associated with worse survival.

On the potential of wearable bioimpedance for longitudinal fluid monitoring in end-stage kidney disease

2021 ◽  
Author(s):  
Lucas Lindeboom ◽  
Seulki Lee ◽  
Fokko Wieringa ◽  
Willemijn Groenendaal ◽  
Carlo Basile ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Fluid Management ◽  
Wearable Devices ◽  
Invasive Technique ◽  
Haemodynamic Instability ◽  
End Stage Kidney Disease ◽  
Similar Frequency ◽  
Home Dialysis ◽  
Fluid Status ◽  
End Stage

Abstract Bioimpedance spectroscopy (BIS) has proven to be a promising non-invasive technique for fluid monitoring in haemodialysis (HD) patients. While current BIS-based monitoring of pre- and post-dialysis fluid status utilizes benchtop devices, designed for intramural use, advancements in micro-electronics have enabled the development of wearable bioimpedance systems. Wearable systems meanwhile can offer a similar frequency range for current injection as commercially available benchtop devices. This opens opportunities for unobtrusive longitudinal fluid status monitoring, including transcellular fluid shifts, with the ultimate goal of improving fluid management, thereby lowering mortality and improving quality of life for HD patients. Ultra-miniaturized wearable devices can also offer simultaneous acquisition of multiple other parameters, including haemodynamic parameters. Combination of wearable BIS and additional longitudinal multiparametric data may aid in the prevention of both haemodynamic instability as well as fluid overload. The opportunity to also acquire data during interdialytic periods using wearable devices likely will give novel pathophysiological insights and the development of smart (predicting) algorithms could contribute to personalizing dialysis schemes and ultimately to autonomous (nocturnal) home dialysis. This review provides an overview of current research regarding wearable bioimpedance, with special attention to applications in end-stage kidney disease patients. Furthermore, we present an outlook on the future use of wearable bioimpedance within dialysis practice.

scholarly journals P0070ARE BIOMARKERS OF AGEING IN THE FORM OF TELOMERE LENGTH AND/OR THE DNA METHYLATION STATUS ASSOCIATED WITH FRAILTY PHENOTYPE IN PATIENTS WITH END STAGE KIDNEY DISEASE ON DIALYSIS?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Vasantha Muthuppalaniappan ◽  
Kieran McCafferty ◽  
Muhammad Yaqoob
Keyword(s):  
Dna Methylation ◽  
Kidney Disease ◽  
Telomere Length ◽  
Biological Age ◽  
Chronological Age ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
Frailty Phenotype ◽  
Cpg Sites ◽  
End Stage

Abstract Background and Aims There appears to be an accelerated ageing process seen among patients with end stage kidney disease. They often exhibit prematurely aged phenotypes which include frailty, sarcopenia and protein energy wasting. These phenotypes are associated with increased morbidity and mortality. The exact reason for premature ageing in this cohort is poorly understood. We hypothesised that biomarkers of cellular senescence and biological age may be associated with phenotypes of ageing observed in dialysis patients; in particular the frailty phenotype. Both telomere length (TL) and DNA methylation (DNAm) status have been recognised as predictors of biological age. The aim of the study was to investigate the relationship between TL and DNAm status with frailty phenotype among patients on dialysis. Method This was a single centre prospective observational study among eligible haemodialysis (HD) and peritoneal dialysis (PD) patients as per the inclusion and exclusion criteria. All recruited patients had their DNA extracted from peripheral leucocytes and frailty was measured by using the Fried Frailty Phenotype criteria. Extracted DNA was used to measure TL by quantitate polymerase chain reaction according to the modified Cawthon protocol. DNAm status was measured by sodium bisulphite conversion with targeted sequencing of 48 CpG sites. All baseline demographic data were obtained from electronic patient record. Results Between the period of December 2015 to July 2018, 239 dialysis (125 HD, 114 PD) patients were recruited. The age range of the study recruits were 23 to 83 years of age with a mean age of 54.3 years. There were 44 and 43 females in the HD and PD group respectively. All patients had TL measured and 228 patients (118 in HD, 110 in PD) had DNAm status measured successfully. Frailty assessments at baseline were completed in 213 patients (110 in HD, 103 in PD). A decrease in mean TL (p&lt;0.001) and increased mean DNAm age (p&lt;0.001) was observed in the frail group. TL and DNAm status were significantly associated with frailty in a univariate analysis, p=0.010 and p=0.014 respectively but only TL remained significant in a multivariate analysis to predict frailty, p=0.018. Increased frailty was observed in dialysis patients with shorter TL which remained significant following multivariate logistic regression analysis. A receiver operating characteristic curve analysis demonstrated that TL was a significant predictor of frailty, p&lt;0.001 with an area under the curve of 0.64. A decrease of TL by one standard deviation was associated with a 52.2% increase risk of frailty when adjusted for age and gender in this dialysis cohort. Conclusion The study supports the hypothesis that TL; a biomarker of ageing is better associated with frailty, an ageing phenotype in comparison to DNAm status in dialysis patients. This is the first study to show a significant association between TL and frailty status in the dialysis patients. DNAm status is derived from an individual’s chronological age and may not be the best surrogate for chronological age. Therefore, to use this measure seems rather counter intuitive as the incorporation of chronological age might mask clinically significant associations that exist when the DNAm status is considered in isolation. These findings provide a preliminary proof of concept validation that TL is associated with frailty and may provide the basis of future research. The use of targeted methylation CpG sites may be a better predictor of frailty in this cohort which is an area that has sparked an interest.

scholarly journals End-stage kidney disease and COVID-19: An incentive to consider other renal replacement therapies

2021 ◽  
Author(s):  
Sima Sadat Hejazi ◽  
Meimanat Hosseini ◽  
Abbas Ebadi ◽  
Hamid Alavi Majd
Keyword(s):  
Kidney Disease ◽  
End Stage Kidney Disease ◽  
Renal Replacement Therapies ◽  
End Stage

The article's abstract is not available.  

scholarly journals Psychological distress of patients with end-stage kidney disease undergoing dialysis during the 2019 coronavirus disease pandemic: A cross-sectional study in a University Hospital

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260929
Author(s):  
Jin Young Yu ◽  
Ji Sun Kim ◽  
Chae-Min Hong ◽  
Ka Young Lee ◽  
Nam-Jun Cho ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Kidney Disease ◽  
Propensity Score ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
Cross Sectional ◽  
Symptoms Of Depression ◽  
End Stage

Introduction Previous studies have revealed that the COVID-19 pandemic can cause psychological distress such as depression and anxiety. Patients with chronic kidney disease (CKD) might be more vulnerable to psychological distress due to the COVID-19 pandemic. Its impact could be different according to dialysis modality. The aim of this study was to investigate COVID-19-related psychological stress experienced by end-stage kidney disease (ESKD) patients and identify differences in concerns about COVID-19 between hemodialysis (HD) and peritoneal dialysis (PD) patients. Methods This cross-sectional study included 148 dialysis patients at Soonchunhyang University Cheonan Hospital from August 2020 to September 2020. These patients responded to a questionnaire covering mental health status and COVID-19 related concerns. Symptoms of depression, anxiety, stress, and insomnia were measured using a 9-item Patient Health Questionnaire (PHQ-9), a 7-item Generalized Anxiety Disorder (GAD-7) scale, a 22-item Impact of Event Scale-Revised (IES-R), and a 7-item Insomnia severity Index (ISI), respectively. Outcomes of HD and PD patients were compared by propensity score matching analysis. Results Dialysis patients reported psychological distress including symptoms of depression, anxiety, stress, and insomnia. HD patients showed higher scores for depression (p = 0.018), anxiety(p = 0.005), stress(p<0.001), and insomnia(p = 0.006) than the PD patients. After propensity score matching, HD was associated with depression(p = 0.0131), anxiety(p = 0.0143), and stress(p = 0.000415). Conclusion Dialysis patients showed psychological distress during the COVID-19 pandemic period, with HD patients having more severe symptoms than PD patients.

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