scholarly journals Assessing the Adequacy of Hemodialysis Patients via the Graph-Based Takagi-Sugeno-Kang Fuzzy System

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Aiyan Du ◽  
Xiaofen Shi ◽  
Xiaoyi Guo ◽  
Qixiao Pei ◽  
Yijie Ding ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Fuzzy System ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Dialysis Adequacy ◽  
Feasible Method ◽  
Body Weights ◽  
Stage Renal Disease ◽  
End Stage ◽  
Takagi Sugeno

Maintenance hemodialysis is the main method for the treatment of end-stage renal disease in China. The K t / V value is the gold standard of hemodialysis adequacy. However, K t / V requires repeated blood drawing and evaluation; it is hard to monitor dialysis adequacy frequently. In order to meet the need for repeated clinical assessments of dialysis adequacy, we want to find a noninvasive way to assess dialysis adequacy. Therefore, we collect some clinically relevant data and develop a machine learning- (ML-) based model to predict dialysis adequacy for clinical hemodialysis patients. We collect 250 patients, including gender, age, ultrafiltration (UF), predialysis body weight (preBW), postdialysis body weights (postBW), blood pressure (BP), heart rate (HR), and blood flow (BF). An efficient graph-based Takagi-Sugeno-Kang Fuzzy System (G-TSK-FS) model is proposed to predict the dialysis adequacy of hemodialysis patients. The root mean square error (RMSE) of our model is 0.1578. The proposed model can be used as a feasible method to predict dialysis adequacy, providing a new way for clinical practice. Our G-TSK-FS model could be used as a feasible method to predict dialysis adequacy, providing a new way for clinical practice.

scholarly journals The Relationship Between Dialysis Adequacy And Fatigue In Patients On Maintenance Hemodialysis

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Sri Suparti ◽  
Sodikin Sodikin ◽  
Endiyono Endiyono
Keyword(s):  
Life Quality ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
P Value ◽  
Dialysis Adequacy ◽  
Cross Sectional ◽  
Severe Fatigue ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Fatigue and inadequacy dialysis are common problem in hemodialysis patients. The dialysis inadequacy can cause an increased progression of impaired renal function, as well as the increased morbidity and mortality, and declining productivity of hemodialysis patients. Fatigue prevalence ranged from 44,7- 97% from mild to severe. Fatigue is a common complaint of hemodialysis patients that can lower physical function and life quality. To determine the correlation between adequacy and the fatigue level of the patients with End Stage Renal Disease (ESRD) undergoing hemodialysis. This study used a descriptive analytic and cross sectional approach involving 75 respondents and the FACIT-G Questionnaire was used to collect the data. The inclusion criteria are male and female patients aged 18 -70, undergoing hemodialysis for more than 3 months with a frequency of 2 times at least 4 hours, composmentis patients. The adequacy hemodialysis was assessed using the Kt/V formula. All data were collected during the session of hemodialysis. Pearson Product moment test wes used to analyze the data. The mean dialysis adequacy was 1.43±0.380, 57(76%) only 13 (17.3%) patients had adequate dialysis (minimum laboratory standard Kt / v = 1.8) and inadequate were 62 (82.7%) patients. The mean of fatigue was 20.07 and 62 (82.7%) respondents experienced severe fatigue. There was no significant correlation between adequacy and the fatigue level of the patients with ESRD undergoing hemodialysis with p value 0.504 (α> 0.05). Mostly patients had inadequate dialysis, both adequate and inadequate dialysis patients had experience fatigue from mild to severe. Multiple individuale and personnel factors affect dialysis adequacy directly or conversely.

scholarly journals Effects of Arterial Needle Placement in Arteriovenous Fistula on Dialysis Adequacy of End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis

2016 ◽  
Vol 1 (2) ◽  
Keyword(s):  
Blood Flow ◽  
Arteriovenous Fistula ◽  
Intervention Group ◽  
Maintenance Hemodialysis ◽  
Control Group ◽  
Needle Placement ◽  
Dialysis Adequacy ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage

Objective: The arterial needle placement in arteriovenous fistula (AVF) can either be antegrade (in the direction of blood flow or pointing towards the heart) or retrograde (against the direction of blood flow) while venous needle placement should always be in the same direction as the blood flow. This study determined the effects of arterial needle placement in the arteriovenous fistula on dialysis adequacy of End-Stage Renal Disease (ESRD) patients undergoing maintenance hemodialysis in United Candelaria Doctors Hospital - Nephro Synergies Inc. (UCDHNSI) Hemodialysis Center. Methods: A randomized controlled trial design was used in the study. A total of 20 non-diabetic, non-cardiac patients on maintenance hemodialysis for more than 6 months were randomized either to the intervention group (patients’ AVF were cannulated in a retrograde manner) or the control group (patients’ AVF were cannulated in an antegrade manner). Urea reduction ratio (URR) and Kt/V as well as access recirculation percentage were used to determine dialysis adequacy. Pre-dialysis, in the first 30 minutes of dialysis initiation and post-dialysis blood samples were obtained in each patient in 6 succeeding hemodialysis considering dialyzer reuse up to fifth reuse. Means were compared by independent t-test. Results: The findings of the study revealed that the mean URR and Kt/V of the subjects cannulated in retrograde manner and antegrade manner were 69.35% and 1.45, and 74.65% and 1.70, respectively. The mean access recirculation percentage of the subjects was 4.65% in the intervention group and 3.02% in the control group. There was a significant difference on URR and Kt/V of the subjects using retrograde and antegrade arterial needle placement in 6 succeeding hemodialysis sessions. There was no significant difference on access recirculation percentage of the subjects using retrograde and antegrade arterial needle placement in 6 succeeding hemodialysis sessions. Conclusions: Antegrade arterial needle placement provides more adequate hemodialysis than retrograde arterial needle placement in terms of URR and Kt/V values among non-diabetic, non-cardiac patients undergoing maintenance hemodialysis in 6 succeeding hemodialysis sessions. The directions of the arterial needle either retrograde and antegrade did not have significant effects on access recirculation.

Role of Platelet Activation in the Pathogenesis of Heart Failure in End-Stage Renal Disease Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4636-4636
Author(s):  
Ryan McMillan ◽  
Vinod Bansal ◽  
Leonidas Skiadopoulos ◽  
Debra Hoppensteadt ◽  
Omer Iqbal ◽  
...  
Keyword(s):  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Dialysis Session ◽  
Positive Correlation ◽  
Activated Platelets ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Maintenance Hemodialysis Patients

Abstract Introduction: Heart failure (HF) is prevalent in patients with End-Stage Renal Disease (ESRD) with an incidence of approximately 40%. ESRD patients exhibit both quantitative and qualitative changes in platelets due to the uremic milleu and / or stress caused by the dialysis filtration membranes. Platelet Factor 4 (PF4) and Platelet Derived Growth Factor (PDGF) are released from the alpha granules of activated platelets and play a role in heparin neutralization and angiogenesis, respectively. The purpose of this study was to determine the interplay of platelets and their released mediators and their relevance to the pathogenesis of HF in ESRD patients. Material and Methods: Under IRB approval, ninety blood samples from maintenance hemodialysis patients at Loyola University outpatient dialysis unit were collected prior to dialysis session and stored at -70°C. Twenty-five male and twenty-five female plasma samples from healthy individuals were obtained as a control (George King Biomedical Overland Park, KS). Maintenance hemodialysis patients' and healthy volunteers' plasma samples were used to profile PDGF-BB, Heparin anti Xa, and PF4 using commercial sandwich and competitive ELISA kits (R&D Systems, Minneapolis, MN | Hyphen Biomed, Neuville-sur-oise, France). In addition, patients' HF diagnoses, comorbidities, medications, and clinical laboratory parameters were reviewed through the patients' medical records. Results: Plasma biomarkers PF4 (P < 0.0001; % change = 247.76) and heparin level as measured by an anti Xa methods were significantly increased (P < 0.05) in patients with ESRD in comparison to the values obtained in normal healthy volunteers. PDGF-BB was not found to be significantly increased (P = 0.4045 ; % change = 40.3%). PF4, Heparin levels, and PDGF-BB were not found to be significantly elevated in ESRD (+) HF vs ESRD (-) HF (P > 0). In male ESRD (+) CHF vs ESRD (-) HF, platelet counts were significantly decreased (P = 0.0476 ; % change = -16.5). Systolic BP and PLT count had a positive correlation in both male and female ESRD patients and in male ESRD (+) HF patients (P = 0.016 and P = 0.044, respectively), but not in female ESRD HF (+) patients (P = 0.172). PLT count and PDGF were found to have a positive correlation in ESRD HF (+) patients (P = 0.045). In ESRD (+) HF patients, PF4 had a positive correlation with proBNP (P = 0.045) and Heparin levels had a negative correlation with proBNP (P = 0.045). Discussion: Elevated PF4 in the ESRD patients compared to normals suggest that there may be increased platelet granule release or an upregulation of PF4. The platelets may be activated due to dialysis procedure stress from the previous session, the uremic environment, or heparin-PF4 complexed with antibodies binding to the platelet surface. Elevated heparin levels in the ESRD patients compared to normal suggests that heparinization at dialysis session may lead to an anticoagulated state between sessions in several of these patients. Since these patients are continually heparinized, it is expected to see increased levels of platelet release products such as PF4 due to their mobilization from platelets. Activated platelets may lead to platelet exhaustion and thrombocytopenic responses. Interestingly thrombocytopenia is only noticed in male ESRD (+) HF patients suggesting gender differences and the potential role of hormonal regulation. These results suggest that both the quantitative and qualitative defects in platelets play an important role in the mediation of the pathogenesis of HF in ESRD patients underscoring the potential benefit of antiplatelet drugs. Disclosures No relevant conflicts of interest to declare.

scholarly journals IMPACT OF DURATION OF HEMODIALYSIS ON LIPID PROFILE IN END STAGE RENAL DISEASE PATIENTS RECEIVING HEMODIALYSIS.

2020 ◽  
Vol 27 (06) ◽  
pp. 1230-1236
Author(s):  
Sadia Rehman ◽  
Santosh Kumar ◽  
Fatima Mehboob ◽  
Fatima Rehman ◽  
Syed Hidayat Ali ◽  
...  
Keyword(s):  
Renal Disease ◽  
Lipid Profile ◽  
End Stage Renal Disease ◽  
Serum Triglyceride ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Healthy Controls ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

End Stage Renal Disease (ESRD) patients receiving hemodialysis are at a higher risk of developing dyslipidemia which is undoubtedly a predisposing factor of cardiac related disease in these patients. Objectives: To assess serum lipid profile in subjects having end stage renal disease and receiving maintenance hemodialysis and to compare it with normal healthy controls and also to assess the effects of duration of hemodialysis on the lipid profile. Study Design: A case-control study. Setting: Executed in the Nephrology Department of JPMC. Period: January 2018 to January 2019. Material and Methods: Blood samples were obtained from a total of 90 subjects. Subjects were stratified into 3 groups including cases of ESRD receiving maintenance hemodialysis and matched healthy controls. Analysis for serum triglyceride, serum VLDL, total cholesterol, LDL and HDL was done. Results: A significant rise in serum triglyceride content and total serum cholesterol of hemodialysis patients (p < 0.01) was detected as compared to healthy controls. A statistically significant decrease was found in serum HDL level (p < 0.01) in hemodialysis patients in comparison to healthy controls. The impact of the hemodialysis duration was found to deteriorate the lipid profile of patients having longer duration of hemodialysis. Conclusion: Dyslipidemia was found to be evident in hemodialysis patients. The duration of hemodialysis sessions was found to affect the lipid profile of ESRD patients, which may play a role in higher incidence of atherosclerotic related cardiac events among these patients.

scholarly journals MO851INCIDENCE AND MORTALITY OF CORONAVIRUS DISEASE (COVID 19) IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Nevena Grujic ◽  
Snezana Pešić ◽  
Radomir Naumovic
Keyword(s):  
Severe Disease ◽  
Hemodialysis Patients ◽  
High Risk Group ◽  
Maintenance Hemodialysis ◽  
Increased Risk ◽  
Hospital Stays ◽  
Serious Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
Prolonged Hospital

Abstract Background and Aims In December 2019, an outbreak of coronavirus disease 2019 (covid 19) due to SARS Cov2 began in China and spread worldwide. Hemodialysis patients represent a unique group of patients, mostly elderly, imunocompromised, with numerous comorbidities. Patients with end stage renal disease are thought to be at increased risk of disease, severe disease and death from Covid 19 infection. In addition, dialysis centers are a suitable place for an outbreak of the epidemic. All of the above represents a group of hemodialysis patients particularly susceptible to infection and the development of serious disease. Method We reviewed data of all maintenance hemodialysis patients in hemodialysis centar of Zvezdara Hospital, Belgrade, Serbia. We include all patients with COVID 19 infection in period between April 1 2020 and January 10 2021. Results Of 232 patients undergoing hemodialysis, 68 (29,31%) were infected with Sars-Cov-2. 46 (67,64%) patients were males and 22 (32,35%) females. The age range of the patients was 35 to 87 years, the mean age was 65,25. The underlyind cause of terminal renal failure in 25 patients was hipertensiv nefroangiosklerosis, 14 diabetic nephropathy, 10 opstructiv nephropathy, 9 polycystic kidney disease, and 10 other cause of kidney failure. The average of hemodialysis duration was 70,70 months. The average durations of disease was 15 days. Mortality has been estimated at 33,82% (23 patients). Among patients who died 8 (34,78%) were females, and 15 (65,21%) males. Conclusion The mortality among hemodialysis patients diagnosed with Covid 19 is high. Hemodialysis patients typically present with multiple comorbidities and are considered to be a high-risk group for infections. Hemodialysis patients with Covid-19 may have prolonged hospital stays and unfavorable prognoses and should be closely monitored.

scholarly journals Clinicodemographic Profile and Outcome of Maintenance Hemodialysis Patients in a Tertiary Hospital of Central Nepal, Chitwan

2020 ◽  
Vol 18 (1) ◽  
pp. 9-14
Author(s):  
M. Ghimire ◽  
S. Vaidya ◽  
H.P. Upadhyay
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Volume Overload ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
P Value ◽  
Stage Renal Disease ◽  
End Stage ◽  
Maintenance Hemodialysis Patients

Background Maintenance hemodialysis is a popular treatment modality of renal replacement therapy for end stage renal disease patients; however their mortality seemed to be rising in our centre. There were no previous studies regarding the clinicodemographic profile and outcome of maintenance hemodialysis patients from this region. Objective This study was carried out with an objective to know the clinicodemographic profile and outcome of maintenance hemodialysis patients in our centre. Method This study was a hospital based prospective observational study carried out over a period of three year, from May 2016 to April 2019, in the hemodialysis unit of the department of nephrology. All the consecutive end stage renal disease patients on maintenance hemodialysis were included in the study. The patient’s demographic profile and outcome were studied and analysed using appropriate statistical tools. Result A total of 156 patients were enrolled in the study. Males were 96(61.5%) and females were 60(38.5%). The mean age of the patient was 52.2±15.6 years. The commonest causes of end stage renal disease and reasons for admission were Type 2 diabetes mellitus 68(43.6%) and volume overload with heart failure 101(64.7%) respectively. At the end of three years, 39(25%) were expired, 14(8.9%) were transferred to other centre and four (2.6%) underwent kidney transplantation. The average duration of hemodialysis was 20.3± 17.5 months. Majority of the patients 154(98.7%) had repeat admission ranging from 1 time 21(13.5%) to 10 times two (1.3%). There was a significant association between age ≥ 40 years and diabetes with mortality (p value < 0.003 and < 0.028 respectively). Conclusion The commonest cause of end stage renal disease and the reason of admission were Type 2 diabetes mellitus 68 (43.6%) and volume overload with heart failure 101 (64.7%) respectively. The overall mortality was 39 (25%) and the commonest cause of mortality was sepsis/health care associated pneumonia 30 (76.9%). There was significant association between age ≥ 40 years and diabetes with mortality (p value < 0.003 and < 0.028 respectively).

scholarly journals Comparison of Paricalcitol (I.V) and Alfacalcidol (I.V) in Treatment of Secondary Hyperparathyroidism (SHPT) in Hemodialysis Patients

2020 ◽  
Vol 24 (4) ◽  
pp. 378-383
Author(s):  
Mansoor Abbas Qaisar ◽  
Zain Ul Abideen ◽  
Fateh Sher Chattah ◽  
Muhammad Nadeem ◽  
Zahid Hafeez
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Care Hospital ◽  
Open Label ◽  
Dialysis Unit ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACT   Objective of study: To Compare the efficacy of Alfacalcidol (I.V) and Paricalcitol (I.V) for the treatment of secondary hyperparathyroidism  (SHPT)  in hemodialysis patients. Materials and Methods: An open-label randomized clinical trial  carried out to compare the efficacy of intravenous paricalcitol and alfacalcidol. We recruited 80 patients with end stage renal  disease receiving  maintenance hemodialysis in a tertiary care hospital dialysis unit. The participants were randomly divided into two  groups. A wash out period of one week was decided for each patient in which he/she did not receive any medication for treatment of hypocalcemia, hyperphosphatemia or secondary hyperparathyroidism. Afterwards, patients  received  expanding dosage of alfacalcidol or paricalcitol  for a time of about four months and then after a further wash out period of one week, each group received  opposite treatment (paricalcitol or alfacalcidol) for further  four months (16 weeks). Results: The analyzed data for the same end points revealed no difference between the two groups. No significant statistical difference in terms of  calcium levels in both groups was noted. The study also found no big difference  in the ability of both drugs to treat secondary hyperparathyroidism, while keeping serum phosphate and calcium levels inside the desired range. The study also found no distinction in the frequency of hypercalcemia and  hyperphosphatemia as a side effect of Vitamin D analogue’s treatment.   Conclusion: The study concludes that alfacalcidol and paricalcitol are equally effective in treatment of secondary hyperparathyroidism in dialysis population. Since Paricalcitol is expensive as compared to alfacalcidol, in an economically challenged country like Pakistan, Alfacalcidol can be a better  choice when treating SHPT as we did not  find any gross difference in the ability of two drugs to restrict SHPT.   Keywords:  Alfacalcidol, Paricalcitol, Secondary hyperparathyroidism, Hemodialysis.

scholarly journals Hemodialysis Membranes: Interleukins, Biocompatibility, and Middle Molecules

2002 ◽  
Vol 13 (suppl 1) ◽  
pp. S62-S71
Author(s):  
Walter H. Hörl
Keyword(s):  
End Stage Renal Disease ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Necrosis Factor Alpha ◽  
Middle Molecules ◽  
End Products ◽  
Factor Alpha ◽  
Stage Renal Disease ◽  
End Stage ◽  
Necrosis Factor

ABSTRACT. Maintenance hemodialysis patients display evidence of elevated interleukin-1 (IL-1) and tumor necrosis factor alpha release after stimulation either by contaminated dialysate, bioincompatible membrane material, or both. This release is followed by the stimulated secretion of a large number of other interleukins, particularly IL-6, the cytokine principally responsible for acute-phase protein synthesis. It has been shown that high levels of the circulating proinflammatory cytokines IL-1, tumor necrosis factor alpha, IL-6, and IL-13 are associated with mortality in hemodialysis patients. Essential functions of polymorphonuclear leukocytes—that is, phagocytosis, oxygen species production, upregulation of specific cell surface receptor proteins, or apoptosis—are disturbed in patients with end-stage renal disease. These are further altered as a result of complement activation by the hemodialysis procedure, particularly if bioincompatible dialyzers are used. Polymorphonuclear leukocyte degranulation occurring during extracorporeal circulation does not depend on complement activation but rather on intracellular calcium and the presence or absence of the degranulation inhibitory proteins angiogenin and complement factor D. Clinical signs and symptoms of end-stage renal disease patients are at least in part related to the accumulation of middle molecules such as β2-microglobulin, parathyroid hormone, advanced glycation end products, advanced lipoxidation end products, advanced oxidation protein products (formed as a result of oxidative stress, carbonyl stress, or both), granulocyte inhibitory proteins, or leptin. Currently available membrane materials do not provide long-lasting, effective reduction of middle molecules in patients who require maintenance hemodialysis.

Serum Thiamine Values in End-Stage Renal Disease Patients under Maintenance Hemodialysis

2015 ◽  
Vol 85 (5-6) ◽  
pp. 348-355 ◽  
Author(s):  
Masamitsu Ubukata ◽  
Nobuyuki Amemiya ◽  
Kosaku Nitta ◽  
Takashi Takei
Keyword(s):  
Thiamine Deficiency ◽  
Risk Index ◽  
Nutritional Risk ◽  
Maintenance Hemodialysis ◽  
Dialysis Patients ◽  
Significant Difference ◽  
Nutritional Risk Index ◽  
Serum Aspartate Aminotransferase ◽  
Stage Renal Disease ◽  
End Stage

Abstract. Objective: Hemodialysis patients are prone to malnutrition because of diet or many uremic complications. The objective of this study is to determine whether thiamine deficiency is associated with regular dialysis patients. Methods: To determine whether thiamine deficiency is associated with regular dialysis patients, we measured thiamine in 100 patients undergoing consecutive dialysis. Results: Average thiamine levels were not low in both pre-hemodialysis (50.1 ± 75.9 ng/mL; normal range 24 - 66 ng/mL) and post-hemodialysis (56.4 ± 61.7 ng/mL). In 18 patients, post-hemodialysis levels of thiamine were lower than pre-hemodialysis levels. We divided the patients into two groups, the decrease (Δthiamine/pre thiamine < 0; - 0.13 ± 0.11) group (n = 18) and the increase (Δthiamine/pre thiamine> 0; 0.32 ± 0.21)) group (n = 82). However, there was no significance between the two groups in Kt/V or type of dialyzer. Patients were dichotomized according to median serum thiamine level in pre-hemodialysis into a high-thiamine group (≥ 35.5 ng/mL) and a low-thiamine group (< 35.4 ng/mL), and clinical characteristics were compared between the two groups. The low-thiamine value group (< 35.4 ng/ml; 26.8 ± 5.3 ng/ml) exhibited lower levels of serum aspartate aminotransferase and alanine aminotransferase than the high-thiamine value group (≥ 35.4 ng/ml; 73.5 ± 102.5 ng/ml) although there was no significance in nutritional marker, Alb, geriatric nutritional risk index , protein catabolic rate and creatinine generation rate. Conclusion: In our regular dialysis patients, excluding a few patients, we did not recognize thiamine deficiency and no significant difference in thiamine value between pre and post hemodialysis.

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