Impacts of dialysis adequacy and intradialytic hypotension on changes in dialysis recovery time

Abstract Background Dialysis recovery time (DRT) surveys capture the perceived time after HD to return to performing regular activities. Prior studies suggest the majority of HD patients report a DRT > 2 h. However, the profiles of and modifiable dialysis practices associated with changes in DRT relative to the start of dialysis are unknown. We hypothesized hemodialysis (HD) dose and rates of intradialytic hypotension (IDH) would associate with changes in DRT in the first years after initiating dialysis. Methods We analyzed data from adult HD patients who responded to a DRT survey ≤180 days from first date of dialysis (FDD) during 2014 to 2017. DRT survey was administered with annual KDQOL survey. DRT survey asks: “How long does it take you to be able to return to your normal activities after your dialysis treatment?” Answers are: < 0.5, 0.5-to-1, 1-to-2, 2-to-4, or > 4 h. An adjusted logistic regression model computed odds ratio for a change to a longer DRT (increase above DRT > 2 h) in reference to a change to a shorter DRT (decrease below DRT < 2 h, or from DRT > 4 h). Changes in DRT were calculated from incident (≤180 days FDD) to first prevalent (> 365-to- ≤ 545 days FDD) and second prevalent (> 730-to- ≤ 910 days FDD) years. Results Among 98,616 incident HD patients (age 62.6 ± 14.4 years, 57.8% male) who responded to DRT survey, a higher spKt/V in the incident period was associated with 13.5% (OR = 0.865; 95%CI 0.801-to-0.935) lower risk of a change to a longer DRT in the first-prevalent year. A higher number of HD treatments with IDH episodes per month in the incident period was associated with a 0.8% (OR = 1.008; 95%CI 1.001-to-1.015) and 1.6% (OR = 1.016; 95%CI 1.006-to-1.027) higher probability of a change to a longer DRT in the first- and second-prevalent years, respectively. Consistently, an increased in incidence of IDH episodes/months was associated to a change to a longer DRT over time. Conclusions Incident patients who had higher spKt/V and less sessions with IDH episodes had a lower likelihood of changing to a longer DRT in first year of HD. Dose optimization strategies with cardiac stability in fluid removal should be tested.

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Impacts of Dialysis Adequacy and Intradialytic Hypotension on Changes in Dialysis Recovery Time

10.21203/rs.2.23452/v2 ◽

2020 ◽

Author(s):

Murilo Guedes ◽

Roberto Pecoits-Filho ◽

Juliana El Ghoz Leme ◽

Yue Jiao ◽

Jochen G. Raimann ◽

...

Keyword(s):

Odds Ratio ◽

Lower Risk ◽

Recovery Time ◽

First Year ◽

Intradialytic Hypotension ◽

Dialysis Adequacy ◽

Dialysis Treatment ◽

Fluid Removal ◽

Lower Likelihood ◽

Adjusted Logistic Regression

Abstract Background:Dialysis recovery time (DRT) surveys capture the perceived time after HD to return to performing regular activities. Prior studies suggest the majority of HD patients report a DRT >2hours. However, the profiles of and modifiable dialysis practices associated with changes in DRT relative to the start of dialysis are unknown. We hypothesized hemodialysis (HD) dose and rates of intradialytic hypotension (IDH) would associate with changes in DRT in the first years after initiating dialysis.Methods:We analyzed data from adult HD patients who responded to a DRT survey ≤180 days from first date of dialysis (FDD) during 2014 to 2017. DRT survey was administered with annual KDQOL survey. DRT survey asks: “How long does it take you to be able to return to your normal activities after your dialysis treatment?” Answers are: <0.5, 0.5-to-1, 1-to-2, 2-to-4, or >4 hours. An adjusted logistic regression model computed odds ratio for a change to a longer DRT (increase above DRT >2 hours) in reference to a change to a shorter DRT (decrease below DRT <2 hours, or from DRT >4 hours). Changes in DRT were calculated from incident (≤180 days FDD) to first prevalent (>365-to-≤545 days FDD) and second prevalent (>730-to-≤910 days FDD) years.Results:Among 98616 incident HD patients (age 62.6±14.4 years, 57.8% male) who responded to DRT survey, a higher spKt/V in the incident period was associated with 13.5% (OR=0.865; 95%CI 0.801-to-0.935) lower risk of a change to a longer DRT in the first-prevalent year. A higher number of HD treatments with IDH episodes per month in the incident period was associated with a 0.8% (OR=1.008; 95%CI 1.001-to-1.015) and 1.6% (OR=1.016; 95%CI 1.006-to-1.027) higher probability of a change to a longer DRT in the first- and second-prevalent years, respectively. Consistently, an increased in incidence of IDH episodes/months was associated to a change to a longer DRT over time.Conclusions:Incident patients who had higher spKt/V and less sessions with IDH episodes had a lower likelihood of changing to a longer DRT in first year of HD. Dose optimization strategies with cardiac stability in fluid removal should be tested.

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Impacts of Dialysis Adequacy and Intradialytic Hypotension on Changes in Dialysis Recovery Time

10.21203/rs.2.23452/v1 ◽

2020 ◽

Author(s):

Murilo Guedes ◽

Roberto Pecoits-Filho ◽

Juliana El Ghoz Leme ◽

Yue Jiao ◽

Jochen G. Raimann ◽

...

Keyword(s):

Lower Risk ◽

Recovery Time ◽

First Year ◽

Intradialytic Hypotension ◽

Dialysis Adequacy ◽

Dialysis Treatment ◽

Fluid Removal ◽

Patient Reported ◽

Lower Likelihood ◽

Adjusted Logistic Regression

Abstract Background: Patient reported long dialysis recovery time (DRT) is common and associated with higher hospitalization and mortality. The goal of our study was to test the hypothesis that hemodialysis (HD) dose and intradialytic hypotension (IDH) rates are associated with dialysis recovery time (DRT). Methods: We analyzed data from adult HD patients who responded to DRT survey ≤180 days from first date of dialysis (FDD) during 2014 to 2017. DRT survey was administered with annual KDQOL survey. DRT survey asks: “How long does it take you to be able to return to your normal activities after your dialysis treatment?” Answers are: <0.5, 0.5-to-1, 1-to-2, 2-to-4, or >4 hours. An adjusted logistic regression model computed odds ratio for increased/maintained longer DRT (increase above DRT >2 hours) in reference to decreased/maintained shorter DRT (decrease below DRT <2 hours, or from DRT >4 hours). Changes in DRT were calculated from incident (≤180 days FDD) to first prevalent (>365-to-≤545 days FDD) and second prevalent (>730-to-≤910 days FDD) years. Results: Among 98616 incident HD patients (age 62.6±14.4 years, 57.8% male) who responded to DRT survey, a higher spKt/V in the incident period was associated with 13.5% (OR=0.865; 95%CI 0.801-to-0.935) lower risk of longer DRT in the first-prevalent year. A higher number of HD treatments with IDH episodes/month in the incident period was associated with a 0.8% (OR=1.008; 95%CI 1.001-to-1.015) and 1.6% (OR=1.016; 95%CI 1.006-to-1.027) higher probability of a longer DRT in the first- and second-prevalent years, respectively. Consistently, an increased in incidence of IDH episodes/months was associated to longer DRT over time. Conclusions: Incident patients who had higher spKt/V and less sessions with IDH episodes had a lower likelihood of longer DRT in first year of HD. Dose optimization strategies with cardiac stability in fluid removal should be tested.

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Higher Ultrafiltration Rate Is Associated with Longer Dialysis Recovery Time in Patients Undergoing Conventional Hemodialysis

American Journal of Nephrology ◽

10.1159/000476076 ◽

2017 ◽

Vol 46 (1) ◽

pp. 3-10 ◽

Cited By ~ 14

Author(s):

Wael F. Hussein ◽

Rohini Arramreddy ◽

Sumi J. Sun ◽

Marc Reiterman ◽

Brigitte Schiller

Keyword(s):

Recovery Time ◽

Multivariable Analysis ◽

Female Gender ◽

Intradialytic Hypotension ◽

Ultrafiltration Rate ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Fluid Removal ◽

Immediate Recovery ◽

Number Of Patients

Background: Increased mortality and morbidity are reported in association with high ultrafiltration rate (UFR) and with long dialysis recovery time (DRT). We studied the association between UFR and DRT. Methods: This is a cross-sectional, observational study was conducted. Patients on thrice-weekly hemodialysis (HD) with self-reported DRT between August and December 2014 were included. We examined the association of 30-day average UFR with recovery time. Results: The total number of patients included in this study was 2,689. DRT in categories of immediate recovery, >0-≤2, >2-≤6, >6-≤12, and >12 h, were reported in 27, 28, 17, 9, and 20% of the patients respectively. In multivariable analysis, longer DRT was associated with female gender, non-black race, higher body weight, lower serum albumin, chronic heart failure, cerebrovascular disease, missed dialysis sessions, higher pre-dialysis systolic blood pressure, and larger UF volume. Compared to UFR of <10, UFR ≥13 mL/kg/h was associated with longer DRT, OR of 1.16 (95% CI 0.99-1.36), and 1.28 (95% CI 1.06-1.54) in the unadjusted and the adjusted analyses respectively. Intradialytic hypotension was also associated with longer DRT in the unadjusted (per 10% higher frequency, OR 1.04 [95% CI 1.01-1.07]) and adjusted analyses (OR 1.03 [95% CI 1.00-1.07]). Conclusion: Long recovery time is common after HD. Rapid fluid removal is associated with longer DRT.

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Risk of Weight Loss in Adult Patients and the Effect of Staffing Registered Dietitians in Kaifukuki (Convalescent) Rehabilitation Wards: A Retrospective Analysis of a Nationwide Survey

Healthcare ◽

10.3390/healthcare9060753 ◽

2021 ◽

Vol 9 (6) ◽

pp. 753

Author(s):

Shinta Nishioka ◽

Yoji Kokura ◽

Takatsugu Okamoto ◽

Masako Takayama ◽

Ichiro Miyai

Keyword(s):

Weight Loss ◽

Odds Ratio ◽

Lower Risk ◽

Nationwide Survey ◽

Adult Patients ◽

Weight Class ◽

Registered Dietitians ◽

Lower Odds ◽

Nutrition Care ◽

Class 1

There is scarce evidence regarding the risk of weight loss and the effect of having registered dietitians (RDs) on staff in rehabilitation wards on weight loss. We aimed to examine the effects of RDs in Kaifukuki (convalescent) rehabilitation wards (KRWs) on the prevention of weight loss in adult patients. Data from 2-year nationwide annual surveys on KRWs in Japan were retrospectively analysed. Weight loss was defined as loss of ≥5% weight during the KRW stay. Risk of weight loss in class 1 KRWs (obligated to provide nutrition care) was compared with that in class 2–6 KRWs (not obligated). Risk of weight loss in class 2–6 KRWs with RDs was compared to those without. Overall, 17.7% of 39,417 patients lost weight. Class 1 KRWs showed a lower risk of weight loss than class 2–6 KRWs (17.3% vs. 18.5%, p = 0.003). KRWs with RDs showed a significantly lower incidence of weight loss than those without RDs (16.1% vs. 18.8%, p = 0.015). Class 1 KRWs and exclusively staffed RDs were independently associated with lower odds of weight loss (odds ratio = 0.915 and 0.810, respectively). Approximately 18% of KRW patients lost weight, and having RDs on staff can lower the risk of weight loss.

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TET2 Mutation and High miR-22 Expression as Biomarkers to Predict Clinical Outcome in Myelodysplastic Syndrome Patients Treated with Hypomethylating Therapy

Current Issues in Molecular Biology ◽

10.3390/cimb43020065 ◽

2021 ◽

Vol 43 (2) ◽

pp. 917-931

Author(s):

Jina Yun ◽

Young Sok Ji ◽

Geum Ha Jang ◽

Sung Hee Lim ◽

Se Hyung Kim ◽

...

Keyword(s):

Myelodysplastic Syndrome ◽

Odds Ratio ◽

Lower Risk ◽

Genetic Mutations ◽

Dna Hypermethylation ◽

Leukemic Transformation ◽

Mutation Status ◽

Similar Tendency ◽

Tet2 Mutation ◽

Expression Status

Tet methylcytosine dioxygenase 2 (TET2) is one of the most frequently mutated genes in myelodysplastic syndrome (MDS). TET2 is known to involve a demethylation process, and the loss of TET2 is thought to cause DNA hypermethylation. Loss of TET2 function is known to be caused by genetic mutations and miRNA, such as miR-22. We analyzed 41 MDS patients receiving hypomethylating therapy (HMT) to assess whether TET2 mutation status and miR-22 expression status were associated with their clinical characteristics and treatment outcomes. Responsiveness to HMT was not affected by both TET2 mutation (odds ratio (OR) 0.900, p = 0.909) and high miR-22 expression (OR 1.548, p = 0.631). There was a tendency for TET2 mutation to be associated with lower-risk disease based on IPSS (Gamma = −0.674, p = 0.073), lower leukemic transformation (OR 0.170, p = 0.040) and longer survival (Hazard ratio 0.354, p = 0.059). Although high miR-22 expression also showed a similar tendency, this tendency was weaker than that of TET2 mutation. In summary, the loss of TET2 function, including both TET2 mutation and high miR-22 expression, was not a good biomarker for predicting the response to HMT but may be associated with lower-risk disease based on IPSS, lower leukemic transformation and longer survival.

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Physiological Biomarkers Assessed by Low-Tech Exercise Tests Predict Complications and Overall Survival in Patients Undergoing Pneumonectomy Due to Lung Cancer

Cancers ◽

10.3390/cancers13040735 ◽

2021 ◽

Vol 13 (4) ◽

pp. 735

Author(s):

Tomasz Marjanski ◽

Damian Wnuk ◽

Robert Dziedzic ◽

Marcin Ostrowski ◽

Wioletta Sawicka ◽

...

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

High Risk ◽

Odds Ratio ◽

Cardiac Complications ◽

First Year ◽

Exercise Tests ◽

Walking Test ◽

Increased Risk ◽

Surgery Department

Due to its debilitating character pneumonectomy this is last-resort procedure. Preoperative results of the 6-min walking test (6MWT) help to identify high risk of postoperative complications and increased mortality in patients undergoing lobectomy for lung cancer. The aim of the study was to validate the value of 500 m in 6MWT as an indicator, which differentiates risk of complications in patients undergoing pneumonectomy. 125 patients who underwent pneumonectomy at Thoracic Surgery Department between 2009 and 2018. On the day preceding the surgery, patients underwent 6MWT. The patients were in median age of 63 years. The cut-off value of 500 m identified patients with increased 90-day mortality [17.9% vs. 3.5%, odds ratio (OR) 6.271, 95% confidence interval (CI) 1.528–25.739], first-year mortality (30.7% vs. 11.6%, OR 3.378, 95% CI 1.310–8.709), and overall survival (p = 0.02). Patients who covered a distance ≤ 500 m had an increased risk of atrial fibrillation (35.9% vs. 16.3%, OR 2.880, 95% CI 1.207–6.870) and cardiac complications (38.4% vs. 19.8%, OR 2.537, 95% CI 1.100–5.849). Patients unable to reach 500 m in 6MWT are in a high risk of postoperative death after pneumonectomy, what may be a result of increased frequency of postoperative cardiac complications. Poor result of 6MWT is a predictor of worse overall survival.

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Associations between Red Blood Cell and Platelet Transfusions and Retinopathy of Prematurity

Neonatology ◽

10.1159/000512020 ◽

2020 ◽

pp. 1-7

Author(s):

Tobias Hengartner ◽

Mark Adams ◽

Riccardo E. Pfister ◽

Diane Snyers ◽

Jane McDougall ◽

...

Keyword(s):

Retinopathy Of Prematurity ◽

Odds Ratio ◽

Case Control Study ◽

Case Control ◽

Control Group ◽

Case Group ◽

Same Sex ◽

Live Births ◽

Adjusted Logistic Regression ◽

Control Study

Aim: The aim of this study is to examine possible associations between the transfusion of RBC or platelets (PLTs) and the development of retinopathy of prematurity (ROP) in infants. Methods: This retrospective, national, case-control study included all live births in Switzerland between 2013 and 2018. We investigated preterm infants at a gestational age of <28 weeks, who developed higher stage ROP (≥stage 2, n = 178). Each case infant was matched to another of the same sex who did not develop ROP (n = 178, control group). Results: When compared with the control group, we observed higher numbers of RBC transfusions per infant and higher percentages of infants receiving PLT transfusions in the case group. An adjusted logistic regression analysis revealed that both RBC (odds ratio [OR] 1.081, 95% confidence interval [CI] 1.020–1.146) and PLT transfusions (OR = 2.502, 95% CI 1.566–3.998) numbers were associated with ROP development. Conclusions: Multiple RBC and PLT transfusions are associated with higher stage ROP development. Prospective studies are required to determine their potential as risk factors.

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Quality of Life and Hemodynamic Effects of Switching From Hemodialysis to Hemodiafiltration: A Canadian Controlled Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211057717 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110577

Author(s):

Isabelle Ethier ◽

Immaculate Nevis ◽

Rita S. Suri

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Repeated Measures ◽

Recovery Time ◽

Randomized Clinical Trials ◽

Analysis Of Covariance ◽

Intradialytic Hypotension ◽

Laboratory Values

Background: Recent randomized clinical trials have demonstrated beneficial effects of hemodiafiltration (HDF) compared with hemodialysis (HD) on mortality and hemodynamic stability. Data on quality of life in HDF compared with HD is limited. Objective: This study aimed to determine whether patients receiving HD experience improvements in quality of life, hemodynamic and laboratory parameters after switching to HDF. Design: Observational controlled cohort study. Setting & Patients: Adult patients receiving maintenance dialysis were followed for 3 months both before and after transfer to a new unit, where they received HDF. Prior to transfer, control patients were already treated by HDF. Methods: Quality of life at baseline and follow-up was measured using the validated minutes to recovery (MR) question. Dialysis data were collected for 3 consecutive sessions monthly; laboratory values were collected monthly. Wilcoxon signed rank test and repeated measures analysis of covariance were used to evaluate pre/post transfer changes and quantile regression to identify predictors of change in recovery time. Results: Of 227 patients, 82 died, were transplanted, were hospitalized or did not transfer, leaving 123 subjects and 22 controls for analysis. MR did not improve with switching to HDF, although patients with MR > 60 min before transfer experienced a significant decrease in their MR, compared with controls. There was no improvement in intradialytic hypotension with HDF. There were no differences in laboratory values before vs after switch. Limitations: Nonrandomized single-center study, including only small numbers of patients and covering a short follow-up period; hemodynamic values only evaluated over 1 week per month; residual kidney function not recorded. Conclusions: In this Canadian experience of HDF, patients remained stable with respect to several laboratory and dialysis related parameters. Switch to HDF was associated with substantially reduced recovery time in patients with MR > 60 minutes at baseline.

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The protective association between statins use and adverse outcomes among COVID-19 patients: a systematic review and meta-analysis

10.1101/2021.02.08.21251070 ◽

2021 ◽

Author(s):

Ronald Chow ◽

James Im ◽

Nicholas Chiu ◽

Leonard Chiu ◽

Rahul Aggarwal ◽

...

Keyword(s):

Systematic Review ◽

Odds Ratio ◽

Lower Risk ◽

Meta Analysis ◽

Adverse Outcomes ◽

Risk Of Mortality ◽

Before And After ◽

Statin Usage ◽

Similar Risk ◽

Ventilation Studies

ABSTRACTIntroductionStatins may reduce a cytokine storm, which has been hypothesized as a possible mechanism of severe COVID-19 pneumonia. The aim of this study was to conduct a systematic review and meta-analysis to report on adverse outcomes among COVID-19 patients by statin usage.MethodsLiteratures were searched from January 2019 to December 2020 to identify studies that reported the association between statin usage and adverse outcomes, including mortality, ICU admissions, and mechanical ventilation. Studies were meta-analyzed for mortality by the subgroups of ICU status and statin usage before and after COVID-19 hospitalization. Studies reporting an odds ratio (OR) and hazard ratio (HR) were analyzed separately.ResultsThirteen cohorts, reporting on 110,078 patients, were included in this meta-analysis. Individuals who used statins before their COVID-19 hospitalization showed a similar risk of mortality, compared to those who did not use statins (HR 0.80, 95% CI: 0.50, 1.28; OR 0.62, 95% CI: 0.38, 1.03). Patients who were administered statins after their COVID-19 diagnosis were at a lower risk of mortality (HR 0.53, 95% CI: 0.46, 0.61; OR 0.57, 95% CI: 0.43, 0.75). The use of statins did not reduce the mortality of COVID-19 patients admitted to the ICU (OR 0.65; 95% CI: 0.26, 1.64). Among non-ICU patients, statin users were at a lower risk of mortality relative to non-statin users (HR 0.53, 95% CI: 0.46, 0.62; OR 0.64, 95% CI: 0.46, 0.88).ConclusionPatients administered statins after COVID-19 diagnosis or non-ICU admitted patients were at lower risk of mortality relative to non-statin users.

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Incident infection during the first year of treatment – A comparison of clozapine and paliperidone palmitate long-acting injection

Journal of Psychopharmacology ◽

10.1177/02698811211058973 ◽

2022 ◽

pp. 026988112110589

Author(s):

Shubhra Mace ◽

Olubanke Dzahini ◽

Victoria Cornelius ◽

Hadar Langerman ◽

Ebenezer Oloyede ◽

...

Keyword(s):

Mental Health ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Paliperidone Palmitate ◽

First Year ◽

Risk Of Infection ◽

Long Acting ◽

First Time ◽

Health Trust ◽

Incident Infection

Background: To examine the risk of infection in patients prescribed clozapine compared with patients prescribed paliperidone palmitate long-acting injection (PPLAI). Method: A retrospective, 1-year, cohort study conducted on events occurring in eligible patients beginning treatment for the first time with clozapine or PPLAI between June 2017 and June 2019 in a UK mental health trust providing in-patient and out-patient services. Results: The study included 64 patients starting clozapine and 120 patients starting PPLAI. Incidence of infection was greater in clozapine starters than in PPLAI starters (28% vs 6%; p = 0.001; adjusted odds ratio 5.82 (95% confidence interval (CI) = 2.15–15.76, p = 0.001). Infectious episodes in clozapine patients were not related to changes in neutrophil counts. Incident infection in the clozapine group was highest in the first 3 months of treatment. The most commonly reported infection in the clozapine group was chest infection; however, the majority of infections were non-chest-related. Conclusion: Patients starting clozapine showed a substantially increased likelihood of infection compared with patients starting PPLAI.

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