scholarly journals Contribution of Volume Overload and Angiotensin II to the Increased Pulse Wave Velocity of Hemodialysis Patients

2002 ◽  
Vol 13 (1) ◽  
pp. 177-183
Author(s):  
J. L. Tycho Vuurmans ◽  
Walther H. Boer ◽  
Willem-Jan W. Bos ◽  
Peter J. Blankestijn ◽  
Hein A. Koomans
Keyword(s):  
Angiotensin Ii ◽  
Healthy Subjects ◽  
Pulse Wave ◽  
Volume Overload ◽  
Hemodialysis Patients ◽  
Volume Reduction ◽  
Aortic Compliance ◽  
Dialysis Patients ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACT. Aortic compliance is decreased in patients with end-stage renal disease. This malfunction contributes to high aortic systolic pressures and thus to the development of left ventricular hypertrophy. It was hypothesized that besides structural vascular changes, functional changes as a result of hypervolemia and increased vasoconstrictor activity, in particular angiotensin II, play a role in decreasing aortic compliance. Nineteen hemodialysis patients were studied before and 24 h after they had been dialyzed to dry weight. Applanation tonometry of peripheral arteries was used to estimate aortic pulse wave velocity (PWV), known to depend on aortic compliance, and aortic systolic pressure augmentation (augmentation index [Aix]). Predialysis aortic PWV was increased in the dialysis patients compared with matched healthy subjects (9.9 ± 3.1 versus 7.5 ± 1.1 m/s; P < 0.05). The AIx was also increased (35 ± 6 versus 25 ± 10; P < 0.05). Volume reduction with dialysis had no significant effect on PWV (9.3 ± 1.5 m/s), but the AIx decreased (28 ± 7; P < 0.05). A subset of 10 patients were restudied after 1 wk of angiotensin-converting enzyme inhibition (ACEi) with enalapril 5 mg once daily. ACEi decreased both predialysis as postdialysis BP but had no effect on pulse pressure and heart rate, which remained elevated compared with healthy subjects. ACEi also decreased predialysis aortic PWV, from 11.0 ± 3.5 to 9.1 ± 2.1 m/s (P < 0.05) but had no significant effect on AIx. During treatment with ACEi, the same volume reduction with dialysis decreased aortic PWV further to 8.0 ± 1.4 m/s (P < 0.05), a figure not different from PWV in healthy subjects. AIx decreased to an even slightly subnormal value (12 ± 23; P < 0.05). It was concluded that volume overload and angiotensin II both contribute to elevated PWV and AIx in dialysis patients. Volume reduction and ACEi both improve the aortic PWV and AIx. Combined volume reduction and ACEi has an enhanced effect that, in the present patients, was so large that PWV and AIx were no longer elevated. Monitoring and correcting of arterial pressure waves is feasible and may be an important tool in the treatment of patients with end-stage renal disease.

scholarly journals Duchenne Smile is Associated with Quality of Life and Survival in Hemodialysis Patients

2020 ◽  
Vol 44 (3) ◽  
pp. 313-325
Author(s):  
Mabel Aoun ◽  
Ghassan Sleilaty ◽  
Leony Antoun ◽  
Racha Dib ◽  
Dania Chelala
Keyword(s):  
Quality Of Life ◽  
Hemodialysis Patients ◽  
Physical Component Score ◽  
Dialysis Patients ◽  
Duchenne Smile ◽  
Health Related Qol ◽  
Health Related ◽  
Stage Renal Disease ◽  
End Stage

Objectives: Hemodialysis is the most used renal replacement modality for end-stage renal disease patients. Dialysis patients are usually assessed for quality of life (QoL) but smiling was never studied. Duchenne smile is a genuine expression of joy, associated with better survival in some groups of the general population. In this study, we aimed to evaluate whether the smile of dialysis patients can predict their QoL and mortality. Methods: All hemodialysis patients in Saint-George Hospital were included in this prospective study. Patients were interviewed using the Health-Related QoL questionnaire and followed for 10 days for smile screening. Those who smiled more than 34% of time were considered as smiling, then followed for death over 2 years. Results: Overall, 71 patients were studied. Duchenne smile was associated with death at 1 and 2 years (HR = 0.194 [95% CI 0.039-0.958], p = .044) but not with sex or diabetes. Smiling showed a statistically significant correlation with older age, fewer hospitalizations, vitality, physical component score, several QoL scores and general health. Conclusions: A simple observation of patients' Duchenne smile by nephrologists in hemodialysis units can give an idea about their QoL and 2-year survival.

scholarly journals Cognitive performance in dialysis patients - "when is the right time to test?"

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hristos Karakizlis ◽  
Stefanie Thiele ◽  
Brandon Greene ◽  
Joachim Hoyer
Keyword(s):  
Chronic Kidney Disease ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Performance ◽  
End Stage Renal Disease ◽  
Hemodialysis Patients ◽  
Dialysis Patients ◽  
Total Scale Score ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Cognitive impairment in chronic kidney disease, especially in end stage renal disease, is a public health problem. Nevertheless, the cause of chronic kidney disease still remains unclear. A prevalence of cognitive impairment in patients with end stage renal disease of up to 87% has been found. Methods The study at hand deals with the research on the – potential – effect of timing on cognitive performance when testing cognitive impairment in hemodialysis patients during the dialysis cycle. We tested cognitive performance with a neuropsychological test battery (RBANS, Repeatable Battery for the Assessment of Neuropsychological Status) on two occasions while patients were on dialysis as well as on a dialysis-free day. In addition, all participants were rated using the Geriatric Depression Scale (GDS) and several demographic and clinical variables were recorded in order to investigate their possible influence on cognitive performance. The patients were recruited in three dialysis centers in the central region of Hesse, Germany. Twenty-six participants completed the 3 testings during a period of 6 weeks. The testing was carried out in the dialysis centers. Results Looking at the total scale score, patients achieved the best cognitive performance in the RBANS during the first 2 h on dialysis with 81.1 points. When comparing the scores of the three measurement occasions (first 2 h, Timepoint 1 vs. last 2 h, Timepoint 2 vs. dialysis free day, Timepoint 3, however, no significant difference in the total scale score was detected. But patients showed significantly better cognitive performance in language in the first 2 h (p < 0.001) as well as in the last 2 h (p < 0.001) compared with the dialysis-free day. Conclusion Due to the high prevalence of cognitive impairment, there is an increasing need to assess cognitive function in dialysis patients. Our data show that the time point of testing (first 2 h on hemodialysis vs. last 2 h on hemodialysis vs. Hemodialysis free day) had no influence of cognitive function in hemodialysis patients in routine indications.

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 Management of Insomnia in Hemodialysis Patients: A Literature Review

2020 ◽  
Vol 13 (2) ◽  
pp. 93-99
Author(s):  
Nisrina Nur Aini ◽  
Arina Maliya
Keyword(s):  
Literature Review ◽  
Sleep Disorders ◽  
Hemodialysis Patients ◽  
Pharmacological Therapy ◽  
Dialysis Patients ◽  
Pharmacological Management ◽  
Results Management ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Hemodialysis (HD) therapy is the most common therapy for patients with End Stage Renal Disease (ESRD). Insomnia prevalent among dialysis patients which affects their quality of life and death. Although hemodialysis therapy has been proven to prolong survival, the action of hemodialysis therapy has complications that cause symptoms, one of which is sleep disturbance. Complaints of sleep disorders that are often encountered in dialysis units are experienced by 50-80% of dialysis patients. Of the various sleep disorders, insomnia is one of the symptoms that is often experienced by ESRD patients. Methods: A literature review comparing several literatures through the search of accredited journal sites such as PubMed, Elsevier, ResearchGate, and Neliti with the keywords management insomnia in hemodialysis patients in the 2015-2020 period. Research Results: Management of insomnia is reviewed with the aim of providing guidance to encourage treatment. In the six journals reviewed, education on sleep hygiene, CBT-I, relaxation therapy, massage therapy, and drug administration (with caution) improving the quality of sleep for hemodialysis patients. Conclusions: Pharmacological and non-pharmacological management to overcome insomnia in hemodialysis patients can be given by considering the factors that influence it. Management is advised to use a nonpharmacological approach first. The administration of pharmacological therapy is recommended only for short-term use, used with caution in hemodialysis patients.

SERUM PROCALCITONIN LEVELS IN PATIENTS WITH END-STAGE RENAL DISEASE (ESRD)

2017 ◽  
pp. 28-33
Author(s):  
Thi Khanh Trang Ngo ◽  
Bui Bao Hoang
Keyword(s):  
Heart Failure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Hemodialysis Patients ◽  
Dialysis Patients ◽  
Baseline Serum ◽  
Hs Crp ◽  
Stage Renal Disease ◽  
End Stage

Background: Although procalcitonin (PCT) has been described as a new marker of inflammation in dialysis patients, it has not been studied in patients with end-stage renal disease (ERSD) in Viet Nam. The objective of this study was to evaluate: serum PCT levels in patients with ERSD and its association to other inflammation (hs-CRP, IL-6) and nutritional (albumin, prealbumin, BMI) factors and the cardiovascular disease (CVD) events (heart failure, cerebrovascular disease, coronary heart disease, urgence hypertension) after 1-year follow-up. Subjects and methods: A total of 174 patients without infection (include: 57 predialysis patients, 56 continuous ambulatory peritoneal dialysis patients, 61 hemodialysis patients) were enrolled. Inflammatory markers (PCT, hs-CRP, IL-6) and nutritional parameters (albumin, prealbumin, BMI) were determined. CVD events (heart failure, cerebrovascular disease, coronary heart disease, urgence hypertension) were evaluated during 12 months of follow-up. Results: The median baseline serum PCT levels of them were 0.44 ng/ml (0.23 – 0.98). Of them, 79 patients (45.4%) had baseline serum PCT levels of over 0.5 ng/ml, which is the cut-off point suggestive of sepsis in non-dialytic individuals. Hemodialysis patients was associated with significantly higher PCT values than predialysis and peritoneal dialysis patients. The patients with elevated PCT plasma levels had the BMI lower. PCT and IL-6 were positively correlated with each other. Compared to patients with serum PCT levels of under 0.5 ng/ml, patients with serum PCT levels of over 0.5 ng/ml had an increased CVD risk in 12 months of follow-up (HR: 2.09; 95% CI: 1.31-3.33; p=0.002). Conclusion: In the absence of infection, PCT may increase due to reduced renal elimination and increased synthesis. Furthermore, serum PCT could serve as a marker of low-grade inflammation, which substantially increase CVD events risk in patients with ERSD. Keywords: Procalcitonin, end-stage renal disease

Disparate Information Provided by Pulse Wave Velocity versus Other Measures of Aortic Compliance in End-Stage Renal Disease

Nephron ◽  
2021 ◽  
pp. 1-11
Author(s):  
Jenni Kaarina Koskela ◽  
Kati Vääräniemi ◽  
Anna Mari Helena Tahvanainen ◽  
Jukka Mustonen ◽  
Satu Mäkelä ◽  
...  
Keyword(s):  
Pulse Pressure ◽  
Pulse Wave ◽  
Characteristic Impedance ◽  
Stroke Index ◽  
Aortic Compliance ◽  
Control Groups ◽  
Subendocardial Viability Ratio ◽  
Lower Ratio ◽  
Stage Renal Disease ◽  
End Stage

<b><i>Introduction:</i></b> Unfavorable changes in cardiac and arterial function are related to poor prognosis in chronic kidney disease (CKD). We compared hemodynamic profiles between subjects with end-stage renal disease and 2 control groups with corresponding pulse wave velocities (PWVs). <b><i>Methods:</i></b> Noninvasive hemodynamics were recorded during passive head-up tilt in CKD stage 5 patients (<i>n</i> = 35), patients with primary hypertension (<i>n</i> = 35, <i>n</i> = 30 with antihypertensive medications), and subjects without cardiovascular or renal diseases and cardiovascular medications (<i>n</i> = 70). The groups were selected to have corresponding age, sex, body mass index, and PWV. Hemodynamic data were captured using whole-body impedance cardiography and radial tonometric pulse wave analysis. <b><i>Results:</i></b> Supine blood pressure did not differ between the groups, but upright diastolic blood pressure was lower in CKD patients than in the 2 control groups (<i>p</i> ≤ 0.001 for both, RANOVA). Despite similar PWV, supine aortic pulse pressure was higher in CKD patients versus nonmedicated subjects (<i>p</i> = 0.029). Two additional measures indicated reduced aortic compliance in CKD patients versus both control groups: lower ratio of stroke index to aortic pulse pressure (<i>p</i> ≤ 0.023) and higher aortic characteristic impedance (<i>p</i> ≤ 0.003). The subendocardial viability ratio was lower in the CKD group than in both control groups (<i>p</i> ≤ 0.039). <b><i>Conclusion:</i></b> In the absence of differences in PWV, higher aortic pulse pressure and characteristic impedance, and lower ratio of stroke index to aortic pulse pressure, suggest reduced aortic compliance and impaired left ventricular function in CKD patients. A lower subendocardial viability ratio predisposes the CKD patients to impaired cardiac oxygen supply versus hypertensive patients and nonmedicated controls.

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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