scholarly journals Dialysis Adequacy and Risk of Dementia in Elderly Hemodialysis Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Hyung Woo Kim ◽  
Jong Hyun Jhee ◽  
Young Su Joo ◽  
Ki Hwa Yang ◽  
Jin Ju Jung ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Lower Risk ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Dialysis Adequacy ◽  
Assessment Program ◽  
Quartile Group ◽  
The Mean ◽  
Elderly Hemodialysis Patients

Objective: Dementia is prevalent among elderly patients undergoing hemodialysis. However, the association between dialysis adequacy and the risk of dementia is uncertain.Methods: A total of 10,567 patients aged >65 years undergoing maintenance hemodialysis who participated in a national hemodialysis quality assessment program were analyzed. The patients were classified into quartile groups based on single-pool Kt/V levels. The associations between single-pool Kt/V and the development of dementia, Alzheimer's disease (AD), and vascular dementia (VD) were examined.Results: The mean age of the patients was 72.9 years, and 43.4% were female. The mean baseline single-pool Kt/V level was 1.6 ± 0.3. During a median follow-up of 45.6 (45.6–69.9) months, there were 27.6, 23.9, and 2.8 events/1,000 person-years of overall dementia, AD, and VD, respectively. The incidences of overall dementia, AD, and VD were lowest in the highest single-pool Kt/V quartile group. Compared with the lowest single-pool Kt/V quartile, the risks of incident overall dementia and AD were significantly lower in the highest quartile [sub-distribution hazard ratio (sHR): 0.69, 95% confidence interval (CI): 0.58–0.82 for overall dementia; sHR: 0.69, 95% CI: 0.57–0.84 for AD]. Inverse relationships were found between the risks of developing overall dementia and AD, and single-pool Kt/V. However, no significant relationship was observed between single-pool Kt/V levels and VD development.Conclusions: Increased dialysis clearance was associated with a lower risk of developing dementia in elderly hemodialysis patients.

MO888QUALITY OF LIFE AND QUALITY OF SLEEP IN MAINTENANCE HEMODIALYSIS PATIENTS: REPORTS FROM TWO HEMODIALYSIS CENTERS IN IRAN

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Samaneh Hashemi ◽  
Roya Rezaee ◽  
AmirHossein Saeedi ◽  
Hazhir Hojati ◽  
Reza Yahyavi Sahzabi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Kidney Disease ◽  
Sleep Quality ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Quality Of Sleep ◽  
Dialysis Adequacy ◽  
The Mean ◽  
Phosphorus Levels

Abstract Background and Aims Patients with End Stage Kidney Disease (ESKD) usually tend to have lower Quality of Life (QoL) compared to the general population. The purpose of this study was to determine the QoL and quality of sleep in patients on maintenance hemodialysis (MHD) and its relation with medical factors. Method This descriptive-analytical study was performed on 145 patients on MHD in two hospitals affiliated to Abadan University of Medical Sciences. Patients' QoL was assessed via KDQOL-SF questionnaire. For sleep quality, Pittsburgh Sleep Quality Questionnaire (PSQI) was used. Demographic information of patients, type of vascular access, history of dialysis, and frequency and duration of each dialysis session were collected. The average results of related laboratory tests in the last six months, were also recorded for each patient. Results Of 145 MHD patients, 81 (55%) were men and 64 were women. Most patients (53%) were between 30 and 60 years old. Illiteracy was present in 48 (33%) patients. Unemployed patients accounted for 70% of patients (99) and most of the participants (83.44%) lived in the city. Of 145 patients, 102 (70.34%) were married, 20 (13.79%) were single, and the rest were widows. The mean dialysis adequacy of patients was 1.14, and 53% had dialysis adequacy less than 1.2. The average quality of life score was 66.00 ±13, suggesting a high QoL in this group of patients. literacy was significantly associated with QoL score (P<0.001). Likewise, there was significant association between QoL score and income level (p <.001), the effect of Kidney disease on life (p <.001), working status (p <.009), social functioning (p <.046), and marital status (p <.001). The quality of social interactions was significantly associated with residence location (p <.001). On the other hand, the presence of Kidney disease burden, sexual dysfunction, unemployment, role emotional and role physical, was associated with low QoL scores. We found a significant relationship between hemoglobin level and cognitive function (p <.001, r= .075). In addition, significant relationships between phosphorus levels and physical function (p=.021) and role emotional (P:0.04) were observed. Seemingly, phosphorus levels were inversely related with sexual function in our patients (p <0.001, r= - .013). Our data also suggested that serum calcium levels may have an impact on the patients’ social function (p=.038). The mean score of sleep quality was 7.00±4.00. Most of the patients (61%) had a PSQI>5, indicating a poor sleep quality. High sleep quality (PSQI<5) is significantly associated with low age and high-income level. There was also a significant relationship between the average sleep quality and general health (p <0.001, r= -0.206), social function (p= 0.018, r=-0.208), and energy fatigue (p <0.001, r= -0.309). Conclusion Our study showed that a wide range of determinants, including demographic, socioeconomic and disease-related factors can significantly influence the QoL and sleep quality in ESKD patients undergoing hemodialysis. Among them, modifiable factors including laboratory test results, socioeconomic determinants and psychosocial status should be addressed and accordingly treated and solved. Hence, an improvement in both the QoL and sleep quality of maintenance hemodialysis patients will be expected. Keywords Hemodialysis, Quality of life, Sleep quality, Sociodemographic characteristics.

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 P1584FRAILTY IN MAINTENANCE HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Zauresh Amreyeva ◽  
Gulnar Chingayeva ◽  
Abay Shepetov ◽  
Assiya Kanatbayeva ◽  
Arina Yespotayeva
Keyword(s):  
Nutritional Status ◽  
Elderly Patients ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Measurement Tool ◽  
Frail Patients ◽  
Dialysis Vintage ◽  
Significant Difference ◽  
The Mean ◽  
Elderly Hemodialysis Patients

Abstract Background and Aims The population in Kazakhstan is rapidly aging, as a result the number of geriatric patients on maintenance hemodialysis (MHD) has been increasing. Frailty is prevalent in dialysis patients and is one of the common factors that can lead to increased morbidity and mortality. The primary objectives of this study were to evaluate the prevalence of frailty in elderly patients on MHD by using Edmonton Frailty Scale and assess their association with clinical and laboratory measurements. A secondary objective was to investigate the relationship between nutritional status and frailty. Method From July to September 2018, a total of 65 elderly patients undergoing HD in 7 dialysis facilities in Almaty, Kazakhstan were enrolled in this cross-sectional study. All participants were evaluated for the cognitive status through Mini-Mental State Examination (MMSE), nutritional status by using Mini Nutritional Assessment (MNA), Malnutrition-Inflammation Score (MIS), and anthropometric measurements (body mass index (BMI), triceps skinfold (TSF), mid-arm muscle circumference (MAMC)), functionality (Handgrip strength), as well biochemical data were collected from medical records. Frailty was defined in accordance with the Edmonton Frail scale (EFS). Results The study participants’ median age was 69 (range: 65–88) years old, and median dialysis vintage was 36 (IQR 15–60) months, 53.8% were female. The main comorbidities were hypertension (69.2%) and diabetes (35.4%). The prevalence of frailty assessed by the EFS was 23.1% (men: 13.3%; women: 86.7), 43.1% patients were non-frail (men: 64.3%; women: 35.7%), 33.8% patients were vulnerable (men: 45.5%; women: 54.5%). Based on MIS the prevalence of PEW was 73.8% and, according to MNA, the risk of malnutrition was detected in 47.7%, and 9.2% had malnutrition. No significant difference was observed between genders in the frequency of PEW. Mean body weight was 69.1±11.3kg, the mean BMI was slightly overweight 25.6±4.29kg/m2, while hand-grip strength was 21.33±3.36 in men and 15.5±5.51 in women, p=0.008, and it is lower than the normal population standard values. The frail patients group had a higher proportion of women 86.7% (p=0.001), worse nutritional status (93.3% and 86,7% had PEW evaluated by MIS (p=0.018) and MNA (p=0.035), respectively), more frequency of falls (p=0.01), anemia (p=0.038) when compared to group of non-frail and vulnerable patients. 66.7% of frail patients were widowed (p=0.005). The mean MMSE in this group of patients was 26.7±1.9. Conclusion The prevalence of frailty among elderly hemodialysis patients in this study was 23.1%, and we detected that 86.7% of them were female, as well PEW increased in frail patients. Also the study showed that protein-energy wasting is common among elderly hemodialysis patients. Its prevalence varies between 73.8% and 56.9% depending on the measurement tool used to evaluate the nutritional status. In our country with limited resources, EFS, MIS and MNA could help to follow elderly hemodialysis patients.

scholarly journals Hemodialysis Experience of a Large Group of Syrian Refugees in Turkey: All Patients Deserve Effective Treatment

2019 ◽  
Vol 44 (1) ◽  
pp. 43-51 ◽  
Author(s):  
Meltem Gursu ◽  
Mustafa Arici ◽  
Kenan Ates ◽  
Rumeyza Kazancioglu ◽  
Pinar Guneser Yavas ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Maintenance Hemodialysis ◽  
Syrian Refugees ◽  
Dialysis Adequacy ◽  
Limited Experience ◽  
Dialysis Vintage ◽  
One Year ◽  
Age Range ◽  
Annual Mortality

Background/Aims: Refugee dialysis is a worldwide growing dilemma with limited experience. This report presents the largest hemodialysis (HD) patient registry data of Syrian refugees in Turkey. Methods: Demographic, clinical, laboratory, and dialysis practice data of 345 Syrian HD patients during one year were collected and analyzed. Results: There were 345 prevalent Syrian HD patients at the end of 2016. Majority of the patients were placed in the Southeast Anatolian Region. The majority of the patients (74.8%) are in the age range of 20-64 years. Dialysis vintage in Turkey is less than 12 months in 20.8% and less than one month in 29.3% of patients. The vascular access was arteriovenous fistula in the majority of patients (72.5%). Kt/V is over 1.7 in 57%, serum albumin is above 35 g/L in 65.8% and hemoglobin level is more than 100 g/L in %65.2 of the patients. The ratio of patients with serum phosphorus level of 1.13-1.77 mmol/L was 56.2%. Twenty Syrian HD patients (14 male, 6 female) died within the year 2016 and annual mortality rate was 5.7%. Conclusion: This study with the largest number of Syrian refugees undergoing maintenance hemodialysis showed good dialysis practices, acceptable values for dialysis adequacy and biochemical parameters along with lower mortality compared to native HD population of Turkey. Longer follow up will enrich the knowledge related to care of refugee population in all over the world.

scholarly journals P1493CORRELATION BETWEEN END-DIALYSIS OVER-WEIGHT IN INITIAL STAGE OF HEMODIALYSIS AND PROGNOSIS IN INCIDENT HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ping Zhang ◽  
Ying Wang ◽  
Xi Yao ◽  
Shaohua Chen ◽  
Chunping Xu ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cardiovascular Mortality ◽  
Multivariate Regression ◽  
Independent Risk Factor ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Interdialytic Weight Gain ◽  
The Relationship

Abstract Background and Aims The volume factor of maintenance hemodialysis patients is closely related to the prognosis. We hypothesized that the excess weight after dialysis (end-dialysis over-weight, edOW) is an important factor of volume impact survival in hemodialysis (HD) patients. The purpose of this study was to analyze the relationship between edOW and long-term prognosis of patients with maintenance hemodialysis. Method This retrospective study observed incident hemodialysis patients who treated in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University from January 1, 2008 to April 30, 2017, three times a week for at least one year. The end point of follow-up was death, abdominal dialysis, kidney transplantation, transfer or until April 30, 2018. The general data of the patients included age, gender, BMI, primary renal disease, CVD, first hemodialysis access, albumin(Alb), Haemoglobin(Hb), blood pressure, heart rate, ultrafiltration rate(UFR), interdialytic weight gain IDWG, end -dialysis overweight (edOW). Cox multivariate regression was used to analyze the relationship between edow and all-cause mortality and cardiovascular mortality. Results Totally 469 patients male, 64% were enrolled, with an average age of 56.9 ± 17.1 years. During the follow-up period, 102 patients died. The main cause of death was cardiovascular and cerebrovascular events, accounting for 44.7%. The mean value of edow was 0.28 ± 0.02 kg. Kaplan-Meier(Log-rank test) survival analysis showed that the long-term survival rate of the group with edow ≤ 0.28kg was better than that of the group with edow > 0.28kg (P = 0.042), and the cardiovascular mortality of the group with edow > 0.28kg was significantly higher than that of the group with edow ≤ 0.28kg (P = 0.001). Cox multivariate regression analysis showed that edow was an independent risk factor for all-cause death in hemodialysis patients (P = 0.025, AhR = 1.541, 95% CI 1.057-2.249), and also an independent risk factor for CVD death in hemodialysis patients (P = 0.007, AhR = 1.929, 95% CI 1.198-3.107). Conclusion EdOW is an independent risk factor of long-term all-cause and cardiovascular death in hemodialysis patients.

scholarly journals P1646SURVIVAL OF KIDNEY TRANSPLANTS ACCORDING TO PRESENCE OF HLA ANTIBODIES WHEN DONORSPECIFIC ANTIBODIES ARE SCREENED DURING POSTTRANSPLANT FOLLOW-UP

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Inge Derad ◽  
Johanna Busch ◽  
Martin Nitschke ◽  
Malte Ziemann
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Graft Survival ◽  
Graft Loss ◽  
Immunosuppressive Regimen ◽  
Term Survival ◽  
Hla Antibodies ◽  
Transplant Survival ◽  
The Mean

Abstract Background and Aims Posttransplant kidney survival depends on several risk factors. A careful immunogenetic matching and the absence of HLA donor specific antibodies (DSA) seem to determine the longevity of the transplant. Method Screening the presence of donor specific HLA antibodies in our posttransplant outpatients was implemented in 2010 (every 6 months in case of DSA free patients for two years, then yearly, and every 3 months in case of DSA + patients for two years, then twice a year). At the same time a treatment protocol was implemented, omitting reduction of immunosuppressive drugs in case of newly detected DSA, and most important with preventing steroid withdrawal in this case.The present single center study reports the long-term survival and kidney function from patients undergoing HLA-screening after transplantation between 2010 and 2016 with a follow-up until 2018. Using a Kaplan-Meier analysis patients without HLA antibodies (no HLA-ab), with HLA antibodies but without DSA (NDSA), and with donor-specific HLA antibodies (DSA) were compared by logrank-testing. Results A full dataset was obtained from 318 patients. The mean overall survival (patients and organ function) didn´t differ between the three groups, p=0.318: no HLA-ab 7.2 years (95%confidence interval 6.7;7.6), NDSA 6.6 (5.9;7.2), DSA 6.8 (6.1;7.5), overall 7.0 (6.6;7.3), events are given in Table1. Whereas the mean patient survival didn´t differ between the groups (p=0.715), the mean death-censored graft survival differed significantly, p=0.008, with a reduced transplant survival in the patients with HLA antibodies but without donorspecific antibodies: no HLA-ab 8.0 years (95%confidence interval 7.7;8.3), NDSA 7.0 (6.4;7.6), DSA 7.6 (7.1;8.2), overall 7.7 (7.4;8.0), numbers are given in Table1. Conclusion In conclusion, the presence of HLA antibodies was associated with a reduced transplant survival. Patients with HLA antibodies had a worse survival than patients with DSA undergoing HLA screening with a personalised immunosuppressive regimen. Immunosuppressive regimen of the groups, as well as other known risk factors of graft survival have to be further analysed. The results of these multivariate analyses have to be awaited to determine whether the risk for graft loss inferred by HLA antibodies is independent from other factors.

P1545LOW SOCIOECONAMIC STATUS INCREASES MORTALITY RISK IN KOREAN MAINTENANCE HEMODIALYSIS PATIENTS: A LONGITUDINAL COHORT STUDY USING HEMODIALYSIS QUALITY ASSESSMENT DATA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Young-Ki Lee ◽  
Hayne Cho Park ◽  
Ajin Cho ◽  
Do Hyoung Kim ◽  
Juhee Kim ◽  
...  
Keyword(s):  
Health Insurance ◽  
Confidence Interval ◽  
Quality Assessment ◽  
Mortality Risk ◽  
Hemodialysis Patients ◽  
Hazard Ratio ◽  
Maintenance Hemodialysis ◽  
Low Ses ◽  
Assessment Data ◽  
Maintenance Hemodialysis Patients

Abstract Background and Aims The number of hemodialysis (HD) patients and their medical expenses are growing rapidly in Korea due to entry into aging society and accompanying diseases such as diabetes and hypertension. Whether low socioeconomic status (SES) affect poorer HD survival is controversial with most reports come from the USA. Therefore, this study was performed to evaluate the effect of SES upon mortality in Korean maintenance HD patients using periodic HD quality assessment data. Method The HD quality assessment has been performed periodically by Health Insurance review and Assessment Service (HIRA) since 2001. We used 4th and 5th HD quality assessment data from the year of 2013 and 2015 respectively for collecting demographic and clinical data. The 4th survey was a sample survey while the 5th survey was a complete enumeration survey. We also collected data on patient comorbidity using the diagnosis codes from the health insurance claims database. The mortality data was collected until Dec 2017. As a proxy indicator reflecting SES, we classified subjects as a Medical Aid (MA) recipients (“low” SES) or a National Health Insurance (NHI) beneficiary (“middle/high” SES). We analyzed mortality risk based on SES using Cox proportional hazard model. Results A total of 21,786 HD patients from 4th survey and 35,454 HD patients from 5th survey were included in the analysis. The ratio between NHI beneficiary and MA recipient was 76.7% versus 23.3%. Mean age of the subjects was 59.0 years old in 4th survey and 60.3 years old in 5th survey. The MA recipients were younger and showed higher proportion of male, shorter duration of HD, lower body mass index (BMI), higher systolic and diastolic blood pressures before HD compared to the NHI beneficiary. The NHI beneficiary demonstrated higher proportion of diabetes, hypertension, cerebrovascular accidents, and dementia compared to the MA recipients. Two groups did not differ in dialysis efficiency presented as single pool Kt/V. A total of 7,173 deaths occurred in 2013 participants, while 7,306 deaths occurred in 2015 participants. After adjusting for age, gender, Charlson’s comorbidity index, BMI, presence of atrial fibrillation, serum albumin, and serum creatinine, MA recipients showed significantly higher mortality risk compared to the NHI beneficiary (hazard ratio 1.162; 95% confidence interval 1.092-1.237, p<0.001 in 4th survey and hazard ratio 1.078; 95% confidence interval 1.013-1.146, p=0.017 in 5th survey). Conclusion Low SES independently increased mortality risk in Korean maintenance hemodialysis patients.

scholarly journals Cardiovascular Disease and All-Cause Mortality in Male Twins With Discordant Cardiorespiratory Fitness: A Nationwide Cohort Study

2020 ◽  
Vol 189 (10) ◽  
pp. 1114-1123
Author(s):  
Marcel Ballin ◽  
Anna Nordström ◽  
Peter Nordström
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Confidence Interval ◽  
Cardiorespiratory Fitness ◽  
Military Service ◽  
Lower Risk ◽  
Hazard Ratio ◽  
Familial Factors ◽  
All Cause Mortality

Abstract Whether genetic and familial factors influence the association between cardiorespiratory fitness (CRF) and cardiovascular disease (CVD) is unknown. Two cohorts were formed based on data from 1,212,295 men aged 18 years who were conscripted for military service in Sweden during 1972–1996. The first comprised 4,260 twin pairs in which the twins in each pair had different CRF (≥1 watt). The second comprised 90,331 nonsibling pairs with different CRF and matched on birth year and year of conscription. Incident CVD and all-cause mortality were identified using national registers. During follow-up (median 32 years), there was no difference in CVD and mortality between fitter twins and less fit twins (246 vs. 251 events; hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.83, 1.20). The risks were similar in twin pairs with ≥60-watt difference in CRF (HR = 0.96, 95% CI: 0.57, 1.64). In contrast, in the nonsibling cohort, fitter men had a lower risk of the outcomes than less fit men (4,444 vs. 5,298 events; HR = 0.83, 95% CI: 0.79, 0.86). The association was stronger in pairs with ≥60-watt difference in CRF (HR = 0.65, 95% CI: 0.59, 0.71). These findings indicate that genetic and familial factors influence the association of CRF with CVD and mortality.

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