scholarly journals Mindfulness-based Virtual Reality Intervention in Hemodialysis Patients: A Pilot Study on End-User Perceptions and Safety

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005522020
Author(s):  
Rosalba Hernandez ◽  
Brett Burrows ◽  
Matthew H.E.M. Browning ◽  
Killivalavan Solai ◽  
Drew Fast ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Pilot Trial ◽  
Hemodialysis Patients ◽  
Virtual Space ◽  
Maintenance Hemodialysis ◽  
Nintendo Wii ◽  
Intervention Delivery ◽  
Head Mounted Display ◽  
Dialysis Vintage ◽  
System Usability

Background: Virtual reality (VR) is an evolving technology that is becoming a common treatment for pain management and psychological phobias. While non-immersive devices (i.e., the Nintendo Wii) have been previously tested with hemodialysis patients, no studies to date have used fully-immersive VR as a tool for intervention delivery. The current pilot trial tests the initial safety, acceptability, and utility of VR during maintenance hemodialysis treatment sessions-particularly, whether VR triggers motion sickness that mimics or negatively impact treatment related symptoms (e.g., nausea). Methods: Hemodialysis patients (n=20) were enrolled in a Phase I single-arm proof-of-concept trial. While undergoing hemodialysis, participants were exposed to our new JovialityTM VR program. This 25-minute program delivers mindfulness training and guided meditation using the Oculus Rift head-mounted display. Participants experienced the program on two separate occasions. Prior and immediately following exposure, participants recorded motion-related symptoms and related discomfort on the Simulator Sickness Questionnaire. Utility measures included end-user's ability to be fully immersed in the virtual space, interact with virtual objects, find hardware user-friendly, and easily navigate the JovialityTM program with the System Usability Score scale. Results: Mean age was 55.3 (+/-13.1) years; 80% male; 60% African American; and mean dialysis vintage was 3.56 (+/-3.75) years. At the first session, there were significant decreases in treatment and/or motion-related symptoms following VR exposure (22.6 vs. 11.2; p=0.03); scores >20 indicate problematic immersion. HD end-users reported high levels of immersion in the VR environment and rated the software easy to operate, with average System Usability Scores of 82.8/100. Conclusions: Hemodialysis patients routinely suffer from fatigue, nausea, lightheadedness, and headaches that often manifest during their dialysis sessions. Our JovialityTM VR program decreased symptom severity without adverse effects. VR programs may be a safe platform to improve the dialysis patient experience.

scholarly journals Physically Based Soap Bubble Synthesis for VR

2021 ◽  
Vol 11 (7) ◽  
pp. 3090
Author(s):  
Sangwook Yoo ◽  
Cheongho Lee ◽  
Seongah Chin
Keyword(s):  
Virtual Reality ◽  
Virtual Space ◽  
Soap Bubble ◽  
Temporal Constraints ◽  
High Expectations ◽  
Soap Bubbles ◽  
Physical Motion ◽  
Head Mounted Display ◽  
Interesting Topic ◽  
Physically Based

To experience a real soap bubble show, materials and tools are required, as are skilled performers who produce the show. However, in a virtual space where spatial and temporal constraints do not exist, bubble art can be performed without real materials and tools to give a sense of immersion. For this, the realistic expression of soap bubbles is an interesting topic for virtual reality (VR). However, the current performance of VR soap bubbles is not satisfying the high expectations of users. Therefore, in this study, we propose a physically based approach for reproducing the shape of the bubble by calculating the measured parameters required for bubble modeling and the physical motion of bubbles. In addition, we applied the change in the flow of the surface of the soap bubble measured in practice to the VR rendering. To improve users’ VR experience, we propose that they should experience a bubble show in a VR HMD (Head Mounted Display) environment.

scholarly journals Role of Roxadustat in Improving Erythropoiesis-Stimulating Agent (ESA)-Resistant Anemia in Patients on Maintenance Hemodialysis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 47-47
Author(s):  
Satoshi Funakoshi
Keyword(s):  
Iron Metabolism ◽  
Conflicts Of Interest ◽  
Hypoxia Inducible Factor ◽  
Transferrin Saturation ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Reactive Protein ◽  
Study Results ◽  
Dialysis Vintage ◽  
Patients With Diabetes

Background: Roxadustat, an oral hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitor, is shown to stimulate erythropoiesis thus improving iron metabolism. Again, while hyperglycemic states are known to be associated with a decreased tissue hypoxia response, to date, roxadustat has not been revaluated for its role in improving anemia in patients with or without diabetes in clinical settings. Methods: A total of 64 hemodialysis patients being treated with epoetin α (9000 units weekly) participated in the study after giving informed consent. They were switched from intravenous epoetin α to oral roxadustat (100 mg 3 times weekly) therapy and were assessed 8 weeks later for improvements in anemia, as well as for changes in parameters for iron metabolism and C-reactive protein (CRP). Results: The study included 39 patients without diabetes (mean age, 71.1 ± 12.1 years; mean dialysis vintage, 7.5 ± 7.4 years; mean GA, 16.2 ± 2.9%) and 27 patients with diabetes (mean age, 70.3 ± 10.3 years; mean dialysis vintage, 5.9 ± 5.5 years; mean GA, 24.9 ± 5.5%). As shown in Table, after 8 weeks the Hb concentration was significantly increased from 10.3 ± 0.8 g/dL at baseline to 10.7 ± 1.3 g/dL in patients without diabetes (P = 0.03) but was not increased in patients with diabetes (from 10.4 ± 0.6 at baseline to 10.5 ± 1.1 g/dL). Again, the serum iron, ferritin concentrations and the transferrin saturation ratio were decreased, irrespective of whether or not they had diabetes, with no change shown in serum CRP level. Conclusion: Switching hemodialysis patients with ESA-resistant anemia from ESA to roxadustat led to improvements in anemia only in those without diabetes, while study results suggested the involvement of mechanisms, other than impaired iron utilization or inflammation, in the impairment of hematopoiesis in those with diabetes. Table Disclosures No relevant conflicts of interest to declare.

scholarly journals Derivation and Internal Validation of a Clinical Risk Prediction Tool for Hyperkalemia-Related Emergency Department Encounters Among Hemodialysis Patients

2020 ◽  
Vol 7 ◽  
pp. 205435812095328
Author(s):  
Paul E. Ronksley ◽  
James P. Wick ◽  
Meghan J. Elliott ◽  
Robert G. Weaver ◽  
Brenda R. Hemmelgarn ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hemodialysis Patients ◽  
Regression Coefficients ◽  
Maintenance Hemodialysis ◽  
Model Discrimination ◽  
C Statistic ◽  
Increased Risk ◽  
Dialysis Vintage ◽  
Ed Visits ◽  
Maintenance Hemodialysis Patients

Background: Approximately 10% of emergency department (ED) visits among dialysis patients are for conditions that could potentially be managed in outpatient settings, such as hyperkalemia. Objective: Using population-based data, we derived and internally validated a risk score to identify hemodialysis patients at increased risk of hyperkalemia-related ED events. Design: Retrospective cohort study. Setting: Ten in-center hemodialysis sites in southern Alberta, Canada. Patients: All maintenance hemodialysis patients (≥18 years) between March 2009 and March 2017. Measurements: Predictors of hyperkalemia-related ED events included patient demographics, comorbidities, health-system use, laboratory measurements, and dialysis information. The outcome of interest (hyperkalemia-related ED events) was defined by International Classification of Diseases (10th Revision; ICD-10) codes and/or serum potassium [K+] ≥6 mmol/L. Methods: Bootstrapped logistic regression was used to derive and internally validate a model of important predictors of hyperkalemia-related ED events. A point system was created based on regression coefficients. Model discrimination was assessed by an optimism-adjusted C-statistic and calibration by deciles of risk and calibration slope. Results: Of the 1533 maintenance hemodialysis patients in our cohort, 331 (21.6%) presented to the ED with 615 hyperkalemia-related ED events. A 9-point scale for risk of a hyperkalemia-related ED event was created with points assigned to 5 strong predictors based on their regression coefficients: ≥1 laboratory measurement of serum K+ ≥6 mmol/L in the prior 6 months (3 points); ≥1 Hemoglobin A1C [HbA1C] measurement ≥8% in the prior 12 months (1 point); mean ultrafiltration of ≥10 mL/kg/h over the preceding 2 weeks (2 points); ≥25 hours of cumulative time dialyzing over the preceding 2 weeks (1 point); and dialysis vintage of ≥2 years (2 points). Model discrimination (C-statistic: 0.75) and calibration were good. Limitations: Measures related to health behaviors, social determinants of health, and residual kidney function were not available for inclusion as potential predictors. Conclusions: While this tool requires external validation, it may help identify high-risk patients and allow for preventative strategies to avoid unnecessary ED visits and improve patient quality of life. Trial registration: Not applicable—observational study design.

Egocentric Distance Perception: A Comparative Study Investigating Differences Between Real and Virtual Environments

Perception ◽  
2020 ◽  
Vol 49 (9) ◽  
pp. 940-967
Author(s):  
Ilja T. Feldstein ◽  
Felix M. Kölsch ◽  
Robert Konrad
Keyword(s):  
Virtual Reality ◽  
Virtual Environments ◽  
Distance Perception ◽  
Ecological Validity ◽  
Virtual Space ◽  
Egocentric Distance ◽  
The Real ◽  
Head Mounted Display ◽  
Significant Difference ◽  
Depth Analysis

Virtual reality systems are a popular tool in behavioral sciences. The participants’ behavior is, however, a response to cognitively processed stimuli. Consequently, researchers must ensure that virtually perceived stimuli resemble those present in the real world to ensure the ecological validity of collected findings. Our article provides a literature review relating to distance perception in virtual reality. Furthermore, we present a new study that compares verbal distance estimates within real and virtual environments. The virtual space—a replica of a real outdoor area—was displayed using a state-of-the-art head-mounted display. Investigated distances ranged from 8 to 13 m. Overall, the results show no significant difference between egocentric distance estimates in real and virtual environments. However, a more in-depth analysis suggests that the order in which participants were exposed to the two environments may affect the outcome. Furthermore, the study suggests that a rising experience of immersion leads to an alignment of the estimated virtual distances with the real ones. The results also show that the discrepancy between estimates of real and virtual distances increases with the incongruity between virtual and actual eye heights, demonstrating the importance of an accurately set virtual eye height.

scholarly journals Risk Factors for Low Humoral Response to BNT-162b2 In Hemodialysis Patients

2021 ◽  
Author(s):  
Rui Duarte ◽  
Cátia Figueiredo ◽  
Ivan Luz ◽  
Francisco Ferrer ◽  
Hernâni Gonçalves ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Humoral Response ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Older Age ◽  
Maintenance Hemodialysis ◽  
List Type ◽  
Central Venous ◽  
Dialysis Vintage

AbstractIntroductionMaintenance Hemodialysis (HD) patients are at higher risk of both infection and mortality associated with the new coronavirus 2. Immunization through large-scale vaccination is the cornerstone of infection prevention in this population. This study aims to identify risk factors for low response to the BNT-162b2 (Pfizer BioNTech) vaccine in a HD cohort.Materials and MethodsObservational prospective study of a HD group followed in a Portuguese Public Founded Hemodialysis Center who received BNT-162b2 vaccination. Specific anti-Spike IgG was evaluated as arbitrary units per milliliter (AU/mL) on two separate occasions: 3 weeks after the first dose and 3 weeks after the second. IgG titers, Non-Responders (NR), and Weak-Responders (WR) after each dose were evaluated against risk factors that included demographic, clinical and analytical variables.ResultsHumoral response evaluated by IgG anti-Spike levels showed a strong correlation with Charlson comorbidity index (CCI) and intact parathormone (iPTH) after each inoculation (1st dose: ρ=−0.64/0.54; 2nd dose: ρ=−0.66/0.63, respectively; p<0.01 throughout). After completing both doses: 1) NR were associated with female sex (p<0.01), lower albumin and iPTH (p=0.01); 2) WR showed higher CCI, older age, lower iPTH and lower albumin (p=<0.01, p=0.03, p<0.01, p=0.05, respectively) and, consistently, associated with CCI over 8, age over 75, iPTH under 150 ng/L, female sex, dialysis vintage under 24 months and central venous catheter (CVC) over arteriovenous fistula (p=0.01, p=0.03, p<0.01, p=0.01, p=0.01, p<0.01, respectively). A binary regression model using CCI, sex (male) and CVC was statistically significant in prediction of WR after the 2nd dose with OR (95% CI): 1.81 (1.06-3.08); 0.05 (0.01-0.65); 13.55 (1.06-174.18), respectively (p=0.01).ConclusionOlder age, higher CCI, lower iPTH and albumin, CVC as vascular access and recent hemodialysis initiation (less than 2 years) associate with lower response to vaccination in our study. A higher comorbidity burden is suggested as a more significant surrogate marker for low immunogenicity rather than age alone. Identifying HD patients as a population at high-risk for low response to vaccination is essential for proper policy-making, facilitating the implementation of adequate and individualized contingency protocols.What is already known about this subjectMaintenance hemodialysis patients have lower humoral response to BNT-162b2 COVID-19 vaccine when compared to the general population.Maintenance dialysis patients are at high risk of exposure to coronavirus 2 in addition to a more severe disease course.What this study addsWe suggest Charlson commorbidity index, older age, intact parathormone, central venous catheter as vascular access and lower dialysis vintage as possible surrogate markers of immunogenicity in HD patients.There is a low humoral response after a single dose of the vaccine (50%) that can be increased after the second (86%).What impact this may have on practice or policyStrict Protocols for follow-up measures in HD patients, including closer humoral titers assessment, risk stratification, adequate isolation, and surveillance of symptoms might be necessary in order to improve this population survival/life expectancy.Screening HD patients, seroconversion rates may be improved by giving extra inoculations for patients at risk for low response.

scholarly journals Changes in Quality of Life in Older Hemodialysis Patients: A Cohort Study on Dialysis Outcomes and Practice Patterns

2020 ◽  
Vol 51 (8) ◽  
pp. 650-658
Author(s):  
Ayumi Ishiwatari ◽  
Shungo Yamamoto ◽  
Shingo Fukuma ◽  
Takeshi Hasegawa ◽  
Sachiko Wakai ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Practice Patterns ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Dialysis Vintage ◽  
Health Related Qol ◽  
Health Related ◽  
Dialysis Outcomes ◽  
Maintenance Hemodialysis Patients

Background: Despite improvements in dialysis treatment, mortality rates remain high, especially among older hemodialysis patients. Quality of life (QOL) among hemodialysis patients is strongly associated with higher risk of death. This study aimed to describe the health-related QOL and its change in older maintenance hemodialysis patients and to demonstrate characteristics associated with health-related QOL. Methods: Data on 892 maintenance hemodialysis patients aged 60 years or older who were surveyed using the Kidney Disease Quality of Life Short Form at baseline and 2 years after study enrollment in phases 4 (2009–2011) and 5 (2012–2014) of the Japanese Dialysis Outcomes and Practice Patterns Study were analyzed. We categorized participants into 3 age groups (60–69, 70–79, and ≥80 years) and described baseline physical component summary (PCS) and mental component summary (MCS) scores, as well as their distribution of changes after 2 years across each category. Results: Hemodialysis patients aged 70–79 years and ≥80 years had lower PCS scores than those aged 60–69 years (median: 70–79 years = 43.1; interquartile range [IQR], 35.2–49.4; ≥80 years = 38.8; IQR, 31.6–43.8; 60–69 years = 45.4; IQR, 37.5–51.4; p < 0.001). In contrast, MCS scores did not significantly differ by age category (70–79 years = 45.6; IQR, 38.4–53.7; ≥80 years = 45.4; IQR, 36.9–55.1; 60–69 years = 46.8; IQR, 39.5–55.7; p = 0.1). As dialysis vintage lengthened, the PCS score significantly became lower, whereas no association was found with change in the MCS score. The MCS score declined over time in older patients, especially among those aged 80 years and older after 2 years’ follow-up. Conclusions: Physical QOL became worse as dialysis vintage lengthened. In contrast, mental QOL declined over time within a relatively short period among older maintenance hemodialysis patients.

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 Calcium-based phosphate binder use is associated with lower risk of osteoporosis in hemodialysis patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hiroko Hashimoto ◽  
Satomi Shikuma ◽  
Shintaro Mandai ◽  
Susumu Adachi ◽  
Shinichi Uchida
Keyword(s):  
Vitamin D ◽  
Calcium Supplementation ◽  
Hemodialysis Patients ◽  
Phosphate Binders ◽  
Maintenance Hemodialysis ◽  
Active Vitamin ◽  
Mineral Density ◽  
Active Vitamin D ◽  
Dialysis Vintage ◽  
Osteoporosis Risk

AbstractLoss of bone mineral density (BMD) is a substantial risk of mortality in addition to fracture in hemodialysis patients. However, the factors affecting BMD are not fully determined. We conducted a single-center, cross-sectional study on 321 maintenance hemodialysis patients who underwent evaluation of femoral neck BMD using dual-energy X-ray absorptiometry from August 1, 2018, to July 31, 2019. We examined factors associated with osteoporosis defined by T-score of ≤  − 2.5, using logistic regression models. Median age of patients was 66 years, and 131 patients (41%) were diagnosed with osteoporosis. Older age, female, lower body mass index, diabetes mellitus, and higher Kt/V ratios were associated with higher osteoporosis risk. The only medication associated with lower osteoporosis risk was calcium-based phosphate binders (CBPBs) [odds ratio (OR), 0.41; 95% confidence interval (CI), 0.21–0.81]. In particular, CBPB reduced the osteoporosis risk within subgroups with dialysis vintage of ≥ 10 years, albumin level of < 3.5 mg/dL, active vitamin D analog use, and no proton pump inhibitor (PPI) use. In conclusion, CBPB use was associated with lower osteoporosis risk in hemodialysis patients. This effect might be partially attributable to calcium supplementation, given its higher impact in users of active vitamin D analogs or non-users of PPI, which modulate calcium absorption.

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