A scale development study: Hemodialysis comfort scale version II

Aim Aim of this study was to develop a valid and reliable measuring tool in order to evaluate comfort of patients receiving hemodialysis treatment. Background There has been available a scale developed to evaluate comfort of hemodialysis patients “HDCS (Hemodialysis Comfort Scale).” Due to HDCS consisted of nine items and evaluated comfort in two sub-dimensions, researchers who developed HDCS, stated that number of scale items and dimensions is not sufficient to fully evaluate comfort. Therefore, (Hemodialysis Comfort Scale Version II) HDCS-II was developed with this research and its development process were discussed in this article. Materials and Methods Sample of this methodological research was consisted of 436 chronic hemodialysis patients, treated at five hemodialysis centers between October 2018 and May 2019. In process of creation item pool, comfort theory and literature was examined. The items in the old scale were also revised and included. Thereby a new question pool of 87 items was created. This draft scale was sent for expert opinion. In validity of scale; content validity index, exploratory and confirmatory factor analysis were used. In reliability study; Item analysis, cronbach’s alpha reliability coefficient, parallel form reliability and item analysis based on upper-lower group averages were used. Results There was consistency between expert views relating to items in scale. According to exploratory factor analysis, scale consisted of six dimensions. Cronbach alpha coefficient of 26-item scale was 0.79. Alpha values of the six factor in scale were, respectively; for physical relief 0.83, for physical ease 0.71, for psychospiritual ease 0.87, for psychospiritual transcendence 0.85, for environmental transcendence 0.82, and for sociocultural ease 0.61. Conclusion HDCS-II is a 5-point likert type and consists of 26 items and 6 factors. This scale is a valid and reliable measurement tool that can be used to determine comfort of patients undergoing hemodialysis treatment.

Kinetics of Bilirubin and Ammonia Elimination during Hemadsorption Therapy in Secondary Sclerosing Cholangitis Following ECMO Therapy and Severe COVID-19

In critically ill patients, liver dysfunction often results in coagulopathy and encephalopathy and is associated with high mortality. Extracorporeal clearance of hepatotoxic metabolites, including bilirubin and ammonia, aims to attenuate further hepatocyte damage and liver injury, resulting in decreased mortality. The efficacy of hemadsorption combined with conventional hemodialysis to eliminate bilirubin and ammonia to support the liver’s excretory function in acute liver injury has been described previously. However, the optimal use of liver support systems in chronic liver dysfunction due to secondary sclerosing cholangitis in critically ill patients (SSC-CIP) has not been defined yet. We herein describe the kinetics of successful bilirubin and ammonia elimination by hemadsorption in a patient with SSC-CIP after extracorporeal membrane oxygenation (ECMO) therapy for severe acute respiratory distress syndrome (ARDS) in a patient with coronavirus disease 2019 (COVID-19). During the course of the disease, the patient developed laboratory signs of liver injury during ECMO therapy before clinically detectable jaundice or elevated bilirubin levels. A diagnosis of SSC-CIP was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) based on intraductal filling defects in the intrahepatic bile ducts due to biliary casts. The patient showed stable elevations of bilirubin and ammonia levels thereafter, but presented with progressive nausea, vomiting, weakness, and exhaustion. Based on these laboratory findings, hemadsorption was combined with hemodialysis treatment and successfully eliminated bilirubin and ammonia. Moreover, direct comparison revealed that ammonia is more efficiently eliminated by hemadsorption than bilirubin levels. Clinical symptoms of nausea, vomiting, weakness, and exhaustion improved. In summary, bilirubin and ammonia were successfully eliminated by hemadsorption combined with hemodialysis treatment in SSC-CIP following ECMO therapy and severe COVID-19. This observation is particularly relevant since it has been reported that a considerable subset of critically ill patients with COVID-19 suffer from liver dysfunction associated with high mortality.

Longitudinal effects of modified creatinine index on all-cause mortality in individuals receiving hemodialysis treatment

BACKGROUND: The modified creatinine index (mCI), as a surrogate marker of muscle mass, has been associated with poor outcomes in patients undergoing hemodialysis. However, a single assessment may not reflect the clinical significance before an adverse clinical endpoint. OBJECTIVE: Analyze mCI trajectories and their association with all-cause mortality in incident hemodialysis patients. DESIGN: Retrospective observational cohort. SETTING: Outpatient dialysis facility. PATIENTS AND METHODS: We followed a cohort of patients who underwent maintenance hemodialysis treatment at least three times weekly for at least three months from 19 June 2010 to 29 December 2017. Clinical and laboratory features were measured at baseline. Longitudinal changes in the mCI were modeled using a joint longitudinal and survival model adjusted for baseline covariates and body mass index trajectories. MAIN OUTCOME MEASURE: All-cause mortality. SAMPLE SIZE: 408 with 208 males (50.7%). RESULTS: The mean (SD) age was 62.2 (12.3) years. The mCI changes were evaluated for a median (interquartile range) follow-up of 2.16 (1.13, 3.73) years. Forty-six percent (n=188) of patients reached the endpoint. A steeper slope (per 0.1 unit increase in the decrease rate) in modified creatinine index was associated with increased risk of all-cause mortality (HR, 1.04; 95% CI, 1.02–1.07; P =.011). In addition, an annual 1 mg/kg/day decrease in modified creatinine index level increased the hazard of all-cause mortality by 4% (HR, 1.04; 95% CI, 1.02–1.07; P =.001). LIMITATIONS: Residual kidney function was not observed in the data. Setting was single center and thus results may not be generalizable to other populations. CONCLUSION: All-cause death was significantly associated with loss of muscle mass over time. Longitudinal trajectories of nutritional markers may predict the clinical outcomes in patients undergoing hemodialysis. This may also be valuable for individual risk stratification. Furthermore, early management may provide an opportunity to improve patient survival. CONFLICT OF INTEREST: None.

527 - Anxiety in older Greek patients undergoing hemodialysis

ABSTRACTIntroduction:A significant proportion of patents under hemodialysis treatment manifest anxiety symptoms, which may affect compliance to treatment and quality of life.The aim of the present study was to investigate anxiety levels of patients under hemodialysis treatment, as well as the relationship between socio-demographic/clinical factors and anxiety.Method:A total of 105 patients with chronic kidney failure under hemodialysis treatment (64 men and 41 women) with a mean age of 72.51 ± 7.55 years were recruited and completed (a) a demographic questionnaire and (b) the State-Trait Anxiety Inventory.Results:58.1% of the participants were male; while the 59.6% of the participants were married and the 60.2% were retired. Our participants exhibited higher state, trait and total anxiety levels compared to general population. There were a statistically significant association between factors, including patients’ functionality, gender, physical exercise, hemodialysis complications, marital status, educational level and anxiety levels. Women exhibited a statistically significant higher state anxiety levels compared to men. Widowed participants, that is, people living alone who had experienced the loss of a beloved one, reported higher state, trait and total anxiety levels. Finally, people with higher education showed lower trait and total anxiety. Individuals who were capable of taking care of themselves reported lower state, trait and total anxiety levels with a statistically significant difference compared to those who needed external help. Additionally, those who physically exercised exhibited statistically significant lower state, trait and total anxiety levels compared to those who didn’t exercise.Conclusions:The conclusions of the present study could be a critical point in determining guidelines that would substantially contribute to the improvement of the psychological state of patients undergoing hemodialysis treatment.

528 - Health locus of control beliefs among older Greek hemodialysis patients: Sociodemographic and psychological correlates

ABSTRACTIntroduction:Quality of life of a significant proportion of patents under hemodialysis treatment is determined by their health locus of control beliefs (internal, external, chance).The aim of the present study was to investigate health locus of control of patients under hemodialysis treatment. Moreover, the relationship between socio-demographic, clinical, psychological factors and health locus of control was explored.Method:A total of 105 patients with chronic kidney failure under hemodialysis treatment (64 men and 41 women) with a mean age of 72.51 ± 7.55 years were recruited and completed (a) a demographic questionnaire, (b) the Multidisciplinary Health Locus of Control Scale and (c) the State-Trait Anxiety Inventory.Results:Internal locus of control (the degree to which participants feel they are in control of their own health) fluctuates lower, while locus of control from others (the degree that participants believe that others -doctors- control their health) and luck (the degree to which participants believe their health is a matter of luck) fluctuates higher in our participants than general population. State, trait and total anxiety levels were significantly correlated negatively with internal locus of control and positively with “chance” locus of control scale in the present study.Conclusions:Our participants seemed to feel highly dependent from others, such as treating physicians, nurses, family, hemodialysis machine resulting in a limited sense of freedom and autonomy. Understanding health locus of control beliefs among Greek hemodialysis patients may help health professionals to implement appropriate counseling intervention programs and improve patient psychological state and provided services.