Research

10 pages, 851 KiB

Open AccessArticle

Impact of Vascular Access Flow Suppression Surgery on Cervical Artery Circulation: A Retrospective Observational Study

by Koji Hashimoto, Makoto Harada, Yosuke Yamada, Taro Kanno, Yutaka Kanno and Yuji Kamijo

J. Clin. Med. 2024, 13(3), 641; https://doi.org/10.3390/jcm13030641 - 23 Jan 2024

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Vascular access (VA) flow suppression surgery augments VA flow resistance and can increase other circulation flows hindered by high-flow VA. However, whether VA flow suppression surgery affects cervical circulation has rarely been reported. We aimed to determine the effect of VA flow suppression [...] Read more.

Vascular access (VA) flow suppression surgery augments VA flow resistance and can increase other circulation flows hindered by high-flow VA. However, whether VA flow suppression surgery affects cervical circulation has rarely been reported. We aimed to determine the effect of VA flow suppression surgery on the cervical circulation in patients with high-flow VA. This single-center, retrospective, observational study included 85 hemodialysis patients who underwent VA flow suppression surgery at the Kanno Dialysis and Access Clinic between 2009 and 2018. Blood flow in the VA, bilateral vertebral arteries, and common carotid artery was measured before and after VA flow suppression surgery. The VA flow decreased from 1548 mL/min to 693 mL/min postoperatively. The flow of the vertebral artery on the VA side increased from 55 mL/min to 81 mL/min. The flow in the bilateral common carotid arteries also increased. Patients whose symptoms improved postoperatively showed better improvement in the vertebral artery on the VA side. VA flow suppression surgery in patients with high-flow VA increases the flow of the vertebral artery on the VA side and of the bilateral common carotid arteries. High-flow VA can hinder the vertebral and common carotid circulation. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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13 pages, 1052 KiB

Open AccessArticle

Intradialytic Tolerance and Recovery Time in Different High-Efficiency Hemodialysis Modalities

by Agnieszka Zakrzewska, Jan Biedunkiewicz, Michał Komorniczak, Magdalena Jankowska, Katarzyna Jasiulewicz, Natalia Płonka, Bogdan Biedunkiewicz, Sylwia Małgorzewicz, Agnieszka Tarasewicz, Ewelina Puchalska-Reglińska, Janusz Siebert, Alicja Dębska-Ślizień and Leszek Tylicki

J. Clin. Med. 2024, 13(2), 326; https://doi.org/10.3390/jcm13020326 - 06 Jan 2024

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Abstract

There are several forms of maintenance high-efficiency hemodialysis (HD), including hemodiafiltrations (HDF) in different technical modes and expanded HD, using dialyzers with medium cut-off membranes. The aim of the study was to assess the intradialytic tolerance and length of dialysis recovery time (DRT) [...] Read more.

There are several forms of maintenance high-efficiency hemodialysis (HD), including hemodiafiltrations (HDF) in different technical modes and expanded HD, using dialyzers with medium cut-off membranes. The aim of the study was to assess the intradialytic tolerance and length of dialysis recovery time (DRT) in these modalities. This is an exploratory, crossover study in maintenance HD patients with low comorbidity and no clinical indications for the use of high-efficiency HD, who were exposed to five intermittent dialyses in random order: high-flux hemodialysis (S-HD), expanded HD (HDx), pre-dilution HDF (PRE-HDF), mix-dilution HDF (MIX-HDF) and post-dilution HDF (POST-HDF). Twenty-four dialysis sessions of each method were included in the analysis. Dialysis parameters, including blood flow rate, dialysis fluid flow rate and temperature, and pharmacological treatment were constant. Average total convection volume for post-HDF, pre-HDF and mix-HDF were 25.6 (3.8), 61.5 (7.2) and 47.1 (11.4) L, respectively. During all therapies, patients were monitored for the similarity of their hydration statuses using bioimpedance spectroscopy, and for similar variability over time in systemic blood pressure and cardiac output, while peripheral resistance was monitored using impedance cardiography. The lowest frequency of all intradialytic adverse events were observed during HDx. Delayed DRT was the shortest during PRE-HDF. Patients were also more likely to report immediate recovery while receiving PRE-HDF. These differences did not reach statistical significance; however, the study results suggest that intradialytic tolerance and DRT may depend on the dialysis method used. This supports the need of taking into account patient preferences and quality of life while individualizing high-efficiency therapy in HD patients. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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12 pages, 1046 KiB

Open AccessArticle

Combined Prognostic Value of Preprocedural Protein–Energy Wasting and Inflammation Status for Amputation and/or Mortality after Lower-Extremity Revascularization in Hemodialysis Patients with Peripheral Arterial Disease

by Yoshitaka Kumada, Norikazu Kawai, Narihiro Ishida, Yasuhito Nakamura, Hiroshi Takahashi, Satoru Ohshima, Ryuta Ito, Hideo Izawa, Toyoaki Murohara and Hideki Ishii

J. Clin. Med. 2024, 13(1), 126; https://doi.org/10.3390/jcm13010126 - 25 Dec 2023

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Abstract

Protein–energy wasting is associated with inflammation and advanced atherosclerosis in hemodialysis patients. We enrolled 800 patients who had undergone successful lower-extremity revascularization, and we investigated the association among the Geriatric Nutritional Risk Index (GNRI) as a surrogate marker of protein–energy wasting, C-reactive protein [...] Read more.

Protein–energy wasting is associated with inflammation and advanced atherosclerosis in hemodialysis patients. We enrolled 800 patients who had undergone successful lower-extremity revascularization, and we investigated the association among the Geriatric Nutritional Risk Index (GNRI) as a surrogate marker of protein–energy wasting, C-reactive protein (CRP), and their joint roles in predicting amputation and mortality. They were divided into lower, middle, and upper tertiles (T1, T2, and T3) according to GNRI and CRP levels, respectively. Regarding the results, the amputation-free survival rates over 8 years were 47.0%, 56.9%, and 69.5% in T1, T2, and T3 of the GNRI and 65.8%, 58.7%, and 33.2% for T1, T2, and T3 of CRP, respectively (p < 0.0001 for both). A reduced GNRI [adjusted hazard ratio (aHR) 1.78, 95% confidence interval (CI) 1.24–2.59, p = 0.0016 for T1 vs. T3] and elevated CRP (aHR 1.86, 95% CI 1.30–2.70, p = 0.0007 for T3 vs. T1) independently predicted amputation and/or mortality. When the two variables were combined, the risk was 3.77-fold higher (95% CI 1.97–7.69, p < 0.0001) in patients who occupied both T1 of the GNRI and T3 of CRP than in those who occupied both T3 of the GNRI and T1 of CRP. In conclusion, patients with preprocedurally decreased GNRI and elevated CRP levels frequently experienced amputation and mortality, and a combination of these two variables could more accurately stratify the risk. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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10 pages, 688 KiB

Open AccessArticle

Prevalence of Impaired Physical Mobility in Dialysis Patients: A Single-Centre Cross-Sectional Study

by Špela Bogataj, Jernej Pajek, Blaž Slonjšak and Vanja Peršič

J. Clin. Med. 2023, 12(20), 6634; https://doi.org/10.3390/jcm12206634 - 20 Oct 2023

Cited by 1 | Viewed by 807

Abstract

Impaired physical mobility in hemodialysis (HD) patients is considered an important modifiable risk factor of increased all-cause morbidity and mortality. To our knowledge, no study to date has determined the overall burden of limited physical mobility in prevalent HD patients. The aim of [...] Read more.

Impaired physical mobility in hemodialysis (HD) patients is considered an important modifiable risk factor of increased all-cause morbidity and mortality. To our knowledge, no study to date has determined the overall burden of limited physical mobility in prevalent HD patients. The aim of this research is to investigate impaired physical mobility and its clinical correlates. We conducted a cross-sectional observational study in all patients of the Centre for Acute and Complicated Dialysis at the University Medical Centre of Ljubljana, where the most complex patients receive HD on average three times per week. The data were collected through interviews based on a prepared questionnaire and medical history review. A total of 205 patients were included in this study (63.9 ± 15.4 years). Sixty percent (122/205) of the patients had little or no physical mobility impairment, and others were categorized with a minor or severe mobility limitation. A minor mobility impairment was found in 21% (43/205) of patients: 10 patients (5%) used a mobility aid in the form of a crutch, 9 patients (4%) were dependent on two crutches or a walker, and 24 patients (12%) were temporarily dependent on the assistance of a third person. Severe mobility limitations were observed in 22% (40/205) of patients, ranging from being confined to bed (19/205, 9%), confined to bed but able to perform some movements (19/205, 9%), and ambulatory but dependent on the assistance of a third person for locomotion (2/205, 1%). The most common causes of the limitation of mobility were neurological (19/40, 47.5%), cardiovascular (9/40, 22.5%), musculoskeletal (8/40, 20%), and other causes (4/40, 10%). A significant, moderate positive correlation was observed between mobility problems and the age of the participants (r = 0.36, p < 0.001), while a significant, small positive correlation was obtained between the mobility problems and C-reactive protein (r = 0.15, p = 0.044). Moreover, mobility problems had a small but significant negative correlation with albumin levels (r = −0.15, p = 0.042). When controlling for age, results yield no significant correlations, and, in regression analysis, only the age (p < 0.001) and male gender (p = 0.007) of the participants were independent predictors of mobility impairment. We conclude that impaired mobility has a high overall prevalence among chronic HD patients. Strategies to prevent and improve mobility limitations are strongly needed. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

10 pages, 764 KiB

Open AccessArticle

Predictors for Unsuccessful Reductions in Hemodialysis Frequency during the Pandemic

by Suthiya Anumas, Sithichai Kunawathanakul, Pichaya Tantiyavarong, Pajaree Krisanapan and Pattharawin Pattharanitima

J. Clin. Med. 2023, 12(7), 2550; https://doi.org/10.3390/jcm12072550 - 28 Mar 2023

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Abstract

Background and Objectives: Patients receiving in-center hemodialysis are at a high risk of coronavirus disease 2019 (COVID-19) infection. A reduction in hemodialysis frequency is one of the proposed measures for preventing COVID-19 infection. However, the predictors for determining an unsuccessful reduction in hemodialysis [...] Read more.

Background and Objectives: Patients receiving in-center hemodialysis are at a high risk of coronavirus disease 2019 (COVID-19) infection. A reduction in hemodialysis frequency is one of the proposed measures for preventing COVID-19 infection. However, the predictors for determining an unsuccessful reduction in hemodialysis frequency are still lacking. Materials and Methods: This retrospective observational study enrolled patients who were receiving long-term thrice-weekly hemodialysis at the Thammasat University Hospital in 2021 and who decreased their dialysis frequency to twice weekly during the COVID-19 outbreak. The outcomes were to determine the predictors and a prediction model of unsuccessful reduction in dialysis frequency at 4 weeks. Bootstrapping was performed for the purposes of internal validation. Results: Of the 161 patients, 83 patients achieved a dialysis frequency reduction. Further, 33% and 82% of the patients failed to reduce their dialysis frequency at 4 and 8 weeks, respectively. The predictors for unsuccessful reduction were diabetes, congestive heart failure (CHF), pre-dialysis overhydration, set dry weight (DW), DW from bioelectrical impedance analysis, and the mean pre- and post-dialysis body weight. The final model including these predictors demonstrated an AUROC of 0.763 (95% CI 0.654–0.866) for the prediction of an unsuccessful reduction. Conclusions: The prediction score involving diabetes, CHF, pre-dialysis overhydration, DW difference, and net ultrafiltration demonstrated a good performance in predicting an unsuccessful reduction in hemodialysis frequency at 4 weeks. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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11 pages, 882 KiB

Open AccessArticle

Malnutrition and Insulin Resistance May Interact with Metabolic Syndrome in Prevalent Hemodialysis Patients

by Shuzo Kobayashi, Yasuhiro Mochida, Kunihiro Ishioka, Machiko Oka, Kyoko Maesato, Hidekazu Moriya, Sumi Hidaka and Takayasu Ohtake

J. Clin. Med. 2023, 12(6), 2239; https://doi.org/10.3390/jcm12062239 - 14 Mar 2023

Cited by 1 | Viewed by 1819

Abstract

Background: We sought to determine the prevalence of metabolic syndrome (Mets) and whether 100 cm² of visceral fatty area (VFA) measured by computed tomography (CT) validates the criteria of waist circumference (WC) in hemodialysis (HD) patients. Methods: The study comprised 141 HD [...] Read more.

Background: We sought to determine the prevalence of metabolic syndrome (Mets) and whether 100 cm² of visceral fatty area (VFA) measured by computed tomography (CT) validates the criteria of waist circumference (WC) in hemodialysis (HD) patients. Methods: The study comprised 141 HD patients. Mets was defined according to the criteria of Adult Treatment Panel III (ATP III) and the modified criteria of National Cholesterol Education Program (NCEP) that defines abdominal obesity as a WC of >=85 cm in men and >=90 cm in women. Results: The prevalence of Mets was 31.9% in men and 13.6% in women. However, the prevalence of patients with a body mass index over 25 in all HD patients was only 11.2%. The visceral fatty area (VFA) measured by CT showed a strong positive correlation with WC. The patients with Mets, comparing with those without Mets, have significantly shorter duration of HD, higher high-sensitive C-reactive protein, and higher Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). In the patients with Mets, there was a significant negative correlation between HOMA-IR and serum albumin levels. Multivariate logistic regression analysis showed that HOMA-IR and short duration of HD were chosen as independent risk factors for Mets. Conclusions: Mets is more prevalent in HD patients. In Japanese HD patients, 100 cm² of VFA corresponded to a WC of 85 cm in men and 90 cm in women, thus confirming the validity of the modified criteria. HOMA-IR and serum albumin were significantly correlated in HD patients with Mets. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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15 pages, 2290 KiB

Open AccessArticle

Association of Hyperkalemia and Hypokalemia with Patient Characteristics and Clinical Outcomes in Japanese Hemodialysis (HD) Patients

by Masao Iwagami, Yuka Kanemura, Naru Morita, Toshitaka Yajima, Masafumi Fukagawa and Shuzo Kobayashi

J. Clin. Med. 2023, 12(6), 2115; https://doi.org/10.3390/jcm12062115 - 08 Mar 2023

Cited by 1 | Viewed by 1791

Abstract

This study aimed to examine the characteristics and clinical outcomes of Japanese hemodialysis patients with dyskalemia. A retrospective study was conducted using a large Japanese hospital group database. Outpatients undergoing thrice-a-week maintenance hemodialysis were stratified into hyperkalemia, hypokalemia, and normokalemia groups based on [...] Read more.

This study aimed to examine the characteristics and clinical outcomes of Japanese hemodialysis patients with dyskalemia. A retrospective study was conducted using a large Japanese hospital group database. Outpatients undergoing thrice-a-week maintenance hemodialysis were stratified into hyperkalemia, hypokalemia, and normokalemia groups based on their pre-dialysis serum potassium (sK) levels during the three-month baseline period. Baseline characteristics of the three groups were described and compared for the following outcomes during follow-up: all-cause mortality, all-cause hospitalization, major adverse cardiovascular events (MACE), cardiac arrest, fatal arrythmia, and death related to arrhythmia. The study included 2846 eligible patients, of which 67% were men with a mean age of 65.65 (SD: 12.63) years. When compared with the normokalemia group (n = 1624, 57.06%), patients in the hypokalemia group (n = 313, 11.00%) were older and suffered from malnutrition, whereas patients in the hyperkalemia group (n = 909, 31.94%) had longer dialysis vintage. The hazard ratios for all-cause mortality and MACE in the hypokalemia group were 1.47 (95% confidence interval [CI], 1.13–1.92) and 1.48 (95% CI, 1.17–1.86), respectively, whereas that of death related to arrhythmia in the hyperkalemia group was 3.11 (95% CI, 1.03–9.33). Thus, dyskalemia in maintenance hemodialysis patients was associated with adverse outcomes, suggesting the importance of optimized sK levels. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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18 pages, 867 KiB

Open AccessCommunication

Recent Advances in the Nutritional Screening, Assessment, and Treatment of Japanese Patients on Hemodialysis

by Junko Ishida and Akihiko Kato

J. Clin. Med. 2023, 12(6), 2113; https://doi.org/10.3390/jcm12062113 - 08 Mar 2023

Cited by 3 | Viewed by 2212

Abstract

Patients on hemodialysis (HD) have a higher rate of protein-energy wasting (PEW) due to lower dietary intake of energy and protein (particularly on dialysis days) and greater loss of many nutrients in the dialysate effluent than other patients. The most well-known method of [...] Read more.

Patients on hemodialysis (HD) have a higher rate of protein-energy wasting (PEW) due to lower dietary intake of energy and protein (particularly on dialysis days) and greater loss of many nutrients in the dialysate effluent than other patients. The most well-known method of nutritional screening is the subjective global assessment. Moreover, the Global Leadership Initiative on MalnutIrition has developed the first internationally standardized method for diagnosing malnutrition; however, its use in patients on HD has not been established. In contrast, the nutritional risk index for Japanese patients on HD has recently been developed as a screening tool for malnutrition in patients on HD, based on the modified PEW criteria. These tools are beneficial for screening nutritional disorders, enabling registered dietitians to assess patients’ dietary intake on dialysis and non-dialysis days and provide advice on dietary intake, especially immediately after dialysis cessation. Oral supplementation with enteral nutrients containing whey protein may also be administered when needed. In patients that experience adverse effects from oral supplementation, intradialytic parenteral nutrition (IDPN) should be combined with moderate dietary intake because IDPN alone cannot provide sufficient nutrition. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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8 pages, 651 KiB

Open AccessCommunication

Clinical Significance of Trace Element Zinc in Patients with Chronic Kidney Disease

by Hirotaka Fukasawa, Ryuichi Furuya, Mai Kaneko, Daisuke Nakagami, Yuri Ishino, Shuhei Kitamoto, Kyosuke Omata and Hideo Yasuda

J. Clin. Med. 2023, 12(4), 1667; https://doi.org/10.3390/jcm12041667 - 20 Feb 2023

Cited by 5 | Viewed by 2803

Abstract

The trace element zinc is essential for diverse physiological processes in humans. Zinc deficiency can impair growth, skin reproduction, immune function, maintenance of taste, glucose metabolism, and neurological function. Patients with chronic kidney disease (CKD) are susceptible to zinc deficiency, which is associated [...] Read more.

The trace element zinc is essential for diverse physiological processes in humans. Zinc deficiency can impair growth, skin reproduction, immune function, maintenance of taste, glucose metabolism, and neurological function. Patients with chronic kidney disease (CKD) are susceptible to zinc deficiency, which is associated with erythropoiesis-stimulating agent (ESA) hypo-responsive anemia, nutritional problems, and cardiovascular diseases as well as non-specific symptoms such as dermatitis, prolonged wound healing, taste disturbance, appetite loss, or cognitive decline. Thus, zinc supplementation may be useful for the treatment of its deficiency, although it often causes copper deficiency, which is characterized by several severe disorders including cytopenia and myelopathy. In this review article, we mainly discuss the significant roles of zinc and the association between zinc deficiency and the pathogenesis of complications in patients with CKD. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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7 pages, 814 KiB

Open AccessCommunication

The Impact and Treatment of COVID-19 in Hemodialysis Patients

by Daisuke Katagiri and Kan Kikuchi

J. Clin. Med. 2023, 12(3), 838; https://doi.org/10.3390/jcm12030838 - 20 Jan 2023

Cited by 3 | Viewed by 1716

Abstract

Background: Patients with coronavirus disease 2019 (COVID-19) undergoing maintenance hemodialysis have a poor prognosis and limited treatment options. Methods: This paper outlines the impact of COVID-19, its treatment, and the efficacy of vaccines in Japanese patients undergoing hemodialysis with a review of the [...] Read more.

Background: Patients with coronavirus disease 2019 (COVID-19) undergoing maintenance hemodialysis have a poor prognosis and limited treatment options. Methods: This paper outlines the impact of COVID-19, its treatment, and the efficacy of vaccines in Japanese patients undergoing hemodialysis with a review of the literature. Results: Patients undergoing dialysis in dialysis facilities are at greater risk of exposure to severe acute respiratory syndrome coronavirus 2 than the general population due to limited isolation capabilities. Therefore, vaccines are expected to be effective for patients undergoing dialysis. In addition, effective use of available medications is important because treatment options are limited. Conclusions: Efforts should be made to prevent the spread of the infection to high-risk patients undergoing dialysis while ensuring the effective use of vaccines. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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Review

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16 pages, 1273 KiB

Open AccessReview

Displacing the Burden: A Review of Protein-Bound Uremic Toxin Clearance Strategies in Chronic Kidney Disease

by Didier Sánchez-Ospina, Sebastián Mas-Fontao, Carolina Gracia-Iguacel, Alejandro Avello, Marina González de Rivera, Maddalen Mujika-Marticorena and Emilio Gonzalez-Parra

J. Clin. Med. 2024, 13(5), 1428; https://doi.org/10.3390/jcm13051428 - 01 Mar 2024

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Abstract

Uremic toxins (UTs), particularly protein-bound uremic toxins (PBUTs), accumulate in chronic kidney disease (CKD) patients, causing significant health complications like uremic syndrome, cardiovascular disease, and immune dysfunction. The binding of PBUTs to plasma proteins such as albumin presents a formidable challenge for clearance, [...] Read more.

Uremic toxins (UTs), particularly protein-bound uremic toxins (PBUTs), accumulate in chronic kidney disease (CKD) patients, causing significant health complications like uremic syndrome, cardiovascular disease, and immune dysfunction. The binding of PBUTs to plasma proteins such as albumin presents a formidable challenge for clearance, as conventional dialysis is often insufficient. With advancements in the classification and understanding of UTs, spearheaded by the European Uremic Toxins (EUTox) working group, over 120 molecules have been identified, prompting the development of alternative therapeutic strategies. Innovations such as online hemodiafiltration aim to enhance the removal process, while novel adsorptive therapies offer a means to address the high affinity of PBUTs to plasma proteins. Furthermore, the exploration of molecular displacers, designed to increase the free fraction of PBUTs, represents a cutting-edge approach to facilitate their dialytic clearance. Despite these advancements, the clinical application of displacers requires more research to confirm their efficacy and safety. The pursuit of such innovative treatments is crucial for improving the management of uremic toxicity and the overall prognosis of CKD patients, emphasizing the need for ongoing research and clinical trials. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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17 pages, 1213 KiB

Open AccessReview

The Characteristics of Dialysis Membranes: Benefits of the AN69 Membrane in Hemodialysis Patients

by Shuzo Kobayashi and Takayasu Ohtake

J. Clin. Med. 2023, 12(3), 1123; https://doi.org/10.3390/jcm12031123 - 31 Jan 2023

Cited by 2 | Viewed by 2427

Abstract

Patients undergoing hemodialysis (HD) experience serious cardiovascular complications, through malnutrition, inflammation, and atherosclerosis. Amputation for peripheral arterial disease (PAD) is more prevalent in patients undergoing HD than in the general population. In addition, revascularization procedures in dialysis patients are often associated with subsequent [...] Read more.

Patients undergoing hemodialysis (HD) experience serious cardiovascular complications, through malnutrition, inflammation, and atherosclerosis. Amputation for peripheral arterial disease (PAD) is more prevalent in patients undergoing HD than in the general population. In addition, revascularization procedures in dialysis patients are often associated with subsequent amputation and high mortality rates. To improve the prognosis of dialysis patients, malnutrition and inflammation must be properly treated, which necessitates a better understanding of the characteristics of dialysis membranes. Herein, the characteristics of several dialysis membranes were studied, with a special reference to the AN69 membrane, noting several similarities to low-density lipoprotein (LDL)-apheresis, which is also applicable for the treatment of PAD. Both systems (LDL-apheresis and AN69) have anti-inflammatory and anti-thrombogenic effects because they use a negatively charged surface for extracorporeal adsorptive filtration from the blood/plasma, and contact phase activation. The concomitant use of both these therapeutic systems may have additive therapeutic benefits in HD patients. Here, we reviewed the characteristics of dialysis membranes and benefits of the AN69 membrane in dialysis patients. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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Other

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12 pages, 6729 KiB

Open AccessSystematic Review

Cannulation Technique of Vascular Access in Hemodialysis and the Impact on the Arteriovenous Fistula Survival: Systematic Review and Meta-Analysis

by Ricardo Peralta, Luís Sousa and António Filipe Cristovão

J. Clin. Med. 2023, 12(18), 5946; https://doi.org/10.3390/jcm12185946 - 13 Sep 2023

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Abstract

Adequate cannulation technique (CT) methods and successful puncture are essential for hemodialysis (HD) and arteriovenous fistula (AVF) maintenance. This systematic review and meta-analysis was designed to identify which CT allows better AVF primary patency and lower rates of complications in HD patients. The [...] Read more.

Adequate cannulation technique (CT) methods and successful puncture are essential for hemodialysis (HD) and arteriovenous fistula (AVF) maintenance. This systematic review and meta-analysis was designed to identify which CT allows better AVF primary patency and lower rates of complications in HD patients. The search was carried out on the CINAHL, MEDLINE, Cochrane Library, and Joanna Briggs Institute Library databases to identify all randomized controlled trials (RCTs) and observational studies comparing clinical outcomes of buttonhole (BH) versus rope ladder cannulation (RL) from 2010 to 2022. The Risk-of-Bias (Rob 2) tool was used for RCTs and the ROBINS-I was used for non-randomized studies. RevMan 5.4 was used for the meta-analysis. A total of five RCTs, one quasi-randomized controlled trial, and six observational studies were included. When compared with RL cannulation, BH cannulation significantly increased bacteremia (RR, 2.76, 95% CI (1.14, 6.67), p = 0.02) but showed no differences in AVF primary patency (HR, 1.06, 95% CI (0.45, 4.21), p = 0.90). There was no thrombosis reduction (RR, 0.51, 95% CI (0.23, 1.14), p = 0.10) or intervention number reduction (RR, 0.93, 95% CI (0.49, 1.80), p = 0.84) with BH. Outcomes like pain, hematoma, and aneurism could not be merged due to a lack of data, reported as medians, as well as due to different definitions. The quality in general was poor and the heterogeneity among the studies prevented us from merging the outcomes. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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11 pages, 2835 KiB

Open AccessBrief Report

The Influence of Healthy Habits on Cognitive Functions in a Group of Hemodialysis Patients

by Piotr Olczyk, Patryk Jerzak, Krzysztof Letachowicz, Tomasz Gołębiowski, Magdalena Krajewska and Mariusz Kusztal

J. Clin. Med. 2023, 12(5), 2042; https://doi.org/10.3390/jcm12052042 - 04 Mar 2023

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Abstract

(1) Background: Cognitive impairment (CI) is more prevalent in hemodialysis (HD) patients than in the general population. The purpose of this study was to examine if behavioral, clinical, and vascular variables are linked with CI in individuals with HD. (2) Methods: Initially, 47 [...] Read more.

(1) Background: Cognitive impairment (CI) is more prevalent in hemodialysis (HD) patients than in the general population. The purpose of this study was to examine if behavioral, clinical, and vascular variables are linked with CI in individuals with HD. (2) Methods: Initially, 47 individuals with chronic HD volunteered to participate in the trial, but only 27 patients ultimately completed the Montreal Cognitive Assessment (MoCA) and the Computerized Cognitive Assessment Tool (CompBased-CAT). We collected information on smoking, mental activities, physical activity (Rapid Assessment of Physical Activity, RAPA), and comorbidity. The oxygen saturation (rSO2) and pulse wave velocity (PWV; IEM Mobil-O-Graph) of the frontal lobes were measured. (3) Results: Significant associations were discovered between MoCA and rSO2 (r = 0.44, p = 0.02 and r = 0.62, p = 0.001, right/left, respectively), PWV (r = −0.69, p = 0.0001), CCI (r = 0.59, p = 0.001), and RAPA (r = 0.72, p = 0.0001). Those who actively occupied their time during dialysis and non-smokers achieved higher cognitive exam results. A multivariate regression study demonstrated that physical activity (RAPA) and PWV had separate effects on cognitive performance. (4) Conclusions: Cognitive skills are related to inter-dialysis healthy habits (physical activity, smoking) and intra-dialysis activities (tasks and mind games). Arterial stiffness, oxygenation of the frontal lobes, and CCI were linked with CI. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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