Journal of Clinical Medicine

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18 pages, 285 KiB

Open AccessArticle

The Impact of Dialysis Duration on Multidimensional Health Outcomes: A Cross-Sectional Study

by Leszek Sułkowski, Andrzej Matyja and Maciej Matyja

J. Clin. Med. 2025, 14(2), 376; https://doi.org/10.3390/jcm14020376 - 9 Jan 2025

Cited by 1 | Viewed by 1092

Abstract

Background: Dialysis patients face multidimensional challenges that affect their quality of life. This study aimed to evaluate the association between dialysis duration and various physical, cognitive, and psychosocial parameters, including fatigue, pain, sexual satisfaction, bowel control, vision, cognitive deficits, mental health, social support, [...] Read more.

Background: Dialysis patients face multidimensional challenges that affect their quality of life. This study aimed to evaluate the association between dialysis duration and various physical, cognitive, and psychosocial parameters, including fatigue, pain, sexual satisfaction, bowel control, vision, cognitive deficits, mental health, social support, quality of life, and life satisfaction, while incorporating sociodemographic data for greater context. Methods: A cross-sectional study was conducted using validated instruments such as the Modified Fatigue Impact Scale (MFIS), Pain Effect Scale (PES), Sexual Satisfaction Scale (SSS), Bowel Control Scale (BWCS), Impact of Visual Impairment Scale (IVIS), Perceived Deficits Questionnaire (PDQ), Mental Health Inventory (MHI), Modified Social Support Survey (MSSS), WHOQOL-BREF, and Cantril Ladder. Associations between dialysis duration and these parameters were analyzed. Correlations between current and future life satisfaction were also examined. Results: Dialysis duration significantly affected sexual satisfaction, with scores worsening over time (p = 0.029). Cognitive deficits in planning and organization exhibited a near-significant trend (p = 0.072). Patients with low current life satisfaction anticipated significant future declines (p = 0.001). However, no significant associations were observed between dialysis duration and fatigue, pain, bowel control, vision, mental health, social support, overall quality of life, or life satisfaction. Conclusions: Prolonged dialysis negatively influences sexual satisfaction and may impact specific cognitive domains. The relationship between current and expected life satisfaction highlights the importance of addressing psychological health in this population. While other parameters remained unaffected, individualized care strategies focusing on sexual, cognitive, and psychological support could improve outcomes. Future research should focus on exploring these relationships further and developing targeted interventions to address vulnerable areas, such as sexual, cognitive, and psychological health. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

8 pages, 206 KiB

Open AccessArticle

Influence of Inflammation on Red Blood Cell Lifespan in Peritoneal Dialysis Patients

by Huiping Zhao, Yuchao Zhao, Bei Wu, Li Bai, Lixia Lu and Li Zuo

J. Clin. Med. 2024, 13(23), 7104; https://doi.org/10.3390/jcm13237104 - 24 Nov 2024

Viewed by 863

Abstract

Background and hypothesis: Renal anemia is linked to a decreased lifespan of red blood cells. The factors influencing red blood cell lifespan (RBCLS) in peritoneal dialysis patients, particularly the connection between inflammation and RBCLS, are still not well understood. This cross-sectional study [...] Read more.

Background and hypothesis: Renal anemia is linked to a decreased lifespan of red blood cells. The factors influencing red blood cell lifespan (RBCLS) in peritoneal dialysis patients, particularly the connection between inflammation and RBCLS, are still not well understood. This cross-sectional study was conducted to investigate these relationships. Methods: Patients who had been undergoing peritoneal dialysis for more than 3 months were selected for this study. The carbon monoxide exhalation method was used to detect the life span of red blood cells. The patients were then divided into two groups based on whether the RBCLS was shorter than 75 days. General information, anemia-related indicators, and other laboratory indicators along with their treatment were compared between the two groups. The different indicators were then included in a logistic regression analysis to identify independent risk factors that influence the shortening of RBCLS. Results: A cohort of 59 peritoneal dialysis patients was examined, revealing a median RBCLS of 88 days. Of these patients, 39 exhibited a normal RBCLS, while 20 had a shortened lifespan. A comparison of the two groups indicated that patients with a shorter RBCLS exhibited lower levels of PD vintage (29.5 vs. 56.0, p = 0.031), albumin (34.62 ± 3.01 vs. 37.41 ± 3.60, p = 0.004), cholesterol (4.02 ± 0.54 vs. 4.55 ± 1.21, p = 0.026), and low-density cholesterol (2.19 ± 0.43 vs. 2.75 ± 0.87, p = 0.002), and a higher neutrophil-to-lymphocyte ratio (NLR) (3.05 vs. 2.61, p = 0.026) compared to those with a normal RBCLS. The logistic regression results indicated that PD vintage (OR 0.976, CI 0.958–0.999), albumin (OR 0.668, CI 0.514–0.867), low-density lipoprotein cholesterol (OR 0.046, CI 0.002–0.953), and NLR (OR 1.792, CI 1.016–3.162) were identified as independent risk factors influencing the shortening of RBCLS. Conclusion: Hypoalbuminemia, low LDL, and high NLR in peritoneal dialysis patients are identified as independent risk factors associated with a shortened RBCLS. Key learning points: RBCLS is reduced in both peritoneal dialysis and hemodialysis patients. The neutrophil-to-lymphocyte ratio (NLR) in peripheral blood, a simple and readily available laboratory indicator, can reflect the inflammatory status. This study adds: Nutritional status (albumin and LDL) and inflammatory status (NLR) are significant factors that impact the lifespan of red blood cells in peritoneal dialysis patients. Potential impact: This study presents novel findings on the relationship between chronic inflammation and RBCLS in patients with chronic kidney disease, highlighting the need for additional research in this area. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

18 pages, 1528 KiB

Open AccessArticle

Roxadustat Efficacy and Safety in Patients Receiving Peritoneal Dialysis: Pooled Analysis of Four Phase 3 Studies

by Danilo Fliser, Sunil Bhandari, Alberto Ortiz, Vicki Santos, Najib Khalife, Alina Jiletcovici and Tadao Akizawa

J. Clin. Med. 2024, 13(22), 6729; https://doi.org/10.3390/jcm13226729 - 8 Nov 2024

Viewed by 1524

Abstract

Background/Objectives: Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor approved to treat anemia of chronic kidney disease (CKD). The efficacy and safety of roxadustat compared with parenteral erythropoiesis-stimulating agents (ESAs) were evaluated in patients with anemia of CKD receiving peritoneal dialysis (PD). [...] Read more.

Background/Objectives: Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor approved to treat anemia of chronic kidney disease (CKD). The efficacy and safety of roxadustat compared with parenteral erythropoiesis-stimulating agents (ESAs) were evaluated in patients with anemia of CKD receiving peritoneal dialysis (PD). Methods: This analysis pooled data from four phase 3, multicenter, randomized, open-label, active-comparator studies (PYRENEES, SIERRAS, HIMALAYAS, ROCKIES). The primary endpoints evaluated were hemoglobin change from baseline (CFB) to Weeks 28–36 without rescue therapy and hemoglobin CFB to Weeks 28–52 regardless of rescue therapy use. Safety data were reported. Results: This analysis included 422 patients (215 roxadustat, 207 ESA). Hemoglobin CFB to Weeks 28–36 without rescue therapy and hemoglobin CFB to Weeks 28–52 regardless of rescue therapy achieved non-inferiority for roxadustat vs. ESAs. The mean weekly dose of roxadustat was maintained over time (Weeks 1–4, 3.86 mg/kg/week; Weeks 101–104, 3.27 mg/kg/week), whereas the mean weekly ESA dose increased by 24% (Weeks 1–4, 115.70 IU/kg/week; Weeks 101–104, 143.40 IU/kg/week). Fewer patients treated with roxadustat received intravenous iron supplementation and rescue therapy, and patients treated with an ESA required blood transfusions sooner. Roxadustat-treated patients experienced a greater decrease in low-density lipoprotein cholesterol levels relative to baseline vs. ESA-treated patients. Treatment-emergent adverse events were similar in both treatment groups. Major adverse cardiovascular event (MACE), MACE plus unstable angina or congestive heart failure, and all-cause mortality hazard ratios were <1; the lower limit of the 95% CIs was <0.6, and the upper limit was >1.3. Conclusions: Roxadustat was non-inferior to ESAs in correcting and maintaining hemoglobin levels, with stable dosing and a comparable safety profile, in anemic patients receiving PD. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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13 pages, 1380 KiB

Open AccessArticle

Hemodialysis Experience After Kahramanmaraş Earthquake

by Bulent Kaya, Mustafa Balal, Neslihan Seyrek, Burak Mete and Ibrahim Karayaylali

J. Clin. Med. 2024, 13(21), 6610; https://doi.org/10.3390/jcm13216610 - 4 Nov 2024

Cited by 1 | Viewed by 1176

Abstract

Background: Hemodialysis treatment for acute kidney injury associated with crush syndrome is very complex. In our study, we summarized the problems and complications experienced by our hemodialysis center after the Kahramanmaraş earthquake. Methods: After the earthquake, our hospital treated 1396 victims. [...] Read more.

Background: Hemodialysis treatment for acute kidney injury associated with crush syndrome is very complex. In our study, we summarized the problems and complications experienced by our hemodialysis center after the Kahramanmaraş earthquake. Methods: After the earthquake, our hospital treated 1396 victims. We evaluated the initial indications for dialysis, hemodialysis complications and the mortality of patients undergoing hemodialysis, including crush-related acute kidney injury (n = 82), during the earthquake period. We also compared them with patients who were undergoing hemodialysis (n = 76) in the same period but had end-stage renal failure and acute kidney injury due to other causes (n = 15). Results: After the earthquake, 173 adult patients, 91 (52.6%) of whom were male, with a mean age of 49.5 + 19.7 years, underwent hemodialysis between 6 and 22 February 2023. Patients with crush-related acute kidney injury experienced more complications during hemodialysis, and the increase in creatine kinase activity increased the risk of hemodialysis complications. The most common complications were blood clots in the dialyzer membrane, intradialytic hypotension, and intradialytic insufficient flow. The most frequent indication for initial hemodialysis was hyperkalemia (61, 74.4%). The major problems in the hemodialysis center included inadequate equipment and an insufficient number of experienced health personnel. Conclusions: Hyperkalemia is the most important initial indication for hemodialysis in patients with crush-related acute kidney injury. Crush-related acute kidney injury patients require hemodialysis more frequently, and hemodialysis complications are higher in patients with crush-related AKI, so the hemodialysis treatment of these patients should be more cautious. In an earthquake, hemodialysis centers may face significant challenges, such as damage, transportation issues, power outages, and water outages, which can hinder hemodialysis treatment. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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14 pages, 732 KiB

Open AccessFeature PaperArticle

Cardiovascular and All-Cause Mortality Is Affected by Serum Magnesium and Diet Pattern in a Cohort of Dialysis Patients

by Ioannis Petrakis, Dimitra Bacharaki, Periklis Kyriazis, Olga Balafa, Evangelia Dounousi, George Tsirpanlis, Marios Theodoridis, Ourania Tsotsorou, Anastasia Markaki, Anastasia Georgoulidou, George Triantafyllis, Ioannis Giannikouris, Apostolos Kokkalis, Aristeides Stavroulopoulos and Kostas Stylianou

J. Clin. Med. 2024, 13(14), 4024; https://doi.org/10.3390/jcm13144024 - 10 Jul 2024

Cited by 1 | Viewed by 2256

Abstract

Background: Hypomagnesaemia is associated with an increased overall mortality in patients with chronic kidney disease on dialysis (CKD-5D). Mediterranean-style diet (MD), having a high magnesium content, can serve as a form of dietary magnesium supplementation. We examined whether there is a potential link [...] Read more.

Background: Hypomagnesaemia is associated with an increased overall mortality in patients with chronic kidney disease on dialysis (CKD-5D). Mediterranean-style diet (MD), having a high magnesium content, can serve as a form of dietary magnesium supplementation. We examined whether there is a potential link between increased Mediterranean Diet score (MDS) and elevated serum magnesium (sMg) to assess its impact on reducing mortality risk in CKD-5D patients. Methods: In this multi-center prospective observational study, 117 CKD-5D patients (66 on hemodialysis and 51 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied for a median follow-up period of 68 months. After baseline assessment, including measurement of sMg and MDS, all patients were followed up for cardiovascular (CV) and all-cause mortality. Results: Forty deaths occurred, 58% of which were cardiovascular. Patients who were above the median value of sMg (2.2 mg/dL) had a 66% reduction in CV (crude HR, 0.34; 95% CI, 0.11–0.70), and 49% reduction in all-cause (crude HR, 0.51; 95% CI, 0.27–0.96) mortality, even after adjustment for age, malnutrition inflammation score, left ventricular mass index, peripheral vascular disease and diabetes. Similar results were obtained when sMg was analyzed as a continuous variable. sMg was associated directly with MDS (r = 0.230; p = 0.012). Conclusions: Higher sMg levels are strongly and independently associated with reduced CV and all-cause mortality in CKD-5D patients. A strong correlation exists between MDS and sMg. Elevated sMg levels, achieved through MD adherence, can significantly reduce CV mortality, implicating MD as a mediator of the association between sMg and CV mortality. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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9 pages, 962 KiB

Open AccessArticle

Serum Calcification Propensity T50 Is Associated with Soluble Thrombomodulin in Patients on Hemodialysis

by Takeshi Tadokoro, Akihiko Kato, Hiromitsu Ohmori, Tomio Matsumoto, Makoto Kuro-O, Tsuyoshi Kobayashi and Hideki Ohdan

J. Clin. Med. 2024, 13(12), 3491; https://doi.org/10.3390/jcm13123491 - 14 Jun 2024

Viewed by 1385

Abstract

Background/Objectives: Levels of circulating soluble thrombomodulin (sTM), an anticoagulant factor, are associated with the severity and progression of arteriosclerotic diseases. However, the role of elevated sTM levels remains to be clarified in patients on dialysis. As the calcification propensity time T50 is a [...] Read more.

Background/Objectives: Levels of circulating soluble thrombomodulin (sTM), an anticoagulant factor, are associated with the severity and progression of arteriosclerotic diseases. However, the role of elevated sTM levels remains to be clarified in patients on dialysis. As the calcification propensity time T50 is a novel marker of arterial calcification, we aimed to determine the association between sTM and T50 in patients on hemodialysis (HD). Methods: This cross-sectional study included 49 adult patients on maintenance HD. Correlation analysis was performed to test the association between T50 and patient characteristics. Linear regression was used to evaluate the association between T50 and sTM. Results: Partial correlation analysis showed a strong association between T50 and glycated albumin, phosphorous, and sTM levels (partial correlation coefficient: r [partial] = −0.359, p = 0.023; r [partial] = −0.579, p < 0.001; and r [partial] = 0.346, p = 0.029, respectively). Multivariate linear regression analysis revealed that only sTM level was significantly and positively associated with T50 (β = 0.288; t = 2.27; p = 0.029; 95% confidence interval, 0.082–1.403). Conclusions: sTM is independently and positively associated with the propensity time for calcification, suggesting that sTM could be a good marker of arterial calcification progression in patients on HD. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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10 pages, 1752 KiB

Open AccessArticle

Peritoneal Dialysis-Induced Encapsulating Peritonitis: Diagnostic and Therapeutic Challenges in Women with Benign Gynecological Pathology

by Cristian Iorga, Cristina Raluca Iorga, Iuliana Andreiana, Simona Hildegard Stancu, Traian Constantin and Victor Strambu

J. Clin. Med. 2024, 13(10), 2921; https://doi.org/10.3390/jcm13102921 - 15 May 2024

Viewed by 1560

Abstract

Background: Peritoneal sclerosis (PS) and its most severe form, encapsulating PS (EPS), are rare entities that can occur in various procedures (liver transplantation, intraperitoneal chemotherapy) or secondary to medications (beta-blockers); however, PS or EPS typically occur in patients undergoing peritoneal dialysis as a [...] Read more.

Background: Peritoneal sclerosis (PS) and its most severe form, encapsulating PS (EPS), are rare entities that can occur in various procedures (liver transplantation, intraperitoneal chemotherapy) or secondary to medications (beta-blockers); however, PS or EPS typically occur in patients undergoing peritoneal dialysis as a form of renal function substitution. Medical or surgical treatments can be applied, but morbidity and mortality have high rates. This condition typically presents clinically as an intestinal obstruction caused by the inclusion of the intestinal loops in the peritoneal fibrous membrane. Methods: Herein, we present data from a single tertiary surgery center that has dedicated teams for patients receiving dialysis. Over 12 years, we analyzed a group of 63 patients admitted for catheter replacement/removal or for acute surgical pathology. In five cases (7.9%), we diagnosed EPS. Two patients with EPS presented with atypical abdominal pathologies requiring emergency surgery: one case of hemoperitoneum caused by a ruptured ovarian cyst and one case of uterine fibroids and metrorrhagia. Results: The definitive diagnoses were established intraoperatively and by analyzing the morpho-pathological changes in the peritoneum. The possible intraoperative challenges included laborious dissection, difficulties in restoring the correct anatomical landmarks, an increased duration of the surgical intervention and a high rate of incidents and accidents. Conclusions: The aim of the present study was to emphasize the possibility of other surgical pathologies overlapping with EPS, increasing the complexity of the surgical intervention. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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10 pages, 1410 KiB

Open AccessArticle

Immunomodulation Driven by Theranova Filter during a Single HD Session

by Carlotta Caprara, Grazia Maria Virzì, Katia Chieregato, Nicola Marchionna, Valentina Corradi, Alessandra Brendolan, Claudio Ronco and Monica Zanella

J. Clin. Med. 2024, 13(7), 2147; https://doi.org/10.3390/jcm13072147 - 8 Apr 2024

Cited by 1 | Viewed by 1240

Abstract

Background: Patients with end-stage kidney disease (ESKD) have altered immunity. Patients on hemodialysis (HD) present a coexistence of immunodeficiency and activation of the immune system. We evaluated the immunophenotypic profile induced by the medium cut-off of Theranova filter during a single HD [...] Read more.

Background: Patients with end-stage kidney disease (ESKD) have altered immunity. Patients on hemodialysis (HD) present a coexistence of immunodeficiency and activation of the immune system. We evaluated the immunophenotypic profile induced by the medium cut-off of Theranova filter during a single HD session in the same individual. Methods: This pilot observational study explored 11 patients (75 ± 8 years and 73% male). Blood samples were collected prior to (predialytic, PRE) and after 4 h (postdialytic, POST) standard HD session with a medium cut-off, polyarylethersulfone and polyvinylpyrrolidone blend, BPA-free membrane. We performed an immunophenotyping characterization by using flow cytometry. We evaluated eryptosis RBCs and HLA-DR expression on monocytes and Treg cells. Results: The percentages of eryptosis in lymphocytes (CD3+), lymphocyte T helper (CD3+ and CD4+) cells, and monocytes (CD45+ and CD14+) were similar pre- and post-HD. On the contrary, HLA-DR expression and Treg cell numbers significantly decreased after HD. Conclusions: Many studies have focused on the comparison between healthy volunteers and HD patients, but very few have focused on the changes that occur after an HD session in the same individual. With this pilot observational study, we have revealed an immunomodulation driven by HD treatment with Theranova filter. Our preliminary results can be considered to be a hypothesis, generating and stimulating further studies with better designs and larger populations. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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12 pages, 1578 KiB

Open AccessArticle

Relationship between Permanent Catheter Patency and Nutrient Score in Patients Aged >75 Years Requiring Renal Replacement Therapy

by Moo Jun Kim, Yunkyeong Hwang, Jae Wan Jeon, Hae Ri Kim, Suyeon Han, Heewon Park, Eu Jin Lee, Young Rok Ham, Ki Ryang Na, Hyerim Park and Dae Eun Choi

J. Clin. Med. 2024, 13(6), 1562; https://doi.org/10.3390/jcm13061562 - 8 Mar 2024

Viewed by 1318

Abstract

Background: Malnutrition is common in patients undergoing hemodialysis and is a powerful predictor of morbidity and mortality. This study aimed to investigate the effect of nutritional status on permanent catheter patency in elderly patients aged >75 years of age undergoing dialysis using tunneled [...] Read more.

Background: Malnutrition is common in patients undergoing hemodialysis and is a powerful predictor of morbidity and mortality. This study aimed to investigate the effect of nutritional status on permanent catheter patency in elderly patients aged >75 years of age undergoing dialysis using tunneled dialysis catheters; Methods: Records of 383 patients whose nutritional factors and body cell mass (BCM) were measured simultaneously at the start of dialysis between 14 January 2020 and 30 September 2023, at Chungnam National University Hospital, were retrospectively reviewed. The relationships between permanent catheter patency at 180 days and BCM parameters and clinical parameters were studied using Kaplan–Meier survival curves and multivariate Cox proportional hazards analysis. Results: Age and sexual differences were significant (p ≤ 0.05), and most of the BCM parameters and BCM were not significant (p ≤ 0.05), except for intracellular water. Permanent catheter patency was superior at low controlling nutritional status (CONUT) scores (p < 0.05). After adjustment for covariates, the CONUT score remained an independent factor associated with permanent catheter-patency survival; Conclusions: CONUT scores measured before the start of dialysis are expected to play an important role in predicting the prognosis of permanent catheter-patency survival in patients aged >75 years. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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11 pages, 1182 KiB

Open AccessFeature PaperArticle

Metabolically Abnormal Non-Obese Phenotype Is Significantly Associated with All-Cause Mortality in Hemodialysis Patients

by Jin Hyeog Lee, Hae-Ryong Yun, Hyung Woo Kim, Jung Tak Park, Seung Hyeok Han, Yong-Lim Kim, Yon Su Kim, Chul Woo Yang, Nam-Ho Kim, Shin-Wook Kang and Tae-Hyun Yoo

J. Clin. Med. 2024, 13(4), 1059; https://doi.org/10.3390/jcm13041059 - 13 Feb 2024

Viewed by 1274

Abstract

The association between obesity and all-cause mortality in patients undergoing kidney failure with replacement therapy (KFRT) has shown conflicting results. This study aimed to evaluate whether metabolic abnormalities (MA) increase the risk of all-cause mortality in these patients. Between 2009 and 2015, 1141 [...] Read more.

The association between obesity and all-cause mortality in patients undergoing kidney failure with replacement therapy (KFRT) has shown conflicting results. This study aimed to evaluate whether metabolic abnormalities (MA) increase the risk of all-cause mortality in these patients. Between 2009 and 2015, 1141 patients undergoing KFRT were recruited from the Clinical Research Center for End-Stage Renal Disease dataset. Patients were divided into four groups according to the presence of obesity and MA. Multivariate Cox proportional hazard analysis was performed to determine the association between the phenotypes and all-cause mortality. During a mean follow-up of 4.2 years, all-cause mortality was observed in 491 (43.0%) patients. Obesity had a 24% decreased risk of all-cause mortality compared with non-obesity. In contrast, the presence of MA showed a 1.53-fold increased risk of all-cause mortality. There was a significant interaction between obesity and MA (p = 0.006). In Cox proportional hazard analyses after adjustment of confounding factors, the metabolically abnormal non-obesity (MANO) phenotype showed a 1.63-fold increased risk of all-cause mortality compared with the metabolically healthy non-obesity phenotype. In subgroup analysis, the risk of all-cause mortality was higher in the MANO phenotype; this phenotype was significantly associated with a higher all-cause mortality in patients undergoing KFRT. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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9 pages, 1805 KiB

Open AccessArticle

Self-Reported Physical Inactivity and Mood Disturbances in End-Stage Kidney Disease (ESKD) Patients on Chronic Dialysis Treatment

by Michela Musolino, Pierangela Presta, Paola Cianfrone, Maria Antonietta Errante, Michele Andreucci, Giuseppe Coppolino and Davide Bolignano

J. Clin. Med. 2023, 12(22), 7160; https://doi.org/10.3390/jcm12227160 - 18 Nov 2023

Cited by 5 | Viewed by 1707

Abstract

Background: Physical inactivity and mood disturbances are key issues in individuals with end-stage kidney disease (ESKD) and may lead to poor clinical outcomes. Methods: We performed a pilot, observational study to explore the possible relationships between the self-reported level of physical activity (IPAQ) [...] Read more.

Background: Physical inactivity and mood disturbances are key issues in individuals with end-stage kidney disease (ESKD) and may lead to poor clinical outcomes. Methods: We performed a pilot, observational study to explore the possible relationships between the self-reported level of physical activity (IPAQ) and the severity of mood disturbances (BDI score) in a cohort of 58 ESKD patients undergoing chronic hemodialysis (HD; n = 30) or peritoneal dialysis (PD; n = 28). Results: Overall, ESKD patients were severely inactive (median METs: 590 [460–1850]) and the intensity of overall and walking physical activity was mostly low to moderate. HD individuals appeared less active than PD (METs 550 [250–1600] vs. 1080 [750–1730]; p = 0.003) and were also less prone to walking (METs 180 ± 90 vs. 320 ± 100; p = 0.01), while a barely statistical difference was noticed for the time spent sitting. ESKD individuals displayed a median BDI score of 17 [12–21], which indicated, on average, the presence of borderline depression, which was apparently more evident among HD individuals. A strong, inverse correlation was found between self-reported METs and BDI scores (R = −0.78; p < 0.0001), while such scores paralleled the time spent sitting during a weekday (R = 0.45; p = 0.0004) and a weekend day (R = 0.40; p = 0.002). Conclusions: In ESKD patients on chronic dialysis, physical inactivity and mood disturbances might be significantly inter-connected, thereby amplifying their relative impact on quality of life, dysautonomia and long-term outcomes. Future studies on larger populations are recommended to confirm these preliminary observations. Promoting strategies to improve fitness, along with greater attention to physiological aspects, should be incorporated into the clinical management of ESKD patients. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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Review

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14 pages, 422 KiB

Open AccessReview

Resistant and Apparently Resistant Hypertension in Peritoneally Dialyzed Patients

by Bartosz Symonides, Marlena Kwiatkowska-Stawiarczyk, Jacek Lewandowski, Jacek Stanisław Małyszko and Jolanta Małyszko

J. Clin. Med. 2025, 14(1), 218; https://doi.org/10.3390/jcm14010218 - 2 Jan 2025

Cited by 1 | Viewed by 875

Abstract

Hypertension in chronic kidney disease patients is very common. The definition of resistant hypertension in the general population is as follows: uncontrolled blood pressure (BP) on three or more hypotensive agents in adequate doses, or when patients are on four or more hypotensive [...] Read more.

Hypertension in chronic kidney disease patients is very common. The definition of resistant hypertension in the general population is as follows: uncontrolled blood pressure (BP) on three or more hypotensive agents in adequate doses, or when patients are on four or more hypotensive agent categories irrespective of the BP control, with diuretics included in the therapy. However, these resistant hypertension definitions do not apply to the setting of end-stage kidney disease. True resistant hypertension is diagnosed when adherence to treatment and uncontrolled values of BP by ambulatory blood pressure measurement or home blood pressure measurement are confirmed. Due to these limitations, apparent treatment-resistant hypertension (ATRH) is now defined as an uncontrolled blood pressure on three or more antihypertensive medication classes or the introduction and use of four or more medications regardless of blood pressure level. Concerning dialysis patients, data are very limited on hypertension, its epidemiology, and the prevalence of apparent treatment-resistant hypertension in peritoneal dialysis. In this review, therefore, we discuss the hypertension definitions, targets of the therapy in patients on peritoneal dialyses, and their biases and limitations. We present the pathophysiology, diagnosis, and management of high blood pressure in the peritoneally dialyzed population together with published data on the apparent treatment-resistant hypertension prevalence in this population. Peritoneally dialyzed patients represent a unique population of dialyzed subjects; therefore, studies should be conducted on a larger population with a higher quality of drug adherence and target blood pressure values. The definition of resistant hypertension and apparent resistant hypertension in this group should be redefined, which should also consider residual kidney function in relation to both subclinical and clinical endpoints. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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11 pages, 381 KiB

Open AccessReview

Exploring Health Literacy and Vascular Access Decision Making: A Scoping Review

by Shayna Brathwaite, Olamide Alabi, Lynne Simpson and Nader Massarweh

J. Clin. Med. 2024, 13(13), 3734; https://doi.org/10.3390/jcm13133734 - 26 Jun 2024

Cited by 2 | Viewed by 1606

Abstract

One in seven adults in the United States has chronic kidney disease (CKD) and individuals with the most severe form, end stage kidney disease (ESKD), may require renal replacement therapy with hemodialysis. Despite well-established guidelines indicating that arteriovenous access is the preferred type [...] Read more.

One in seven adults in the United States has chronic kidney disease (CKD) and individuals with the most severe form, end stage kidney disease (ESKD), may require renal replacement therapy with hemodialysis. Despite well-established guidelines indicating that arteriovenous access is the preferred type of vascular access for hemodialysis, in 2021, 85.4% of patients initiated dialysis with a CVC. While the reasons for this evidence–practice gap are unclear, health literacy and patient disease-specific knowledge may play an important role. Importantly, 25% of patients with CKD have limited health literacy. While there is an abundance of research regarding the presence of poor health literacy, poor kidney disease-specific knowledge, and their association with health outcomes in patients with CKD, there is currently a paucity of data about the relationship between health literacy, vascular access-specific knowledge, and vascular access outcomes. The aim of this narrative review is to describe the relationship between health literacy, disease-specific knowledge, and vascular access in patients with CKD. A better understanding of health literacy in this population will help inform the development of strategies to assess patient vascular access-specific knowledge and aid in vascular access decision making. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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