ARTICLE | doi:10.20944/preprints201909.0336.v1
Online: 30 September 2019 (03:21:27 CEST)
Background: Carnitine deficiency is common in patients on dialysis. Serum free carnitine concentration is significantly lower in patients on hemodialysis (HD) than in healthy individuals. However, there are few reports on serum free carnitine concentration in patients on peritoneal dialysis (PD). Methods: We examined serum concentrations of total, free, and acylcarnitine and the acylcarnitine/free carnitine ratio in 34 PD and 34 age-, sex-, and dialysis duration-matched HD patients. We investigated the prevalence of carnitine deficiency and clinical factors associated with carnitine deficiency in the PD group. Results: Prevalence of carnitine deficiency was 8.8% in the PD group and 14.7% in the HD group (P = 0.45). High risk of carnitine deficiency was found in 79.4% of the PD group and 85.3% of the HD group (P = 0.52). Carnitine insufficiency was found in 82.3% of the PD group and 88.2% of HD group (P = 0.49). Multivariate analysis revealed that duration of dialysis and age were independent predictors of serum free carnitine level in the PD group. Conclusions: The prevalence of carnitine deficiency, high risk of carnitine deficiency, and carnitine insufficiency in PD patients was 8.8%, 79.4%, and 82.3%, respectively. These rates were comparable to those in patients on HD.
ARTICLE | doi:10.20944/preprints202009.0066.v1
Subject: Medicine & Pharmacology, Pathology & Pathobiology Keywords: arteriovenous graft; hemodialysis; vascular access; anastomosis
Online: 3 September 2020 (09:26:44 CEST)
Patients with chronic renal failure and vascular diseases require the vascular access for hemodialysis procedure to be performed with the most possible comfort for the patient. Native vein graft has a longer-lasting term in the patients’ limb, lower risk of graft infection and lower price. Native vein graft is constructed from the great saphenous vein, if the diameter of the vessel is smaller than the diameters of vessels (brachial artery, cephalic vein) it is connected to in the cubital fossa region due to the risk of graft folding, that might occur, if the graft diameter is bigger than the diameter of one or both vessels, on which anastomosis is made. The most important sizes, that were taken before graft placement, are the length of the forearm compartment, the distance between the brachial artery and cephalic vein in the cubital fossa region, distance from an expected incision in the brachial artery to the middle of the forearm compartment, the distance between incision in cephalic vein to the middle of the forearm compartment, length of the great saphenous vein (the graft) and diameters of blood vessels, used in the procedure. Finally, the right position of the graft should be determined for the successful outcome of anastomosis creating procedure.
ARTICLE | doi:10.20944/preprints202002.0362.v1
Subject: Medicine & Pharmacology, Nursing & Health Studies Keywords: physical activity; hemodialysis; sclerostin; interleukin 6
Online: 25 February 2020 (06:18:45 CET)
Background: Chronic kidney disease and renal replacement therapy are associated with reduced physical activity, which may result in the presence of mineral-bone disorders and an increase in inflammation markers. The aim of the study was to assess the relationship between the performance of daily physical activity, expressed in the number of steps performed by patients undergoing hemodialysis and the concentration of selected biochemical parameters (SCL, IL-6). Materials and Methods: The study involved 33 patients aged 59.8 ± 9.8 years from the dialysis station at the Department of Nephrology, Transplantology and Internal Medicine PUM. Group C consisted of 30 people aged 54.9 (9.37), with GFR over 60 mL/min/1.73m. The study group was divided into S-N and N-S. Participants of the S-N group were assigned the task of performing the appropriate daily number of steps, and the N-S group was to perform spontaneous physical activity. The tasks were replaced after the third month of the research project. Physical activity was measured with pedometers. Anthropometric and biochemical parameters were assessed at baseline, after the third and sixth month of the study. Descriptive statistics, intergroup comparisons using Mann-Whitney U or Kruskal-Wallis tests and Spearman correlation analysis were performed. The level of significance was set at p≤0.005. Results: Patients from the S-N and N-S groups compared to group C performed significantly fewer steps in the 0-3 month and 4-6 month periods. In the S-N group, with an increase in steps performed in the period of 4-6 months, sclerostin levels dropped in the 6th month. In group C, the concentration of SCL and IL-6 decreased with the increase in the number of steps taken. Only in group C the waist circumference decreased with the increase of the number of steps performed. Conclusions: Patients receiving renal replacement therapy by hemodialysis showed significantly lower physical activity compared to people without kidney disease. Performing bigger number of steps can lower sclerostin levels in hemodialysis patients.
ARTICLE | doi:10.20944/preprints202208.0416.v1
Subject: Medicine & Pharmacology, General Medical Research Keywords: kidney disease; hemodialysis; immunosuppression; pulmonary infections; computed tomography
Online: 24 August 2022 (08:30:16 CEST)
Patients under immunosuppressive therapy for kidney diseases or on maintenance hemodialysis are more susceptible to infection than the general population since loss of renal function per se was an immunocompromised condition. Of relevance, CT imaging plays a crucial role in the detection and management of pulmonary infectious diseases. We hence presented diverse CT findings of pulmonary infections in the above said patients collected during our arduous work against a wide range of pathogens including klebsiella pneumoniae, staphylococcus aureus, candida parapsilosis, aspergillus, cryptococcus, mucor, pneumocystis carinii, cytomegalovirus, mycobacterium and nocardia. Notably, the pulmonary pathological changes were either primary pneumonia or secondary to the catheter-associated bloodstream infection. For a descriptive purpose, pulmonary manifestations of Wegener’s granuloma, lung cancer and diffuse alveolar hemorrhage/infection in vasculitis were also examined. As such, we retrospectively elaborated most likely CT features of each individual pathogen and briefly covered the differential diagnosis as well. Arguably, combination of pattern recognition with knowledge of the clinical setting could make a presumptive diagnosis and early treatment even more convenient. From the experience of first-line nephrologists, our work could make a substantial contribution to the expeditious and efficacious management of pulmonary infections in the pertinent patient population.
ARTICLE | doi:10.20944/preprints201811.0435.v2
Subject: Medicine & Pharmacology, Pediatrics Keywords: chronic kidney disease; hemodialysis; cardiovascular disease; echocardiography; child
Online: 4 July 2019 (10:37:00 CEST)
Assessment of cardiac function is the leading parameter when evaluating the state of the cardiovascular system of patients undergoing chronic hemodialysis. The aim of the paper: to assess the state of the cardiovascular system of these patients using new sensitive echocardiography and Doppler techniques and thus advance the prevention of cardiovascular disease.Method: Twenty children with end-stage renal insufficiency on chronic hemodialysis and twenty healthy controls underwent echocardiographic monitoring using standard Doppler and tissue Doppler imaging. Structural and functional changes in the left ventricle were evaluated.Results: Patients on hemodialysis had significantly greater left ventricular mass indices compared to the controls (p<0.001). The patients on hemodialysis had preserved systolic function – their fractional shortening, ejection fraction and Sm (systolic myocardial velocity) did not differ significantly compared to the controls (p>0.05). Early diastolic function in children on hemodialysis was also preserved: the E/A and Em/Am ratio did not differ significantly from the control group (p>0.05). Children on hemodialysis exhibited impaired late diastolic function (compliance index), that is, considerably higher E/Em compared to controls (p<0.00). Myocardial Performance Index values showed statistically significant elevation in children on hemodialysis compared to the control group (p<0.001).Conclusion: Tissue Doppler in tandem with conventional Pulsed Doppler can provide additional information on left ventricular filling pressures (E/Em) in children on hemodialysis. It is therefore recommended to perform routine measuring of Em waves and the E/Em ratio, not only in order to evaluate myocardial relaxation and ventricular filling pressures, but primarily to stratify risk and provide a prognosis.
ARTICLE | doi:10.20944/preprints202209.0101.v1
Subject: Medicine & Pharmacology, General Medical Research Keywords: COVID-19; hemodialysis; vaccination; cellular immunity; humoral immunity; adverse reactions
Online: 7 September 2022 (05:14:06 CEST)
Most studies on vaccines of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have focused on antibody, but cellular immunities are also critical. We aimed to evaluate the immune reactions of hemodialysis (HD) patients after the administration of the booster dose from the perspective of both humoral and cellular immunities. Hemodialysis patients (HD group) and age- and sex-matched non-dialysis individuals (control group) receiving three doses of BNT162b2 vaccine were measured for anti-SARS-CoV-2 immunoglobulin (IgG) and T-SPOTⓇ.COVID test (T-SPOT) before, 3 weeks, and 3 months after the booster dose. The HD group had significantly higher SARS-CoV-2 IgG levels 3 weeks and 3 months after the booster dose than the control group, although both groups had no difference in SARS-CoV-2 IgG levels before the booster dose. Moreover, the HD group had significantly higher T-SPOT levels before and 3 weeks after the booster dose than the control group, but the difference was not significantly different 3 months after the booster dose. Furthermore, the incidence rates of local and systemic adverse reactions were significantly higher in the HD group than in the control group. HD patients obtained higher SARS-CoV-2 IgG levels and SARS-COV-2-specific T-cell responses after the booster dose than control.
ARTICLE | doi:10.20944/preprints201811.0567.v1
Subject: Life Sciences, Biochemistry Keywords: bio-impedance, phase angle, over-hydration, body composition, nutrition, hemodialysis
Online: 23 November 2018 (15:01:18 CET)
Background A body composition monitor (BCM) has a role not only in determining over-hydration (OH) but also as an aid to nutritional assessment. For dialysis patient-specific clinical applications of BCM, it is necessary to clarify the relationship between body composition parameters and OH in healthy Chinese individuals. Methods This cross-sectional study involved 314 healthy individuals with a mean age of 45.7±13.1 years. BCM measurements were performed while the subjects were fasting. Results The mean OH level was 0.379±0.81 L. Lean tissue index (LTI) and Lean tissue mass (LTM) were significantly higher in males (p<0.001), while fat tissue index (FTI) was significantly higher in females (p<0.001). In univariate correlation analysis, FTI, Fat, and ATM had a negative correlation with OH in females and all subjects (p<0.05), while LTM and BCM had a positive correlation in all subjects (p<0.05). There was a significant negative correlation between phase angle (PhA) and OH in males, females, and all subjects (r=-0.634, p<0.001; r=-0.666, p<0.001; r=-0.484, p<0.001, respectively). In multivariate linear regression analysis, PhA (b=-1.266, p<0.001), LTM (b=0.987, p<0.001), age (b=-0.307, p<0.001) were independent predictors of OH. Conclusions This study demonstrated that age, LTM and especially PhA, had important roles in predicting OH in healthy Chinese individuals. In the future, PhA may aid in clinical assessment by helping to titrate dry weight among hemodialysis patients with malnutrition.
ARTICLE | doi:10.20944/preprints202001.0272.v1
Subject: Medicine & Pharmacology, Psychiatry & Mental Health Studies Keywords: Exergame; depression; hemodialysis; end-stage renal disease; wearable technology; digital health
Online: 23 January 2020 (16:29:53 CET)
Regular exercise can reduce depression. However, the uptake of exercise is limited in patients with end-stage renal disease undergoing hemodialysis. To address the gap, we designed a gamified non-weight-bearing exercise program (Exergame), which can be executed during hemodialysis treatment. The Exergame is virtually supervised based on its interactive feedback via wearable sensors attached on lower extremities. We examined the effectiveness of this program to reduce depression symptom compared to supervised exercise in 73 hemodialysis patients (age=64.5±8.7years, BMI=31.6±7.6kg/m2). Participants were randomized into an Exergame group (EG) or a Supervised-exercise group (SG). Both groups received similar exercise tasks for 4-week, 3-session per week, 30-min per session, during hemodialysis treatment. Depression symptom was assessed at baseline and 4-week using Center for Epidemiologic Studies Depression (CES-D). Both groups showed significant reduction in depression score (37%, p<0.001, Cohen’s effect size d=0.69 in EG vs. 41%, p<0.001, d=0.65 in SG) with no between-group difference for the observed effect (p>0.050). The EG expressed a positive exercise experience including fun, safety, and helpfulness of sensor-feedback. Together, results suggested that the virtually-supervised low-intensity Exergame is feasible during routine hemodialysis treatment. It is as effective as supervised-exercise to reduce depression symptom, while reducing burden of administrating exercise in dialysis clinics.
ARTICLE | doi:10.20944/preprints202012.0560.v1
Subject: Medicine & Pharmacology, Nursing & Health Studies Keywords: hemodialysis; indirect forest therapy; emotion; fatigue; stress; heart rate variability; natural killer cells
Online: 22 December 2020 (12:42:59 CET)
(1) Background: Most hemodialysis patients may experience physiological and psychological stress. Exposure to nature has been previously reported to reduce the measures of psychological and physiological stress, and immune function. This study aimed to investigate psychological and physiological effects of integrated indirect forest therapy on chronic renal failure patients undergoing hemodialysis. (2) Methods: As a quasi-experiment, this study employed a nonequivalent control group, repeated measurements, and a non-synchronized design. A total of 54 participants were included: 26 and 28 in the experimental and control groups, respectively. During hemodialysis, five types of forest therapy stimuli (visual, auditory, olfactory, tactile, and motor) were applied 3 times per week for 4 weeks during 15-minute sessions. (3) Results: Positive but not negative emotion measures differed between the groups after the intervention. Fatigue and physiological stress levels were significantly reduced in the experimental group, whereas no significant difference was found between the groups on the measures of psychological stress. Activation of both the parasympathetic and sympathetic nervous systems was similar in both groups, as was the number of natural killer cells. (4) Conclusion: Integrated indirect forest therapy may help increase positive emotions and reduce fatigue and stress levels during hemodialysis in patients with chronic renal failure.
ARTICLE | doi:10.20944/preprints201809.0529.v1
Subject: Life Sciences, Biotechnology Keywords: hemodialysis; end stage renal disease; diabetes; motor performance; gait; balance; wearable; aging; frailty; diabetic peripheral neuropathy
Online: 27 September 2018 (04:19:43 CEST)
Motor functions are deteriorated by aging. Some conditions may magnify this deterioration. To examine whether hemodialysis (HD) process would negatively impact gait and balance beyond diabetes condition among mid-age adults (48-64 years) and older adults (65+ years). One hundred and ninety-six subjects (age=66.2±9.1 years, body-mass-index=30.1±6.4 kg/m2, female=56%) in 5 groups were recruited: mid-age adults with diabetes undergoing HD (Mid-age HD+, n=38) and without HD (Mid-age HD-, n=40); older adults with diabetes undergoing HD (Older HD+, n=36) and without HD (Older HD-, n=37); and non-diabetic older adults (Older DM-, n=45). Gait parameters (stride velocity, stride length, gait cycle time, and double support) and balance parameters (ankle, hip, and center of mass sways) were quantified using validated wearable platforms. Groups with diabetes had overall poorer gait and balance compared to the non-diabetic group (p<0.050). Among people with diabetes, the HD+ had significantly worsened gait and balance when comparing to the HD- (Cohen’s effect size d=0.63-2.32, p<0.050). Between-group difference was more pronounced among older adults with the largest effect size observed for stride length (d=2.32, p<0.001). Results suggested that deterioration in gait speed among the HD+ was correlated with age (r=-0.440, p<0.001), while this correlation was diminished among the HD-. Interestingly, results also suggested that poor gait in the Older HD- related to poor balance, while no correlation was observed between poor balance and poor gait among the Older HD+. Using objective assessments, results confirmed that the presence of diabetes can deteriorate gait and balance, and this deterioration can be magnified by HD process. Among non-HD people with diabetes, poor static balance described poor gait. However, among people with diabetes undergoing HD, age was a dominate factor describing poor gait irrespective of static balance. Results also suggested feasibility of using wearable platforms to quantify motor performance during routine dialysis clinic visits. These objective assessments may assist in identifying early deterioration in motor function, which in turn may promote timely intervention.
ARTICLE | doi:10.20944/preprints202111.0460.v1
Subject: Medicine & Pharmacology, Nutrition Keywords: Maintenance hemodialysis (MHD) patient; Low-phosphate meal; CKD-MBD (chronic kidney disease-related mineral and bone disorder); Proinflammatory cytokine; TNF-α (tumor necrosis factor-alpha)
Online: 24 November 2021 (15:27:03 CET)
High dietary phosphate intake and poor adherence to phosphate-binding-therapy elevate the risk of hyperphosphatemia in maintenance hemodialysis (HD; MHD) patients. Therefore, chronic kidney disease-related mineral and bone disorder (CKD-MBD) indicators increase; consequently, risks of CKD-MBDs and inflammation are elevated. This double-blind, randomized control trial intervention study was designed to investigate the possibility of reducing blood CKD-MBD indicators and modulating inflammatory indicators by consuming low-phosphate (LP) meals accompanied by a minimum dose of a calcium-based phosphate binder (CaCO3). MHD patients were recruited and randomly assigned to an LP meal group (LP group) or a control group. After initial data collection, blood collection, and dietary counseling, subjects were asked to consume a washout diet for 1 week. During the washout diet period, subjects consumed their usual diet but took 1 tablet of calcium carbonate (1CaCO3) as a phosphate binder with each meal. After the washout diet period, subjects in the LP group and control group respectively consumed LP meals and regular meals twice a day for 1 week. Meat in the LP meals was boiled before the regular cooking process, but meat in control meals was not. All meals were supplied by a central kitchen so that the contents of phosphate and other nutrients could be identified. In total, 40 MHD patients completed the study program. After 1 week of the dietary intervention, the blood Ca x P product and dietary phosphate had significantly decreased in the LP group compared to the control group (p<0.05). The LP group had significantly lower variations in dietary phosphate intake, blood calcium, Ca x P product, and tumor necrosis factor (TNF)-α than the control group by comparing differences between after the dietary intervention and the baseline (△after intervention - baseline, p<0.05). The increase in dietary phosphate intake (△3rd - 2nd dietary phosphate intake) augmented the increase in the TNF-α level by 6.24-fold (odds ratio [95% confidence interval]: 6.24 [1.12~34.92], p<0.05). These results highlighted the conclusion that LP meals accompanied by a minimum dose of CaCO3 downregulated pro-inflammation by reducing CKD-MBD indicators which was triggered by decreasing dietary phosphate intake.