Hemodialysis International最新文献

{"title":"Post-Hemodialysis Flow-Dependent Hepatic Function Impairment in Individuals With End Stage Kidney Disease and Chronic Inflammation","authors":"Oscar Swift, Bobby V. M. Dasari, Malcolm A. Finkelman, Yonglong Zhang, Sivakumar Sridharan, Enric Vilar, Ken Farrington","doi":"10.1111/hdi.70016","DOIUrl":"10.1111/hdi.70016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The liver plays an important role to prevent translocation of gut-derived toxins from the portal to the systemic circulation. Chronic inflammation is common in patients receiving hemodialysis, and increased gut permeability to microbial material has been implicated in its pathogenesis. This study sought to establish if flow-dependent hepatic function was impaired in chronically inflamed individuals treated with hemodialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty adults receiving outpatient hemodialysis were recruited. Subjects with known liver or gastrointestinal disease, acute inflammation, and hemodynamic instability during hemodialysis were excluded.</p>\u0000 \u0000 <p>Participants were divided into two groups (<i>n</i> = 25): individuals with chronic inflammation (defined as a median high-sensitivity C-reactive protein (hs-CRP) ≥ 5 mg/dL over the preceding 3 months) with no apparent cause and a noninflamed group.</p>\u0000 \u0000 <p>Flow-dependent hepatic function (defined as a composite of hepatic perfusion, hepatocyte clearance and biliary excretion) was assessed following hemodialysis by indocyanine green clearance to derive: (1) indocyanine green-plasma disappearance rate and (2) indocyanine green-retention after 15 min. Serum beta-D-glucan levels pre- and post-hemodialysis were measured as surrogate markers of gastrointestinal permeability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Indocyanine green-plasma disappearance rate was reduced in the inflamed group versus the noninflamed group (19.4 (8.7)%/min vs. 23.8 (14.4)%/min; <i>p</i> = 0.02). Indocyanine green-retention after 15 min was higher in the inflamed group (5.4 (6.8)% vs. 2.9 (5.0)%; <i>p</i> = 0.02). Noninvasive hepatic fibrosis and steatosis assessments were similar in both groups. Pre-hemodialysis beta-D-glucan levels were similar (63 (42) pg/ml vs. 49 (11) pg/ml; <i>p</i> = 0.13), whereas post-hemodialysis beta-D-glucan levels were higher in the inflamed group (82 (48) pg/ml vs. 58 (27) pg/ml; <i>p</i> < 0.001), and in those with flow-dependent hepatic impairment (72 (45) vs. 55 (32) pg/ml; <i>p</i> = 0.004). In linear regression analysis, indocyanine green-retention after 15 min and post-hemodialysis beta-D-glucan levels were independent predictors of median hs-CRP, explaining 21% of the variation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Individuals with otherwise unexplained inflammation had impaired hepatic function post-hemodialysis and higher post-hemodialysis bet","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"118-129"},"PeriodicalIF":1.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Knowledge in Adolescents Undergoing Hemodialysis in Palestine: The Impact of a Video-Assisted Educational Program","authors":"Nawras Fashafsheh,&nbsp;Ping Lei Chui,&nbsp;Mahmoud Danaee,&nbsp;Ahmad Ayed,&nbsp;Lee Lee Lai","doi":"10.1111/hdi.70015","DOIUrl":"10.1111/hdi.70015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hemodialysis is a common initial treatment for young individuals with end-stage renal disease. Educating these patients is crucial for improving their knowledge and well-being. Lifestyle modifications, promoted through health education, are essential for reducing hemodialysis-related complications. Although traditional face-to-face education is prevalent, video-based education offers a more convenient and cost-effective alternative with numerous benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to evaluate the impact of a video-assisted educational program on the knowledge of adolescents undergoing hemodialysis in Palestine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a quasi-experimental, pretest-posttest intervention study with 68 adolescent patients (Aged 13–18) diagnosed with end-stage kidney disease (ESKD). Patients were divided into two groups based on their treating hospital: an experimental group (<i>n</i> = 34) received video-based education, whereas a control group (<i>n</i> = 34) received traditional face-to-face education. Knowledge in both groups was assessed using the validated Kidney Knowledge Questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A Generalized Estimating Equation analysis revealed a statistically significant difference in knowledge scores between the experimental and control groups across pretest, posttest, and follow-up assessments (<i>p</i> = 0.024). Furthermore, within both the experimental and control groups, there were statistically significant improvements in total knowledge scores from pretest to posttest and follow-up assessments (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Implementing effective educational interventions can enhance the knowledge of individuals undergoing hemodialysis. Therefore, we recommend using video-based instruction as a practical, easy, and engaging approach for educating hemodialysis patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"215-223"},"PeriodicalIF":1.2,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Video Streaming With Virtual Reality Glasses During Arteriovenous Fistula Needle Insertion on Pain and Anxiety of Individuals Undergoing Hemodialysis Treatment","authors":"Sevil Güler,&nbsp;Selçuk Öztürk,&nbsp;Seda Şahan,&nbsp;Ulaş Serkan Topaloğlu","doi":"10.1111/hdi.70010","DOIUrl":"10.1111/hdi.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Virtual reality headsets are increasingly used in medical procedures to help manage pain and anxiety. This study investigated the effect of a video played through a virtual reality headset on pain and anxiety levels during arteriovenous (AV) fistula needle insertion in patients undergoing hemodialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This randomized controlled trial included 80 patients from a hemodialysis ward, with 40 in the intervention group and 40 in the control group. Data were collected using a Personal Information Form (developed by the researcher based on relevant literature to gather descriptive and medical characteristics), the visual analogue scale (VAS) for pain severity, and the State–Trait Anxiety Inventory to measure anxiety levels. The intervention group utilized a virtual reality headset during the procedure. The intervention was applied during a single dialysis treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The mean pain score in the intervention (virtual reality headset) group was 6.2 ± 0.8, significantly lower than the control group's mean pain score of 8.3 ± 0.9 (<i>p</i> &lt; 0.001). The mean State Anxiety Inventory score for the intervention (virtual reality headset) group was 41.9 ± 3.6, which was significantly lower than the control group's mean score of 64.6 ± 3.4 (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results of this pilot study suggest that using a virtual reality headset significantly reduced both pain and anxiety in patients undergoing AV fistula needle insertion during hemodialysis. Further studies are indicated to evaluate the utility of virtual reality headset use over a prolonged period.</p>\u0000 \u0000 <p><b>Trial Registration:</b> https://clinicaltrials.gov: NCT06776497</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"37-45"},"PeriodicalIF":1.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain and Analgesic Use in Patients With Chronic Kidney Disease Not on Dialysis: A Systematic Review","authors":"Nikhil Nair,&nbsp;Murilo Guedes,&nbsp;Shaarav Ghose,&nbsp;Rohan Kumar,&nbsp;Kush Doshi,&nbsp;Natalia Alencar-de Pinho,&nbsp;Charlotte Tu,&nbsp;Brian Bieber,&nbsp;Christian Combe,&nbsp;Helmut Reichel,&nbsp;Christos Argyropoulos,&nbsp;Roberto Pecoits-Filho,&nbsp;Rupesh Raina","doi":"10.1111/hdi.70013","DOIUrl":"10.1111/hdi.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic pain is common in patients with chronic kidney disease (CKD), yet pain management in non-dialysis-dependent CKD (NDD-CKD) is underexplored. Inappropriate analgesic use poses significant risks in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate patterns of analgesic use—specifically opioids and NSAIDs—and associated clinical characteristics in patients with NDD-CKD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted following PRISMA 2020 guidelines. Databases including PubMed and ClinicalTrials.gov were searched in December 2024 using MeSH terms related to CKD, analgesics, opioids, and NSAIDs. Inclusion criteria targeted NDD-CKD patients with reported analgesic use. Data extraction and risk of bias assessments were performed independently by two reviewers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine studies encompassing 3,674,959 patients were included. Opioid use was reported in 324,111 patients (22.8%), while NSAIDs were used in 1,095,052 (77.1%). Opioid use increased with CKD severity and pain intensity, but was associated with higher mortality, especially in frail or comorbid patients. NSAID use was prevalent in early-stage CKD and associated with nephrotoxic risk and may occur without clinician oversight. Regional variation and inconsistent prescribing practices were noted. No study directly compared opioid vs. NSAID outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Analgesic use in NDD-CKD is widespread and varies by region, CKD stage, and pain severity. Inadequate pain control is common. Standardized guidelines tailored to CKD patients are urgently needed to optimize pain management while minimizing harm.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"176-187"},"PeriodicalIF":1.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Severe Bisoprolol Poisoning Using Continuous Kidney Replacement Therapy: A Case Report and Literature Review","authors":"Antonino Previti,&nbsp;Alessandro Panico,&nbsp;Alessandro Visonà Dalla Pozza,&nbsp;Francesco Rizzato,&nbsp;Paolo Luca Lentini","doi":"10.1111/hdi.70012","DOIUrl":"10.1111/hdi.70012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>We report the case of a 65-year-old Caucasian woman who presented to our emergency department following the ingestion of approximately thirty 2.5 mg bisoprolol tablets. Initially stable, she rapidly developed severe bradycardia and hypotension, culminating in cardiogenic–distributive shock that required intubation, aggressive vasoactive support, and advanced metabolic therapies. Due to concurrent hepatic and renal dysfunction impairing drug elimination, continuous kidney replacement therapy (CKRT) was initiated as a supportive intervention and potential drug elimination pathway. The patient's condition progressively improved, leading to complete recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In addition to describing our clinical experience, we provide a concise literature review on the use of CKRT in beta-blocker poisoning, highlighting current knowledge gaps and the need for cautious interpretation in the absence of direct pharmacokinetic measurements.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"291-295"},"PeriodicalIF":1.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proactive Iron Versus Reactive Iron in Hemodialysis","authors":"Gerry George Mathew","doi":"10.1111/hdi.70014","DOIUrl":"10.1111/hdi.70014","url":null,"abstract":"","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"279-280"},"PeriodicalIF":1.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal Pulmonary Embolism Secondary to Heparin-Induced Thrombocytopenia in Hemodialysis: A Case Study","authors":"Yan Yang,&nbsp;Zibo Xiong,&nbsp;Yingying He,&nbsp;Aihong Wang,&nbsp;Xiaoyan Huang,&nbsp;Wei Liang","doi":"10.1111/hdi.70011","DOIUrl":"10.1111/hdi.70011","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heparin and low-molecular-weight heparin (LMWH) are first-line anticoagulants in hemodialysis but may trigger heparin-induced thrombocytopenia (HIT), a severe immune-mediated complication. Despite its clinical significance, HIT is often misdiagnosed early, increasing thromboembolic risks and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Report</h3>\u0000 \u0000 <p>We present a case of a 61-year-old male patient who developed HIT during initial hemodialysis. The patient exhibited recurrent catheter thrombosis, intermuscular venous thrombosis in the lower extremities, and progressive thrombocytopenia following LMWH administration during dialysis. The diagnosis was confirmed by IgG-specific anti-PF4/heparin antibody testing. Shortly after the last dialysis session, the patient developed acute dyspnea and chest pain. Computed tomography angiography of the chest revealed pulmonary embolism. Despite aggressive intervention, the patient's condition deteriorated rapidly, with platelet counts dropping to 5 × 10⁹/L, culminating in a fatal outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The combination of dialysis catheter thrombosis and declining platelet counts constitutes an essential early diagnostic clue for HIT in hemodialysis patients, the recognition of which could prevent fatal thromboembolic complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"288-290"},"PeriodicalIF":1.2,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Oral Candidiasis in Hemodialysis Patients: Candida Species and Associated Risk Factors","authors":"Maryam Erfaninejad,&nbsp;Abdol Sattar Pagheh,&nbsp;Aynaz Ghojoghi,&nbsp;Vajehallah Raeesi,&nbsp;Eisa Nazar,&nbsp;Mahnaz Fatahinia,&nbsp;Nafiseh Ramezani,&nbsp;Parvin Askari,&nbsp;Seydeh Fereshte Mohammadi,&nbsp;Masood Ziaee","doi":"10.1111/hdi.70007","DOIUrl":"10.1111/hdi.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dialysis patients, often immunocompromised, are highly susceptible to infectious diseases, including oral candidiasis, the most common mycotic infection of the oral mucosa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To identify risk factors for oral candidiasis in dialysis patients to improve management strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted in Birjand, Iran, involving 158 dialysis patients. Oral samples were cultured on CHROMagar <i>Candida</i> medium, with <i>Candida</i> species identified using colony color and molecular techniques. Multiple logistic regression analysis was used to determine predictors of oral candidiasis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 158 patients, 69 (43.7%) tested positive for oral candidiasis, yielding 97 <i>Candida</i> isolates. <i>Candida albicans</i> was the most prevalent species (55.7%), followed by <i>Candida glabrata</i> (22.7%). Significant predictors of oral candidiasis included longer dialysis duration (OR = 7.48; 95% CI = 1.31–2.05; <i>p</i> &lt; 0.001), male gender (OR = 3.07; 95% CI = 1.12–8.39; <i>p</i> = 0.02), and smoking (OR = 7.48; 95% CI = 1.98–28.31; <i>p</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Oral candidiasis is a prevalent opportunistic infection in dialysis patients, particularly among men, smokers, and those with extended dialysis duration. Enhanced screening, especially in developing countries, may be useful to address this often-overlooked condition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"130-137"},"PeriodicalIF":1.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Nursing Care Based on Kolcaba's Comfort Theory on Symptom Severity and Comfort of Hemodialysis Patients","authors":"Gamze Goke Arslan,&nbsp;Sebnem Cinar Yucel","doi":"10.1111/hdi.70009","DOIUrl":"10.1111/hdi.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The present study was conducted to investigate the effect of nursing care structured according to Kolcaba's comfort theory and given to hemodialysis patients on their symptom severity and comfort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This quasi-experimental study was conducted with 46 patients; 22 were in the intervention group and 24 were in the control group, who received treatment in the hemodialysis unit of a training and research hospital in Türkiye between November 2021 and May 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Patient Information Form (PIF), Dialysis Symptom Index (DSI) and Hemodialysis Comfort Scale-Version II (HDCS-II) were used to collect data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>While the mean DSI scores decreased in the intervention group over time, they increased in the control group. The mean score obtained from the overall HDCS-II increased over time in three follow-ups performed at different times in the intervention group. The mean score obtained from the overall HDCS-II decreased over time in three follow-ups performed at different times in the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the present study, nursing care structured according to Kolcaba's Comfort Theory given to hemodialysis patients reduced the severity of the symptoms in the participants and increased their comfort levels.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"194-206"},"PeriodicalIF":1.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Anything Gained From Estimating Blood Volume in Hemodialysis From Extracellular Volume Divided by a Constant Factor?","authors":"Sebastian Mussnig,&nbsp;Simon Krenn,&nbsp;David Keane,&nbsp;Manfred Hecking,&nbsp;Daniel Schneditz","doi":"10.1111/hdi.70008","DOIUrl":"10.1111/hdi.70008","url":null,"abstract":"<p>In a follow-up to a previous study [<span>1</span>], Kron et al. recently [<span>2</span>] examined whether blood volume (BV) in hemodialysis patients could be estimated from extracellular volume (ECV) derived from bioimpedance spectroscopy, assuming a constant physiological 1-over-3 relationship between these volumes, described previously [<span>1, 3</span>]. The authors compared BV estimated from bioimpedance (ECV/3) to their experimental BV, measured using their dialysate dilution method [<span>4</span>]. The overall bias was 0.2 L and small, but the 95% confidence limits were ±1.2 L and large. The authors attributed all error to bioimpedance and to deviations from the population-derived 1-over-3 relationship, and it ultimately remained unclear how estimated BV information should be used.</p><p>Kron et al. asked “Can Bioimpedance Analysis Be Used to Estimate Absolute Blood Volume in Hemodialysis Patients?” and answered that this estimation is only possible in patients without severe fluid overload. This interpretation hinges on data that the authors were not able to provide because they excluded patients with “severe volume expansion” and selected “stable patients without recorded intradialytic morbid events in the previous 3 weeks”. We reproduced the analysis by Kron et al. [<span>2</span>] in a larger population [<span>5</span>] without exclusions, with longitudinal measurements over multiple months. We found (a) that the margin of error might even be larger and showed (b) that BV is overestimated by ECV/3 in those patients who are increasingly fluid overloaded (Figure 1). In a separate cohort with repeated measurements covering 5 weeks, we found that ECV and fluid overload followed an expected weekly cycle, decreasing during the week and increasing during the long treatment interval, whereas pre-dialysis BV remained more or less unchanged and independent of fluid overload, without any clear weekly pattern [<span>6</span>]. Similar to previous findings [<span>7</span>], our data suggest that variable fluid overload is predominantly located in the extravascular space and that the BV/ECV ratio may not be constant.</p><p>While Kron et al. are to be congratulated for their contributions to volume estimation in dialysis patients, the present analysis [<span>2</span>] does not seem appropriate to answer the question they posed not only because data were obtained at a single time point, but more importantly because they excluded fluid overload as the condition of interest. Direct measurement of blood volume is required to uncover pathological imbalances between the intravascular and interstitial spaces. BV should not be estimated by ECV/3 assuming a constant factor in patients who suffer from fluid disequilibrium.</p><p>The authors declare no conflicts of interest.</p><p>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"277-278"},"PeriodicalIF":1.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}