Seminars in Dialysis最新文献

{"title":"Computational fluid dynamics simulation of hemodynamic changes in a hemodialysis patient with central venous stenosis treated with stent.","authors":"Biyun Teng, Qining Fu, Zhe Wang","doi":"10.1111/sdi.13170","DOIUrl":"10.1111/sdi.13170","url":null,"abstract":"<p><p>We comment on the recently published to investigate hemodynamic changes in central venous stenosis patients before and after stent placement. Through the evidence, we believe that the boundary conditions in computational models and simulations of this study are incorrect in three points.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10156735","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":"Novel method for laparoscopic rectus sheath tunneling with Lin's tube in peritoneal dialysis catheter implantation.","authors":"Yuntzu Chang, Wei-Jung Chang, Huang Cheng-Yen, Ping-Fang Chiu, Kuo-Hua Lin","doi":"10.1111/sdi.13165","DOIUrl":"10.1111/sdi.13165","url":null,"abstract":"<p><p>Laparoscopic implantation of a catheter through rectus sheath tunnel minimizes the risks of catheter failure and reduces some complications like catheter migration, hernias, and leaks. We described a novel method for laparoscopic catheter rectus sheath tunneling using an aspiration tube and a silk tie (Lin's tube). This material is easily available and yields a small fascial defect with an equivalent cannula size to minimize tissue disruption. The technique is feasible, reproducible and it may reduce the risks of postoperative leakage and hemorrhage.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10158550","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":"Neutrophil reactive oxygen formation, bacterial infections and mortality in malnourished hemodialysis patients: Evaluation of clinical outcomes.","authors":"Hadar Mudrik-Zohar, Danny Alon, Naomi Nacasch, Aviad Sternschuss, Meidad Greenberg, Sydney Benchetrit, Ronit Gavrieli, Tali Zitman-Gal, Keren Cohen-Hagai","doi":"10.1111/sdi.13168","DOIUrl":"10.1111/sdi.13168","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with end stage kidney disease undergoing maintenance hemodialysis (MHD) are prone to malnutrition and infections.</p><p><strong>Objective: </strong>The objective of this study was to evaluate the effect of polymorphonuclear (PMN) cell dysfunction on clinical outcomes of MHD patients, in association with nutritional status.</p><p><strong>Methods: </strong>This prospective study investigated 39 MHD patients by evaluating the oxidative activity of their PMN cells using Phorbol 12-Myristate-13-Acetate (PMA) stimulation. Blood samples were taken from each participant at dialysis initiation. Demographics, laboratory data, and clinical outcomes during a 24-month follow-up period were obtained from electronic medical records.</p><p><strong>Results: </strong>Phagocytic activity was described in percentiles of mean fluorescence intensity (MFI) of PMA levels. There were no differences in comorbidities between patients with low or high MFI-PMA percentiles. Patients in the lowest (25th) MFI-PMA percentile (N = 10) had poorer nutritional status and more frequent severe infections compared to the other 29 patients (4.3 ± 3.4 events versus 2 ± 2.2 events, p = 0.017). Furthermore, they had more frequent hospitalizations (>3) due to infections (70% versus 41%, p = 0.073) and their mortality rate was higher (80% versus 31%, p = 0.007). The odds ratio for all-cause mortality was 8.85. In multivariate analysis, the MFI-PMA percentile and ischemic heart disease were the strongest predictors of all-cause mortality (p = 0.02 and p = 0.005, respectively).</p><p><strong>Conclusions: </strong>Low MFI-PMA levels were associated with poor nutritional status and adverse clinical outcomes and might serve as a prognostic biomarker, predicting severe infections and mortality among malnourished MHD patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10512468","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":"Incidence and risk factors of cognitive dysfunction in hemodialysis patients: A systematic review and meta-analysis.","authors":"Jun Liu, Kehong Chen, Jia Chen, Lili Fu, Weiwei Zhang, Jing Lin, Jingfang Wan","doi":"10.1111/sdi.13171","DOIUrl":"10.1111/sdi.13171","url":null,"abstract":"<p><strong>Background: </strong>The study aims to explore the incidence and risk factors of cognitive dysfunction in hemodialysis patients.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, and Web of Science databases were searched for clinical studies on the association between hemodialysis and cognitive dysfunction from the database's inception to 1 December 2022. Two researchers independently completed data extraction and risk of bias assessments for the included studies. All statistical analyses were performed using STATA15.0 software.</p><p><strong>Results: </strong>Ten studies were included in this meta-analysis, with a total of 5535 hemodialysis patients, that is, 2033 patients with cognitive dysfunction and 3502 patients with normal cognitive function. The Newcastle-Ottawa Scale scores of the included studies were greater than 5. Meta-analysis results suggested that the incidence of cognitive dysfunction in hemodialysis patients was (effect size = 51%, 95% confidence interval [CI] [0.33, 0.69]), and hemodialysis patients with cognitive dysfunction were often older than those with normal cognition (standard mean difference [SMD] = 0.49, 95% CI [0.31, 0.68]). Female gender was a risk factor for cognitive dysfunction in hemodialysis patients (relative risk [RR] = 1.21, 95% CI [1.04, 1.41]); diabetes (RR = 1.33, 95% CI [1.04, 1.71]) and stroke (RR = 1.66, 95% CI [1.08, 2.55]) increased the incidence of cognitive dysfunction in hemodialysis patients.</p><p><strong>Conclusions: </strong>The most important risk factors for cognitive dysfunction associated with hemodialysis might be female gender, old age, diabetes, and stroke. Close attention should be paid to such patients for early prevention.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10215670","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":"Manual compression technique improves the success rate in the treatment of thrombosed aneurysmal arteriovenous fistula: A single-center experience.","authors":"Cheng-Yu Ko,&nbsp;Li-Ying Yu,&nbsp;Po-Wei Chen,&nbsp;Chih-Chang Ko,&nbsp;Tian-Xi Lin,&nbsp;Cheng-Han Lee,&nbsp;Ping-Yen Liu,&nbsp;Hsien-Yuan Chang","doi":"10.1111/sdi.13127","DOIUrl":"https://doi.org/10.1111/sdi.13127","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular intervention for thrombosed aneurysmal arteriovenous fistula (AVF) is still a challenge. Manual compression technique (MCT)-assisted angioplasty may be helpful, but there is no evidence or data to support it.</p><p><strong>Methods: </strong>From January 2018 to May 2021, patients with thrombosed aneurysmal AVFs were retrospectively enrolled. The patients were separated into the MCT group or the traditional group according to the procedure received. Technical failure, clinical failure, 90-day patency, and safety were analyzed.</p><p><strong>Results: </strong>A total of 159 cases (64 ± 12 years old, 60% male) were enrolled, of which 87 cases received MCT and 72 underwent traditional angioplasty. No technical failure was observed in the MCT group, while five technical failures were observed in the traditional group (0% vs. 7%, p = 0.02). There were no differences in the clinical failure rate (3% vs. 7%, p = 0.30), 90-day patency rate, or procedure time between the MCT group and the traditional group. There was no symptomatic pulmonary embolism or other complication in the two groups.</p><p><strong>Conclusion: </strong>MCT is a low-cost, less invasive, and safe procedure for thrombosed aneurysmal AVF, and it achieves a higher technical success rate than traditional angioplasty.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10510419","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":"Combined aerobic and resistance exercise in maintenance hemodialysis patients: A meta-analysis.","authors":"Yixiu Liu, Xiju Luo, Siyan Deng, Jing Chen, Lu Zhang, Ying Huang, Huagang Hu","doi":"10.1111/sdi.13162","DOIUrl":"10.1111/sdi.13162","url":null,"abstract":"<p><p>Exercise brings many benefits to patients undergoing maintenance hemodialysis (MHD), but the effect of combined aerobic and resistance exercise remains unclear. English and Chinese databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, Wan Fang, and CBM) were searched from inception to January 2023 to retrieve qualified randomized controlled trials. The literature selection, data extraction, and risk of bias assessment of included studies were conducted independently by two reviewers. Meta-analysis was performed using RevMan 5.3 software. A total of 23 studies with 1214 participants were included, and 17 of the interventions were conducted during dialysis. Results showed that combined aerobic and resistance exercise (CARE) improved the peak oxygen uptake, six-minute walking test, 60 s sit-to-stand test (STS), 30 s STS, dialysis adequacy, five (out of eight) domains and physical component summary of health-related quality of life (HRQOL) measured by the Medical Outcomes Study Short Form-36, blood pressure, and hemoglobin for MHD patients compared with usual care. No significant changes were found in the mental component summary of HRQOL, C-reactive protein, creatinine, potassium, sodium, calcium, and phosphate. Subgroup analysis showed that intradialytic CARE ameliorated more outcomes, except for handgrip strength and hemoglobin, than non-intradialytic ones. CARE is an effective way to improve physical function, aerobic capacity, dialysis adequacy, and HRQOL for MHD patients. Strategies should be implemented by clinicians and policymakers to motivate patients to do more exercise. Well-designed clinical trials are warranted to explore the effectiveness of non-intradialytic CARE.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9835303","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":"Early start hemodialysis with a catheter may be associated with greater mortality: A propensity score analysis.","authors":"Gustavo Laham, Gervasio Soler Pujol, Jenny Guzman, Natalia Boccia, Anabel Abib, Carlos H Diaz","doi":"10.1111/sdi.13157","DOIUrl":"10.1111/sdi.13157","url":null,"abstract":"<p><strong>Introduction: </strong>Deciding when and how to initiate hemodialysis (HD) is still controversial. An early start (ES) seems to show a lack of benefit. \"Lead time bias\" and comorbidities have been associated with different outcomes in ES groups. On the other hand, it is well accepted that the impact the type of vascular access (VA) has on patient survival. Our aim was to evaluate survival with early start (ES) versus late start (LS) on HD, taking into account the vascular access (VA) used.</p><p><strong>Methods: </strong>Between 01/1995 and 06/2018, 503 incidental patients initiated HD at our Dialysis Unit. eGFR was estimated by the CKD-EPI equation. Diabetes mellitus (DM), coronary disease (CD), and peripheral vascular disease (PVD) were considered comorbid conditions. According to eGFR and VA, patients were divided into four groups: G1: ES (eGFR > 7 mL/min) with catheter (ES + C), G2: ES with fistula or graft (F/G) (ES + F/G), G3: LS (eGFR< 7 mL/min) with catheter (LS + C), and G4: LS with F/G (LS + F/G). The cut-off value to define ES or LS was based on median eGFR for these 503 patients. We compared patient's survival rates by Kaplan-Meier and log-rank test. The four groups were compared before and after matching with propensity scores (PS). Cox analysis was performed to determine the impact of predictors of mortality.</p><p><strong>Results: </strong>Median eGFR was 7 (5.3-9.5) mL/min/1.73 m² , median follow-up time was 30.9 (13-50) months, 52.1% had F/G access at entry, and 46.9% died during the observation period. Among the four groups, the ES + C were significantly older, and there were more diabetics and comorbid conditions, while phosphatemia, iPTH, albumin, and hemoglobin were significantly higher in the LS groups. Before propensity score (PS) matching, the ES + C group had a poor survival rate (p < 0.0001), while LS + F/G access had the best survival. After PS, a total of 180 patients were selected in the same four groups and ES + C kept showing a statistically significant poorer survival. Multivariate analysis revealed that ES + C was an independent predictor of mortality.</p><p><strong>Conclusion: </strong>In this retrospective study, ES + C on HD was associated with a higher mortality rate than LS. This association persisted after PS matching.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9837050","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 association of cognition with protein energy wasting and synaptic transmission in chronic kidney disease.","authors":"Xia Yang, Yujun Quan, Erzhong Wu, Yuecheng Jiang, Qian Song, Yue Li, Qian Li, Zhaolin Sun, Jing Yuan, Yan Zha, Xiaoli Cui","doi":"10.1111/sdi.13146","DOIUrl":"10.1111/sdi.13146","url":null,"abstract":"<p><strong>Introduction: </strong>In recent years, consciousness impairment in patients with end-stage renal disease (ESRD) has been paid more and more attention, but the cause and mechanism of consciousness state change is not clear.</p><p><strong>Methods: </strong>As the hippocampus played a crucial role in consciousness, we explored the pathological and electrophysiological changes in chronic kidney disease (CKD) mouse hippocampus.</p><p><strong>Results: </strong>Whole-cell recordings in hippocampal neurons showed that miniature excitatory postsynaptic current (mEPSC) frequency decreased, but the amplitude was unaltered in CKD_8w mice. In addition, α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor-mediated EPSCs (AMPAR-EPSCs) and N-methyl-D-aspartic acid receptor-mediated EPSCs (NMDAR-EPSCs) in hippocampal Schaffer collateral-CA1 synapses displayed a significant decline in CKD_8w mice. Although the ratio of AMPAR-/NMDAR-EPSCs did not change, the paired-pulse ratio (PPR) in CKD_8w mice increased. Intriguingly, the mEPSC frequency and AMPAR-/NMDAR-EPSCs amplitudes were positively associated with body weight, and the mEPSC frequency was negatively correlated with serum creatinine in CKD_8w mice, indicating a potential correlation between cognition and nutritional status in patients with CKD. To confirm the above hypothesis, we collected the clinical data from multiple hemodialysis centers to analyze the correlation between cognition and nutritional status.</p><p><strong>Conclusion: </strong>Our analysis indicated that protein energy wasting (PEW) was a possible independent risk factor for consciousness dysfunction in maintenance hemodialysis (MHD) patients. Our results provided a more detailed mechanism underlying the cognitive impairment (CI) in ESRD patients at the synaptic level. Last but not least, our results showed that PEW was a probable new independent risk factor for CI in cases with ESRD.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10210041","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":"Hyponatremia and mortality in patients undergoing maintenance hemodialysis: Systematic review and meta-analysis.","authors":"Takamasa Miyauchi, Hiroki Nishiwaki, Aya Mizukami, Masahiko Yazawa","doi":"10.1111/sdi.13140","DOIUrl":"10.1111/sdi.13140","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review and meta-analysis examined the relationship between hyponatremia and worse outcomes in patients undergoing maintenance hemodialysis.</p><p><strong>Methods: </strong>The MEDLINE, EMBASE, CENTRAL, and Web of Science databases were used to search for relevant articles. The target population was patients on maintenance hemodialysis (those undergoing hemodialysis for ≥60 days). The defined outcomes were death, cardiovascular disease, cognitive decline, and falls. Meta-analysis was performed with a random-effects model of pairwise comparisons of normonatremia and hyponatremia defined for each study, 1-mmol/L increment of sodium analysis, and dose-response analysis using the sodium concentration defined for each study. This study was registered with PROSPERO (registration number CRD42018087667).</p><p><strong>Results: </strong>Thirteen articles were included. The pairwise analysis revealed that the hazard ratio for all-cause mortality was 1.45 (95% confidence interval, 1.31-1.61). The analysis of 1-mmol/L increment of sodium included six studies with a hazard ratio for all-cause mortality of 0.94 (95% confidence interval, 0.91-0.97) for each 1-mmol/L increase in the serum sodium concentration. In the dose-response analysis, assuming a linear relationship, a sodium increment of 1 mmol/L revealed a hazard ratio for all-cause mortality of 0.97 (95% confidence interval, 0.96-0.98). Other outcomes could not be integrated.</p><p><strong>Conclusions: </strong>Hyponatremia is associated with all-cause mortality in patients undergoing maintenance hemodialysis. Healthcare providers should pay special attention to even the slightest indication of hyponatremia.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9824146","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":"Antecubital perforating vein stent-grafting for radiocephalic arteriovenous fistula recovery: A case report.","authors":"Daniel Mendes, Paulo Almeida, Andreia Pinelo, João Castro, António Norton-de-Matos","doi":"10.1111/sdi.13158","DOIUrl":"10.1111/sdi.13158","url":null,"abstract":"<p><p>Stent-grafts have been increasingly used in hemodialysis arteriovenous accesses, particularly in recurrent stenosis or in cases of vein rupture after percutaneous transluminal angioplasty (PTA). Although they limit neointimal hyperplasia, stenosis development at stent edges remains a concern. Despite their advantages, they are seldom used on the forearm veins due to fracture risk associated with elbow motion and the potential to limit cannulation sites. This report presents a novel application of stent-grafts in salvaging a radio-cephalic arteriovenous fistula in an 84-year-old male to treat a single outflow path at the elbow through a stenosed antecubital perforating vein, after failed PTA. The vascular access remained patent 18 months after the procedure, with no need for additional treatments at this target lesion, even though a PTA was required for juxta-anastomotic stenosis. This report highlights a possible further use of covered stents in arteriovenous vascular accesses.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9834829","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}