Caracterización de la situación problémica en un estudio psicosocial con pacientes con enfermedad renal crónica

Introducción: La enfermedad renal crónica es un problema de salud a nivel mundial, su manifestación más grave, la insuficiencia renal crónica, incide en el contexto cubano y determina el crecimiento de pacientes en hemodiálisis. El objetivo del texto es valorar los principales resultados del diagnóstico y caracterización de la situación problémica en un estudio de carácter psicosocial con pacientes con Insuficiencia Renal Crónica en la sala de Hemodiálisis del municipio Florida, de la provincia de Camagüey. Método: Es una investigación-acción participativa de corte experimental, que se desarrolla entre enero 2023 y diciembre del 2024 la cual constituye salida del proyecto de investigación Sistema de acciones psicosociales para el perfeccionamiento de la atención integral a los pacientes con enfermedades no transmisibles. El universo está constituido por 56 pacientes y la muestra por 22, que reciben tratamiento depurador y conservador, 22 familiares y 12 profesionales del servicio. El instrumento de investigación por excelencia fue la encuesta a participantes. Resultados: La edad de los pacientes no es definitiva de un grupo etario; predominan los hombres; se constata un elevado por ciento de pacientes con poca tolerancia a la adherencia al tratamiento e insuficiente desarrollo de las habilidades psicosociales y declaran la necesidad de poseer conocimientos para lograr estados de salud que conlleven a la sobrevida. Discusión: No existe coincidencia con lo constatado en la determinación de los grupos etarios de prevalencia para la enfermedad, pero los especialistas insisten en que la enfermedad no es privativa de un período de vida específico; reconocen la importancia del conocimiento de los factores de riesgo por el paciente para la prevención, promoción y educación en salud y resaltan la necesidad de la comunicación y la empatía entre el personal de salud y el paciente, para lograr resultados y estados emocionales favorables ante la enfermedad y el tratamiento.

Introduction: Chronic kidney disease is a global health problem. Its most serious manifestation, chronic kidney failure, affects the Cuban context and determines the growth of patients on hemodialysis. The objective of the text is to evaluate the main results of the diagnosis and characterization of the problematic situation in a psychosocial study with patients with Chronic Renal Failure in the Hemodialysis room of the Florida municipality, of the county of Camagüey. Method: It is an experimental participatory action research, which takes place between January 2023 and December 2024, which constitutes the output of the research project System of psychosocial actions for the improvement of comprehensive care for patients with non-communicable diseases. The universe is made up of 56 patients and the sample is made up of 22, who receive purifying and conservative treatment, 22 family members and 12 service professionals. The research instrument par excellence was the participant survey. Results: The age of the patients is not definitive of an age group; men predominate; A high percentage of patients are found to have low tolerance for adherence to treatment and insufficient development of psychosocial skills and declare the need to possess knowledge to achieve health states that lead to survival. Discussion: There is no coincidence with what was found in the determination of the prevalence age groups for the disease, but specialists insist that the disease is not exclusive to a specific period of life; recognize the importance of the patient's knowledge of risk factors for prevention, promotion and health education and highlight the need for communication and empathy between health personnel and the patient, to achieve favorable results and emotional states in the face of the disease and treatment.

Type 2 diabetes increase the risk of arteriovenous fistula non-maturation, mediated by postoperative vascular hemodynamics.

BACKGROUND: The progression of atherosclerosis in small and medium-sized vessels has been associated with Type 2 diabetes (T2D). However, the influence of T2D on postoperative vascular remodeling and arteriovenous fistula (AVF) maturation is inconclusive. Besides, hemodynamic changes of postoperative vessel are also associated with AVF maturation. This study is intended to investigate the link between T2D and the occurrence of AVF non-maturation, as well as to delve into the impact of postoperative vascular hemodynamic parameters in this process. METHODS: A total of 477 hemodialysis patients, with or without type 2 diabetes, underwent AVF creation at Beijing Haidian Hospital (Haidian Section of Pecking University Third Hospital) from August 2018 to March 2022 were collected, and were followed for 1-5 years. Logistic regression was applied to analyze the association of T2D, postoperative vascular hemodynamic parameters with the risk of AVF non-maturation. To verify the stability of the results, the sensitivity analyses were performed using propensity scores to match patients. We further investigated the regulatory role of the postoperative vascular hemodynamics. RESULTS: There were 173 patients with T2D and 304 patients without T2D in this study. The maturation rate in T2D and non-T2D group was 47.977% and 63.816%, respectively. The findings of logistic regression analysis suggested that T2D significantly increased the risk of AVF immaturity [OR 1.716 (1.019-2.890), P = 0.042]. Besides, T2D was associated with the restriction of postoperative vascular hemodynamic parameters changes, including with decreased diameter of forearm cephalic radial artery and dilation rate of radial artery. The result of logistic regression analysis indicated that cephalic vein diameter at 1-month [0.402 (0.237-0.681), P = 0.001] and cephalic vein diameter at 2-month [0.501 (0.355-0.708), P < 0.001] were independently correlated with AVF maturation. Besides, the results of sensitivity analysis were consistent with that of logistic regression analysis. Moreover, the mediating effects of cephalic vein diameter were significant. CONCLUSION: Our findings discovered that T2D significantly increased the risk of arteriovenous fistula non-maturation, which was mainly mediated by the changes of cephalic vein diameter.

Impact of COVID-19 vaccines in patients on hemodialysis: an Italian multicentre cohort study.

BACKGROUND: The aim of this study was to evaluate the impact on the national health system of COVID-19 infection in vaccinated patients undergoing haemodialysis. METHODS: From the cohort of vaccinated dialysis patients enrolled in 118 dialysis centres, we calculated hospitalisation incidence in COVID-19-infected subjects. COVID-19-related hospitalisations and ICU admissions were analysed over two time periods (prior to administration of the third dose and following administration of the third dose of vaccine) and adjusted for several co-variates. Using the general population as the reference, we then calculated the Standardized Incidence Ratio (SIR) of hospitalisation. RESULTS: Eighty-two subjects out of 1096 infected patients were hospitalised (7.5%) and sixty-four hospitalisations occurred among the 824 infected persons after the third dose. Age ≥ 60 years (Adj RR 2.91; 95% CI 1.34-6.30) and lung disease (Adj RR = 2.45; 95% CI 1.32-4.54) were the only risk factors associated with hospitalisation. The risk of ICU admission in the second time period (Time 2) was reduced by 86% (RR = 0.14; 95% CI 0.03-0.71) compared to the first time period (Time 1). The SIR of hospitalisation (SIR 14.51; 95% CI 11.37-17.65) and ICU admission (SIR 14.58; 95% CI 2.91-26.24) showed an increase in the number of events in dialysis patients compared to the general population. CONCLUSIONS: Our analysis revealed that while the second variant of the virus increased infection rates, it was concurrently associated with mitigated severity of infections. Dialysis patients exhibited a higher susceptibility to both COVID-19 hospitalisation and ICU admission than the general population throughout the pandemic.

The Role of Genedrive in Point of Care Method For Hepatitis C Elimination in Hemodialysis Center.

BACKGROUND: Point of care is laboratory testing conducted close to the site of the patient. Point of care assessment is essential to detect and treat the hepatitis C virus in a single visit. The potential use of Genedrive extends to remote areas and key populations Therefore, there is a need for a simple, and cost-effective examination of methods, such as Genedrive. Genedrive is a rapid and low-cost diagnostic tool for the identification and treatment selection of infectious diseases. The World Health Organization targets to eliminate hepatitis by 2030, which decreases infections by 90%, and decreases deaths by 65%. Point of care could play a significant role in contributing to the elimination of hepatitis C. Chronic kidney disease (CKD) patients on hemodialysis are among the population at risk of hepatitis C due to nosocomial transmission. This study aimed to assess the role of Genedrive in measuring hepatitis C in chronic hepatitis C patients with chronic kidney disease on hemodialysis. METHODS: This study used a cross-sectional design. There were 64 CKD on Hd patients in Cipto Mangunkusumo Hospital tested by Genedrive. ROC analysis was conducted to assess significant hepatitis C among chronic kidney disease on hemodialysis. RESULTS: The calculated detection limit of Genedrive was 3.1x103 IU/mL. Genedrive HCV assay showed 90.6% sensitivity, 96.8% specificity, 92% negative predictive value, and 97% positive predictive value to detect HCV, 10.36 positive likelihood ratio, and 0.09 negative likelihood ratio. CONCLUSION: Genedrive could be a simple and reliable point of care method to detect hepatitis C with chronic kidney disease on hemodialysis.

The Severity, Quality of Life, and Correlated Factors of Chronic Kidney Disease-associated Pruritus between Hemodialysis and Kidney Transplant Patients: A Cross-sectional Study.

BACKGROUND: Chronic kidney disease-associated pruritus (CKD-aP) mainly occurs in hemodialysis (HD) patients and could persist in kidney transplant (KT) recipients. This study aims to compare the severity, correlation of various biochemical factors, and quality of life (QoL) concerning pruritus in CKD. METHODS: A cross-sectional study was conducted on HD and KT recipients with chronic pruritus, where the 5-Dimensional (5-D) Itch Scale and Dermatology Life Quality Index (DLQI) were used to evaluate pruritus severity and QoL. Results: Among the 60 subjects, 76.7% of HD patients had moderate-to-severe pruritus, whereas in the KT group, 83.3% experienced mild pruritus (p < 0.001). The median DLQI score was 5 (3-6) and 3 (2-4), respectively (p < 0.001). There was a correlation between hs-CRP and the 5-D itch score in the HD group (r = 0.443; p < 0.05), whereas e-GFR was correlated with the 5-D itch score in the KT group (r = -0.424; p < 0.05). CONCLUSION: Moderate-to-severe pruritus was more common in HD patients. While pruritus in KT recipients had a mild effect on QoL, pruritus in the HD group had a mild-moderate impact on QoL. There was a correlation between hs-CRP and e-GFR and the severity of pruritus in HD and KT recipients, respectively.

Short-term effect of low-dose roxadustat combined with erythropoiesis-stimulating agent treatment for erythropoietin-resistant anemia in patients undergoing maintenance hemodialysis.

Background: Erythropoietin resistance is present in some patients with chronic kidney disease, especially in those undergoing hemodialysis, and is often treated using roxadustat rather than iron supplements and erythropoiesis-stimulating agents (ESAs). However, some patients cannot afford full doses of roxadustat. This retrospective study investigated the efficacy of low-dose roxadustat combined with recombinant human erythropoietin (rhuEPO) therapy in 39 patients with erythropoietin-resistant renal anemia undergoing maintenance hemodialysis (3-4 sessions/week). Methods: The ability of the combination of low-dose roxadustat and rhuEPO to increase the hemoglobin concentration over 12 weeks was assessed. Markers of iron metabolism were evaluated. Eligible adults received 50-60% of the recommended dose of roxadustat and higher doses of rhuEPO. Results: The mean hemoglobin level increased from 77.67 ± 11.18 g/dL to 92.0 ± 8.35 g/dL after treatment, and the hemoglobin response rate increased to 72%. The mean hematocrit level significantly increased from 24.26 ± 3.99% to 30.04 ± 3.69%. The soluble transferrin receptor level increased (27.29 ± 13.60 mg/L to 38.09 ± 12.78 mg/L), while the total iron binding capacity (49.22 ± 11.29 mg/L to 43.91 ± 12.88 mg/L) and ferritin level (171.05 ± 54.75 ng/mL to 140.83 ± 42.03 ng/mL) decreased. Conclusion: Therefore, in patients with ESA-resistant anemia who are undergoing hemodialysis, the combination of low-dose roxadustat and rhuEPO effectively improves renal anemia and iron metabolism.

Unplanned hemodialysis initiation: A retrospective analysis of patient characteristics and prognosis in an emergency hospital.

INTRODUCTION: Functional decline occurs during dialysis initiation, particularly in unplanned cases. To prevent unplanned hemodialysis, we aimed to identify associated factors from the first referral to the nephrology department to hemodialysis initiation and assess patient prognosis post-unplanned hemodialysis initiation. METHODS: This retrospective study involved 257 Japanese patients initiating hemodialysis and compared patient characteristics based on whether hemodialysis was planned or unplanned at a single center. Patient outcomes were evaluated in collaboration with maintenance hemodialysis centers. RESULTS: Unplanned hemodialysis initiation correlated with heart failure history (p < 0.05) and infections like pneumonia (p < 0.001). Patients with unplanned hemodialysis initiation had a worse prognosis than those with planned initiation (p < 0.001), and multivariable Cox regression showed it as an independent risk factor for death (p < 0.05). CONCLUSIONS: Hygiene and careful attention to heart failure may reduce unplanned hemodialysis and improve patient well-being and healthcare efficiency. This retrospective analysis highlights crucial considerations for optimizing the initiation of hemodialysis.

[MRI-Based Assessment of Hepatic Iron Overload and Steatosis in Patients Undergoing Hemodialysis:Current Status,Challenges,and Perspectives].

Long-term treatment of anemia involving frequent blood transfusions and intravenous iron administration increases the risks of hepatic iron overload and steatosis in the patients undergoing hemodialysis.Pathological accumulation of iron damages hepatocytes,not only elevating the risks of progressive hepatic fibrosis and cirrhosis but also potentially accelerating the process of hepatic steatosis.Iron overload and steatosis may interact with each other,exacerbating liver damage and ultimately leading to further deterioration of hepatic fibrosis and cirrhosis.MRI characterized by non-invasiveness and high repeatability,enables the simultaneous quantitative assessment of hepatic iron and fat content,providing crucial information for early diagnosis and intervention of liver diseases.In recent years,researchers have achieved significant advances in the application of MRI in the diagnosis and treatment of liver diseases.MRI can accurately reflect the extent of hepatic iron overload and steatosis in patients and predict the risk of liver diseases.This article reviews the latest advances,challenges,and perspectives in the application of MRI in assessing hepatic iron overload and steatosis in the patients undergoing hemodialysis,aiming to offer valuable references for clinical practice.

Anti-neutrophil Cytoplasmic Antibody-Negative Rapid Progressive Glomerulonephritis With Mild Pathological Presentation in an Older Patient: A Case Report.

This case report discusses the management of anti-neutrophil cytoplasmic antibodies (ANCA)-negative rapid progressive glomerulonephritis (RPGN) in a 68-year-old man with a complex medical history, presenting with fatigue, edema, and acute renal failure. Despite the absence of positive biomarkers for specific RPGN types, the clinical progression suggested microscopic polyangiitis, leading to intensive immunosuppressive therapy with cyclophosphamide and rituximab. The patient's condition was further complicated by the coexistence of nephritic and nephrotic syndromes, requiring nuanced management strategies, including prolonged hemodialysis. After initial treatment failure, remission was eventually achieved, allowing cessation of dialysis and significant recovery of renal function. This case highlights the challenges of diagnosing and managing ANCA-negative RPGN, particularly the importance of a tailored, dynamic approach to treatment in resource-limited settings. The recovery observed underscores the potential for renal function improvement even after prolonged periods of intensive therapy, reinforcing the need for persistence and adaptability in managing complex RPGN cases.

Naphthalene Ball Ingestion Leading to Intravascular Hemolysis and Acute Kidney Injury.

Naphthalene is an aromatic hydrocarbon found in mothballs, deodorizers, or insecticides. Naphthalene poisoning is not commonly seen in the pediatric age group due to its pungent odor and taste, water insolubility, and poor absorption from the gastrointestinal tract (GIT). This case report describes a five-year-old boy who experienced accidental naphthalene mothball ingestion resulting in intravascular hemolysis and acute kidney injury (AKI). Naphthalene exposure can cause severe complications, especially in children. The clinical presentation included fever, abdominal pain, vomiting, decreased urine output, and hematuria. The laboratory findings revealed hemolytic anemia, elevated serum creatinine, and proteinuria. The child received supportive treatment including intravenous fluids, packed red blood cell transfusions, and hemodialysis for AKI. Early diagnosis and intervention are crucial for a favorable outcome. This case highlights the importance of considering naphthalene poisoning in the differential diagnosis of children with hemolysis and AKI.

Atomoxetine for Intradialytic Hypotension in a Patient on Hemodialysis: A Case Report.

Intradialytic hypotension significantly affects patient safety and clinical outcomes during hemodialysis. Despite various pharmacological and nonpharmacological interventions, effective management remains elusive. In this report, we detail a case of intradialytic hypotension in a male patient in his 40s, undergoing hemodialysis with a history of polycystic kidney disease. Eight years ago, the patient underwent bilateral nephrectomy because of a severe cystic infection, after which his systolic blood pressure (BP) persistently remained at 50-70 mm Hg during dialysis sessions. The initial treatment strategy for hypotension included fludrocortisone, midodrine, and prednisolone, leading to a slight temporary increase in BP, which subsequently declined. As the patient's condition deteriorated, the administration of norepinephrine or dopamine became necessary to sustain BP during dialysis. Given the patient's resistance to these treatments, a daily dose of 25 mg of atomoxetine was introduced. Following this treatment, there was a gradual improvement in the patient's vertigo, weakness, and BP. This case illustrates that low-dose atomoxetine can alleviate symptoms and elevate BP in patients experiencing severe intradialytic hypotension during hemodialysis.

Impact of volume indices in bioelectrical impedance measurement on the assessment of cardiac function indices by echocardiography in hemodialysis patients.

INTRODUCTION: Cardiovascular events resulting from volume overload are a primary cause of mortality in hemodialysis patients. Bioelectrical impedance analysis (BIA) is significantly valuable for assessing the volume status of hemodialysis (HD) patients. In this article, we explore the correlation between the volume index measured by BIA and the cardiac function index assessed by echocardiography (ECG) in HD patients. METHODS: Between April and November 2018, we conducted a cross-sectional study involving randomly selected 126 maintenance HD patients. Comprehensive data on medical history and laboratory test results were collected. Subsequently, we investigated the correlation between volume indices measured by BIA and cardiac function parameters by ECG. RESULTS: We discovered a significant correlation between the volume indices measured by BIA and various parameter of cardiac function. The Left Ventricular Hypertrophy (LVH) group exhibited higher levels of the percentage of Extracellular Water (ECW%) and the percentage of Total Body Water (TBW%) compared to the Non-LVH group. Extracellular Water (ECW) and Third Interstitial Fluid Volume (TSFV) were identified as independent risk factors for Left Ventricular Mass (LVM), and both demonstrated a high predictive value for LVM. ECW% emerged as an independent risk factor for the Left Ventricular Mass Index (LVMI), with a high predictive value for LVMI. CONCLUSION: ECW and TSFV were found to be positively associated with cardiac function parameters in HD patients.

Replacement of the massive amino acid losses induced by hemodialysis: A new treatment option proposal for a largely underestimated issue.

BACKGROUND: A series of interesting literature reports acknowledges the notable loss of essential and non-essential amino acids (EAAs and NEAAs) during hemodialysis sessions. These losses may exceed 800 g/year, thus contributing towards accelerating the onset of malnutrition in hemodialysis patients (HD). OBJECTIVE: A novel tailored amino acid formula for oral administration was developed to replace total amounts of each individual amino acid lost during dialysis diffusive/convective HD strategies, monitoring the effects produced on nutritional and hematological status. METHODS: A three-month randomized double-blind study was conducted on 30 subjects over the age of 70 years extrapolated from a total population of 86 hemodialysis patients. The 30 patients were randomly assigned to two groups: a treatment group of 15 HD patients (TG) to whom a novel mixture containing 5.4 g of AAs was administered solely on interdialytic days, and a control group of 15 HD patients (CG) who received no amino acid supplementation. The AAs mixture was administered post-dialysis at an extended interval from the end of solute and compartmental rebound to replace AA losses and optimize their role in protein anabolism. RESULTS: The results obtained highlighted a significant improvement in protein intake g/kg/day (Protein Catabolic Rate, p = 0.014), and increased IgG (p = 0.008) and C3 serum levels (p = 0.003) in the TG group alone. Fat mass losses were initially confirmed by means of bioelectrical impedance analysis (BIA) (p = 0.011) and plicometry (p < 0.001) in the CG group alone, although the main objective was to preserve nutritional status and, particularly, muscle mass. The study was extended to investigate the effects produced on anemia, yielding evidence of continued positive effects three months after the end of the study in the TG group alone based on an increase in Hb levels from 11.2 ± 0.6 to 12.1 ± 0.6 (p = 0.004) associated with a reduced demand for erythropoietin i.v. from 12928 ± 9033 to 9286 ± 5398 U.I/week (p = 0.012) and iron i.v. from 75.9 ± 55 to 71.4 ± 33.4 mg/week (p = 0.045). CONCLUSIONS: The results obtained following oral administration of this novel tailored AA replacement mixture aimed at reinstating the high AA losses produced during hemodialysis suggest the mixture should be prescribed as a standard procedure to all HD patients.

Improving Malnutrition Screening among Hemodialysis Patients.

Individuals receiving hemodialysis are at increased risk of malnutrition; however, regular diagnosis of malnutrition using subjective global assessment (SGA) is time-consuming. This study aimed to determine whether the Canadian Nutrition Screening Tool (CNST) or the Geriatric Nutrition Risk Index (GNRI) screening tools could accurately identify hemodialysis patients at risk for malnutrition. A retrospective medical chart review was conducted for in-centre day shift hemodialysis patients (n = 95) to obtain the results of the SGA assessment and the CNST screener and to calculate the GNRI score. Sensitivity and specificity analyses showed only a fair agreement between the SGA and CNST (sensitivity = 20%; specificity 96%; κ = .210 (95% CI, -0.015 to .435), p < .05) and between the SGA and GNRI (sensitivity = 35%; specificity = 88%; κ = .248 (95% CI, .017 to .479), p < .05). There was no significant statistical difference between the accuracy of either tool in identifying patients at risk of malnutrition (p = .50). The CNST and GNRI do not accurately screen for risk of malnutrition in the hemodialysis population; therefore, further studies are needed to determine an effective malnutrition screening tool in this population.

Heart failure biomarkers in hemodialysis patients.

The diagnosis of end-stage renal disease (ESRD) is made when the estimated glomerular filtration rate is less than 15 mL/min/1.73 m2. Most patients with that stage of chronic kidney disease (CKD) are eligible for renal replacement treatment, which includes kidney transplantation, hemodialysis and peritoneal dialysis. It is well recognized that CKD raises the risk of cardiovascular disease and is linked to a higher cardiovascular death rate in this population. Additionally, the largest risk of cardiovascular events is seen in ESRD patients. Heart failure (HF) and dangerous arrhythmias, which are more common in the advanced stages of CKD, are two additional causes of cardiovascular death in addition to atherosclerosis-related complications such as myocardial infarction and stroke. In this review the significance of natriuretic peptides and other HF biomarkers in hemodialysis patients, as tools for cardiovascular risk assessment will be discussed.

The Time to Negative Conversion among Adult COVID-19 Patients on Chronic Hemodialysis Admitted at the Philippine General Hospital - A Retrospective Cohort Study.

Objectives: In the Philippines, patients on chronic hemodialysis with COVID-19 remain admitted in hospitals despite clinical recovery because most free-standing dialysis units require proof of negative conversion via Reverse Transcriptase - Polymerase Chain Reaction (RT-PCR). This study aims to determine the time to negative conversion of COVID-19 RT-PCR testing among adult patients on chronic hemodialysis with COVID-19 admitted at the Philippine General Hospital (PGH) and bring insight in using the symptom or time-based procedure as recommended by local guideline, and ultimately, to ensure delivery of adequate hemodialysis despite being infected with COVID-19, shorten isolation period, and conserve resources especially in resource-limited settings. Methods: This is a retrospective cohort study on all adult patients on chronic hemodialysis who were admitted in PGH after the diagnosis of COVID-19 by RT-PCR between March 2020 and February 2021. Descriptive statistics was used in summarizing the data. Results: A total of 90 patients on chronic hemodialysis who tested positive for COVID-19 via RT-PCR admitted at PGH were included in the study. Most of these patients had moderate COVID-19 at 53.3%. The median number of days from onset of symptoms to clinical recovery was 14.5 days. The median time to first negative conversion was 18 days. Most of these patients had negative conversion at the second week. The correlation coefficient between time to clinical recovery and negative conversion was 0.214. Conclusion: Among adult patients on chronic hemodialysis who were admitted in PGH after the diagnosis of COVID-19, the time to negative conversion was longer compared to the time to clinical recovery with a very weak correlation between the two.

Association Between Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score and Arteriovenous Fistula Failure in Patients on Maintenance Hemodialysis.

BACKGROUND: Arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis in end-stage renal disease (ESRD) patients but has a significant failure rate. Atherosclerotic cardiovascular disease (ASCVD) is a major cause of mortality in ESRD patients. Atherosclerosis of the peripheral vessels may contribute to poor maturation of AVF leading to the exploration of the ASCVD score as a prognostic tool for AVF failure. METHODS: This study included 110 hemodialysis patients with AVFs and aimed to examine the association between ASCVD score and AVF failure. Participants were categorized into the presence of vascular access failure (N=12) and absence of vascular access failure (N=98), and demographic and clinical data were collected.  Results: The study comprised predominantly male patients (63.6%), with a notable prevalence of hypertension and diabetes. Twelve patients experienced AVF failure, with pseudoaneurysms and thrombosis being the predominant causes. The ASCVD risk group at intermediate and high stages exhibited a statistically significant risk (relative risk (RR)=1.403; 95% CI, 1.041-1.904) of AVF failure in comparison to the low and borderline ASCVD risk groups. There was no association of age, gender (male and female), body mass index (BMI), serum calcium, serum phosphorus, intact parathyroid hormone (iPTH), and serum albumin with AVF failure. CONCLUSION: The ASCVD score emerges as a potential prognostic tool to identify dialysis patients at high risk of AVF failure, suggesting avenues for targeted interventions and improved patient care. However, limitations of the ASCVD risk estimator and study limitations, such as small sample size and absence of mortality data, warrant cautious interpretation and necessitate further exploration in larger patient populations.

Evaluation of Clinical Characteristics of Critically Ill COVID-19 Patients With Renal Failure.

INTRODUCTION: This study aimed to investigate the clinical characteristics and prognostic factors of critically ill COVID-19 patients with renal failure admitted to the ICU. METHODS: We analyzed 300 adult patients with SARS-CoV-2 infection admitted to the ICU between November 1, 2020, and June 1, 2022. Demographic data, renal function parameters, and outcomes were collected and analyzed. RESULTS: The median age was 72 years, and 54.3% were men. Mechanical ventilation was required for 86.3% of patients, with 71.0% needing invasive ventilation. Renal failure was present in 43.3% of patients at ICU admission, significantly associated with older age, higher mechanical and invasive ventilation needs, and increased ICU mortality (76.9% vs. 51.8%, p<0.001). Patients with renal failure had elevated levels of urea, creatinine, C-reactive protein (CRP), D-dimer, white blood cell (WBC), neutrophil (Neu), and procalcitonin (PCT) (p<0.001 for all). Among patients with acute kidney injury (AKI), those with AKI had significantly higher median age (75 vs. 66 years, p<0.001), mechanical ventilation requirement (93.6% vs. 74.3%, p<0.001) and ICU mortality (79.1% vs. 35.4%, p<0.001). Elevated levels of urea (76 vs. 44 mg/dL, p<0.001) and creatinine (1.4 vs. 0.8 mg/dL, p<0.001), as well as inflammatory markers CRP and D-dimer (p=0.001), were observed in AKI patients. Survivors had lower median age (66.0 vs. 74.0 years, p<0.001) and lower prevalence of chronic kidney disease (CKD) (4.5% vs. 12.8, p=0.019) and AKI (34.8% vs. 78.7%, p<0.001). Non-survivors exhibited higher levels of urea, creatinine, lactate dehydrogenase (LDH), CRP, ferritin, and D-dimer (p<0.001 for all). CONCLUSION: Renal failure and AKI are prevalent in critically ill COVID-19 patients and are associated with worse outcomes. Elevated creatinine and urea levels at ICU admission are significant predictors of ICU mortality, underscoring the importance of early recognition and management of renal impairment in these patients.

Effects of Dietary Fiber Intake and the Prevalence of Constipation Among Patients With End-Stage Renal Disease (ESRD) in Jeddah, Saudi Arabia: A Cross-Sectional Observational Study.

RATIONALE/BACKGROUND: Hemodialysis (HD) patients with end-stage renal disease (ESRD) are particularly prone to constipation, which has become a growing public health issue. Nutritional therapy, such as fiber intake, significantly influences the management of constipation. In Saudi Arabia, there is limited data on fiber consumption and its correlation with constipation management in HD patients. AIMS: The study aimed to investigate the correlation between dietary fiber intake and its effect on the prevalence of constipation in HD patients. MATERIALS AND METHODS: This cross-sectional observational study of 77 ESRD patients on HD aged 18+ was conducted in a single dialysis center over six months. A questionnaire was employed to diagnose constipation (as defined by the Rome IV criteria of constipation), and seven-day food records were used to evaluate dietary fiber intake. RESULTS: A study found a high prevalence of constipation (53%) among participants, with a lower daily fiber intake than recommended. However, a significant relationship was found between fiber intake and constipation (p < 0.05) with lower fiber intake in constipated patients compared to non-constipated (p = 0.001). CONCLUSION: The study highlights a significant link between fiber intake and constipation in HD patients, suggesting adequate daily intake of fiber was effective in preventing constipation and that nutritional counseling should include adequate daily fiber intake in medical therapy management.

Improving well-being and enhancing awareness in patients undergoing hemodialysis through the person-centered IARA model: an exploratory study.

Chronic kidney disease (CKD) globally represents a significant health challenge, particularly among patients undergoing chronic hemodialysis. A careful nutritional and pharmacological prescription plays a key role in the effective management of these patients to optimize serum electrolytes, such as potassium, phosphorus, and protein intake. Furthermore, these patients can suffer psychological distress due to dietary restrictions and tight medication schedules. The present study explores the effectiveness of the person-centered IARA model in improving physiological markers and quality of life in CKD patients undergoing hemodialysis treatment. To demonstrate the effectiveness of the IARA model, 60 patients (M = 40; F = 20; 60.5 ± 9.9 years) undergoing thrice-weekly hemodialysis sessions were enrolled and randomly and blindly assigned to the Control or IARA group. The reduction in abnormal blood potassium, phosphorus, and total protein levels was investigated, alongside the psychological state through the SF-12 questionnaire. Preliminary findings showed a discernible reduction in the frequency of abnormal blood K (> 5.0 mmol/L) and P (> 4.5 mmol/L) levels in the IARA group compared to the Control group. In particular, such reductions were approximately 40% for K (OR = 0.57; 95% CL = 0.23/1.46) and about 15% for P (OR = 0.86; 95% CL = 0.27/2.74). A similar tendency was also observed for patient fluid intake during each hemodialysis session, with the frequency of higher-risk patients in the IARA group being 50% lower (OR = 0.50; 95% CL = 0.07/3.79) than that of the Control group. Although preliminary findings from this study suggest that the IARA model may have a positive effect on CKD patients' subjective wellbeing and quality of life (QoL), further research is needed to understand the long-term impact of the IARA intervention.