The effects of a short-term meditation-based mindfulness protocol in patients receiving hemodialysis.

Mindfulness-based approaches that promote health, improve quality of life, and reduce the impact of comorbidities are key aspects in chronic diseases management. We aimed to verify the impact of a short-term meditation protocol on psychosocial and physiological parameters in chronic hemodialysis patients. We enrolled twenty-two patients, median age of 69.5 years old, into a 12-week meditation protocol that occurred during each hemodialysis session for 10-20 minutes, 3x/week, in a private tertiary hospital. We then evaluated clinical, psychological, and laboratorial parameters pre- and post-meditation. Patients exhibited a better control of serum phosphorus (-0.72 mg/dL; P = 0.002), a decrease in systolic blood pressure (-1.90 mmHg; P = 0.009), a 23% decrease in depressive symptoms (P = 0.014), and an increase of 7% in the self-compassion scale (P = 0.048) after meditation. To note, we observed an increase in 13% of the mindfulness score (P = 0.019). Our preliminary study describes the effects of a short-term meditation protocol in chronic hemodialysis setting. We observed a decrease in depressive symptoms and in blood pressure values, an improvement in self-compassion and serum phosphorous levels. In conjunction with the promising results of meditation in chronic kidney disease setting, this encouraging preliminary study supports the need for additional clinical trials.

Labile plasma iron generation after intravenous iron is time-dependent and transitory in patients undergoing chronic hemodialysis.

Iron supplementation in hemodialysis patients is fundamental to erythropoiesis, but may cause harmful effects. We measured oxidative stress using labile plasma iron (LPI) after parenteral iron replacement in chronic hemodialysis patients. Intravenous iron saccharate (100 mg) was administered in patients undergoing chronic hemodialysis (N = 20). LPI was measured by an oxidant-sensitive fluorescent probe at the beginning of dialysis session (T0), at 10 min (T1), 20 min (T2), and 30 min (T3) after the infusion of iron and at the subsequent session; P < 0.05 was significant. The LPI values were significantly raised according to the time of administration and were transitory: -0.02 +/- 0.20 micromol/L at the beginning of the first session, 0.01 +/- 0.26 micromol/L at T0, 0.03 +/- 0.23 micromol/L at T1, 0.09 +/- 0.28 micromol/L at T2, 0.18 +/- 0.52 micromol/L at T3, and -0.02 +/- 0.16 micromol/L (P = 0.001 to 0.041) at the beginning of the second session. The LPI level in patients without iron supplementation was -0.06 +/- 0.16 micromol/L. Correlations of LPI according to time were T1, T2, and T3 vs. serum iron (P = 0.01, P = 0.007, and P = 0.0025, respectively), and T2 and T3 vs. transferrin saturation (P = 0.001 and P = 0.0003, respectively). LPI generation after intravenous saccharate administration is time-dependent and transitorily detected during hemodialysis. The LPI increment had a positive correlation to iron and transferrin saturation.

Hemoglobin and hematocrit at the end of hemodialysis: a better way to adjust erythropoietin dose?

A severe disadvantage of administration of recombinant human erythropoietin to hemodialysis patients has been reported. A significant correlation has been shown with hemoglobin values determined online by use of the blood volume monitor (BVM) and by laboratory measurement. Online hemoglobin and hematocrit were measured by use of the BVM during hemodialysis session. Data were analyzed by t test and statistical significance was defined as a P of <0.05. Increases in the mean values of hemoglobin and hematocrit from 11.6 +/- 1.9 to 13.9 +/- 2.4 g/dL (17.4 +/- 7.1%, P = 0.02) and from 34.4 +/- 6.8 to 42 +/- 8.3% (20.6 +/- 8.8%, P = 0.022), respectively, were observed from the beginning to the end of dialysis. We hypothesize that a new strategy for adjusting erythropoietin dose may be based on hemoglobin and hematocrit values evaluated at the end of hemodialysis, when patients are no longer hypervolemic. Inadvertent high levels of hemoglobin could be one explanation why patients present higher rates of cardiovascular and access-related events, especially when monitored online by use of the BVM to achieve the dry weight.

Análise crítica dos resultados preliminares obtidos com a monitorização do volume sanguíneo em pacientes submetidos à / Initial eperience with bBlood monitoring in hemodialysis patients

Introdução: O BVM (Blood Volume Monitor) está associado à redução das intercorrências intradialíticas. Métodos: Análise preliminar de 177 registrosgráficos do RBV (Relative Blood Volume) gerados pelo BVM de 14 pacientes com insuficiência renal em hemodiálise convencional. Realizados ajustes no“peso seco” e no perfil de ultrafiltração e comparação dos valores do RBV crítico obtidos empiricamente e por fórmula preestabelecida. Resultados:Realizados 12,2 ± 9,3 registros do RBV por paciente. As médias de idade e de tempo de hemodiálise foram 68 ± 16,8 anos e 31,5 ± 18,5 mesesrespectivamente. Houve redução do “peso seco” em média de 2,6 ± 1,7 kg em 12 pacientes e mudança no perfil de ultrafiltração em quatro pacientesdiabéticos. Os valores interindividuais do RBV crítico obtidos empiricamente e pela fórmula variaram de 83,2.