Activation and disease control of patients on chronic hemodialysis: An observational study.

BACKGROUND AND OBJECTIVE: Patient activation is a concept that refers to the willingness to manage one's health and medical care. To assess it, a patient activation measure (PAM) has been developed and validated. Several studies report low activation in patients with chronic diseases. However, information on activation in hemodialysis patients is scarce. The aim of the present study is to describe the activation level of patients on chronic treatment in an HD unit and its relationship with disease control parameters. MATERIALS AND METHODS: Cross-sectional observational study in patients with advanced chronic kidney disease on chronic HD treatment. Ninety-six patients were included. Activation was measured with the PAM-13 questionnaire. Its relationship with descriptive variables (age, sex, comorbidity, studies, habitat) and disease control variables (vascular access, blood flow, potassaemia, phosphataemia, interdialytic gain) was studied. For this purpose, Spearman's correlation test, multiple linear regression model and logistic model were used as statistical methods. RESULTS: The mean (SD) PAM-13 score was 63.19 (15.21). Activation was significantly associated with vascular access (P = 0.003), blood flow (P = 0.024), and interdialytic gain of patients (P = 0.008). CONCLUSIONS: Activation in patients on chronic hemodialysis treatment is low. Higher activation is related having an arteriovenous fistula, higher blood flow and lower interdialytic gain. Future studies are needed to confirm and apply our results.

The Effect of Intradialytic Exercise Using Virtual Reality on the Body Composition of Patients with Chronic Kidney Disease.

BACKGROUND: Individuals with chronic kidney disease (CKD) often experience reduced muscle strength and diminished health-related quality of life (HRQoL), and engaging in regular exercise may improve them. The aim of this study was to assess the effect of intradialytic exercise using non-immersive virtual reality (VR) on body composition of patients with CKD on hemodialysis (HD). METHODS: This was a substudy in a clinical trial of intradialytic exercise intervention using a non-immersive VR game in which the patient interacted by moving the lower limbs. Body composition was determined by BCM Fresenius multifrequency stereoscopic bioimpedance. Body mass index (BMI), fat tissue index (FTI), lean tissue index (LTI), extracellular/intracellular water (EIW), and phase angle (PA) were recorded in 52 patients, 24 in the control group (CG) and 28 in the exercise group (EG). RESULTS: Statistically significant differences were observed between both groups. The LTI increased in the EG while it decreased in the CG. The FTI and the EIW decreased in the EG compared to the increase observed in the CG. CONCLUSIONS: Intradialytic exercise using non-immersive VR was associated with an increase in LTI and a decrease in FTI of CKD patients on HD.

Nutritional status and its relationship with COVID-19 prognosis in hemodialysis patients.

Introduction: Introduction: among the groups more affected by the COVID-19 pandemic were patients undergoing chronic hemodialysis (HD) treatment due to their comorbidities, advanced age, impaired innate and adaptive immune function, and increased nutritional risk due to their underlying inflammatory state. All of these factors contribute to a higher risk of severe complications and worse outcomes compared to the general population when infected with SARS-CoV-2. Objective: the objective of this study was to describe the nutritional characteristics of and their potential association with the prognosis of COVID-19 in patients undergoing chronic HD treatment. Method: a descriptive, retrospective, observational design. All cases of COVID-19 in patients undergoing chronic treatment at the Hemodialysis Unit of Hospital de Manises, Valencia, Spain, from the start of the pandemic to before vaccination were included. Results: for that, 189 patients were studied, who received chronic HD treatment in the hospital unit, 22 patients were diagnosed with COVID-19 (12 %) in that period. The mean age was 71 years, 10 were women, the Charlson index was 6.59 points, diabetes mellitus 10, vintage HD 51.6 months, 2 patients had previously received a currently non-functioning kidney transplant, 16 had arteriovenous fistula as vascular access, and 6 had central vascular access. The mean dialysis session time was 220.14 minutes and the initial value of the single dose of the Kt/V pool was 1.7. 16 patients had body composition measurement, a strong association (p < 0.05) was identified between mortality and BMI, as well as mortality and FTI. Furthermore, the differences between deceased and surviving groups in the serum levels of various variables related to nutritional status were analyzed, finding significant differences with p < 0.05 in the value of triglycerides and ferritin. Conclusions: higher body mass index and higher body fat content, along with lower baseline levels of triglycerides and ferritin, were significantly associated with higher COVID-19 mortality in patients on chronic hemodialysis. These findings suggest that the initial nutritional status of these patients can significantly influence the prognosis of SARS-CoV-2 infection.

Introducción: Introducción: entre los grupos más afectados por la pandemia de COVID-19 se encuentran los pacientes en tratamiento crónico de hemodiálisis (HD) por sus comorbilidades, edad avanzada, deterioro de la función inmune innata y adaptativa, y mayor riesgo nutricional por su estado inflamatorio de base. Todos estos factores contribuyen a un mayor riesgo de complicaciones graves y peores resultados en comparación con la población general cuando se infectan con SARS-CoV-2. Objetivo: el objetivo de este estudio es describir las características nutricionales y su potencial asociación con el pronóstico de COVID-19 en pacientes en tratamiento crónico de HD. Método: diseño observacional retrospectivo y descriptivo. Se incluyeron todos los casos de COVID-19 en pacientes en tratamiento crónico en la Unidad de Hemodiálisis del Hospital de Manises, Valencia, desde el inicio de la pandemia hasta antes de la vacunación. Resultados: de 189 pacientes que recibieron tratamiento de HD crónica en la unidad hospitalaria, 22 pacientes fueron diagnosticados con COVID-19 (12 %) en ese período. La edad media fue de 71 años, 10 eran mujeres, índice de Charlson de 6,59 puntos, diabetes mellitus 10, tiempo en diálisis 51,6 meses, 2 pacientes habían recibido previamente un trasplante renal actualmente no funcionante, 16 tenían fístula arteriovenosa como acceso vascular, y 6 tenían acceso vascular central. El tiempo medio de la sesión de diálisis fue de 220,14 minutos y el valor inicial de la dosis única del pool de Kt/V fue de 1,7. Tenían medición de la composición corporal 16 pacientes, se identificó una fuerte asociación (p < 0,05) entre mortalidad e IMC, así como mortalidad y FTI. Además las diferencias entre los grupos de fallecidos y sobrevivientes en los niveles séricos de diversas variables relacionadas con el estado nutricional fueron analizados, encontrando diferencias significativas con p < 0,05 en el valor de triglicéridos y ferritina. Conclusiones: un índice de masa corporal más alto y un mayor contenido de grasa corporal, junto con niveles basales más bajos de triglicéridos y ferritina, se asocian significativamente a una mayor mortalidad por COVID-19 entre los pacientes en hemodiálisis crónica. Estos hallazgos sugieren que el estado nutricional inicial de estos pacientes puede influir significativamente en el pronóstico de la infección por SARS-CoV-2.

Impact of an intradialysis virtual-reality-based exercise program on healthcare resources expenditure: a micro-costing analysis.

BACKGROUND: Engagement in exercise by haemodialysis (HD) patients has been shown to generate benefits both in terms of improved functional capacity and in the health-related quality of life. The use of non-immersive virtual reality (VR) games represents a new format for the implementation of intradialysis exercise. Some studies have shown that engaging in exercise for 6 months reduces the consumption of antihypertensive drugs and decreases the time spent admitted to hospital among individuals receiving HD treatments. The objective of this study was to evaluate changes in the consumption of healthcare resources and micro-costing for patients on HD who completed a VR exercise program. MATERIALS AND METHODS: Design: This study is a secondary analysis of a clinical trial. The participants performed an intradialysis exercise program with non-immersive virtual reality for 3 months. The variables were recorded in two periods: 12 months before and 12 months after the start of the exercise program. RESULTS: The micro-costing analysis showed a significant decrease in the mean cost, in euros, for the consumption of laboratory tests - 330 (95% CI:[- 533, - 126];p = 0.003), outpatient visits - 351 ([- 566, - 135];p = 0.003), and radiology tests - 111 ([- 209, - 10];p = 0.03) in the 12 months after the implementation of the exercise program relative to the 12 months prior to its start. CONCLUSION: The implementation of intradialysis exercise programs decreased the expenditure of some healthcare resources. Future studies could help clarify if longer interventions would have a stronger impact on these cost reductions.

Hemodynamic Tolerance of Virtual Reality Intradialysis Exercise Performed during the Last 30 Minutes versus the Beginning of the Hemodialysis Session.

Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p < 0.001) and systolic blood pressure (6.25 (0.04,12.47) mmHg; p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability.