Effects of a mobile application on improving self-management of adult patients receiving peritoneal dialysis: A randomized controlled trial.

AIM: This study aimed to develop a mobile application for improving self-management and to evaluate its effects in adult patients on peritoneal dialysis (PD). METHODS: This randomized controlled trial was registered with the Korean Clinical Research Information Service Registry (KCT0007267) and conducted at a tertiary hospital. A self-management mobile application (SMA) was developed based on social cognitive theory and the ADDIE (analysis, design, development, implementation, and evaluation) model. The SMA includes information about disease management; self-recording of data on diet, exercise, medication, and health behavior; and healthcare providers' support and feedback. Participants aged 19-65 years were randomly allocated to the intervention group (n = 27) using the SMA for 10 weeks, and the control group (n = 26) receiving usual care. PD-related knowledge and self-efficacy, PD-related health behavior, biomarkers, and health-related quality of life (HRQoL) were surveyed pretest/posttest and analyzed using SPSS 23.0. RESULTS: Compared to the controls, the intervention group showed significant improvement in PD-related knowledge and health behavior, albumin, and hemoglobin. HRQoL domains of symptoms/problems of kidney disease and disease impact on daily activity were improved in the intervention group. CONCLUSION: The SMA is an effective intervention for enhancing health behaviors as well as improving the HRQoL of patients with PD. Without any limitations on time or location, patients with PD can easily use the SMA to monitor their health conditions, efficiently manage their disease, and perform PD-related behaviors. Nurses can implement high-quality tailored healthcare by using patients' lifelog data from the SMA.

Serum VEGF-D level is correlated with renal dysfunction and proteinuria in patients with diabetic chronic kidney disease.

ABSTRACT: Biomarkers associated with chronic kidney disease (CKD) may play a crucial role in the early diagnosis of diabetic kidney disease. However, there have been few reports published on serum vascular endothelial cell growth factor (VEGF)-D in patients with diabetic CKD. We divided patients with diabetic CKD into two groups: CKD 3-4 and CKD 5. In total, 42 patients with diabetic kidney disease and seven healthy controls without diabetes mellitus were enrolled in this study. An observational study was conducted to evaluate the serum VEGF-D levels and other clinical parameters in each group and to assess the relationship among these factors. The serum levels of VEGF-D were higher in the CKD 3-4 group and CKD 5 group than in the control group. However, there was no significant difference in serum levels of VEGF-D between CKD stage 3-4 group and CKD stage 5 group. Correlation analysis showed that serum VEGF-D was negatively correlated with estimated glomerular filtration rate but positively correlated with serum creatinine, urine albumin-to-creatinine ratio, and urine protein-to-creatinine ratio. Serum VEGF-D was a good biomarker in receiver operating characteristic analysis and independently associated with CKD stages in multiple linear regression analysis. Circulating VEGF-D was positively correlated with blood growth/differentiation factor-15, endostatin, and chemokine (C-X-C motif) ligand 16 levels. Serum VEGF-D levels were correlated with renal dysfunction, albuminuria, and proteinuria in patients with diabetic kidney disease. Elucidation of the role of VEGF-D as a biomarker requires further study.

Serum nitric oxide level correlates with serum brain natriuretic peptide and whole blood viscosity in hemodialysis patients.

BACKGROUND: Nitric oxide (NO) is tonically synthesized by the vascular endothelium and known as a marker of vasodilatation and blood flow. As NO has a critical role in hemodynamics, NO may be associated with other hemodynamics-related factors including atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP) and whole blood viscosity (WBV). It has been reported that serum NO level increased in patients undergoing hemodialysis. However, there are few reports about the relationship between NO and hemodynamic parameters in hemodialysis patients. OBJECTIVE: We investigated the associations between serum levels of NO and other hemodynamics-related factors such as ANP, BNP and WBV in patients with hemodialysis. METHODS: NO, ANP, and BNP levels before hemodialysis were measured using ELISA method. We measured WBV in pre- and post-dialysis. RESULTS: Mean serum levels of NO, ANP, and BNP were 13.97 ±â€¯10.34 µg/mL, 198.85 ±â€¯61.56 pg/mL, and 1233.32 ±â€¯280.81 pg/mL, respectively in patients with hemodialysis. The mean WBV values at shear rates of 1, 5, and 300 s-1 for pre-dialyses were 168.5 ±â€¯62.5, 76.9 ±â€¯20.6, and 33.3 ±â€¯3.8 mP, respectively. Serum NO level was positively correlated with WBV at shear rates of 1, 5, and 300 s-1 at pre- and post-hemodialysis. There is a correlation between serum nitrite levels and the change of SBV during hemodialysis. Serum nitrite levels correlated with the serum BNP levels. ANP levels have a negative correlation with pre-dialytic WBV. However, BNP levels did not correlate with WBV during hemodialysis. CONCLUSIONS: WBV is linked to an imbalance in serum vasoactive substances in hemodialysis patients and can cause significant hemodynamic disturbance.

Changes in whole blood viscosity during hemodialysis and mortality in patients with end-stage renal disease.

Whole blood viscosity (WBV) plays a role in hemorheology and is determined by many factors such as red blood cell factors, plasma protein and blood volume. As WBV changes during hemodialysis, mortality may be due to changes in WBV in patients on hemodialysis. However, there are few prospective data on the relationship between changes in WBV and overall mortality in dialysis patients. We tried to investigate the correlations between values of WBV at variable shear rates before and after hemodialysis and overall or atherosclerosis-related mortality in patients with end-stage kidney disease.Forty-three patients receiving hemodialysis were enrolled in this study. In this 5.8-year prospective observational study, analyses of the effects of WBV at shear rates of 300 s-1 (systolic WBV; SBV), 5 s-1 (diastolic WBV5; DBV5), and 1 s-1 (diastolic WBV1; DBV1) during dialysis on all-cause and atherosclerotic mortality was performed.Among a total of 43 patients, 27 (62.7%) died over the course of the study. Thirteen deaths were caused by atherosclerotic events. A high degree of change in WBV at shear rates of 300 s-1 and 5 s-1 during hemodialysis (ΔSBV, ΔDBV5) was positively correlated with overall mortality (HR = 4.688, 95% confidence interval [CI], 1.269-17.319, p = 0.020; HR = 3.941, 95% CI, 1.057-14.701, p = 0.041, respectively). A high degree of change in diastolic blood pressure (ΔDBP) during hemodialysis was also positively correlated with overall mortality (HR = 3.035, 95% CI, 1.039-8.867, p = 0.042). However, comparative analysis between WBV at shear rates of 300 s-1, 5 s-1, and 1 s-1 and overall mortality did not reveal any significant relationships. Kaplan-Meier analysis revealed that the all-cause mortality was significantly higher in patients from a high degree of change of WBV at shear rates of 300 s-1, compared to those from the moderate or low degree of changes of WBV at shear rates of 300 s-1 (p = 0.020, log-rank test). Survival rate in high ΔDBP was lower than that of moderate or low ΔDBP group in Kaplan-Meier survival analysis (p = 0.004, log-rank test).Our data showed that a high degree of change in WBV at variable shear rates during hemodialysis might impact overall survival in patients with end-stage kidney disease. However, large-scale studies to evaluate the relationship of WBV with overall mortality and atherosclerotic mortality will be needed.