Predictive factors of infection in patients with chronic kidney disease using hemodialysis catheters.

Background: Infection is the most frequent complication of central venous catheters used for hemodialysis. Objectives: The purpose of this study was to the determine the central venous catheter-related infection rate at a dialysis center in the Brazilian state of Amazonas and to identify risk factors and the microbiological profile of the infections. Methods: This was an observational study with prospective data collection over a 12-month period by chart analysis and face-to-face interviews with patients undergoing hemodialysis using central venous catheters at a dialysis center. Results: 96 central venous catheters were analyzed in 48 patients. 78 of these were non-tunneled central venous catheters (81.3%) and 18 were tunneled central venous catheters (18.7%), 53.1% of the catheters were exchanged because of infection and blood cultures were obtained from 35.2% of the patients who had catheter-related infections. Gram-negative bacteria were isolated from five of the nine blood cultures in which there was bacterial growth and Gram-positive bacteria were isolated from the other four. The most commonly isolated bacteria was Staphylococcus hominis, found in 22.2% of positive blood cultures. Conclusion: The overall hemodialysis venous catheter infection rate was 10.1 episodes/1000 catheter days, 15.1 episodes/1000 catheters days in non-tunneled catheters and 3.3 episodes/1000 catheters days in tunneled catheters. The infection predisposing factors identified were use of non-tunneled catheters and having 2 hemodialysis sessions per week. Regarding the microbiological profile, over half of the bacteria isolated were Gram-negative.

Effects of an arteriovenous fistula stenosis prevention program in patients receiving hemodialysis.

BACKGROUND: To increase the efficiency of hemodialysis, an appropriate vascular pathway must be created, and its function must be maintained. This study aimed to identify the effects of an arteriovenous fistula (AVF) stenosis prevention program on upper muscular strength, blood flow, physiological indexes, and self-efficacy among patients receiving hemodialysis. METHODS: The participants were patients receiving hemodialysis at Keimyung University Dongsan Medical Center in Daegu, Republic of Korea. They were divided into experimental and control groups based on the day of the week they received hemodialysis at the outpatient department and included 25 participants each. The study was conducted for 8 weeks. RESULTS: The AVF stenosis prevention program was effective in improving upper extremity muscle strength (F=15.23, p<0.001) and blood flow rate (F=36.00, p<0.001). As a result of the program, the phosphorus index level, which is a physiological indicator in hemodialysis patients, decreased (F=8.64, p<0.001). Encouragement and support through text messages and practice lists also resulted in an increase in self-efficacy (F=18.62, p<0.001). CONCLUSION: The AVF stenosis prevention program in this study resulted in an increase in upper extremity muscle strength through grip strength exercises and was effective in preventing AVF stenosis by increasing the blood flow rate.

Measures to Contain the Transmission of Hepatitis C in a Chronic Kidney Care Hospital Unit in the Triângulo Mineiro in Brazil: A Case Study.

Objectives: Hepatitis C virus elimination is complex. The objective was to analyze measures to eliminate virus transmission in a hemodialysis unit. Methods: Case study composed of multiple units of analysis. The scenario is the hemodialysis unit of a Brazilian public hospital. Population composed of health service records. Descriptive analyzes were performed and the beginning of the event was considered as the moment of increased incidence of HCV. The intentional and purposeful collection of information for understanding the event and implementing interventions. Results: The subunits of analysis were related to: clinical-epidemiological profile, active search, transmission routes, management protocol and results achieved. In August 2019, out of 45 patients, six were reactive for anti-HCV. All received treatment. Patients had exposure to contaminated medical equipment, objects or hands of professionals. Preventive measures were adopted and routine techniques were corrected. Situational Analysis Committee guided the management of the event. No new cases were detected. Conclusions: Strategies for the microelimination of the C virus in a dialysis environment are demonstrated and it shows the multidisciplinary efforts in conducting the event.

Dialysis specialist care and patient survival in hemodialysis facilities: a Korean nationwide cohort study.

BACKGROUND: It is important for the dialysis specialist to provide essential and safe care to hemodialysis (HD) patients. However, little is known about the actual effect of dialysis specialist care on the survival of HD patients. We therefore investigated the influence of dialysis specialist care on patient mortality in a nationwide Korean dialysis cohort. METHODS: We used an HD quality assessment and National Health Insurance Service claims data from October to December 2015. A total of 34,408 patients were divided into two groups according to the proportion of dialysis specialists in their HD unit, as follows: 0%, no dialysis specialist care group, and ≥50%, dialysis specialist care group. We analyzed the mortality risk of these groups using the Cox proportional hazards model after matching propensity scores. RESULTS: After propensity score matching, 18,344 patients were enrolled. The ratio of patients from the groups with and without dialysis specialist care was 86.7% to 13.3%. The dialysis specialist care group showed a shorter dialysis vintage, higher levels of hemoglobin, higher single-pool Kt/V values, lower levels of phosphorus, and lower systolic and diastolic blood pressures than the no dialysis specialist care group. After adjusting demographic and clinical parameters, the absence of dialysis specialist care was a significant independent risk factor for all-cause mortality (hazard ratio, 1.10; 95% confidence interval, 1.03-1.18; p = 0.004). CONCLUSION: Dialysis specialist care is an important determinant of overall patient survival among HD patients. Appropriate care given by dialysis specialists may improve clinical outcomes of patients undergoing HD.

Importance of Confirmatory Tests for Sars-Cov-2 Infection in Hemodialysis Patients: A Multicenter Mexican Registry

Abstract Background: Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, patients with chronic kidney disease vulnerable to suffering more severe COVID-19 disease and worse outcomes have been identified Objectives: Our study's aim was to determine the incidence, characteristics, and outcomes of SARS-CoV-2 infection in patients of hemodialysis (HD) units in Mexico and to describe the availability of confirmatory testing Methods: This study was multicentric study of 19 HD units, conducted between March 2020 and March 2021 Results: From a total of 5779 patients, 955 (16.5%) cases of suspicious COVID-19 were detected; a SARS-CoV-2 reverse transcription polymerase chain reaction test was done in only 50.6% of patients. Forty-five percentages were hospitalized and 6% required invasive mechanical ventilation (IMV). There was no significant difference in mortality between confirmed (131/483) and suspicious (124/472) cases (p = 0.74). The percentage of patients in need of hospitalization, IMV, and deceased was greater than in the rest of the study population Conclusions: The study revealed that 49.4% of the cases were not confirmed, a worrisome observation given that this is a highly vulnerable population (higher probability of contagion and worse outcomes), in which 100% of patients should have a confirmatory test

Translation, cross-cultural adaptation and validation of the EPOCH-RRT questionnaire "Empowering Patients On Choices For Renal Replacement Therapy" for the Brazilian context / Tradução, adaptação transcultural e validação do questionário EPOCH-RRT "Empowering Patients On Choices For Renal Replacement Therapy" para o contexto brasileiro

Abstract Introduction: Chronic kidney disease (CKD) is a global public health problem. In Brazil, the incidence and prevalence rates of dialysis CKD progressively increase, but the transition process is a challenge for patients and caregivers in coping with the disease. Dialysis urgency, lack of planned access or prior knowledge of treatment is a reality for most. Guidelines recommend that treatment options should include the conscious preference of a fully informed patient. However, pre-dialysis educational information is an exception, leading to a large number of unplanned initial dialysis. The original study "Empowering Patients on Choices for Renal Replacement Therapy" (EPOCH-RRT) aimed to identify patient priorities and gaps in shared decision-making about dialysis, using structured interviews with questions about demographics, clinical history and patients' perception of their health. The goal of this study was to carry out the translation, cross-cultural adaptation and validation of the questionnaires used in the EPOCH-RRT Study for the Brazilian context. Method: This is a methodological study that consisted of the initial translation, synthesis of the translations, back translation, review by a committee of experts, pre-test and evaluation of the psychometric properties of the instrument. All ethical precepts were followed. Results: The questionnaires were translated, adapted and validated for the Brazilian context. Additionally, it was applied to 84 chronic renal patients on hemodialysis, peritoneal dialysis and outpatients. Discussion: There is a lack of an educational-therapeutic approach aimed at patients with CKD, and the EPOCH-RRT questionnaire can be a tool for Brazilian dialysis services to change this paradigm.

Resumo Introdução: A doença renal crônica (DRC) é um problema de saúde pública mundial. No Brasil, as taxas de incidência e prevalência da DRC dialítica aumentam progressivamente, mas o processo de transição apresenta-se como desafio para pacientes e cuidadores no enfrentamento da doença. Urgência dialítica, ausência de acesso planejado ou conhecimento prévio do tratamento é uma realidade para a maioria. Diretrizes recomendam que opções de tratamento devam incluir a preferência consciente de um paciente totalmente informado. No entanto, informação educacional pré-diálise é exceção, acarretando grande número de diálises iniciais não planejadas. O estudo original "Empowering Patients on Choices for Renal Replacement Therapy" (EPOCH-RRT) teve por objetivo identificar as prioridades do paciente e as lacunas na tomada de decisões compartilhadas sobre a diálise, utilizando entrevistas estruturadas, com questões sobre dados demográficos, história clínica e percepção dos pacientes sobre sua saúde. O objetivo desta pesquisa foi realizar a tradução, adaptação transcultural e validação dos questionários utilizados no Estudo EPOCH-RRT para o contexto brasileiro. Método: Trata-se de estudo metodológico que consistiu na tradução inicial, síntese das traduções, retro tradução, revisão por um comitê de especialistas, pré-teste e avaliação das propriedades psicométricas do instrumento. Todos os preceitos éticos foram seguidos. Resultados: Os questionários foram traduzidos, adaptados e validados para o contexto brasileiro. Adicionalmente, foi aplicado em 84 pacientes renais crônicos em hemodiálise, diálise peritoneal e ambulatoriais. Discussão: Há carência de enfoque educativo-terapêutico dirigido aos pacientes com DRC, e o questionário EPOCH-RRT pode ser uma ferramenta para serviços de diálise brasileiros mudarem esse paradigma.

The effect of positive thinking training on hope and adherence to treatment in hemodialysis patients: a randomized controlled trial.

BACKGROUND: Patients undergoing hemodialysis are exposed to psychological problems, such as despair, which in turn can be a trigger for them to abandon the treatment process. This study aimed to determine the effect of positive thinking training on hope and adherence to treatment in hemodialysis patients. METHODS: This randomized controlled trial was performed on 80 hemodialysis patients referred to two hemodialysis centers in Shiraz, Iran. They were randomly divided into an intervention and a control group. Eight sessions of positive thinking skills training carried out individually on the patients' bedsides. The primary and secondary outcomes were hope and adherence to treatment, respectively. The data were collected using Snyder Hope Questionnaire, End-Stage Renal Disease Adherence Questionnaire, laboratory tests, and weight measurements. Data were analyzed by Chi-square and Paired and Independent T-test using SPSS software version 18. RESULTS: After the intervention, the mean score of hope was significantly higher in the intervention group (42.1 ± 6.1) than in the control group (38.7 ± 6.5) (p = 0.024). Moreover, after the intervention, the mean score of adherence to treatment was significantly higher in the intervention group (1070.2 ± 80.1) compared to the control group (1018.4 ± 105.3) (p = 0.019). In addition, blood urea nitrogen, phosphate and inter-dialytic weight gain were lower in the intervention group compared to the control group after the intervention. CONCLUSIONS: The findings showed that positive thinking interventions could lead to improvement in hope and adherence to treatment in hemodialysis patients. Positive thinking training could be used in caring of hemodialysis patients to improve their hope and adherence to treatment. Trial registration RCT Registry: Iranian Registry of Clinical Trials; RCT registration number: IRCT20180915041044N1; Registration date: 19/12/2018.

Fatores associados à autoavaliação de saúde bucal por adultos em hemodiálise / Factors associated with self-rated oral health in adults with hemodialysis

Resumo Introdução Pacientes com insuficiência renal crônica podem apresentar prejuízos em sua saúde bucal em decorrência da própria doença, do tratamento e das alterações de estilo de vida associadas. Objetivo Avaliar os fatores associados à autoavaliação de saúde bucal ruim entre adultos com insuficiência renal crônica submetidos à hemodiálise. Método Estudo transversal com 243 adultos submetidos à hemodiálise em um hospital do sul de Minas Gerais nos anos de 2013 e 2014. O desfecho foi avaliado pelo autorrelato da condição bucal dicotomizada em boa (ótima/boa) e ruim (regular/ruim/péssima). As variáveis independentes incluíram condições sociodemográficas, saúde geral, saúde bucal e uso de serviços odontológicos, a partir de informações coletadas por meio de questionário. A associação entre o desfecho e as variáveis independentes foi testada por meio de modelos logísticos múltiplos com inclusão hierarquizada de variáveis. Resultados A prevalência de autoavaliação de saúde bucal ruim foi de 35,4%. Os mais jovens (p = 0,015), os que se submetem à hemodiálise há menos tempo (p = 0,016), têm halitose (p <0,001), necessitam de tratamento odontológico (p <0,001) e tiveram a última consulta odontológica por motivo diferente de dor (p = 0,027) expressaram maiores chances de autoavaliação de saúde bucal ruim, independentemente de condições sociodemográficas e de saúde. Conclusão Condições sociodemográficas, tempo em hemodiálise, agravos à saúde bucal e uso de serviços odontológicos influenciaram a autoavaliação da saúde bucal dos adultos submetidos à hemodiálise.

Abstract Background Patients with chronic renal failure may have their oral health impaired as a result of the disease itself, its treatment, and its associated lifestyle alterations. Objective To assess the factors associated with poor self-rated oral health among adults with chronic renal failure treated by hemodialysis. Method This is a cross-sectional study with 243 adults undergoing hemodialysis in a hospital in Minas Gerais, Brazil in 2013-2014. The outcome was assessed by the self-report of oral health categorized into good (excellent/good) and bad (fair/bad / very bad). The independent variables included sociodemographic conditions, general health, oral health, and the use of dental services were collected through a structured questionnaire. The association between the outcome and the independent variables was tested using multiple logistic models with hierarchical inclusion of variables. Results The prevalence of poor self-rated oral health was 35.4%. The youngest (p = 0.015), those who have undergone hemodialysis in the shortest time (p = 0.016), have halitosis (p <0.001), need dental treatment (p <0.001), and had their last dental appointment not for pain (p = 0.027) expressed higher odds of poor self-rated oral health, independently of sociodemographic and health conditions. Conclusion Sociodemographic conditions, time on hemodialysis, oral impairments, and use of dental services affected the oral health self-assessment among adults undergoing hemodialysis.

Fatores preditivos de infecção em pacientes renais crônicos em uso de cateteres venosos centrais / Predictive factors of infection in patients with chronic kidney disease using hemodialysis catheters

Resumo Contexto Infecção é a complicação mais frequente do uso de cateter venoso central em hemodiálise. Objetivo O propósito do trabalho foi determinar a taxa de incidência de infecções de cateteres venosos centrais para hemodiálise em um centro de diálise no estado do Amazonas, bem como seus fatores preditivos, além de traçar o perfil microbiológico dessas infecções. Métodos Trata-se de um estudo observacional, com dados coletados mensalmente e de forma prospectiva, por meio de entrevista e análise de prontuários de pacientes submetidos a hemodiálise por meio de cateteres venosos centrais em um centro de diálise durante um período de 12 meses. Resultados Foram analisados 96 cateteres venosos centrais, de 48 pacientes. Do total, foram 78 cateteres venosos não tunelizados (81,3%) e 18 cateteres venosos tunelizados (18,7%). Dos cateteres acompanhados, 53,1% foram trocados por motivo de infecção, sendo realizada hemocultura de 35,2% dos pacientes que apresentaram infecção de cateter. Quanto ao perfil microbiológico, das nove hemoculturas positivas, em cinco foram isoladas bactérias gram-negativas, e em quatro foram isoladas bactérias gram-positivas. A bactéria mais frequentemente isolada foi a Staphylococcus hominis, presente em 22,2% das hemoculturas positivas. Conclusão A taxa de incidência global de infecção de cateteres venosos centrais foi de 10,1 episódios por 1.000 dias de cateter, sendo de 15,1 nos cateteres não tunelizados e de 3,3 nos cateteres tunelizados. Os fatores preditivos identificados foram o uso de cateter venoso central não tunelizado e a realização de duas sessões de diálise semanais. Quanto ao perfil microbiológico, pouco mais da metade das bactérias isoladas foram gram-negativas.

Abstract Background Infection is the most frequent complication of central venous catheters used for hemodialysis. Objectives The purpose of this study was to the determine the central venous catheter-related infection rate at a dialysis center in the Brazilian state of Amazonas and to identify risk factors and the microbiological profile of the infections. Methods This was an observational study with prospective data collection over a 12-month period by chart analysis and face-to-face interviews with patients undergoing hemodialysis using central venous catheters at a dialysis center. Results 96 central venous catheters were analyzed in 48 patients. 78 of these were non-tunneled central venous catheters (81.3%) and 18 were tunneled central venous catheters (18.7%), 53.1% of the catheters were exchanged because of infection and blood cultures were obtained from 35.2% of the patients who had catheter-related infections. Gram-negative bacteria were isolated from five of the nine blood cultures in which there was bacterial growth and Gram-positive bacteria were isolated from the other four. The most commonly isolated bacteria was Staphylococcus hominis, found in 22.2% of positive blood cultures. Conclusion The overall hemodialysis venous catheter infection rate was 10.1 episodes/1000 catheter days, 15.1 episodes/1000 catheters days in non-tunneled catheters and 3.3 episodes/1000 catheters days in tunneled catheters. The infection predisposing factors identified were use of non-tunneled catheters and having 2 hemodialysis sessions per week. Regarding the microbiological profile, over half of the bacteria isolated were Gram-negative.

Executive summary of the Korean Society of Nephrology 2021 clinical practice guideline for optimal hemodialysis treatment.

The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists' support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient's condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There are also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).

Executive summary of the Korean Society of Nephrology 2021 clinical practice guideline for optimal hemodialysis treatment

The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists' support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient's condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There are also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).

Hemodiálisis vs Hemodiafiltración en línea / Hemodialysis vs Hemodiafiltration online

INTRODUCCIÓN. La incorporación de nuevas tecnologías como la hemodiafiltración en línea, han mejorado parámetros metabólicos/nutricionales en los pacientes que se encontraban en hemodiálisis convencional; en la actualidad no existen datos registrados en la población ecuatoriana que se encuentra sometida a esta clase de tecnologías. OBJETIVO. Comparar la evolución clínico-metabólica de pacientes que estaban en hemodiálisis convencional y cambiaron a hemodiafiltración en línea, determinar si es favorable la migración de la terapia hemodialítica difusiva a convectiva y establecer si el cambio de terapia dialítica ocasionó resultados favorables. MATERIALES Y MÉTODOS. Estudio analítico retrospectivo. Población y muestra de 38 pacientes enfermos renales crónicos en terapia de sustitución renal modalidad hemodiálisis convencional que cambiaron a hemodiafiltración en línea, independientemente del tiempo de diagnóstico y tratamiento en la unidad de hemodiálisis del Hospital de Especialidades Carlos Andrade Marín, Quito-Ecuador, durante el periodo marzo 2016 a marzo 2017. RESULTADOS. Los efectos nutricionales y metabólicos pudieron denotar mayor ponderación de resultados favorables en la modalidad de hemodiafiltración. En la estabilidad hemodinámica y la dosis de diálisis se evidenció una leve superioridad en la modalidad de hemodiafiltración en comparación a la Hemodiálisis. En las dosis administradas de Calcio, Hierro, Eritropoyetina y Calcitriol no existieron diferencias significativas entre las dos modalidades de tratamientos. CONCLUSIÓN. El cambio de modalidad de Hemodiálisis convencional a Hemodiafiltración en línea fue favorable, y mejoró los parámetros clínicos/metabólicos de los pacientes que requieren terapia de sustitución renal.

INTRODUCTION. The incorporation of new technologies such as online haemodiafiltration have improved metabolic/nutritional parameters in patients who were on conventional haemodialysis; At present, there are no registered data on the Ecuadorian population that is subjected to this kind of technology. OBJECTIVE. To compare the clinical-metabolic evolution of patients who were on conventional hemodialysis and changed to online hemodiafiltration, to determine if the migration from diffusive to convective hemodialysis therapy is favorable and to establish if the change in dialysis therapy caused favorable results. MATERIALS AND METHODS. Retrospective analytical study. Population and sample of 38 patients with chronic kidney disease in conventional hemodialysis modality renal replacement therapy who changed to online hemodiafiltration, regardless of the time of diagnosis and treatment in the hemodialysis unit of the Hospital de Especialidades Carlos Andrade Marín, Quito-Ecuador, during the period March 2016 to March 2017. RESULTS. The nutritional and metabolic effects could denote a greater weighting of favorable results in the hemodiafiltration modality. In hemodynamic stability and dialysis dose, a slight superiority was evidenced in the hemodiafiltration modality compared to hemodialysis. In the administered doses of Calcium, Iron, Erythropoietin and Calcitriol there were no significant differences between the two treatment modalities. CONCLUSION. The change of modality from conventional hemodialysis to online hemodiafiltration was favorable, and improved the clinical/metabolic parameters of patients requiring renal replacement therapy.

Influence of the Workload and Years of Experience of Nurses on Hemodialysis Quality Using Korean National Hemodialysis Adequacy Evaluation Data.

The aim of this study is to examine the influence of nurses' workload and years of experience on the rate of patients with normal calcium-phosphorus products levels and the adequacy evaluation grade of hemodialysis (HD) facilities using 2015 and 2018 national HD adequacy evaluation data. The data of 616 hospital-level outpatient HD facilities were analyzed using multiple linear regression and ordinal logistic regression. A higher rate of nurses with ≥2 years of HD experience was correlated with a higher rate of patients with normal calcium-phosphorus levels. As the average daily number of HD cases per nurse increased, the probability of HD facilities' receiving the higher adequacy evaluation grade decreased by 83% (odds ratio (OR)=.17, 95% confidence interval (CI)=.14-.22), whereas it increased by 4% as the rate of nurses with ≥2 years of HD experience increased by 1%p (OR=1.04, 95% CI=1.03-1.05). Reducing the nursing workload by maintaining sufficient nurses and increasing the rate of nurses with ≥2 years of HD experience would improve the quality of HD and patient outcomes.

Percutaneous Removal of Intracardiac Retained Hemodialysis Catheter: A Rare Complication of a Commonly Used Procedure.

Hemodialysis catheter fracture with distal embolization is a rare complication. The natural process of retained asymptomatic hemodialysis is unclear. This is a report of an iatrogenic fracture of the tip of the hemodialysis catheter in an adult patient who was successfully retrieved using an image-guided endovascular technique. In the event of catheter fracture with distal embolization, percutaneous retrieval is the treatment of choice.

Importance of Confirmatory Tests for Sars-Cov-2 Infection in Hemodialysis Patients: A Multicenter Mexican Registry.

Background: Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, patients with chronic kidney disease vulnerable to suffering more severe COVID-19 disease and worse outcomes have been identified. Objectives: Our study's aim was to determine the incidence, characteristics, and outcomes of SARS-CoV-2 infection in patients of hemodialysis (HD) units in Mexico and to describe the availability of confirmatory testing. Methods: This study was multicentric study of 19 HD units, conducted between March 2020 and March 2021. Results: From a total of 5779 patients, 955 (16.5%) cases of suspicious COVID-19 were detected; a SARS-CoV-2 reverse transcription polymerase chain reaction test was done in only 50.6% of patients. Forty-five percentages were hospitalized and 6% required invasive mechanical ventilation (IMV). There was no significant difference in mortality between confirmed (131/483) and suspicious (124/472) cases (p = 0.74). The percentage of patients in need of hospitalization, IMV, and deceased was greater than in the rest of the study population. Conclusions: The study revealed that 49.4% of the cases were not confirmed, a worrisome observation given that this is a highly vulnerable population (higher probability of contagion and worse outcomes), in which 100% of patients should have a confirmatory test.

Application effects of arteriovenous fistula cannulation by buttonhole technique with blunt needles in patients subjected to hemodialysis / 中国基层医药

Objective:To investigate the application effect of arteriovenous fistula cannulation by buttonhole technique with blunt needles in patients subjected to hemodialysis.Methods:Seventy-six patients who underwent hemodialysis in Hemodialysis Room, The First Hospital of Jiaxing between June 2016 and June 2019 were included in this study. They were randomly divided into control and observation groups ( n = 38/group). The control group was subjected to arteriovenous fistula cannulation using a regional puncture method. The observation group was subjected to arteriovenous fistula cannulation by buttonhole technique with blunt needles. One-time success rate of puncture was recorded in each group. The maximum transverse diameters of the fistula before and after 6 months of puncture were measured. Severity of pain at the time of puncture was evaluated using Visual Analogue Scale (VAS). Complications were recorded in each group. Patient compliance was investigated using a questionnaire. Patient's quality of life was evaluated using Kidney Disease Quality of Life Short Form 1.3. Results:One-time success rate of puncture in the observation group was significantly higher than that in the control group [97.37% (37/38) vs. 84.21% (32/38), χ2 = 3.93, P = 0.04]. The maximum transverse diameter of the fistula in the observation group was significantly smaller than that in the control group [(4.36 ± 0.11) mm vs. (7.26 ± 0.48) mm, t = 36.30, P < 0.01]. At 6 months after puncture, the maximum transverse diameter of the fistula in each group increased compared with that before puncture (both P < 0.05). The VAS score in the observation group was significantly lower than that in the control group [(0.82 ± 0.24) points vs. (3.11 ± 0.32) points, t = 35.29, P < 0.01]. The incidence of complications in the observation group was significantly lower than that in the control group [5.26% (2/38) vs. 21.05% (8/38), χ2 = 4.15, P = 0.04]. The compliance score in the observation group was significantly higher than that in the control group [(36.32 ± 3.21) points vs. (27.18 ± 2.69) points, t = 13.45, P < 0.01]. The scores of role limitations caused by physical health problems, pain, role limitations caused by emotional health problems in the observation group were significantly lower than those in the control group (all P < 0.05). The scores of physical functioning, general health perceptions, emotional well-being, social functioning, energy/fatigue, and overall health rating item in the observation group were significantly higher than those in the control group (all P < 0.05). Conclusion:Arteriovenous fistula cannulation by buttonhole technique with blunt needles can increase success rate of puncture, reduce pain, decrease the incidence of complications and exhibit protective effects on arteriovenous fistula, thereby improving patient's quality of life and increasing treatment compliance.

Repercusiones ocupacionales en personas con enfermedad renal crónica terminal que asisten a hemodiálisis: un marco de justicia ocupacional / Repercussões ocupacionais em pessoas com doença renal crônica terminal que fazem hemodiálise: um marco na justiça ocupacional / Occupational repercussions in people with end-stage chronic kidney disease who attend hemodialysis: an occupational justice framework

Resumen Objetivo Conocer las repercusiones ocupacionales que provoca el tratamiento de hemodiálisis en personas que padecen Enfermedad Renal Crónica Terminal (ERC) y de qué manera las políticas públicas en Chile, específicamente, Garantías Explícitas de Salud (GES) abordan las necesidades de esta población. Método Se utilizaron pautas de observación ambiental, notas de campo, entrevistas semiestructuradas a usuarios, usuarias y profesionales que se desempeñan en la Unidad de Hemodiálisis del Hospital Base de Valdivia, Chile. Además, se realizó un análisis documental que incluyó guías clínicas y normas técnicas de la Unidad de Hemodiálisis. Resultados Los datos se organizaron en 5 tópicos: Unidad de hemodiálisis Hospital Base Valdivia, Proceso de cambio y adaptación, Rutinas y hábitos, Roles y Suficiencia de políticas públicas. Se evidencian quiebres en las historias ocupacionales, dificultades en el proceso de adaptación y la necesidad de un abordaje integral que no es considerado por las políticas públicas. Conclusion Se propone la necesidad de un tratamiento multidisciplinario que considere un acompañamiento en el proceso de adaptación ocupacional, en especial en etapas tempranas después del diagnóstico, a fin de prevenir el impacto en la calidad de vida de esta población, así como la necesidad de desarrollar más estudios acerca del tema.

Resumo Objetivo Conhecer as repercussões ocupacionais do tratamento hemodialítico em pessoas com Doença Renal Crônica Terminal e como as políticas públicas no Chile, especificamente as Garantias Explícitas de Saúde atendem às necessidades dessa população. Método Foram utilizadas diretrizes de observação ambiental, notas de campo, entrevistas semiestruturadas com usuários, usuários e profissionais que atuam na Unidade de Hemodiálise do Hospital Base de Valdívia, Chile. Além disso, foi realizada uma análise documental que incluiu diretrizes clínicas e normas técnicas da Unidade de Hemodiálise. Resultados Os dados foram organizados em 5 tópicos: Unidade de hemodiálise da Base Hospitalar Valdívia, Processo de mudança e adaptação, Rotinas e hábitos, Papéis e Suficiência das políticas públicas. São evidenciadas quebras nas histórias ocupacionais, dificuldades no processo de adaptação e a necessidade de uma abordagem abrangente que não é contemplada pelas políticas públicas. Conclusão Propõe-se a necessidade de um tratamento multiprofissional que considere um acompanhamento no processo de adaptação ocupacional, principalmente nas fases iniciais após o diagnóstico, a fim de prevenir o impacto na qualidade de vida desta população, bem como a necessidade de desenvolver mais estudos sobre o assunto.

Abstract Objective To know the occupational repercussions caused by hemodialysis treatment in people suffering from Terminal Chronic Kidney Disease and how public policies in Chile, specifically, Explicit Health Guarantees address the needs of this population. Method Environmental observation guidelines, field notes, and semi-structured interviews with users and professionals who work in the Hemodialysis Unit of the Hospital Base de Valdivia, Chile were used. In addition, a documentary analysis was carried out that included clinical guidelines and technical standards of the Hemodialysis Unit. Results The data were organized into 5 topics: Hospital Base Valdivia hemodialysis unit, Process of change and adaptation, Routines and habits, Roles and Sufficiency of public policies. Breaks in occupational histories, difficulties in the adaptation process and the need for a comprehensive approach that is not considered by public policies are evidenced. Conclusion The need for a multidisciplinary treatment is proposed that considers an accompaniment in the process of occupational adaptation, especially in the early stages after diagnosis in order to prevent the impact on the quality of life of this population, as well as the need to develop more studies on the subject.

Executive Summary of the Korean Society of Nephrology 2021 Clinical Practice Guideline for Optimal Hemodialysis Treatment.

The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists' support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient's condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There is also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).

Chronic hemodialysis patients: A comparison of clinical, laboratory and nutritional parameters among elderly and non-elderly patients

ABSTRACT Aim: To compare nutritional, clinical and laboratory parameters data among elderly and non-elderly patients on hemodialysis. Methods: It is a cross-sectional study, with a sample of 34 patients (17 non-elderly participants between 18 to 59 years of age, and 17 elderly participants aged 60 years or older), from the Nephrology Unit, Hospital Santa Casa de Misericórdia, Pelotas/RS/BR. Demographic, socioeconomic, clinical, laboratory, anthropometric data and information on food consumption were collected. Results: Most elderly and non-elderly patients had low income and education. Among elderly participants, weight values, pre and post-dialysis, interdialytic weight gain, median diastolic blood pressure pre and post-dialysis and urea, were higher than among the non-elderly. About 65% of the non-elderly and 70.6% of the elderly subjects had inadequate caloric intake. The same occurred with protein intake, for which 58.8% of the non-elderly and 82.3% of the elderly patients presented inadequate protein intake. Conclusion: There was a tendency of weight gain in the elderly, which may increase the risks of treatment. Evidence indicates an association between the intake of energy and protein in the diet of patients on hemodialysis, requiring an adequate diet and dialysis, in order to avoid complications related to kidney disease.

RESUMEN Objetivos: Comparar parámetros nutricionales, clínicos y de laboratorio de pacientes ancianos y no ancianos sometidos a hemodiálisis. Métodos: Estudio transversal, realizado con una muestra de 34 pacientes, de los cuales 17 eran no ancianos de 18 años y más y menos de 60 años y 17 ancianos de 60 años y más, de la Unidad de Nefrología del Hospital Santa Casa. de Misericórdia de Pelotas / RS / BR. Se recopilaron datos demográficos, socioeconómicos, clínicos, de laboratorio, antropométricos y de consumo de alimentos. Resultados: La mayoría de los pacientes ancianos y no ancianos eran de bajos ingresos y educación. En los ancianos, se encontraron valores de peso, pre y posdiálisis, aumento de peso interdialítico, mediana de la presión arterial diastólica pre y posdiálisis y urea más alta en comparación con los no ancianos. Aproximadamente el 65% de las personas no ancianas y el 70,6% de las personas mayores presentaban una ingesta calórica inadecuada, lo mismo ocurrió con la ingesta proteica, donde el 58,8% de las personas no ancianas y el 82,3% de las personas mayores presentaban una ingesta proteica inadecuada. Conclusión: Hubo una tendencia al aumento de peso en los ancianos, lo que puede traer riesgos al tratamiento. La evidencia indica una asociación entre la ingesta energética y proteica en la dieta de pacientes en hemodiálisis, requiriendo adaptación de la dieta y diálisis para evitar complicaciones relacionadas con la enfermedad renal.

COVID-19 in dialysis units: A comprehensive review.

The coronavirus disease 2019 (COVID-19) pandemic has been challenging for healthcare professionals worldwide. One of the populations affected by the pandemic are patients on renal replacement therapy, as kidney disease is an independent risk factor for severe COVID-19 and maintenance dialysis (a life-sustaining therapy) cannot be interrupted in the vast majority of cases. Over the past months, several authors and medical societies have published recommendations and guidelines on the management of this population. This article is a comprehensive review regarding the measures to prevent, contain and deal with a COVID-19 pandemic in the dialysis setting. We recapitulate the epidemiology and pathophysiology of COVID-19 in kidney dysfunction and present the main recommendations concerning the screening of healthcare personnel, dialysis patients and visitors as well as measures to improve the safety of the dialysis facilities' environments. In addition to preventive measures, this article briefly describes actions directed towards management of an outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within a dialysis facility, the management of complications in dialysis patients with COVID-19 and overall data regarding the management of children with kidney disease.