Pain during Arteriovenous Fistula Cannulation in Chronic Renal Patients on Hemodialysis

This study aimed to evaluate pain intensity in chronic renal patients under hemodialysis during the arteriovenous fistula cannulation. It was a cross-sectional study conducted in a hemodialysis clinic in the second semester of 2014. 70 individuals participated in the research and were assessed by the visual analogue scale. The project was approved with opinion number 453.508-2013. During cannulation, the pain reported was moderate in 58.5% of patients, intense in 30% and mild in 11.5%. There was no association between the occurrence of pain in relation to gender, shift and time of hemodialysis. The study points out to the need for pre-cannulation analgesia to improve comfort during the procedure.

Analyzing risk factors for postoperative acute renal failure requiring dialysis after valve surgery

Objective To evaluate risk factors for postoperative acute renal failure requiring dialysis (ARF-D) after hear valve surgery. Methods Adult patients (age≤18 years) underwent valve surgery with preoperative serum creati nine 【 300 μmol / L were included between January 2005 and December 2008. Fifty patients developed ARF-D

Coronary sinus endocarditis in a hemodialysis patient:A case report and review of literature

BACKGROUND Infective endocarditis is more common in hemodialysis patients than in the general population and is sometimes difficult to diagnose.Isolated coronary sinus(CS)vegetation is extremely rare and has a good prognosis,but complicated CS vegetation may have a poorer clinical course.We report a case of CS vegetation accidentally found via echocardiography in a hemodialysis patient with undifferentiated shock.The CS vegetation may have been caused by endocardial denudation due to tricuspid regurgitant jet and subsequent bacteremia.CASE SUMMARY A 91-year-old man with dyspnea and hypotension was transferred from a nursing hospital.He was on regular hemodialysis and had a history of severe grade of tricuspid regurgitation.There was no leukocytosis or fever upon admission.Repetitive and sequential blood cultures revealed absence of microorganism growth.Chest computed tomography showed lung consolidation and a large pleural effusion.A mobile band-like mass on the CS,suggestive of vegetation,was observed on echocardiography.We diagnosed him with infective endocarditis involving the CS,pneumonia,and septic shock based on echocardiographic,radiographic,and clinical findings.Infusion of broad-spectrum antibiotics,fluid resuscitation,inotropic support,and ventilator care were performed.However,the patient died from uncontrolled infection and septic shock.CONCLUSION CS vegetation can be fatal in hemodialysis patients with impaired immune systems,especially when it delays the diagnosis.

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 lifesustaining 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.

Nursing Diagnostics of Nutrition Domain of NANDA International in Hemodialysis Patients

Introduction: The dialysis causes the loss of the nutrients and the elevation of catabolism, thus, patients in dialysis have at high risk for the loss of body reserves of protein and energy. Objective: To identify nursing diagnoses of nutrition domain of NANDA International in hemodialysis patients and to correlate them to the socioeconomic and clinical data. Design: Cross-sectional study. Setting: Performed in a large university hospital in northeastern Brazil. Participants: The first stage was carried out with 50 patients, selected with the following inclusion criteria: Being hospitalized and undergoing hemodialysis in that hospital;aged 18 years old or over;being conscious and oriented. Exclusion criteria were patients undergoing hemodialysis in that hospital with external service, pregnant women and patients being treated by plasmapheresis. In the second stage, participants were three nursing specialists in nephrology and nursing diagnoses. Methods: The defining characteristics of the nursing diagnoses inserted in the nutrition domain were observed in patients and then these data were judged by nurses, in order to identify diagnoses present in each patient. The Chi-square, Fisher’s exact and Mann-Whitney tests were used in the analysis of the relationship of socioeconomic and clinical data, with an adopted p value of p = 0.001), origin (p = 0.014), religion (p = 0.046) and income (p = 0.039), respectively. Conclusion: The variables that showed significant association were risk of impaired liver function and gender;imbalanced nutrition: More than body requirements and origin requirements;risk for deficient fluid volume and religion;and deficient fluid volume and income.

Analysis of current status of and barriers to exercise participation among patients on maintenance hemodialysis

Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method.The data of patients on MHD were collected using the general information questionnaire,Physical Activity Rating Scale,Exercise Benefits/Barriers Scale(EBBS),and Exercise Self-Efficacy Scale(ESES).The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models.Results:Patients on MHD had a low exercise volume score of 13.71±0.68 points and a medium EBBS score of 63.36±0.40 points.Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects,including low monthly household income per capita(odds ratio[OR]=86.741,95%confidence interval[CI][1.164-6.465],P=0.042),primary underlying disease of diabetic nephropathy(OR=45.993,95%CI[1.353-1.564],P=0.033),the belief that“fatigue in lower extremities hinders exercise”(OR=4.697,95%CI[1.127-19.585],P=0.034),and the belief that“physical exercise bringing optimistic and positive life attitude”(OR=0.074,95%CI[0.007-0.830],P=0.035).Conclusions:Since patients on MHD had low physical exercise volume,the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD.Therefore,feasible and effective intervention measures can be formulated based on ESES in clinical nursing.

Effect of renal function and hemodialysis on the serum tumor markers in patients with chronic kidney disease

In patients with chronic renal failure,whether they have had hemodialysis or not,the specificity of some of the serum tumor markers for the diagnosis of the corresponding tumors is decreased while others remain as valuable as they are in patients with normal kidney function.The detection of tumor markers is extensively used for the diagnosis of corresponding tumors.It has been recently shown that some tumor markers are higher in patients with chronic kidney disease(CKD)than in the normal population.The effects of renal function and hemodialysis were examined on serum levels of some of the tumor markers including CEA,CA_(199),CA_(125),AFP,CA_(153),CA_(724),CYFRA21-1,NSE,SCC-Ag,PSA,and fPSA.The 232 non-dialysis patients with CKD and 37 chronic uremic patients treated with maintenance hemodialysis were enrolled in this study.The 232 non-dialysis patients were divided into three groups according to their Ccr.In group 1,Ccr wash25 mL/min.In group 2,Ccr was between 25 and 50 mL/min.In group 3,Ccr wasi50 mL/min.The male patients were also divided into three groups to compare the serum levels of PSA and fPSA among the three groups.Nine tumor markers in 37 uremic patients were tested.For comparison,37 non-dialysis patients with similar Ccr of the same age and gender served as controls.There existed significant differences in serum levels of CEA,CA_(199),CYFRA21-1,NSE,and SCC-Ag among different Ccr groups and the markers bore a negative correlation with Ccr.There were no significant differences among the three groups in the serum concentrations of CA_(125),AFP,CA_(153),CA_(724),PSA and fPSA.The serum levels of CA125 and NSE were significantly higher(P<0.01)in hemodialysis patients than in the nondialysis control patients.In patients with chronic renal failure,who were or were not on hemodialysis,the specificity of serum CEA,CA_(199),CYFRA21-1,NSE,CA_(125) and SCC-Ag for the diagnosis of the corresponding tumors was decreased while serum AFP,CA153,CA724,PSA and fPSA were as valuable as they were in patients with normal kidney function.Hemodialysis further increased the serum level of CA_(125) and NSE.

Acute kidney injury and electrolyte disorders in COVID-19

Acute kidney injury(AKI)and electrolyte disorders are important complications of hospitalized coronavirus disease 2019(COVID-19)patients.AKI is thought to occur due to multiple pathophysiological mechanisms,such as multiple organ dysfunction(mainly cardiac and respiratory),direct viral entry in the renal tubules,and cytokine release syndrome.AKI is present in approximately one in every ten hospitalized COVID-19 patients.The incidence rates of AKI increase in patients who are admitted to the intensive care unit(ICU),with levels higher than 50%.Additionally,renal replacement therapy(RRT)is used in 7%of all AKI cases,but in nearly 20%of patients admitted to an ICU.COVID-19 patients with AKI are considered moderate-to-severe cases and are managed with multiple interdisciplinary conducts.AKI acts as a risk factor for mortality in severe acute respiratory syndrome coronavirus 2 infection,especially when RRT is needed.Electrolyte disorders are also common manifestations in hospitalized COVID-19 patients,mainly hyponatremia,hypokalemia,and hypocalcemia.Hyponatremia occurs due to a combination of syndrome of inappropriate secretion of antidiuretic hormone and gastrointestinal fluid loss from vomiting and diarrhea.When it comes to hypokalemia,its mechanism is not fully understood but may derive from hyperaldosteronism due to renin angiotensin aldosterone system overstimulation and gastrointestinal fluid loss as well.The clinical features of hypokalemia in COVID-19 are similar to those in other conditions.Hypocalcemia is the most common electrolyte disorder in COVID-19 and seems to occur because of vitamin D deficiency and parathyroid imbalance.It is also highly associated with longer hospital and ICU stay.

Water and sodium restriction on cardiovascular disease in young chronic hemodialysis patients

Background Left ventricular hypertrophy （LVH） is an independent predictor of morbidity and mortality in chronic hemodialysis （CHD） patients. It remains unclear whether efforts to correct fluid overload in young CHD can reverse LVH. This prospective single-center cohort study evaluated left ventricular masses index （LVMI） evolution in fluid overloaded young CHD patients with or without water-sodium control. Methods A total of 106 young patients aged between 22 and 44 years on CHD were enrolled in this prospective, control study. Patients were divided into three groups according to the percentage of interdialytic weight gain （PIDWG （%） = 100% x （predialysis weight - dry weight）/dry weight） at baseline. Thirty-six patients with PIDWG more than 5% received health education to restrict water-sodium intake strictly （Group I）. Other 36 patients with comparable fluid status levels （the PIDWG more than 5%） did not receive health education to restrict water-sodium intake strictly （Group Ⅱ） and those with PIDWG less than 5% （Group Ⅲ, n=34） were sewed as controls. Echocardiographic studies were performed to evaluate LVMI at baseline and then after 1, 3 and 6 months. The total follow-up time was 6 months. Results There was no significant difference in clinical data （such as age, gender, aetiology of renal failure and nutritional state, etc.） among the three groups at baseline. At baseline, the prevalence of LVH in Group I, Ⅱ and Ⅲ was 75.0%, 72.2% and 55.9%, respectively. LVMI was directly correlated with PIDWG （r = 0.779, P 〈0.01）. After 6 months, the PIDWG in Group I decreased in mean by （3.77±1.09）%, and LVMI decreased in mean by （27.59±12.15） g/m2. The prevalence of LVH decreased in mean by 25.0%, and the blood pressure decreased in mean by （14.69±11.50） mmHg/ （7.14±7.51） mmHg. The medication category and total medication frequency of hypotensive drugs significantly decreased in Group I at 6 months. However the urine volume and the levels of serum creatinine and serum albumin in Group I were not significantly different compared to the baseline. The level of LVMI in Group Ⅱ was significantly increased after 6 months compared with the baseline. After 6 months, the level of LVMI in Group Ⅲ were not significantly different compared with the baseline. Conclusions A high prevalence of LVH was present in young CHD patients, and was associated with fluid overload. Reduction fuild overload with water-sodium control can reverse LVH in young CHD patients.

Good news for end stage renal disease patients

End stage renal disease （ESRD）, with a prevalence in China of about 200-250 cases per million, is one of the major diseases that seriously threaten human health and cause poverty. Recently, with the advancement of healthcare system reform in China, basic medical insurance now covers over 95% of urban and rural residents, and a high-reimbursement system for the catastrophic diseases including ESRD has been established. The improvement of healthcare policy calls on the medical community to strengthen healthcare service capability for severe illness,

Thrombosis of the superior vena cava and auxiliary branches in patients with indwelling catheterization of the internal jugular vein

Background Central venous thrombosis is a serious and life-threatening complication in hemodialysis （HD） patients with an indwelling catheter. The present study aimed to investigate the prevalence and characteristics of thrombosis of the superior vena cava and auxiliary branches in Chinese HD patients with an indwelling internal jugular venous catheter and to explore its risk factors.Methods Fifty-four patients on maintenance hemodialysis （MHD） with an indwelling catheter were enrolled in this cross-sectional study. The thrombosis of the internal jugular vein, subclavical vein, brachiocephalic vein and superior vena cava was assessed by vascular ultrasound. Collected were data on age, gender, ultrafiltration volume, Kt/V, blood pressure, levels of hemoglobin, serum albumin, lipid, calcium, and phosphorus, and parathyroid hormone.Results The patients were given short-or long-term double lumen central venous catheters. Among them, 42 patients had the catheter placed into the right internal jugular vein, and 12 patients into the left internal jugular vein. Different degrees of central venous thrombosis were found in 33 patients （61.1%）. The prevalence of thrombosis in the jugular vein, brachiocephalic vein, subclavical vein and superior vena cava was 61.1% （33/54）, 44.4% （24/54）, 16.7% （9/54） and 5.6% （3/54）, respectively. Among the 33 HD patients with central venous thrombosis, the percentages for one, two, three and four affected veins were 27.3% （9/33）, 45.4% （15/33）, 18.2% （6/33） and 9.1% （3/33）, respectively. Twelve （12/33, 36.4%） of the 33 HD patients with central venous thrombosis had clinical symptoms. Nine patients （27.3%） had edema of the upper extremity and 3 （9.1%） had new-onset symptoms of pulmonary embolism such as cough, chest distress and short breath. The incidences of diabetes mellitus and malignant tumor and levels of lipoprotein a and homocysteic acid were significantly higher in the HD patients with central venous thrombosis than in those without central venous thrombosis. Logistic regressive analysis revealed that high level of homocysteic acid was the important risk factor for central venous thrombosis in HD patients with indwelling catheterization of the internal jugular vein.Conclusions The prevalence of central venous thrombosis in Chinese HD patients with indwelling catheterization of the internal jugular vein is quite high, especially in those patients with diabetes mellitus, malignant tumor, high levels of serum lipoprotein and homocysteic acid. Its clinical symptoms are insidious but dangerous. High level of homocysteic acid may be the important risk factor for central venous thrombosis in Chinese HD patients with indwelling catheterization of the internal jugular vein.