Effect of On-Line Hemodiafiltration on Dry Weight Adjustment in Intradialytic Hypotension-Prone Patients: Comparative Study of Conventional Hemodialysis and On-Line Hemodiafiltration

Introduction: Correct adjustment of dry weight after hemodialysis (HD) with no signs of hypervolemia is important. Intradialytic hypotension (IDH) is the most common complication during HD. IDH occurs in 15% to 30% and possibly in up to 50% of dialysis sessions. IDH augments mortality essentially due to chronic overhydration and the inability to reach the proper dry weight. On-line hemodiafiltration (ol-HDF) has been reported to reduce the frequency of IDH. The aim of this study was to assess the effect of ol-HDF on hemodynamic stability and dry weight adjustment compared with low-flux HD. Methods: IDH-prone HD patients at our center were enrolled. This study was designed as a crossover trial with two phases (A arm: low-flux HD for 8 weeks followed by ol-HDF for 8 weeks vs. B arm: ol-HDF for 8 weeks followed by low-flux HD for 8 weeks) and two treatment arms (ol-HDF vs. low-flux HD), each phase lasting 8 weeks. We measured the proportion of body water using a body composition monitor (BCM). Results: In a comparison of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) reductions from the baseline blood pressure between the HD and ol-HDF groups, statistically significant differences were observed only in the SBP of the B arm (SBP: HD vs. HDF, -9.83 ± 6.64 vs. -4.62 ± 1.61 mmHg, p = 0.036;DBP: HD vs. HDF, -3.29 ± 4.05 vs. -1.86 ± 1.49 mmHg, p = 0.261). Neither the mean of the interdialytic body weight gains nor the frequency of IDH was different between the A and B arms (p = 0.817 and p = 0.562, respectively). In terms of dialysis modality, there were no significant differences in the amount of overhydration between the conventional HD and ol-HDF groups during the two study phases, as measured by the BCM (A arm: p = 0.875, B arm: p = 0.655). Conclusion: Our study did not show a better benefit of ol-HDF to reach the dry weight compared with low-flux HD in IDH-prone patients.

Filtration performance and modeling of granular bed for dust removal from coal pyrolytic vapors

Dust removal from pyrolytic vapors at high temperatures is an obstacle to the industrialization of the coal pyrolysis process.In this work,a granular bed with expanded perlites as filtration media was designed and integrated into a 10 t·d^(–1)coal pyrolysis facility.The testing results showed that around 97.56%dust collection efficiency was achieved.As a result,dust content in tar was significantly lowered.The pressure drop of the granular bed maintained in the range of 356 Pa to 489 Pa.The dust size in the effluent after filtration exhibited a bimodal distribution,which was attributed to the heterogeneity of the dust components.The effects of filtration bed on pyrolytic product yields were also discussed.A modified filtration model based on the macroscopic phenomenological theory was proposed to describe the performance of the granular bed.The computation results were well agreed with the experimental data.

Deep bed filtration model for cake filtration and erosion

Many phenomena in nature and technology are associated with the filtration of suspensions and colloids in porous media. Two main types of particle deposition,namely, cake filtration at the inlet and deep bed filtration throughout the entire porous medium, are studied by different models. A unified approach for the transport and deposition of particles based on the deep bed filtration model is proposed. A variable suspension flow rate, proportional to the number of free pores at the inlet of the porous medium, is considered. To model cake filtration, this flow rate is introduced into the mass balance equation of deep bed filtration. For the cake filtration without deposit erosion,the suspension flow rate decreases to zero, and the suspension does not penetrate deep into the porous medium. In the case of the cake filtration with erosion, the suspension flow rate is nonzero, and the deposit is distributed throughout the entire porous medium. An exact solution is obtained for a constant filtration function. The method of characteristics is used to construct the asymptotics of the concentration front of suspended and retained particles for a filtration function in a general form. Explicit formulae are obtained for a linear filtration function. The properties of these solutions are studied in detail.

Ablation behaviour and mechanical performance of ZrB_(2)-ZrC-SiC modified carbon/carbon composites prepared by vacuum infiltration combined with reactive melt infiltration

The development of advanced aircraft relies on high performance thermal-structural materials,and carbon/carbon com-posites(C/C)composited with ultrahigh-temperature ceramics are ideal candidates.However,the traditional routes of compositing are either inefficient and expensive or lead to a non-uniform distribution of ceramics in the matrix.Compared with the traditional C/C-ZrC-SiC composites prepared by the reactive melt infiltration of ZrSi_(2),C/C-ZrB_(2)-ZrC-SiC composites prepared by the vacuum infiltration of ZrB_(2) combined with reactive melt infiltration have the higher content and more uniform distribution of the introduced ceramic phases.The mass and linear ablation rates of the C/C-ZrB_(2)-ZrC-SiC composites were respectively 68.9%and 29.7%lower than those of C/C-ZrC-SiC composites prepared by reactive melt infiltration.The ablation performance was improved because the volatilization of B_(2)O_(3),removes some of the heat,and the more uniformly distributed ZrO_(2),that helps produce a ZrO2-SiO2 continu-ous protective layer,hinders oxygen infiltration and decreases ablation.

Refining safety considerations for intradialytic blood flow restriction exercise. Commentary on “Concerns on the application of blood-flow restriction resistance exercise and thrombosis risk in hemodialysis patients”

I read with great interest the article“Concerns on the application of blood flow restriction resistance exercise and thrombosis risk in hemodialysis patients”by Correa et al.1 The study presents complementary data from a previous randomized controlled trial,2 exploring the application of intradialytic blood flow restriction exercise for hemodialysis patients.

Concerns about the application of resistance exercise with blood-flow restriction and thrombosis risk in hemodialysis patients

Background:Hemodialysis(HD) per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR) exercise in HD patients,identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model.The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise(RE) with BFR on this molecule.Methods:Two hundred and six HD patients volunteered for this study(all with a glomerular filtration rate of <15 mL/min/1.73 m2).The RE+BFR session consisted of 50% arterial occlusion pressure during 50 min sessions of HD(intradialytic exercise).RE repetitions included concentric and eccentric lifting phases(each lasting 2 s) and were supervised by a strength and conditioning specialist.Results:Several variables were associated with elevated levels of D-dimer,including higher blood glucose,citrate use,recent cardiovascular events,recent intercurrents,higher inflammatory status,catheter as vascular access,older patients(>70 years old),and HD vintage.Furthermore,RE+BFR significantly increases D-dimer after 4 h.Patients with borderline baseline D-dimer levels(400-490 ng/mL) displayed increased risk of elevating D-dimer over the normal range(≥500 ng/mL).Conclusion:These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE+BFR.D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE+BFR.

A high Li-ion diffusion kinetics in multidimensional and compact-structured electrodes via vacuum filtration casting

Manufacturing process,diffusion co-efficient and areal capacity are the three main criteria for regulating thick electrodes for lithium-ion batteries(LIBs).However,simultaneously regulating these criteria for LIBs is desirable but remains a significant challenge.In this work,niobium pentoxide(Nb_(2)O_(5))anode and lithium iron phosphate(LiFePO_(4))cathode materials were chosen as the model materials and demonstrate that these three parameters can be simultaneously modulated by incorporation of micro-carbon fibers(MCF)and carbon nanotubes(CNT)with both Nb_(2)O_(5) and LFP via vacuum filtration approach.Both as-prepared MNC-20 anode and MLC-20 cathode achieves high reversible areal capacity of≈5.4 m A h cm^(-2)@0.1 C and outstanding Li-ion diffusion coefficients of≈10~(-8)cm~2 s~(-1)in the half-cell configuration.The assembled MNC-20‖MLC-20 full cell LIB delivers maximum energy and power densities of244.04 W h kg^(-1)and 108.86 W kg^(-1),respectively.The excellent electrochemical properties of the asprepared thick electrodes can be attributed to the highly conductive,mechanical compactness and multidimensional mutual effects of the MCF,CNT and active materials that facilitates rapid Li-ion diffusion kinetics.Furthermore,electrochemical impedance spectroscopy(EIS),symmetric cells analysis,and insitu Raman techniques clearly validates the enhanced Li-ion diffusion kinetics in the present architecture.

Machine learning-based comparison of factors influencing estimated glomerular filtration rate in Chinese women with or without nonalcoholic fatty liver

BACKGROUND The prevalence of non-alcoholic fatty liver(NAFLD)has increased recently.Subjects with NAFLD are known to have higher chance for renal function impairment.Many past studies used traditional multiple linear regression(MLR)to identify risk factors for decreased estimated glomerular filtration rate(eGFR).However,medical research is increasingly relying on emerging machine learning(Mach-L)methods.The present study enrolled healthy women to identify factors affecting eGFR in subjects with and without NAFLD(NAFLD+,NAFLD-)and to rank their importance.AIM To uses three different Mach-L methods to identify key impact factors for eGFR in healthy women with and without NAFLD.METHODS A total of 65535 healthy female study participants were enrolled from the Taiwan MJ cohort,accounting for 32 independent variables including demographic,biochemistry and lifestyle parameters(independent variables),while eGFR was used as the dependent variable.Aside from MLR,three Mach-L methods were applied,including stochastic gradient boosting,eXtreme gradient boosting and elastic net.Errors of estimation were used to define method accuracy,where smaller degree of error indicated better model performance.RESULTS Income,albumin,eGFR,High density lipoprotein-Cholesterol,phosphorus,forced expiratory volume in one second(FEV1),and sleep time were all lower in the NAFLD+group,while other factors were all significantly higher except for smoking area.Mach-L had lower estimation errors,thus outperforming MLR.In Model 1,age,uric acid(UA),FEV1,plasma calcium level(Ca),plasma albumin level(Alb)and T-bilirubin were the most important factors in the NAFLD+group,as opposed to age,UA,FEV1,Alb,lactic dehydrogenase(LDH)and Ca for the NAFLD-group.Given the importance percentage was much higher than the 2nd important factor,we built Model 2 by removing age.CONCLUSION The eGFR were lower in the NAFLD+group compared to the NAFLD-group,with age being was the most important impact factor in both groups of healthy Chinese women,followed by LDH,UA,FEV1 and Alb.However,for the NAFLD-group,TSH and SBP were the 5th and 6th most important factors,as opposed to Ca and BF in the NAFLD+group.

Sleep quality in middle-aged and elderly hemodialysis patients:Impact of a structured nursing intervention program

BACKGROUND Poor sleep quality is common among hemodialysis patients and can significantly impact their well-being.This study aimed to evaluate the effectiveness of a structured nursing intervention program in improving sleep quality in middleaged and elderly hemodialysis patients.AIM To evaluate the impact of nursing intervention on sleep quality in hemodialysis patients.METHODS This cross-sectional study was conducted in a tertiary hospital,the First Affiliated Hospital of Nanchang University,in 2023.This study included 105 middle-aged and elderly hemodialysis patients aged≥45 years who underwent maintenance hemodialysis for at least 3 mo,utilizing the Pittsburgh Sleep Quality Index(PSQI)to identify poor sleepers.Those identified underwent a 12-wk nursing intervention program focusing on education,relaxation techniques,and counseling.Post-intervention,sleep quality was reassessed using the PSQI.RESULTS The study found that 68.6%of hemodialysis patients were poor sleepers.Following the 12-wk nursing intervention program,there was a significant decrease in the mean global PSQI score from 8.9±3.2 to 5.1±2.7(P<0.001),indicating improved sleep quality.This demonstrated the effectiveness of the structured nursing intervention in enhancing sleep quality for middle-aged and elderly hemodialysis patients.CONCLUSION The structured nursing intervention program focusing on sleep hygiene education,relaxation techniques,and counseling effectively improved sleep quality among middle-aged and elderly hemodialysis patients.The significant decrease in the mean global PSQI score post-intervention indicates the positive impact of tailored nursing interventions in addressing poor sleep quality in this patient population.These findings emphasize the importance of implementing targeted nursing interventions to enhance the quality of life for hemodialysis patients by addressing the prevalent issue of poor sleep quality.

Endogenous Candida albicans endophthalmitis in a patient with chronic renal failure on hemodialysis

Dear Editor,We report a rare case of endogenous endophthalmitis caused by Candida albicans in a patient with chronic renal failure concomitant hemodialysis.A 71-year-old man with a history of hypertension and 2-year chronic renal failure on hemodialysis via a native arteriovenous fistula(AVF)was presented to the local hospital due to fever 3wk ago.No pathogens were detected through blood culture on admission,and his fever gradually subsided with intravenous ceftriaxone sodium.After a week of fever,he experienced progressive blurred vision in both eyes,accompanied by pain and headaches.Subsequent magnetic resonance imaging(MRI)of the brain revealed sinusitis.He had not undergone any previous eye surgeries or trauma.

Ferritin and mortality in hemodialysis patients with COVID-19:A systematic review and meta-analysis

Objective:To investigate the difference in serum ferritin levels between deceased and surviving regular hemodialysis patients with COVID-19.Methods:We conducted a systematic search across four databases following the PRISMA statement guidelines.Studies reporting ferritin levels and mortality of regular hemodialysis patients with COVID-19 were included.Employing the random-effects model,we performed a meta-analysis to determine the mean difference in serum ferritin levels between the studied groups,along with their corresponding 95%confidence intervals.The meta-analysis was carried out using Review Manager 5.4 and Stata 16.Results:A total of 1013 patients from seven studies were included in this study.Our meta-analysis showed higher mean serum ferritin in the deceased compared to surviving regular hemodialysis patients with COVID-19,with a mean difference of 449.43 ng/mL[95%CI(244.07,654.80),P<0.0001;I2=58%,P=0.003].Conclusions:Our study found a higher mean of serum ferritin levels in the deceased compared to surviving regular hemodialysis patients with COVID-19.

Antioxidants Enzymes Activities and NO Levels in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis—A Comparative Study

It consists of a retrospective study with twenty-two individuals diagnosed with DRC: fourteen HD and eight CAPD, followed up in the dialysis center of Antonio Pedro University Hospital (HUAP) of Fluminense Federal University (UFF), between 2015 and 2017. Fifteen healthy control (HC) subjects were included, without diagnosed CKD. Patients with HIV positive, hepatitis A, B, and C, pregnant, cancer, smokers, alcoholics and those exposed to X-rays in the last 3 months, were excluded. Objectives: As oxidative stress and endothelial dysfunction may be linked to the higher prevalence of CVD in CKD patients, we measured the activities of the antioxidants enzymes: SOD and GPx and total NO levels in the plasma and serum of end-stage CKD patients undergoing dialysis therapy, comparing with the HC group. Methods: Quantification of NO levels was performed by fluorometric kit, while activities of SOD and GPx were determined using kinetic methods. Results: We found higher plasma SOD activity in HD (8.58 U/ml) and CAPD (10.14 U/ml), compared to C (3.73 U/ml) group, while GPx activity was decreased in HD (115.38 nmol/h/ml) and CAPD (122.76 nmol/h/ml) groups compared to HC group (275.83 nmol/h/ml). Total serum NO concentration was decreased in HD (14.09 pmol/μl) and CAPD (10.26 pmol/μl), compared to non-CKD patients (49.65 pmol/μl). Conclusion: Decreased total serum NO and GPx activities may lead to endothelial dysfunction and consequently a higher prevalence of CVD in CKD patients.

Normal Range of Neutrophile to Lymphocyte Ratio in Healthy, Chronic Kidney Disease Stage 4 - 5 and Hemodialysis Participant in a Sub-Saharan African Context

Background: Neutrophile to lymphocyte ratio (NLR) is a well-established marker of inflammation. It has been reported to be high in chronic kidney disease (CKD) and it is described as a prognosis factor in hemodialysis patients. However, limited data are available about the normal range of NLR in healthy adults as well as CKD patients including hemodialysis black Africans in Sub-Saharan countries. We sought to study NLR in healthy and advanced CKD in a single Cameroonian health facility. Methods: Blood samples were obtained from blood donors, CKD stage 4 and non-dialysis stage 5, and hemodialysis patients for more than 6 months. Patients with confounding factors such as positive CRP, infection, and recent use of steroids were excluded. RNL means standard deviations (SDs), and 95% confidence intervals (95% CI) were determined. RNL range was defined as percentiles P2.5 to P97.5. Results: A total of 102 participants were included. Mean age was 40.45 ± 9.97 years and 58.8% were male. Age and sex distribution were similar in the three groups. Leucopenia and neutropenia were common in all the groups. Means NLR was 1.29 ± 0.57 (95% CI 1.08 - 1.49) range between 0.55 to 2.67;2.31 ± 1.3 (95% CI 1.75 - 2.88) with range between 0.69 to 4.31 and 2.14 ± 0.98 (95% CI 1.85 - 2.44) with range between 0.77 to 4.32 respectively in controls, CKD, and hemodialysis participants. NLR was comparable in CKD and hemodialysis patients (p = 0.99). Compared to controls, NLR was significantly elevated in CKD (p = 0.043) and hemodialysis patients (p Conclusion: Our data suggest that the normal range for NLR in adult nongeriatric healthy and advanced CKD patients including those on chronic hemodialysis may vary between 0.55 to 2.67 and 0.69 to 4.32 respectively.

Effectiveness of Ultrasound-Guided Arteriovenous Fistulas Cannulation in Difficult Hemodialysis Arteriovenous Access: A Meta-Analysis of Randomised Controlled Trials

Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guided cannulation may improve successful cannulation and reduce complications associated with unnecessary punctures. The study aims to conduct the meta-analyze to examine the effectiveness of renal nurse-performed US-guided cannulation to improve successful cannulation and reduce AVF-related complications in difficult AVF access. Design: A meta-analysis of randomised controlled trials. Methods: A systemic search was performed on electronic databases including CINAHL Plus, Web of Science, and PubMed from inception to October 2023. Risk ratios (RR) and standardized mean differences (SMD) were estimated using random-effect models for considerable homogeneity, and the Scottish Intercollegiate Guidelines Network (SIGN) methodology was adopted for critical appraisal. Results: Four RCTs were included. The results showed US-guided AVF cannulation had a significant effect in improving successful cannulation (RR: 0.19, 95% CI: 0.06 to 0.63, p = 0.007), and was favorable in reducing cannulation-associated complications (RR: 0.44, 95% CI: 0.10 to 1.93, p = 0.28), compared with blind needle cannulation. Conclusion: US-guided cannulation performed by renal nurses has the potential to improve successful cannulation, and fewer complications in hemodialysis patients with difficult arteriovenous access. Relevance to Clinical Practice: The results suggest the value of further training for renal nurses in US-guided cannulation, and broader implementation of US-guided cannulation to improve patient outcomes. Future studies could explore the optimal nursing training and longer-term benefits of US-guided cannulation by renal nurses in difficult AVF access. Patient or Public Contribution: No Patient or Public Contribution as this is a meta-analysis using the secondary data published in the RCTs.

Correlation between Wnt Signalling Inhibitors (Dickkopf-1 & Sclerostin) and the Intimal Medial Thickness in Children on Maintenance Hemodialysis

Background: Wnt signalling inhibitors (Dickkopf-1 and Sclerostin) signalling play a role in vascular development and may contribute to calcification. Aim: To investigate the association between Dickkopf-1 and sclerostin serum concentrations in children undergoing maintenance hemodialysis with intimal medial thickness and peak systolic velocity of the main arteries. Patients and Methods: A study was conducted on 40 children undergoing maintenance hemodialysis and controls of the same age and sex. The study measured the initial medial thickness (IMT) and peak systolic velocity (PSV) of the main vessels (carotid, ulnar, and femoral). Dickkopf-1 and sclerostin serum levels in both groups were assessed, and a routine investigation was performed. Results: The findings indicate that the levels of serum Dickkopf-1 and Sclerostin were significantly higher in the hemodialysis group 2540.65 (2215.4 - 2909.2 pg/ml) and 1.17 (0.85 - 2.03 ng/ml)respectively (P = 0.001), compared to their control group it was 1110.45 (885.45 - 1527.65 pg/ml) and 0.28 (0.25 - 0.32 ng/ml)) respectively P = 0.001. Additionally, there was a significant increase in intima-media thickness (IMT) with a decrease in peak systolic velocity (PSV) in the main blood vessels, including the carotid, ulnar, and femoral arteries. A significant correlation was also observed between Dickkopf-1 and sclerostin levels and IMT of the carotid, ulnar, and femoral arteries. Conclusion: Wnt signalling inhibitors (Dickkopf-1 and Sclerostin) exert effects beyond the bone and significantly contribute to early vascular calcification in pediatric patients undergoing maintenance hemodialysis.

A Look to Nursing Care Perceived by Adolescents in a Hemodialysis Unit

Background: Adolescent’s perception of nurse care imparted in the hemodialysis unit and the needs that they do not always express are an important starting point to optimize attention and care given by nurse professional;the goal is to reach the holistic focus characteristic of the discipline, and then generate scientific evidence that will help other health professionals, regarding given attention to patients in this step of their lives suffering chronic renal damage subjected to hemodialysis. Objective: To analyze the perception of adolescents with chronic kidney disease about nurse care in a hemodialysis unit. Methods: Qualitative and phenomenological study under the philosophic scope of Merleau Ponty, with a descriptive design;the information collection was through semi-structured interviews, field notes, and participants’ observation from three adolescents’ informers subjected to renal substitution by hemodialysis three times per week, in a high specialty medical unit in Mexico City. Selection of informers was by convenience and their previous authorization was requested by signed informed consent. The analysis of qualitative data was according to Rodríguez et al. Results: Four categories with seven subcategories emerged: Category 1, Adolescent’s perception regarding nursing care on hemodialysis;Category 2, Care during hemodialysis process;Category 3, The world of hemodialysis;Category 4, Corporeity from adolescent’s look. Conclusion: Nursing care to adolescents during hemodialysis must be accompanied by comprehension, communication, and knowledge of patients, regarding their needs perceived to know the way they live their chronic kidney illness, through their body, their world and the way they see themselves. The main characteristics of nurse care are communication and constant interaction with nurse-adolescent, this openness to an unknown world for them is seen as a pleasant interaction, perceived as necessary and it helps them to feel good in their hemodialysis treatment.

Humoral Response and Tolerance of Vaccination against SARS-CoV-2 in Adults Senegalese Patients Undergoing Hemodialysis: A Multicenter Prospective Study

Introduction: Following the COVID-19 pandemic, vaccination has been proposed in several countries as the main preventive measure despite very limited data, particularly in dialysis patients. We conducted this study to assess the immunological response to vaccination in Senegalese hemodialysis patients. Patients and Methods: We conducted a prospective study, in two dialysis centers in Dakar from March 30th to August 30th, 2021 including patients on hemodialysis for >6 months, vaccinated against SARS-CoV-2 according to the vaccination schedule recommended by WHO. A vaccine response was considered positive when seroconversion was observed after one dose of vaccine. The clinical efficacy of immunization was defined as the absence of new COVID-19 infection in patients who received a complete vaccination. Results: Among the 81 patients included in the study, 7.4% had anti-Spike IgM antibodies before their first vaccination. Seroprevalence of IgM antibodies was 38.3% one month after the first vaccine dose (at M1) and 8.6% one month after the second dose (at M4). Anti-Spike IgG antibodies were present in 40.3% of patients before vaccination, in 90.1% at M1, and in 59.7% at M4. Among patients previously infected with SARS-CoV-2, 10.2% had IgM antibodies at M0, 31.6% at M1, and 10.5% at M4 post-vaccination. Similarly, seroprevalences of IgG antibodies in this subgroup were 31.5%, 61.3%, and 50.0% respectively at M0, M1, and M4 post-vaccination. A comparison of seroconversion rates between M0 and M4 showed significant differences only for IgG in COVID-19 naive patients. Mean duration in dialysis and the existence of previous COVID-19 infection were associated with patients’ vaccinal response after the two doses. Age, gender and the use of immunosuppressive treatment did not influence post-vaccinal antibody production. Conclusion: Vaccination against COVID-19 in Senegalese hemodialysis patients induced a low seroconversion rate but it was well tolerated. Moreover, the induced protection was neither strong nor durable, particularly in patients with longer duration in dialysis.

Advancing Pediatric Hemodialysis Care through the Novel Intervention in Children’s Healthcare (NICH) Program

Racial, ethnic, and socioeconomic disparities present daunting hurdles that prevent equitable health outcomes for patients with end-stage kidney disease (ESKD) on hemodialysis. Additional resources, such as the Novel Intervention in Children’s Health (NICH) at Lucille Packard Children’s Hospital Stanford, provide individualized support to best assist families by assessing barriers to care with the goal of improving health outcomes. In this retrospective cohort study, we reviewed patients with ESKD on hemodialysis involved in NICH to explore if NICH serves as a liaison between the patients and multidisciplinary medical team and to explore if NICH helps patients better manage the challenges of end-stage kidney disease. Through the electronic medical record system, EPIC, we reviewed the patients’ surveys to identify barriers to care, which included school and life engagement difficulty, lack of mental health resources, food and transportation insecurity, and cultural/language barriers. We also tracked the number of hospitalizations and ED visits before and during the patients’ enrollment in NICH. We discovered that through NICH, the aforementioned barriers to care were eliminated, the number of hospitalizations and emergency department visits was reduced, and all patients transitioned from inactive to active on the transplant list. NICH successfully improved the health outcomes of these patients and empowered patients to be more engaged in their care.

Causes and Prognosis of Cases of Acute Obstructive Renal Failure Managed at the Donka National Hemodialysis Center

Introduction: Acute obstructive renal failure (AORF) is a frequent clinical situation, secondary to obstruction of the urinary excretory tract. Whatever the cause, urinary tract obstruction suddenly opposes glomerular filtration and is responsible for tubulointerstitial lesions. It accounts for 10% of acute renal failure (ARF). The aim of this study was to identify the causes and prognosis of cases of acute obstructive renal failure managed at the Centre National d’hémodialyse Donka. Material and Methods: This was a prospective descriptive study lasting 6 months, from September 1, 2022 to February 29, 2023. All patients undergoing haemodialysis for acute obstructive renal failure who agreed to participate in the study and whose medical records were complete were included. Results: During the course of the study, we registered 97 haemodialysis patients, including 20 cases (20.62%) of acute obstructive renal failure. The mean age of the patients was 57.8 ± 10.54 years, with a male predominance of 11 cases (55%) and a sex ratio of 1.22. The reasons for consultation were dominated by physical asthenia 11 cases (55%), lumbar pain 9 cases (50%), vomiting 6 cases (30%) and acute urine retention 6 cases (30%). Arterial hypertension 16 cases (80%) and urinary tract infection 10 cases (50%) were the most common antecedents. The etiologies of RAOI were dominated by lithiasis 10 cases (50%), neoplasia 6 cases (30%) and benign prostatic hypertrophy 3 cases (15%). mean creatinine was 1267.60 ± 710.76 μmol/l with extremes of 243 μmol/l and 2822 μmol/l, mean urea was 39.56 ± 18.36, hyperkalemia in 14 cases (70%) and hyponatremia in 8 cases (40%). After hemodialysis, 9 cases (45%) recovered renal function, 4 cases (20%) became chronic and 7 cases (35%) died. Conclusion: The frequency of AKI remains non-negligible in our department, and early detection and prompt management would considerably reduce the morbidity and mortality associated with this pathology.

The impact of foot reflexology on fatigue and sleep quality in school-aged children undergoing hemodialysis

Objective:This study aimed to evaluate the effects of foot reflexology on fatigue and sleep quality in school-aged children receiving hemodialysis.Methods:A quasi-experimental pretest-posttest design was utilized.Thirty children of ages 6-12 undergoing in-center hemodialysis were recruited.The Pittsburgh Sleep Quality Index(PSQI)and Inventory of Fatigue Symptom(IFS)scales were administered at baseline.Participants then received 30 min of foot reflexology massage before hemodialysis sessions 3 days per week for 12 weeks.Posttest administration of the sleep and fatigue scales occurred after the intervention period.Results:Reflexology massage led to significant improvements in sleep quality components,including duration(0%-30%normal sleepers),efficiency(0%-50%>85%),latency(50%-0%>60 min),disturbances,and daytime dysfunction.The mean PSQI score decreased from 18.2 to 9.7(P<0.05).Fatigue severity substantially decreased,with the mean IFS score improving from 105.7 to 64.1(P<0.05).Conclusion:Foot reflexology is an effective nursing intervention for reducing fatigue and improving sleep quality in children on hemodialysis,warranting integration into routine care.