There is a renewed interest in HHD with mainly short daily session schedules and rarely long nocturnal sessions (LNHD). Data on medical practices and care organization of HHD programs are scarce. Benabed A et al. [Néphrologie&Thérapeutique 2017;13:18–25] described patients, practice and outcomes in low flow dialysate HD. KIHDNEY cohort study described practices at European level. In 2024, we decided to conduct a national survey to describe HDD practices and care organization: this is the objective of our “home survey” about organization of care and medical practices in HHD. Questionnaire sent in April 2024 to french nephrologists of all dialysis centers without selection via a secure e-platform. The questionnaire covers (1) characteristics of nephrologists and centers, (2) reasons for not offering or offering HHD, (3) patient profiles, (4) recruitment and training program and (5) organization of centers. Only doctors' claims are collected, no patient data is collected. We present here interim results (January 2025) of this survey which will be closed in May 2025. 70 nephrologists respondents to date (see Fig. 1). 86% of respondents have a HHD program. 14% don't have such program (economically not profitable, lack of medical evidence, lack of personal motivation, delegation to third-party center). The respondents are from public hospitals (49%), private clinics (11%) and dialysis associations (34%). HHD programs are heterogeneous: 25% dedicated to HDD, 34% to home (HD+ PD), 17% to home + in center HD, 22% without dedicated structure. Number of HHD patients per center is low : all modalities combined 92% of respondents have between 0–10 patients. HHD is offered mainly based on medical evidence (82%) and demand from patients (58%). Patient acceptance rate for HHD varies from 1% to 25% for 82% of respondents: refusals expressed due to “treatment introduced at home", fear of puncture, personal lifestyle choices, technical complexity. Conversely, HHD acceptance factors are quality of life, autonomy of care, geographic mobility. Age of HHD patients is 26–50 y. (38%), 51–75 y. (61%). Male gender = 60%. Comorbidities are type 2 diabetes (52%), obesity (37%), coronary artery disease (34%). Preferred indications are Young age, autonomous patient, heart failure, hyperphosphatemia. Exit modes from HHD modality are mainly renal transplantation (RT) and in center HD, Exceptionally PD or hybrid modality PD/ HDD. The Modality preceding HDD is often Self-dialysis / in center HD / CKD ND and rarely RT and PD. 75% of respondents have a HDD recruitment program for “dialysis initiation” (93%) and “urgent start program” (62%). Role of nephrologists in HHD programs is equally shared: All doctors follow all patients, one doctor follows all patients, Each doctor follows his patients. Only 10% of nurses are participating in HHD program in full time. 26% of respondents claim advanced nurses practitioners involved in HHD program. These are interim data with probable return from experienced centers (selection bias?). These initial data indicate low number of HDD patients per center, absence of a barrier related to the doctor in this survey, expected causes of refusal (fear of puncture, technical and organizational complexity), expected preferential indications and a HDD mainly from AVF but the KTC is prescribed. These data encourage to continue the survey until May 2025 in order to have more information on the prescriptions and the structures/organization of HDD programs.
Background: Vascular access (VA) is a central condition for hemodialysis (HD). Screening patients' views regarding their VA is a significant end point for improving the quality of care. The Short-form Vascular Access Questionnaire (SF-VAQ) is a specific questionnaire to assess patients' satisfaction levels regarding their VA.Purpose: This study aims to develop the Portuguese version of the SF-VAQ and assess its psychometric properties.Methods: A forward and back translation was used. A multicentric study was conducted with 156 patients undergoing hemodialysis to psychometric testing. Reliability (internal consistency and test-retest) was assessed using Cronbach's alpha and Intraclass Correlation Coefficient. A construct validity test was conducted using factor analysis. The convergent validity was calculated using the correlation coefficient.Results: An obtained Cronbach's alpha of 0.77 indicates good internal consistency. The test-retest reliability was established using the Intraclass Correlation Coefficient (ICC) of 0.771. The four sub-scales proposed by the instrument's designer were confirmed, which together accounted for 53% of the variance. The correlation with the Visual Analogue Scale was r = 0.895 (p < 0.001), confirming the convergent validity.Conclusion: The Portuguese version of the SF-VAQ is a valid and reliable instrument with good psychometric properties to be implemented to promote an evaluation of VA satisfaction in HD patients and improve patient care.
Objectives: In adults with chronic kidney disease, not on dialysis, there is a recent recommendation suggesting the prescription of a Mediterranean diet pattern but there is still no evidence to suggest a specific dietary pattern for hemodialysis (HD) patients. The aim of this study was to identify dietary patterns in HD patients and analyze their relationship with nutritional status, physical activity, and survival.Design and Methods: This was a longitudinal prospective multicenter study with 12 months of follow-up that included 582 HD pa-tients from 37 dialysis centers. Clinical parameters, dietary intake, and physical activity were assessed. Dietary patterns were derived from principal component analysis. A p-value lower than 0.05 was considered statistically significant.Results: Three different dietary patterns were identified: "Mediterranean,""Western,"and "low animal protein."Patients in the Med-iterranean pattern group showed higher intakes of protein (P = .040), omega 3 fatty acids (P < .001), vitamins B12 (P < .001), B6 (P < .001), C (P < .001), D (P < .001), folic acid (P < .001) and presented a higher practice of moderate physical activity (P = .010). Despite the lower number of deaths that occurred in the Mediterranean dietary pattern group, we did not observe a statistically signif-icant lower mortality risk (P = .096).Conclusions: The Mediterranean style pattern was associated with a better nutritional intake profile and lifestyle related factors such as a higher practice of moderate physical activity in HD patients.
BACKGROUND:Zinc is essential for human nutrition and plays an important role in hemodialysis (HD) patients. The aim of this study is to analyze the relationship between zinc intake and mortality in HD patients.METHODS:This is a longitudinal, prospective, multicenter study with 582 HD patients from 37 dialysis centers. We recorded clinical and body composition parameters. Dietary intake and physical activity data were obtained using the Food Frequency Questionnaire and International Physical Activity Questionnaire. All statistical tests were performed using SPSS 24.0 software. A P value lower than 0.05 was considered statistically significant.RESULTS:Patients' mean age was 67.8 ± 17.7 years and median HD vintage was 65 (43-104) months. About 53.6% of the patients presented a deficient daily intake of zinc. Patients with the highest zinc intake were those who had a higher lean tissue index (P = .022), energy (P < .001), and protein (p = .022) intakes. Zinc intake was positively correlated with energy (r = 0.709) and protein intake (r = 0.805) and negatively correlated with the malnutrition screening tool score (r = -0.087). A higher energy, protein, and lower carbohydrates intake, as well as lower HD vintage and higher lean tissue index were predictors of zinc intake. A higher mortality risk was observed in patients with zinc intake below the recommended values, even after the adjustment for age, presence of diabetes, gender, dialysis vintage, albumin, lean tissue index, energy intake/kilogram, and level of physical activity (P = .021).CONCLUSION:There is a high prevalence of HD patients with an inadequate zinc intake, which is related to worse nutritional and body composition parameters and with a higher mortality risk.
As high serum potassium levels can lead to adverse outcomes in hemodialysis (HD) patients, dietary potassium is frequently restricted in these patients. However, recent studies have questioned whether dietary potassium really affects serum potassium levels. The dietary approaches to stop hypertension (DASH) diet is considered a healthy dietary pattern that has been related to lower risk of developing end-stage kidney disease. The aim of this study was to analyze the association between a dietary pattern with high content of potassium-rich foods and serum potassium levels in HD patients. This was an observational, cross-sectional, multicenter study with 582 HD patients from 37 dialysis centers. Clinical and biochemical data were registered. Dietary intake was obtained using the Food Frequency Questionnaire. Adherence to the DASH dietary pattern was obtained from Fung’s DASH index. All statistical tests were performed using SPSS 26.0 software. A p-value lower than 0.05 was considered statistically significant. Patients’ mean age was 67.8 ± 17.7 years and median HD vintage was 65 (43–104) months. Mean serum potassium was 5.3 ± 0.67 mEq/L, dietary potassium intake was 2465 ± 1005 mg/day and mean Fung´s Dash Index was 23.9 ± 3.9. Compared to the lower adherence to the DASH dietary pattern, patients with a higher adherence to the DASH dietary pattern were older (p < 0.001); presented lower serum potassium (p = 0.021), serum sodium (p = 0.028), total fat intake (p = 0.001) and sodium intake (p < 0.001); and had higher carbohydrate intake (p < 0.001), fiber intake (p < 0.001), potassium intake (p < 0.001), phosphorus intake (p < 0.001) and body mass index (p = 0.002). A higher adherence to this dietary pattern was a predictor of lower serum potassium levels (p = 0.004), even in the adjusted model (p = 0.016). Following the DASH dietary pattern, which is rich in potassium, is not associated with increased serum potassium levels in HD patients. Furthermore, a higher adherence to the DASH dietary pattern predicts lower serum potassium levels. Therefore, generalized dietary potassium restrictions may not be adequate, at least for those with a DASH diet plan.
