Seirei Christopher University

Abstract Background The initiation of hemodialysis (HD) is a physiologically and functionally unstable period, often marked by abrupt fluid shifts, metabolic disturbances, and clinical decompensation. Frailty at HD initiation is associated with adverse outcomes. However, the link between unplanned dialysis initiation and frailty remains unclear. Because unplanned initiation often reflects insufficient predialysis care and acute systemic decline, it may be associated with frailty status at initiation. Methods This single-center cross-sectional study enrolled 93 patients with end-stage renal disease who initiated HD between September 2022 and September 2024. Frailty was assessed using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria. The primary exposure was dialysis initiation type (planned versus unplanned). Prevalence ratios (PR) for frailty were estimated using modified Poisson regression. Sensitivity analyses included analyses excluding the weight-loss component, reanalysis using the Clinical Frailty Scale, and additional adjustment for delayed rehabilitation initiation. Results Frailty prevalence at dialysis initiation was 51.6%. It was significantly higher in the unplanned group than in the planned group (74.2% versus 40.3%, p = 0.002). Unplanned initiation was significantly associated with frailty (PR 1.65; 95% confidence interval [CI] 1.04–2.62). Conclusions Unplanned dialysis initiation was significantly associated with a higher prevalence of frailty at dialysis initiation. These findings suggest that patients undergoing unplanned initiation may represent a subgroup with a particularly high frailty burden at the time of dialysis transition, supporting the clinical importance of frailty assessment at dialysis initiation.

Patients undergoing hemodialysis often experience impaired exercise tolerance and circulatory instability due to fluid removal and metabolic alterations during dialysis. Although rehabilitation is recommended for this population, the physiological effects of exercise performed after dialysis remain unclear. This study aimed to compare circulatory dynamics and skeletal muscle oxygenation during exercise performed post-dialysis and on non-dialysis days in maintenance hemodialysis patients, to characterize physiological differences that may inform rehabilitation timing. Twelve stable hemodialysis patients from Seirei Sakura Citizen Hospital participated in this cross-sectional study. After a graded exercise test to determine peak work rate (Peak WR), participants performed constant-load cycling exercise at 40

Rationale & Objective: Kidney disease is associated with reduced physical function, muscle mass, and quality of life (QoL). Neuromuscular electrical stimulation (NMES) is a promising intervention to address these outcomes. This study aimed to update previous meta-analyses by including the latest randomized controlled trials (RCTs). Study Design: Systematic review and meta-analysis of RCTs. Setting & Study Populations: RCTs evaluating effects of NMES in adult patients with kidney disease. Selection Criteria for Studies: Outcomes included muscle strength, muscle mass, functional capacity, physical performance, activities of daily living, physical activity, health-related QoL, and adverse events. Data Extraction: A systematic search was conducted in PubMed, Cochrane Library, and ICHUSHI (April 27, 2024). Analytical Approach: Random-effects meta-analyses were performed using Review Manager 5.4. Risk of bias and certainty of evidence were assessed using RoB 2.0 and GRADE. Results: Twelve RCTs involving 289 participants were included. All participants underwent hemodialysis; no studies included patients on peritoneal dialysis, with predialysis chronic kidney disease, or post-kidney transplant recipients. NMES significantly improved lower-limb muscle strength (standardized mean difference, 0.84; 95% CI, 0.56-1.11; P < 0.001), 6-minute walk distance (mean difference, 48.15; 95% CI, 15.86-80.44; P = 0.003), and sit-to-stand performance (standardized mean difference, 0.80; 95% CI, 0.17-1.43; P = 0.01), without significantly increasing adverse events. No significant effects were found on appendicular skeletal muscle mass, timed up and go test, Short Physical Performance Battery, activities of daily living, physical activity, or HRQoL. The certainty of evidence ranged from very low to moderate across outcomes. Limitations: Most studies had small sample sizes and high risk of bias. Conclusions: NMES is a safe and effective intradialytic intervention for improving lower-limb muscle strength and functional capacity in patients undergoing hemodialysis. High-quality RCTs involving broader kidney disease populations are warranted to further establish its clinical utility.

This study explores how Japanese female nursing students' mindset beliefs influence their learning and effort regulation in both nursing and English, identifying key differences and similarities with implications for both TESOL and international nursing education. Using a mixed-methods design, the study incorporated semi-structured interviews with 10 participants, which included both closed-ended quantitative and open-ended qualitative questions to gain a comprehensive understanding of their perceptions and strategies. The findings revealed that most participants attributed success in both nursing and English to effort rather than innate talent. Thematic analysis highlighted the importance of consistent effort and communication skills, with clearer goals and more role models in nursing, and occasional instances of being overwhelmed due to academic demands. The study offers insights into balancing nursing-specific content and foreign language learning, recommending structured learning plans, mentoring systems, and a focus on the transferability of soft skills between domains to support nursing students in managing interdisciplinary challenges.