ABSTRACT Background Chronic fluid imbalance in maintenance hemodialysis can increase cardiovascular risk through activation of the renin–angiotensin–aldosterone pathway. This study compared the endocrine and hemodynamic effects of three fluid management strategies in adults receiving maintenance hemodialysis in a prospective two‐center observational cohort study. Methods Six hundred patients were assigned to fluid management by clinical assessment, bioimpedance‐guided monitoring, or absolute blood volume monitoring, with 200 patients in each group. Plasma renin activity, angiotensin II, aldosterone, systolic and diastolic blood pressure, and arterial stiffness were measured at baseline and Weeks 6 and 12. Between‐group and over‐time differences were analyzed using adjusted longitudinal and covariance‐based models. Additional analyses examined variation by age, fluid status pattern, and sodium self‐management. Results By Week 12, plasma renin activity, angiotensin II, and aldosterone increased in the clinical assessment group showed smaller increases or minimal change in the bioimpedance‐guided group and declined in the absolute blood volume monitoring group. The absolute blood volume monitoring group also showed the greatest improvement in blood pressure and arterial stiffness over follow‐up. In addition, this group had the lowest frequency of intradialytic hypotension and the strongest improvement in patient self‐management measures. Conclusions Absolute blood volume monitoring was associated with greater short‐term suppression of endocrine activation and better hemodynamic outcomes than clinical assessment or bioimpedance‐guided monitoring during the 12‐week follow‐up period.
Hemodialysis (HD) catheters carry a high risk of life-threatening bloodstream infections and failure. Antimicrobial lock solutions (ALS) are used to reduce this risk, but their overall efficacy on key outcomes like infection rates and catheter survival requires comprehensive evaluation. This systematic review and meta-analysis assess the impact of ALS on preventing catheter-related bloodstream infections (including incidence and density) and on improving catheter survival. A systematic search was conducted across the databases of PubMed, Embase, Scopus, Cochrane Library, and Google Scholar. A meta-analysis was conducted using STATA software. A total of 1183 studies were screened based on title and abstract, and further 282 studies were evaluated in full text. Eventually, 14 studies with 15 treatment arms were included. Key outcomes including central line-associated bloodstream infection (CLABSI), exit infection, and catheter-free survival were conducted separately. ALS demonstrated statistically significant benefits on CLABSI infection and catheter-free survival compared to nonantimicrobial solutions, showing a reduction in CLABSI density with a pooled log odd ratio (logOR) of -1.29 (95% CI: -1.59 to -0.99), lower CLABSI rates (pooled logOR = -1.50, 95% CI: -1.85 to -1.15), and improved catheter-free survival with log hazard ratio (logHR) of -1.11 (95% CI: -1.41 to -0.8). Consistent treatment effects were observed across all lock types with no significant heterogeneity detected. ALS demonstrate statistically significant and clinically important efficacy in reducing CLABSI incidence and density while improving catheter survival in HD patients, establishing them as an essential preventive strategy in clinical practice.
INTRODUCTION:Depression is the third most disabling disease worldwide and is prevalent in patients undergoing hemodialysis. Given the greatly varied prevalence of depression in different regions, this meta-analysis was conducted to elucidate the status of depression in hemodialysis patients. METHODS:PubMed, Embase, Cochrane Library, and Web of Science databases were searched for relevant literature on depression in hemodialysis patients from inception to July 2023. Subgroup analyses and meta-regression were subsequently performed to determine the source of heterogeneity. RESULTS:A total of 137 cross-sectional studies were included, involving 21,608 hemodialysis patients. The random-effects analyses demonstrated that the prevalence of depression was 45.8% in hemodialysis patients (95% confidence interval [CI]: 42.0%-49.6%). Subgroup analysis of national income levels implied that high-income countries had the lowest prevalence of depression at 38.9% (95% CI: 34.1%-43.7%). Studies with a higher proportion of female hemodialysis patients reported a relatively higher prevalence of depression. Subgroup analysis by age revealed that patients under 40 years old had a depression prevalence of 50.8% (95% CI: 25.6%-76.0%), which was higher than that of other age groups. Different self-rating depression scales yielded different prevalence of depression in hemodialysis patients. CONCLUSION:Depressive symptoms are common in hemodialysis patients, so screening and identifying those at risk for depression and developing effective intervention strategies are of great value.
BACKGROUND:Improving physical function is essential for hemodialysis patients. Virtual reality-based methods are practical, well-tolerated, and easily integrated into care. METHODS:A meta-analysis aims to evaluate the effects of virtual reality-based interventions on physical function and their clinical feasibility for patients undergoing hemodialysis. Scientific literature published between January 2002 and June 2024 was searched in six databases. The standardized mean differences were determined using the upper and lower limits of 95% confidence intervals. Publication bias was evaluated using the Egger test and visualized using a funnel plot. RESULTS:Five studies were included in this meta-analysis. The types of virtual reality-based interventions were "treasure hunt" video games (n = 1), Wii Fit Plus games (n = 2), and A la Caza del Tesoro (ACT) video games (n = 2). The effects of virtual reality-based interventions on various measures of physical function, including the sit-stand test, 6-min walk test, timed stand-walk test, walking speed test, and handgrip strength test, were examined; significantly beneficial effects have been observed on many parameters. Furthermore, VR-based interventions did not cause any adverse effects on hemodynamic measurements. Methodological quality analysis revealed four good quality and one medium quality study. Egger testing showed no significant publication bias. CONCLUSIONS:This meta-analysis suggests that virtual reality-based interventions can enhance physical function and are feasible both physiological and behavioral. Nurses and other healthcare professionals can use virtual reality-based interventions to maintain or improve physical function by facilitating adherence.
Exit-site granuloma is a frequent and challenging complication in patients undergoing peritoneal dialysis, predisposing to exit-site infections. Recent evidence suggests a potential role for topical timolol in promoting regression of granulomatous tissue. We report two patients on continuous ambulatory peritoneal dialysis who developed exit-site granulomas. Both patients were treated with topical 0.5% timolol maleate ophthalmic solution applied locally to the exit site three times weekly as part of routine exit-site care. Clinical response was monitored using serial photographs. Complete resolution of the granuloma was achieved within 3 weeks in one patient and within 2 months in the other. Neither patient developed local or systemic adverse effects, and no exit-site infections occurred during treatment. Topical 0.5% timolol maleate may represent a safe, non-invasive, and effective treatment option for peritoneal dialysis exit-site granulomas. Larger studies are warranted to establish its efficacy in larger cohorts.
