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1.
Prebiotics Improved the Defecation Status via Changes in the Microbiota and Short-chain Fatty Acids in Hemodialysis Patients.
Miyoshi, M, Shiroto, A, Kadoguchi, H, Usami, M, Hori, Y
The Kobe journal of medical sciences. 2020;(1):E12-E21
Abstract
Hemodialysis patients often become constipated. We analyzed the effect of prebiotics on the defecation status due to the intestinal environment in hemodialysis patients. Fifteen patients received prebiotics as partially hydrolyzed guar gum for four weeks. The defecation status was assessed using both the Bristol Stool Form Scale and the Japanese version of the Constipation Assessment Scale. The fecal status, microbiota measured by a terminal restriction fragment length polymorphism analysis, and fecal short-chain fatty acid concentrations by gas chromatography were compared before and after prebiotics ingestion. Prebiotics ingestion improved the individual stool form and decreased the constipation score from 5.1 to 3.0. The ratio of short-chain fatty acid-producing microbiota, such as Bifidobacterium and Bacteroides, increased after ingestion (2.35- and 3.17-fold, respectively). Furthermore, the concentration of short-chain fatty acids significantly increased (1.58-fold). The individual dendrogram distribution after ingestion was changed in 8 participants (53.3% of the subjects). In 5 participants (33.3% of the subjects), the clusters were even more noticeably different. Prebiotics improved the defecation status in hemodialysis patients due in part to the composition of intestinal microbiota and short-chain fatty acid concentrations.
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Apple intake improves antioxidant parameters in hemodialysis patients without affecting serum potassium levels.
Giaretta, AG, Schulz, M, Silveira, TT, de Oliveira, MV, Patrício, MJ, Gonzaga, LV, Fett, R, da Silva, EL, Wazlawik, E
Nutrition research (New York, N.Y.). 2019;:56-63
Abstract
Oxidative stress (OS) is associated with increased morbidity and mortality in hemodialysis (HD) patients, and the consumption of fruits seems to improve OS due to their antioxidant properties. Therefore, we hypothesized that Fuji apple intake improves OS markers in HD patients due to its polyphenolic compounds without increasing serum potassium levels. This trial was a 1-group, pre- and posttest comparison between 16 patients who had been on hemodialysis for at least 3 months without any acute illness or hyperkalemia. Each volunteer consumed 2 Fuji apples (~360 g) per day for 1 week. Blood samples were collected at the baseline period and after 8 days for the measurement of total antioxidant status, ascorbic acid, catalase, glutathione peroxidase, superoxide dismutase, reduced glutathione, total oxidant status, oxidative stress index, potassium, phosphorus, uric acid, glucose, and fructosamine. For tolerance evaluation, participants were asked about their bowel habits. Apple intake increased glutathione peroxidase (P = .006) and superoxide dismutase activities (P = .006) and ascorbic acid levels (P = .002). No significant changes were observed in uric acid, potassium, phosphorus, glucose, and fructosamine levels. Additionally, there was a decrease in the catalase activity (P = .021) and in the total antioxidant status values (P = .004). However, increased total oxidant status (P = .003) and oxidative stress index (P = .033) levels were observed after apple intake. In conclusion, the intake of 2 Fuji apples per day for 1 week was well tolerated and improved antioxidant parameters in HD patients without affecting serum potassium levels.
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3.
The Null Effect of Chewing Gum During Hemodialysis on Dry Mouth.
Duruk, N, Eşer, I
Clinical nurse specialist CNS. 2016;(5):E12-23
Abstract
AIMS AND OBJECTIVES The study was conducted to determine the effect of chewing gum during hemodialysis on dry mouth and its symptoms. BACKGROUND The imposition of fluid restriction and the use of medications that reduce saliva production may lead to dry mouth. DESIGN This study is a randomized, controlled, single-blind, crossover experimental study. METHODS The subjects consisted of 61 hemodialysis patients recruited from 4 dialysis centers in southern Turkey. The data were collected using a Patient Identification Form, a Form for Assessing the Symptoms of Dry Mouth, and a Patient Follow-up Form. Saliva samples were obtained for analysis of flow rates. RESULTS The salivary flow rates of the patients increased during the first hour on the day when gum was chewed, and this increase was statistically significant. However, no significant difference was found between the salivary flow rates at the 0- and 4-hour time points on the day when gum was chewed (P > .05). In addition, the salivary pH values were in the normal range on both days, although the pH values tended to be more acidic on the day when gum was not chewed. CONCLUSIONS Overall, it was found that chewing gum for 15 minutes each hour during a hemodialysis session did not increase the saliva amount, maintain the pH value of the saliva within a normal range, or control dry mouth symptoms.
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Development, feasibility, and efficacy of a customized exercise device to deliver intradialytic resistance training in patients with end stage renal disease: Non-randomized controlled crossover trial.
Chan, D, Green, S, Fiatarone Singh, M, Barnard, R, Cheema, BS
Hemodialysis international. International Symposium on Home Hemodialysis. 2016;(4):650-660
Abstract
Introduction This study assessed the feasibility and efficacy of a novel resistance training device used within an intradialytic progressive resistance training (PRT) intervention. Methods Non-randomized, within-subjects crossover design with outcomes assessed at baseline (week 0), postcontrol (week 13) and post-PRT intervention (week 26). Twenty-two hemodialysis patients (59% men, 71 ± 11 years) performed PRT three sessions per week for 12 weeks. The resistance training device was developed to enable the performance of 2 upper body and 3 lower body exercises, unilaterally and bilaterally, both before and during dialysis, with loads of 2.5 to 59 kg. Feasibility outcomes included adverse events, adherence and training load progression. Changes in upper and lower body muscular strength, six-minute walk, aspects of health-related quality of life (HRQoL) and depression were evaluated. Findings The PRT intervention was delivered without serious adverse events, resulted in 71.2% ± 23.3% adherence and significant adaptation of all training loads from pre to mid to post training (83.8%-185.6%, all P < 0.05). Lower body strength (P < 0.001) and HRQoL subscales (Role-Physical, Social Functioning, Role-Emotional) significantly increased (all P < 0.01) and a trend toward reduced depression was noted (P = 0.06). No significant changes were noted in other outcomes. Discussion PRT using the novel resistance training device was feasible and improved measures of physical and psychological health. This device can be utilized in most dialysis centers. Future studies are required to evaluate dose-response effects of PRT prescriptions in subpopulations, and the translation of PRT to standard dialysis practice.
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Previous Vaccination and Age are More Important Predictors of Immune Response to Influenza Vaccine than Inflammation and Iron Status in Dialysis Patients.
Eiselt, J, Kielberger, L, Rajdl, D, Racek, J, Pazdiora, P, Malánová, L
Kidney & blood pressure research. 2016;(2):139-47
Abstract
BACKGROUND/AIMS: The immune response to influenza vaccine may be influenced by many factors, e.g. age, comorbidities or inflammation, and iron status. METHODS We studied the vaccine-induced production of hemagglutination-inhibition antibodies (HI) in 133 hemodialysis patients (HD) and 40 controls. To identify variables associated with the immune response, uni- and multivariate regression analyses were performed with seroconversion in HI titers as a dependent variable, with demographics, comorbidities, previous vaccination, inflammation, and iron status as independent variables. RESULTS Seroconversion rates were lower in HD than in controls [43% versus 73% (H1N1 strain; p < 0.05); 43% versus 53% (H3N2; P=NS); 36% versus 62% (B; p < 0.05)]. In both HD and control groups, the predictors of the inferior HI production were pre-vaccination seroprotection, vaccination in the previous season, and old age. We did not find associations between seroconversion rates and inflammation and iron status in the studied populations. This was also true for a subanalysis of patients without pre-vaccination seroprotection. CONCLUSION The influenza vaccine-induced antibody production was lower in HD than in controls and was independent of inflammation and iron status in both groups. Besides dependence on dialysis, the variables associated with inferior seroconversion rates included pre-vaccination seroprotection, previous vaccination, and old age.
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Non-invasive method for preventing intradialytic hypotension: A pilot study.
Saxena, A, Sharma, RK, Gupta, A, John, MM
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia. 2015;(5):896-905
Abstract
Intradialytic hypotension (IDH) is a life-threatening condition. We evaluated the feasibility of blood volume monitoring (BVM) and blood temperature monitoring (BTM) in preventing IDH in patients prone to the same. Fourteen hemodynamically unstable end-stage renal disease patients who were prone to IDH and unable to achieve dry weight were given BVM treatment twice weekly for two weeks. Forty patients who were not on BVM treatment served as controls. Patients were anemic, had low serum albumin (3.4 ± 0.43 g/dL) and fluid overload and were edematous. Of the 40 patients in the control group, 18 patients experienced IDH and dialysis had to be terminated. The incidence of IDH was 5% in the control group. In the BVM group, the total volume of fluid removed during hemodialysis was between 2.0 and 4.5 L (mean 3.2 L). By the end of dialysis, the hemo-concentration increased by 34.8%. With use of BVM and BTM, the blood pressure did not drop below 120/80 mm Hg, the dialysis sessions were uneventful and none of the patients suffered symptoms of hypotension. There was a difference of 3 kg between weight achieved and dry weight of the patient, although there was a 14.2% reduction in extracellular water (ECW), 14.5% in plasma fluid and 14.5% decrease in interstitial fluid. Blood volume significantly correlated with post-dialysis intracellular water (ICW) (r = 0.722, P = 0.008) and ECW/ICW ratio (r = 0.698, P = 0.012). There was a significant correlation between systolic blood pressure and ECW (r = 0.615, P = 0.033). Diastolic blood pressure significantly correlated with post-dialysis ECW (r = 0.690, P = 0.008), plasma fluid post-dialysis (r = 0.632, P = 0.027) and interstitial fluid (r = 0.604, P = 0.038). The ECW/ICW ratio was high (1.13 ± 0.48; control 0.74), implying overhydration and expanded extracellular fluid. BVM should be included in the dialysis protocol where patient compliance to maintenance hemodialysis is poor and patients are constantly in volume overload.
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Individualization of dialysate calcium concentration according to baseline pre-dialysis serum calcium.
Gonzalez-Parra, E, Gonzalez-Casaus, ML, Arenas, MD, Sainz-Prestel, V, Gonzalez-Espinoza, L, Muñoz-Rodriguez, MA, Tabikh, A, Egido, J, Ortiz, A
Blood purification. 2014;(3-4):224-33
Abstract
BACKGROUND A positive calcium balance may contribute to vascular calcification, while a negative balance increases iPTH. We explored the impact of different dialysate calcium concentrations on bone and mineral metabolism parameters according to pre-dialysis serum calcium levels. RESULTS Fifty-six hemodialysis patients were dialyzed with 3.0 or 2.5 mEq/l dialysate [calcium] in a crossover study of two weeks. Bone mineral metabolites were measured prior to and following the hemodialysis session. A 3.0 mEq/l dialysate [calcium] increased more post-dialysis total calcium and ionized calcium than 2.5 mEq/l dialysate [calcium]. The mildest dialysis-induced changes in calcium and PTH were observed in patients with pre-dialysis serum calcium <8.75 mg/dl dialyzed with 2.5 mEq/l dialysate [calcium] and in patients with pre-dialysis serum calcium >9.15 mg/dl dialyzed with 3.0 mEq/l calcium dialysate. CONCLUSION In conclusion, the individualization of dialysate calcium concentration according to baseline pre-dialysis serum calcium may prevent major excursions in post-dialysis serum calcium and iPTH levels. SHORT SUMMARY High calcium dialysate may increase serum calcium in hemodialysis patients, while low dialysate calcium may increase PTH. Individualization of dialysate calcium according to predialysis serum calcium levels may prevent or decrease unwanted excursions of both serum calcium and PTH.
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Epicardial adipose tissue thickness in hemodialysis patients.
Altun, B, Tasolar, H, Eren, N, Binnetoğlu, E, Altun, M, Temiz, A, Gazi, E, Barutcu, A, Altunoren, O, Colkesen, Y, et al
Echocardiography (Mount Kisco, N.Y.). 2014;(8):941-6
Abstract
AIM: Hemodialysis (HD) patients had higher cardiovascular mortality and it is related to atherosclerosis. Epicardial adipose tissue (EAT) thickness is a marker of atherosclerosis and independent predictor of coronary artery disease. The aim of our study was to evaluate the relationship between EAT and carotid intima-media thickness (CIMT) predictors of early atherosclerosis in HD patients. METHODS The study included 62 HD patients and 40 healthy controls. EAT thickness and CIMT were measured by echocardiography in all subjects. RESULTS Epicardial adipose tissue thickness and CIMT were higher (6.98 ± 1.67 vs. 3.84 ± 0.73 mm, P < 0.001, 0.94 ± 0.17 vs. 0.63 ± 0.11 mm, P < 0.001, respectively) in HD patients than in control subjects. EAT thickness were correlated with CIMT, HD duration, age, and calcium. In addition, HD duration, CIMT, and age were independent predictors of EAT thickness on HD patients in regression analysis. CONCLUSION Epicardial adipose tissue thickness may be a useful indicator of early atherosclerosis in HD patients.
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Long-term oral nutrition supplementation improves outcomes in malnourished patients with chronic kidney disease on hemodialysis.
Sezer, S, Bal, Z, Tutal, E, Uyar, ME, Acar, NO
JPEN. Journal of parenteral and enteral nutrition. 2014;(8):960-5
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Abstract
BACKGROUND There is no consensus on the type, time of initiation, or duration of use of enteral nutrition in patients with chronic kidney disease (CKD). This study aimed to compare the effects of a renal-specific oral nutrition supplement (RS-ONS) and a standard recommended nutrition regime on biochemical and nutrition markers in malnourished patients with CKD on hemodialysis. METHODS Sixty-two malnourished patients with CKD, divided into experimental (RS-ONS; n = 32; mean [SD] age, 62.0 [11.3] years; 55.2% female) and control (CON; n = 30; mean [SD] age, 57.2 [12.3] years; 31% female) groups, were evaluated for anthropometric, biochemical, and inflammatory parameters. RESULTS Mean (SD) serum albumin levels were significantly increased in the RS-ONS group from 3.5 (0.3) g/dL at baseline to 3.7 (0.2) g/dL at 6 months (P = .028). Significantly fewer patients had serum albumin levels of <3.5 g/dL after month 6. Dry weight of patients significantly increased in the RS-ONS but decreased in the CON groups (P < .001 for each). Percent change from baseline revealed negative results for bioelectrical impedance analysis (P < .001) in the CON group. Malnutrition inflammation score at 6 months (P = .006) and erythropoietin (EPO) dose requirements were higher in the CON group (P = .012). CONCLUSIONS Our findings indicate that consuming RS-ONS improves serum albumin and anthropometric measures, as well as reduces EPO dose, in patients with CKD.
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[Undercarboxylated osteocalcin (Glu-OC) bone metabolism and vascular calcification in hemodialyzed patients].
Bentkowski, W, Kuźniewski, M, Fedak, D, Dumnicka, P, Kuśnierz-Cabala, B, Janda, K, Sułowicz, W
Przeglad lekarski. 2013;(9):703-6
Abstract
UNLABELLED Osteocalcin (OC) is witamino-K dependent calcium-binding protein comprising three gamma carboxy glutamic acid residues (Gla) which determines a strong bond with hydroxyapatite. In vitamin K deficiency and/or increased bone resorption undercarboxylated osteocalcin (Glu-OC) appears in the blood. The aim of this study was to evaluate the level of Glu-OC and markers of bone metabolism and their impact on coronary artery calcification in patients with end-stage renal failure treated with repeated hemodialysis. The study included 68 patients (29 women and 39 men) aged 60.3 +/- 12.3 years hemodialysis period 24.5 +/- 4.8 months. Control group consisted of 35 healthy volunteers comparable in terms of age and gender. CACS was evaluated based on multislice spiral computed tomography (MSCT). Measurement of carboxylated osteocalcin (Gla-OC) and Glu-OC, bone alkaline phosphatase (bALP), tartrate-resistant acid phosphatase (TRAP5) were assessed by ELISA and iPTH by Nichols method. Present study demonstrated that the Gla-OC and Glu-OC in hemodialysis patients were significantly higher than the control group 116.37 +/- 70.01 ng/ml and 93.72 +/- 112.63 ng/ml versus 19.51 +/- 3.78 ng/ml and 4.88 +/- 2.63 ng/ ml; p <0.001. Glu-OC level correlated significantly with iPTH, bALP, TRAP5 (p <0.001) and CaSc (p <0.014). CONCLUSIONS 1. The results indicate a significant correlation between Glu-OC and assessed markers of bone metabolism. 2. Research has indicated a link between bone metabolism and the degree of calcification in the coronary arteries.