Cardiovascular disease-associated morbidity and mortality are reportedly higher in hemodialysis (HD) patients compared with peritoneal dialysis (PD) patients. However, few studies have estimated changes in state of depression and cognitive impairment in patients undergoing HD and PD. The present study evaluated the impact of HD or PD on patients' quality of life (QoL), cognitive impairment, and depression status over 2 years. This 24-month observational, prospective study included 45 HD and 30 PD patients. Patients were assessed before and every 12 months after starting dialysis for 24 months. Measurements included QoL (36-Item Short-Form Health Survey [SF-36]), cognitive impairment (Mini-Mental State Examination [MMSE]), depressive state (Center for Epidemiologic Studies Depression Scale [CES-D]), grip strength, and 24-h urine volume (UV). Physical and social component scores of the SF-36 significantly improved in PD patients at 24 months compared with those observed at baseline (42.8 vs. 39.4; P < 0.05 and 46.4 vs. 37.3; P < 0.05, respectively); however, scores remained unchanged in HD patients. MMSE scores were significantly decreased at 12 and 24 months in HD patients (29.0 vs. 26.0, 25.0; P < 0.05), but remained unchanged in PD patients. Moreover, CES-D scores significantly worsened at 24 months in HD patients (12.8 vs. 16.5), but remained unchanged in PD. Preservation of UV and grip strength was associated with SF-36, CES-D, and MMSE scores. Our findings indicate that PD is associated with higher QoL and recovery from cognitive failure compared with HD.

Quality of Life and Emotional Distress in Peritoneal Dialysis and Hemodialysis Patients

This study was aimed to develop and conduct an Omaha system-based continuing nursing program for chronic kidney disease (CKD) patients undergoing peritoneal dialysis (PD) and to explore its effect on patients’ nutritional status. A randomized controlled trial was performed in a teaching hospital in China between June 2017 and July 2018. A total of 203 eligible patients were included and then randomly assigned to the study group (n = 101) or the control group (n = 102). In the study group, health education, treatments and procedures, case management, and surveillance based on the Omaha system were used. In the control group, only common outpatient nursing intervention was given to the patients. Changes in subjective global assessment (SGA), anthropometric measurements including body mass index (BMI), triceps skin-fold thickness (TSF), mid-arm muscle circumference (MAMC), and handgrip strength (HGS), and biochemical parameters (hemoglobin, albumin, pre-albumin, total cholesterol, and creatinine) were evaluated before the intervention and 6 months after the intervention and differences in measurements were analyzed. After intervention, the proportion of well-nourished patients in the study group was significantly improved from 6.19 to 29.90% ($$\chi$$2 = 18.441, P < 0.001), and after 6 months, this was higher in the study group than that in the control group (29.90% vs 9.28%, $$\chi$$2 = 13.090, P < 0.001). Also, mean TSF, MAMC, and HGS were significantly improved in the study group and after 6 months, these levels were higher in the study group than those in the control group (P < 0.05). In addition, levels of hemoglobin, albumin, and pre-albumin in patients in the study group were significantly increased and after 6 months, these levels were higher in the study group than those in the control group (P < 0.05). The continuing nursing program based on the Omaha system improved patients' nutritional status and should be further examined in future studies.

Effects of an Omaha system-based continuing nursing program on nutritional status in patients undergoing peritoneal dialysis: a randomized controlled trial

Detection of arterial stiffness is an important method to predict the occurrence of hypertension complications and to screen patients with high cardiovascular risk. In order to predict the damage of AASI to the renal function of patients with essential hypertension, the prediction of AASI based on stepwise Regression equation scanning for renal function damage in patients with essential hypertension is proposed. Measure the 24 h ambulatory blood pressure of the selected subjects, establish a linear Regression equation scanning, and calculate the slope of the straight line, and finally, the slope is AASI. According to the quartiles, AASI is divided into four parts: group I < 0.53 (n = 49); 0.53 ≤ group II < 0.60 (n = 51); 0.60 ≤ group III < 0.69 (n = 48); group IV ≥ 0.69 (n = 44). Experiment result shows the following: with the increase of AASI, cystatin (CysC) also increased significantly, while CysC-eGFR decreased significantly (P < 0.05). Compared with groups I, II, and III, Scr and CysC in group IV increased (P < 0.05), and Ccr, CysC-eGFR, and (CKD-EPI)-eGFR all decreased (P < 0.05). AASI is positively correlated with CysC performance, and the correlation coefficient r is 0.637. It is negatively correlated with Ccr performance, and r is -0.361. It is negatively correlated with CysC-eGFR, and r is -0.698. And it is negatively correlated with (CKD-EPI)-eGFR, and r is -0.331. Age and 24 h PP also showed an increasing trend with the increase of AASI, and it suggests that age may be an influencing factor that promotes kidney damage caused by hypertension; it also suggests that AASI can be used as a new indicator of arterial compliance; AASI is linearly related to various indicators of renal damage and can be used as a predictive indicator of renal damage caused by essential hypertension; cystatin C and the estimated glomerular filtration rate CysC-eGFR based on cystatin C are better than other indicators reflecting glomerular filtration rate, more sensitively assess the degree of early renal damage. Obesity may also be a factor that promotes kidney damage caused by hypertension.

/pdf/prediction-of-renal-function-damage-in-patients-with-3o53sqbn.pdf

Prediction of Renal Function Damage in Patients with Essential Hypertension Based on Stepwise Regression Equation Scanning by AASI

Introduction An increasing number of systematic reviews and meta-analyses of clinical trials have begun to investigate the effects of exercise interventions in patients with chronic kidney disease (CKD). To systematically appraise and synthesise these results, we will conduct an overview of systematic reviews and meta-analyses. Methods and analysis This is a protocol for an overview of systematic reviews and meta-analyses. We will search four databases: PubMed, Embase, Web of Science Core Collection and Cochrane Central Registry of Controlled Trials. Systematic reviews and meta-analyses of clinical trials evaluating the effect of exercise interventions on patients with CKD will be included. Two independent authors will screen titles and abstracts retrieved in the literature search and select studies meeting the eligibility criteria for full-text review. The methodological quality of the included reviews will be assessed using A Measurement Tool to Assess Systematic Reviews-2. We estimate the summary effects for each meta-analyses based on the standardised mean difference and its 95% CI. Additionally, the heterogeneity will be assessed by I2 evidence of small-study effect and the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation system. Ethics and dissemination Ethics approval are not required as no private information from individuals is collected. The results will be published in a peer-reviewed journal or disseminated in relevant conferences. PROSPERO registration number CRD42020223591.

https://bmjopen.bmj.com/content/bmjopen/11/2/e043011.full.pdf

Therapeutic effects of exercise interventions for patients with chronic kidney disease: protocol for an overview of systematic reviews and meta-analyses of clinical trials.

End-stage kidney disease (ESKD) is a chronic medical condition with a significant symptom burden. Treatment with kidney replacement therapies, including peritoneal dialysis (PD), can improve survival and ameliorate the complications and consequences of ESKD but do not provide a ‘cure’. For many patients, some of whom may be on dialysis for life, the quality, rather than duration of life, is increasingly important. Health-related quality of life (HRQOL) is a concept that relates to the impact of both the disease and its treatment on a patient’s physical, functional, social and psychological well-being. HRQOL is an important outcome measure in patients on PD – it correlates with outcomes such as mortality and hospitalisation, but it also reflects the patient’s perspective and experience of dialysis. Whilst HRQOL is often overlooked as an outcome measure in favour of assessment of mortality, infection rates or dialysis adequacy, it more closely reflects the subjective patient experience of PD and offers opportunities to optimise an individual patient’s care.

Quality of Life in Peritoneal Dialysis

BACKGROUND Residual renal function (RRF) is a crucial factor that plays an important role in peritoneal dialysis (PD) patients, but whether RRF influences the quality of life (QOL) of PD patients is still controversial. The aims of this study were to explore the effects of RRF on QOL in patients with continuous ambulatory peritoneal dialysis (CAPD) and analyze the related factors that might affect patients' QOL. MATERIALS AND METHODS All 120 adult patients in this study received regular CAPD treatment for at least 3 months. Patients were divided into two groups: an RRF group (residual glomerular filtration (rGFR) ≥ 1 mL×min-1×(1.73m2)-1) and a non-RRF group (rGFR ≥ 1 mL×min-1×(1.73m2)-1). The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used as a reference to calculate the scores of CAPD patients for assessing their QOL. Multiple- and single-linear regression analysis was performed to analyze correlation degree of several SF-36-related indexes. RESULTS The indexes of age, gender, cause of disease, complication, body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), hemoglobin (HB), cholesterol, triglycerides, high- and low-density lipoprotein, normalized protein catabolic rate (nPCR), and cardiothoracic ratio (CTR) showed no difference between the two groups (RRF and non-RRF). Comparing with RRF group, the patients without RRF showed a significant difference on indexes of PD duration, urine volume, ultrafiltration volume, dialysis dose, serum albumin, potassium, Kt/V (urea reduction ratio), creatinine, calcium, phosphate, C-reactive protein (CRP), and parathyroid hormone (PTH). Single-linear regression analysis that achieved total score of SF-36 showed no correlation with rGFR, but there was a correlation of SF-36 score with CRP, creatinine, CTR, albumin, and ultrafiltration volume. CONCLUSION These results suggested that there was no correlation between RRF and QOL in CAPD patients, but chronic inflammation, fluid overload, and malnutrition were considered as the main factors that affect patients' QOL. .

The impact of residual renal function on quality of life in patients with peritoneal dialysis .

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The impact of residual renal function on quality of life in patients with peritoneal dialysis .