Impacto del momento de medición y de la sintomatología acontecida durante la hemodiálisis en la Calidad de Vida percibida por el paciente / Impact of measurement timing and symptomatology during hemodialysis on perceived quality of life by the patient

Objetivo: Determinar la relación entre calidad de vida percibida por el paciente en hemodiálisis, el momento de medición de esta y el número de síntomas/complicaciones acontecidos durante la sesión.Material y Método: Estudio observacional longitudinal en pacientes en hemodiálisis con capacidad cognitiva conservada. Se recogieron variables sociodemográficas y clínicas, así como calidad de vida mediante instrumento Coop-Wonka.El estudio se desarrolló en 2 fases:Primera fase: evaluación calidad de vida preHD, cuestionario autoadministrado (en las 12 h previas a 1ª sesión semanal).Segunda fase: 4 semanas más tarde, cumplimentación del mismo cuestionario de calidad de vida, administrado por enfermería (al finalizar 1ª sesión semanal).Durante cuatro semanas se recogieron todos los síntomas, complicaciones mecánicas y situaciones de estrés experimentadas por el paciente durante las sesiones.Resultados: Se estudiaron 61 pacientes, 39 hombres (64%). Edad 67,7±13 años. Tiempo en hemodiálisis 68,7±79 meses. Las puntuaciones globales de calidad de vida relacionada con la salud fueron 25,6±6,9 puntos (1ª fase) y 24,2±7 puntos (2ª fase), con diferencias significativas entre ambos periodos. Se registraron 328 síntomas (0,44±0,54/paciente y sesión).El tiempo en hemodiálisis se relacionó con sintomatología y calidad de vida, presesión y post-sesión.Y la sintomatología se relacionó con calidad de vida relacionada con la salud pre y post-sesión.Conclusiones: A mayor tiempo en hemodiálisis los pacientes presentan peor calidad de vida y más sintomatología durante las sesiones. La percepción sobre su estado de salud, es mejor post-sesión en comparación con la percibida antes de la sesión de diálisis. (AU)

Objective: To determine the relationship between patients’ perceived quality of life on hemodialysis, the timing of its measurement, and the number of symptoms/complications occurring during the session.Material and Method: Longitudinal observational study in hemodialysis patients with preserved cognitive capacity. Sociodemographic and clinical variables and quality of life were collected using the Coop-Wonka instrument. The study was conducted in 2 phases:First phase: pre-HD quality of life evaluation, self-administered questionnaire (12 hours before the 1st weekly session).Second phase: 4 weeks later, completion of the same quality of life questionnaire, administered by nursing staff at the end of the 1st weekly session. All symptoms, mechanical complications, and stress situations experienced by the patient during the sessions were recorded for four weeks.Results: Sixty-one patients were studied, 39 men (64%). The mean age was 67.7±13 years. Time on hemodialysis was 68.7±79 months. Overall scores for health-related quality of life were 25.6±6.9 points (1st phase) and 24.2±7 points (2nd phase), with significant differences between both periods. 328 symptoms were recorded (0.44±0.54/patient and session). Time on hemodialysis was related to symptomatology and quality of life, pre-session and post-session. Symptoma-tology was related to health-related quality of life pre and post-session.Conclusions: Patients who have been on hemodialysis for more extended periods have worse quality of life and more symptoms during the sessions. Their perception of their health status is better post-session compared to pre-dialysis sessions. (AU)

Hemodialysis Session Duration, Ultrafiltration Rate, Interdialytic Weight Gain and their Association with Albumin in Patients on Intermittent Hemodialysis in a Regional Dialysis Unit: A Cross-sectional Study.

Aim Several studies suggest that a low pre-dialysis serum albumin level (<40g/L) is associated with increased mortality in dialysis patients. The objective of this study was to assess if hemodialysis session duration (HSD), ultrafiltration rate (UFR) and interdialytic weight gain percentage (IDWG%) are associated with pre-dialysis serum albumin levels (markers of all-cause mortality), thus influencing mortality.  Method  This is a cross-sectional analytical study in which data were collected from a regional cohort of 59 prevalent chronic hemodialysis patients using a national electronic database (eMED). Continuous data were analyzed using a regression model to assess for an association between HSD, IDWG% and UFR with albumin levels. Results Fifty-six patients were included in the study. Multiple linear regression models demonstrated a cross-sectional association between longer HSD and higher serum albumin levels and a statistically significant positive correlation (r = 0.353; p < 0.05). No significant association of UFR (p = 0.169) and IDWG% (p = 0.549) with albumin was observed. Mean albumin was 38.07 ± 3.96 g/L in the HSD <240 min group compared to 40.50 ± 2.83g/L in the HSD ≥240 min group which was statistically significant (p < 0.05). Conclusion Longer HSD has a cross-sectional association with higher pre-dialysis serum albumin with patients having HSD ≥240 min demonstrating the highest levels of serum albumin. Our study suggests longer HSD may improve mortality in the dialysis population.

Timing of dialysis initiation, duration and frequency of hemodialysis sessions, and membrane flux: a systematic review for a KDOQI clinical practice guideline.

BACKGROUND: In 2006, NKF-KDOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) published clinical practice guidelines for hemodialysis adequacy. Recent studies evaluating hemodialysis adequacy as determined by initiation timing, frequency, duration, and membrane type and prompted an update to the guideline. STUDY DESIGN: Systematic review and evidence synthesis. SETTING & POPULATION: Patients with advanced chronic kidney disease receiving hemodialysis. SELECTION CRITERIA FOR STUDIES: We screened publications from 2000 to March 2014, systematic reviews, and references and consulted the NKF-KDOQI Hemodialysis Adequacy Work Group members. We included randomized or controlled clinical trials in patients undergoing long-term hemodialysis if they reported outcomes of interest. INTERVENTIONS: Early versus late dialysis therapy initiation; more frequent (>3 times a week) or longer duration (>4.5 hours) compared to conventional hemodialysis; low- versus high-flux dialyzer membranes. OUTCOMES: All-cause and cardiovascular mortality, myocardial infarction, stroke, hospitalizations, quality of life, depression or cognitive function scores, blood pressure, number of antihypertensive medications, left ventricular mass, interdialytic weight gain, and harms or complications related to vascular access or the process of dialysis. RESULTS: We included 32 articles reporting on 19 trials. Moderate-quality evidence indicated that earlier dialysis therapy initiation (at estimated creatinine clearance [eClcr] of 10-14mL/min) did not reduce mortality compared to later initiation (eClcr of 5-7mL/min). More than thrice-weekly hemodialysis and extended-length hemodialysis during a short follow-up did not improve clinical outcomes compared to conventional hemodialysis and resulted in a greater number of vascular access procedures (very low-quality evidence). Hemodialysis using high-flux membranes did not reduce all-cause mortality, but reduced cardiovascular mortality compared to hemodialysis using low-flux membranes (moderate-quality evidence). LIMITATIONS: Few studies were adequately powered to evaluate mortality. Heterogeneity of study designs and interventions precluded pooling data for most outcomes. CONCLUSIONS: Limited data indicate that earlier dialysis therapy initiation and more frequent and longer hemodialysis did not improve clinical outcomes compared to conventional hemodialysis.