BackgroundUremic pruritus is a common and intractable symptom in patients on chronic hemodialysis, but factors associated with the severity of pruritus remain unclear. This study aimed to explore the associations of metabolic factors and dialysis adequacy with the aggravation of pruritus.MethodsWe conducted a 5-year prospective cohort study on patients with maintenance hemodialysis. A visual analogue scale (VAS) was used to assess the intensity of pruritus. Patient demographic and clinical characteristics, laboratory parameters, dialysis adequacy (assessed by Kt/V), and pruritus intensity were recorded at baseline and follow-up. Change score analysis of the difference score of VAS between baseline and follow-up was performed using multiple linear regression models. The optimal threshold of Kt/V, which is associated with the aggravation of uremic pruritus, was determined by generalized additive models and receiver operating characteristic analysis.ResultsA total of 111 patients completed the study. Linear regression analysis showed that lower Kt/V and use of low-flux dialyzer were significantly associated with the aggravation of pruritus after adjusting for the baseline pruritus intensity and a variety of confounding factors. The optimal threshold value of Kt/V for pruritus was 1.5 suggested by both generalized additive models and receiver operating characteristic analysis.ConclusionsHemodialysis with the target of Kt/V ≥1.5 and use of high-flux dialyzer may reduce the intensity of pruritus in patients on chronic hemodialysis. Further clinical trials are required to determine the optimal dialysis dose and regimen for uremic pruritus.
These data indicate that HPHD can efficiently relieve UP through clearance of accumulated mid and macro molecules in vivo. This further supports the hypothesis that these molecules are involved in UP.
Blood loss from the access cannulation site during hemodialysis (HD) treatment is inevitable. Nevertheless, during HD, excessive blood loss from the cannulation site is not uncommon. The clinical characteristics associated with it and whether such blood loss could impact on patient outcomes is unknown. This pilot study aims to identify the prevalence and risk factors associated with excessive bleeding (≥ 4 mL/session) from dialysis access cannulation site during regular HD treatments. Stable end-stage renal disease patients receiving maintenance HD via arteriovenous fistula (AVF) or graft (AVG) were included in this study (N = 361). They were closely monitored for one month for the occurrence of excessive access bleeding during each HD session. A total of 4152 sessions of HD were performed during the study period and 143 patients (39.6%) had at least one episode of excessive bleeding from the vascular access (≥ 4 mL/session). Individuals experiencing excessive bleeding episodes had a significantly lower hemoglobin level, higher rate of diabetes, central venous stenosis, longer dialysis vintage, lower serum albumin level, longer hemostasis time and higher AVG and anti-platelet agent use (all P < 0.05). In the multivariable logistic regression model, longer dialysis vintage, central venous stenosis, lower hemoglobin level, and AVG usage were independently associated with occurrence of excessive access bleeding. AVG users also clustered with other risk factors for excessive access bleeding. Our study identified the novel associations between excessive cannulation site bleeding with dialysis vintage, anemia and AVG usage. The significance and impact of long-term chronic, intermittent bleeding from dialysis access should be further explored.
Our group has previously reported that excessive vascular access bleeding during dialysis treatment in stable hemodialysis (HD) patients was associated with anemia and may indicate poorer health. The association between excessive blood loss from access cannulation site and clinical outcomes was unknown. We hypothesized that excessive access bleeding may have an impact on all-cause and cardiovascular (CV) mortality in this population. We prospectively conducted an observational, longitudinal study of 360 HD patients. Excessive access bleeding was defined as at least an occurrence of blood loss greater than 4 mL per HD session during a study period of one month. During a median follow-up of 83 months, all-cause mortality and CV mortality were registered. Outcomes were analyzed by Kaplan-Meier and Cox proportional hazards regression analyses. A total of 118 (32.8%) participants died and 54 of these were from CV death. Using a multivariate Cox proportional hazards regression, access bleeding was found to be an independent predictor of all-cause mortality (HR 1.67, 95% CI 0.96-2.91, P = 0.070) but not for CV death (HR 1.53, 95% CI 0.88-2.68, P = 0.135). Our study identified that excessive access cannulation site bleeding could be a novel marker for increased risk of death in HD patients.
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