Search

Depression and anxiety are highly prevalent psychological disorders in end-stage renal disease (ESRD) that have a negative clinical impact. The purpose of our study was to identify factors associated with the presence of depression and anxiety, in a sample of ESRD patients treated with hemodialysis. We included 187 patients from two dialysis facilities, age 18–65 years. Beck’s depression and anxiety inventories, KDQOL36 questionnaire, the cognitive distortion scale and the Mexican scale of resilience were used. Socio-demographic and clinical information was obtained from medical records. Depression was present in 143 (76.4%) patients. Patient with depression were older (33 (26–52) years vs. 30 (24.43) years, p = 0.025), had a lower education level (36% vs. 9%, p = 0.001), used more medications (67% vs. 36%, p = 0.001), had a comorbidity (75% vs. 41%, p = 0.001), and a higher proportion were waiting for a kidney transplant. Anxiety was present in 112 (59.8%) cases. By multivariate analysis, depression was independently associated with lower education, absence of previous kidney transplant, anxiety, higher cognitive distortion, lower psychological resilience, and lower quality of life scores. In conclusion, lower psychological resilience, lower education level, and higher cognitive distortions are factors associated with depression and anxiety in ESRD patients.

Gender and sex differences affect women with kidney failure (KF) negatively at all stages of the disease. This study assessed gender differences in self-care, hemodialysis symptoms, and quality of life in a sample of 102 adult KF patients treated with hemodialysis, from two clinical centers in Mexico. Self-care agency, quality of life, and the symptoms related to hemodialysis were evaluated through questionnaires, and sociodemographic and laboratory variables were obtained from the clinical records. Compared to male patients, female patients reported similar self-care, lower quality of life subscales (symptoms, physical functioning, pain, and overall health), and higher prevalence and intensity of hemodialysis symptoms. There were gender differences regarding the correlation between self-care and quality of life, symptoms intensity, and symptoms prevalence. In conclusion, women with KF treated with hemodialysis perceived a higher impact of hemodialysis and reported a lower quality of life than men. Despite having a similar self-care agency, the self-care correlations with quality of life and hemodialysis symptoms appeared different between men and women treated with chronic hemodialysis. Such differences may be important in future nursing interventions to improve self-care and quality of life among KF patients.

espanolLa resiliencia consiste en una serie de habilidades personalizadas que sirven para afrontar situaciones adversas y superarlas, e incluso salir fortalecido. La resiliencia en pacientes con insuficiencia renal cronica (IRC) tratados con hemodialisis (HD) se ha evaluado con cuestionarios generales, no especificos para esta poblacion. Objetivo Evaluar las propiedades psicometricas de un cuestionario de resiliencia en pacientes tratados con HD cronica. Metodo Se incluyeron 280 pacientes con IRC (edad 18 a 85 anos, 44% mujeres) tratados con HD al menos dos meses en seis unidades de hemodialisis en Mexico, que respondieron los inventarios de depresion y ansiedad de Beck, un inventario de distorsiones cognitivas y la escala de medicion de resiliencia con mexicanos (RESI-M). Resultados Por duplicidad en mas de un factor, se eliminaron dos de 43 reactivos en el analisis factorial exploratorio. Se confirmaron cinco factores que explicaron 63.4% de la varianza total, con alfa de Cronbach de .96 (el alfa en los cinco factores va de .85 a .95). El analisis confirmatorio mostro un modelo estructural teorico que se ajusta aceptable, equilibrada y parsimoniosamente a los datos empiricos. Los cinco factores se correlacionan positivamente entre ellos y negativamente con los sintomas de ansiedad, depresion y los pensamientos distorsionados. Discusion y conclusion La escala RESI-M es valida y confiable para evaluar resiliencia en pacientes tratados con HD cronica. Los factores de resiliencia evaluados con la RESI-M son un blanco terapeutico potencial para disminuir los sintomas depresivos y ansiosos en estos pacientes. EnglishIntroduction: resilience consists of a series personalized skills to cope with adverse situations and overcome them, and even emerge strengthened. Resilience in patients with chronic renal insufficiency (CRI) treated with hemodialysis (HD) has been evaluated with general questionnaires that are not specific for this population. Objective: to evaluate the psychometric properties of a resilience questionnaire in patients treated with chronic HD. Method: the study included 280 patients with CRI (aged 18 to 85, 44% women) treated with HD for at least two months in six hemodialysis units in Mexico, who completed Beck’s depression and anxiety inventories, an inventory of cognitive distortions, and the Mexican Resilience Measurement Scale (RESI-M). Results: owing to the duplication of more than one factor, two of the 43 items were eliminated in the exploratory factor analysis. We confirmed five factors that explained 63.4% of the total variance, with a Cronbach’s alpha of .96 (the alpha ranges in the five factors from .85 to .95). The confirmatory analysis showed a theoretical structural model that fits the empirical data in an acceptable, balanced, and parsimonious way. The five factors correlate positively with each other and negatively with anxiety and depression symptoms and distorted thoughts. Discussion and conclusion: the RESI-M scale is valid and reliable for assessing resilience in patients treated with chronic HD. Resilience factors evaluated with RESI-M are a potential therapeutic target to reduce depression and anxiety symptoms in these patients.

Se trata de hombre de 28 años de edad conocido previamente sano. Inició su cuadro con presencia de náuseas, vómitos y ataque al estado general. Durante la valoración se documentó nitrógeno ureico en sangre (BUN) 142 mg/dl y creatinina 12.8 mg/dl. Por recursos económicos limitados no fue posible inicio inmediato de terapia dialítica y solo se inició manejo médico. Tras progresión de la sintomatología, se inició terapia dialítica 10 meses después, recibiendo solamente dos sesiones por semana.

The assessment of spontaneous variability of blood pressure and heart rate is based on specific physiological hypotheses about dynamic features, for example, the baroreflex modulation of heart rate over time in daily life. Usually, arterial baroreflex control of heart rate is explored without delays between blood pressure and heart rate data points, within a narrow range of values, excluding the analysis of saturation regions or low-threshold changes. In this work, we examine the dynamic interactions between systolic blood pressure (SBP) and interbeat interval (IBI), in 15-min length time series and for the first time using the analysis of diagonals derived from a cross-recurrence plots in healthy persons and end-stage renal disease (ESRD) patients. We found that ESRD patients have stronger intermittent dynamical interactions between IBI and SBP, but they lose most of the dynamical interactions. Although healthy subjects exhibit a continuously changing order of precedence between IBI and SBP at different lags, ESRD patients preserve this changing order of precedence only for lags >0 beats. NEW & NOTEWORTHY This study is the first to compare the time-variant pattern of systolic blood pressure (SBP) and interbeat interval (IBI) coupling between ESRD patients and healthy volunteers through the analysis of diagonal in cross-recurrence plots, and in the face of an orthostatic challenge. Our results demonstrated alternant interactions on the order of precedence (IBI → SBP or SBP→ IBI) at different time delays. This pattern is different in resting position and during active standing for the two groups studied, and interestingly, some association patterns are lost in ESRD patients. These patterns of alternant interactions on the order of precedence could be related to autonomic neural activities and cardiovascular synchronization at different scales both in time and space. This could reflect physiological adaptive flexibility of cardiovascular regulation. Losing some association patterns in ESRD may be the result of chronic adjustments of many physiological mechanisms (including chronic sympathetic hyperactivity), which could increase cardiovascular vulnerability to hemodynamic challenges.

Despite having good intentions, hemodialysis (HD) clinics often fail to sustain exercise programs that they initiate. There are many reasons for this, including a lack of funding, inadequate training of the clinic staff, a lack of exercise professionals to manage the program or train the staff, and the many challenges inherent to exercising a patient population with multiple comorbid diseases. Despite these barriers, there are several outstanding examples of successful exercise programs in HD clinics throughout the world. The aim of this manuscript is to review the characteristics of four successfully sustained HD exercise programs in Portugal, Canada, Mexico, and Germany. We describe the unique approaches they have used to fund and manage their programs, the varied exercise prescriptions they incorporate, the unique challenges they face, and discuss the benefits they have seen. While the programs differ in many regards, a consistent theme is that they each have substantial and committed support from the entire clinic staff, including the nephrologists, administration, nurses, dietitians, and technicians. This suggests that exercise programs in HD clinics can be successfully implemented and sustained provided significant effort is made to foster a culture of physical activity throughout the clinic. info:eu-repo/semantics/publishedVersion

Power spectral analysis of heart rate variability (HRV) offers a possibility to non-invasively quantify autonomic cardiac regulation. The technique splits the spectrum of the HRV into high frequency (HF), low frequency (LF) and very-low frequency (VLF) bands, and relates their power content to parasympathetic outflow, sympathetic outflow, and hormonal factors as well as thermoregulation, respectively. In this work, we applied this technique on HRV data from 20 end-stage renal disease (ESRD) patients to estimate power distribution in these three bands as well as their changes respect to time during hemodiafiltration (HDF) therapy; as an indirect way to assess the modulatory activity over the cardiac system. HRV data was processed using the continuous wavelet transform (CWT), power was estimated using 5-min as well as 10-min epochs for comparison purposes, and the results were normalized to unity before linear regression analysis. For 5-min epochs, the LF power increased (p = 0.035), while there were no significant changes in the HF power (p = 0.2). In contrast, for 10-min epochs, both the LF (p = 0.002) and HF (p = 0.043) power decreased, while the VLF power increased (p

Background Hemodiafiltration (HDF), as a convective blood purification technique, has been associated with favorable outcomes improved phosphate control, removal of middle-molecules such as Beta2-microglobulin and the occurrence of intradialytic hypotension (IDH) as compared to diffusive techniques. The aim of this retrospective cohort study in dialysis patients receiving HDF in one urban dialysis facility in Mexico City was to investigate the occurrence of IDH during HDF treatments with varying convective volume prescriptions. Methods Subjects were stratified into equal groups of percentiles of convective volume prescription: Group 1 of 0 to 7.53 liters, group 2 of 7.54 to 14.8 liters, group 3 of 14.9 to 16.96 liters, group 4 of 16.97 to 18.9 liters, group 5 of 21 to 19.9 liters and group 6 of 21.1 to 30 liters. Logistic Regression with and without adjustment for confounding factors was used to evaluate factors associated with the occurrence of IDH. Results 2276 treatments of 154 patients were analyzed. IDH occurred during 239 HDF treatments (10.5% of all treatments). Group 1 showed 31 treatments (8.2%) with IDH whereas group 6 showed IDH in only 15 sessions (4% of all treatments). Odds Ratio of IDH for Group 6 was 0.47 (95% CI 0.25 to 0.88) as compared to Group 1 after adjustment. Conclusions In summary the data of this retrospective cohort study shows an inverse correlation between the occurrence of IDH and convective volume prescription. Further research in prospective settings is needed to confirm these findings.

Late referral of patients with chronic kidney disease (CKD) to specialized care by the nephrologist is associated with worse patient outcomes while on dialysis.To determine the prevalence, risk factors, and consequences of late nephrology referral at a Mexican tertiary care hospital.Retrospective chart review of all adult patients who began chronic hemodialysis between 2002 and 2006 at the National Institute of Cardiology "Ignacio Chavez" (NICICh), Mexico City. Timing of referral to Nephrology Department was classified as early, late or very late if the time elapsed between referral and initiation of dialysis was1 month, between 1-6 months oror = 6 months, respectively. Socio-demographic, clinical, laboratory and echocardiographic characteristics were compared according to timing of referral.Eighty four out of 150 patients were included in the analysis. Of these, 56% were referred1 month, and an additional 15% between 1-6 months prior to the initiation of chronic hemodialysis. In univariate analysis, being referred by a relative or friend was associated with a higher risk (p = 0.04), and being employed with a lower risk of late referral (p = 0.05). Late referred patients were more likely to require emergency dialysis and hospitalization, and of not having a permanent vascular access for their first dialysis. They also had a higher prevalence of severe anemia (hematocrit28%) and of residual kidney function (estimated glomerular filtration rate5 mL/min/1.73 m2), as well as increased left ventricular mass.Late nephrology referral is highly prevalent in our population and is associated with markers of suboptimal predialysis care at the onset of chronic dialysis.

Background In hemodialysis, extracorporeal blood flow (Qb) recommendation is 300–500 mL/min. To achieve the best Qb, we based our prescription on dynamic arterial line pressure (DALP). Methods This prospective study included 72 patients with catheter Group 1 (G1), 1877 treatments and 35 arterio-venous (AV) fistulae Group 2 (G2), 1868 treatments. The dialysis staff was trained to prescribe Qb sufficient to obtain DALP between -200 to -250 mmHg. We measured ionic clearance (IK: mL/min), access recirculation, DALP (mmHg) and Qb (mL/min). Six prescription zones were identified: from an optimal A zone (Qb > 400, DALP -200 to -250) to zones with lower Qb E (Qb < 300, DALP -200 to -250) and F (Qb < 300, DALP > -199). Results Treatments distribution in A was 695 (37%) in G1 vs. 704 (37.7%) in G2 (P = 0.7). In B 150 (8%) in G1 vs. 458 (24.5%) in G2 (P < 0.0001). Recirculation in A was 10.0% (Inter quartile rank, IQR 6.5, 14.2) in G1 vs. 9.8% (IQR 7.5, 14.1) in G2 (P = 0.62). IK in A was 214 ± 34 (G1) vs. 213 ± 35 (G2) (P = 0.65). IK Anova between G2 zones was: A vs. C and D (P < 0.000001). Staff prescription adherence was 81.3% (G1) vs. 84.1% (G2) (P = 0.02). Conclusion In conclusion, an optimal Qb can de prescribed with DALP of -200 mmHg. Staff adherence to DLAP treatment prescription could be reached up to 81.3% in catheters and 84.1% in AV fistulae.

Fosinopril prevents hyperfiltration and decreases proteinuria in post-transplant hypertensives. Hypertension and renal mass reduction induce glomerular hypertension (GH), hyperfiltration (HF) and renal injury. GH may contribute to allograft loss in post-transplant hypertensive patients (PT × HT). HF and GH may be evaluated by renal response to acute protein intake (API). Since ACE inhibition may prevent GH, the effects of fosinopril (Fos) were evaluated in 10PT × HT on azathioprine and prednisone. Patients received 5 to 40 mg/day of Fos during 12 months.Baseline MAP (111.1 ± 2.9mm Hg) was significantly reduced by 10 to 12mm Hg, rising to 114.7 ± 2.7mm Hg after Fos was administered. GFR (63.7 ± 5.9 ml/min) decreased after 4 (48.1 ± 4.6, P < 0.05) and 12 months (50.7 ± 4.6, P < 0.05), rising to 59.4 ± 5.6 after Fos was given. There was no GFR response to API before and after one month of Fos, however, a clear response became apparent at 4 (+ 27% P < 0.05), and 12 months (+ 18%, P < 0.05), disappearing after Fos discontinuation. Proteinuria (918.8 ± 710.6 mg/d) decreased after 4 (72.3 ± 21.6 mg/d, P < 0.05) and 12 months, rising to 297.8 ± 172.3 mg/day after therapy. GFR response to API in 22 controls and 17 uninephrectomized donors was 13 and 11%, respectively. Lack of response to API in PT × HT suggests HF and GH. Reduction of GFR, restoration of response to API and reduction of proteinuria, indicate that ACE inhibition with fosinopril ameliorates HF and GH. This effect may be beneficial in preventing hemodynamic-mediated allograft injury.