Uremic pruritus and associated factors in hemodialysis patients: A multi-center study

Background : Uremic pruritus is a common and disturbing problem in hemodialysis patients. Although its pathogenesis is not completely understood, it is thought to be multifactorial. The aim of this study was to identify risk factors of uremic pruritus in hemodialysis patients. Methods : A total of 249 patients from four dialysis centers were included in this study. Data were collected using a questionnaire, the visual analogue scale, and the Hospital Anxiety and Depression Scale. We investigated whether socio-demographic and biochemical parameters were correlated to uremic pruritus. Results : Pruritus was present in 53.4% of the hemodialysis patients. The mean visual analogue scale severity was 6.47 ± 1.56. Patients with white blood cell (WBC) counts ＞ 6.7 × 10³/μL had 1.73 times (95% confidence interval [CI], 1.360-2.888; P = 0.036) more pruritus than did those with WBC counts ＜ 6.7 × 10³/μL. Patients with dry skin were 0.2 times (95% CI, 0.070-0.182; P = 0.028) more likely to suffer from very severe pruritus than were those with normal skin. Conclusion : Uremic pruritus remains a serious problem in dialysis patients. The WBC level and presence of dry skin are thought to be among its causes. Therefore, data regarding the possible risk factors of uremic pruritus must be followed closely in patients at risk

The effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms: A prospective, randomized controlled trial

Introduction The major salivary glands can be stimulated by chewing gum to increase saliva flow and decrease xerostomia. The aim of this study was to investigate the effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms in hemodialysis (HD) patients. Methods This prospective randomized controlled single-blind study was conducted with patients who had been treated for at least 6 months with sessions 3 days a week for 4 hours at two HD units. Patients were randomly allocated to chewing gum group or the control group. In the chewing gum group, gum was chewed for 10 minutes six times a day, and when the patients felt mouth dryness or were thirsty. In the nonchewing gum group, gum was not chewed. The patients were followed-up for 3 months. A total of three saliva samples were taken before starting treatment at the first, 12th, and 36th HD session. Data were collected with the Visual Analogue Scale (VAS), Hemodialysis Patients Fluid Control Scale, Dialysis Symptom Index, and Hospital Anxiety and Depression Scale at baseline, week 4, week 8, and week 12. Findings The study was completed with a total of 44 patients consisting of 22 patients in the each group. The second and third month VAS values (xerostomia) of the patients in the chewing gum groups were statistically significantly lower than those in the control group (P= 0.014,P < 0.001, respectively). The third month salivary flow rate in the chewing gum group was higher than the values in the control group patients (P < 0.001). Discussion It is anticipated that this study will raise nurses' awareness of dry mouth and encourage future studies on interventions to increase the salivary flow rate to prevent or treat dry mouth.WOS:0005735100000012-s2.0-85091685126PubMed: 3299623

Relationship between arteriovenous fistula cannulation practices and dialysis adequacy: A prospective, multicenter study

Background Successful arteriovenous fistula cannulation ensures maximum patient benefit in the haemodialysis procedure. Objective The aim of this study was to determine the effect of various cannulation methods used for arteriovenous fistulas on dialysis adequacy. Design It is a descriptive, cross-sectional and multicenter study. Participants A total of 164 dialysis patients from four dialysis centers were included. Measurements Data were collected by determining patients' characteristics and the arteriovenous fistula cannulation method used, in addition to recording the Kt/V and urea reduction ratio values to evaluate dialysis adequacy. The mean Kt/V and urea reduction ratio values over 3 months after dialysis initiation were used. This trial is registered with , NCT04270292. Results Cannulation with the puncture method was used in 53% of the patients; the fistula needles were inserted in the antegrade direction in 43.9% of the patients; the arterial needle was rotated after fistula needle placement in 63.4% of the patients; and the arterial and venous needles were on the same vascular line in 15.2% of the patients. Placement of the fistula needle in the antegrade direction increased the Kt/V value 0.164 times (95% confidence interval: 0.002-0.212, p = .047). Conclusion Antegrade placement could be a factor influencing dialysis adequacy. We suggest antegrade interventions to the fistula to maximize the patient benefit from the haemodialysis treatment.WOS:0006111903000012-s2.0-85099912817PubMed: 3349274

Are Intensive Care Unit Patients Undergoing Enteral Nutrition Therapy Sufficiently Fed? A Prospective, Descriptive Study

Underfeeding is prevalent in intensive care unit (ICU) patients receiving enteral nutrition (EN). This study aimed to investigate whether ICU patients were fed adequately on the third day of EN. One hundred ten patients who were hospitalized in the 3 mixed ICUs were evaluated for nutrition adequacy. Patient nutritional status was monitored by a nutrition support team. Nutrition provision was found to be adequate in 95.5% (n = 105) and inadequate in 4.5% (n = 5) of patients. A multidisciplinary approach should be employed to ensure that patients receive maximum benefit from EN.WOS:0006365387000052-s2.0-8510401498

Can remote ischemic preconditioning counteract the renal functional deterioration attributable to partial nephrectomy under warm ischemia? Results of an animal study

Background To investigate if remote ischemic preconditioning (RIPC) can offer any renoprotective value by counteracting the deleterious effect of partial nephrectomy (PN) under warm ischemia on renal function. Methods Four groups, each with 5 Wistar albino rats, were constructed; RIPC + PN, PN, RIPC and sham. Right nephrectomy was performed to constitute a solitary kidney model. RIPC denoted sequential clamping/declamping of the femoral artery/vein complex. PN was performed under warm-ischemia following RIPC. Blood samples were collected on multiple occasions until euthanasia on day 7. Immunoassays were conducted to measure the serum and tissues levels of kidney injury markers. Kidneys were examined histologically and morphometric analyzes were performed using digital scanning. Results IL-33 levels did not differ significantly between the groups. Serum levels of KIM-1, NGAL, and aldose reductase in RIPC + PN, PN and RIPC groups were significantly lower than that of sham group. Tissue biomarker levels were similar across groups. The observed trend in mean necrosis area of PN group was higher than that of RIPC + PN group (p > 0.05). The transitional zone between necrosis and healthy tissue showed a trend towards increasing width in the rats subjected to RIPC before PN vs. those who underwent PN without RIPC (p > 0.05). Conclusion RIPC failed to counteract the renal functional consequences of PN under warm ischemia in a solitary kidney animal model. The supportive but marginal histological findings in favor of RIPC's renoprotective potential were not supplemented with the changes in serum and tissue biomarker levels