IntroductionPatients receiving haemodialysis are at increased risk of arrhythmias and sudden cardiac death, but data on arrhythmia burden and the pathophysiology remain limited. Among potential risk ...factors, hypoglycaemia is proposed as a possible trigger of lethal arrhythmias. The development of implantable loop recorders (ILR) and continuous glucose monitoring (CGM) enables long-term continuous ECG and glycaemic monitoring. The current article presents the protocol of a study aiming to increase the understanding of arrhythmias and risk factors in patients receiving haemodialysis. The findings will provide a detailed exploration of the burden and nature of arrhythmias in these patients including the potential association between hypoglycaemia and arrhythmias.Methods and analysisThe study is an investigator-initiated, prospective, multicentre cohort study recruiting 70 patients receiving haemodialysis: 35 with diabetes and 35 without diabetes. Participants are monitored with ILRs and CGM for 18 months follow-up. Data collection further includes a monthly collection of predialysis blood samples and dialysis parameters. The primary outcome is the presence of clinically significant arrhythmias defined as a composite of bradycardia, ventricular tachycardia, or ventricular fibrillation. Secondary outcomes include the characterisation of clinically significant arrhythmias and other arrhythmias, glycaemic characteristics, and mortality. The data analyses include an assessment of the association between arrhythmias and hypoglycaemia and hyperglycaemia, baseline clinical variables, and parameters related to kidney failure and the haemodialysis procedure.Ethics and disseminationThe study has been approved by the Ethics Committee of the Capital Region of Denmark (H-20069767). The findings will be presented at national and international congresses as well as in international peer-reviewed scientific journals.Trial registration numberNCT04841304.
Arteriovenous fistulas (AVFs) are iatrogenic vascular connections established to allow high‐flow intravascular access for patients with chronic kidney disease requiring hemodialysis. The left‐right ...flow shunt results in changes in extracellular fluid volume and blood pressure‐controlling hormones that could affect the residual kidney function. We present a case where a female patient with a brachiocephalic AVF had a fistula flow of >4 L/min. To reduce the flow, a banding procedure was performed. The patient was examined prior to banding and 1 and 2 weeks thereafter. Banding resulted in a marked decrease in AVF flow from >4 to 1 L/min and was associated with reductions in N‐terminal pro‐brain natriuretic peptide of 51% and 67% at 1‐ and 2‐weeks post‐banding, respectively. Mid‐regional pro‐atrial natriuretic peptide concentrations were reduced post‐banding by 17% after 1 week and 25% after 2 weeks. After 1 week, renin, angiotensin II, and aldosterone levels in plasma decreased transiently by 44%, 47%, and >86%, respectively, and returned to pre‐banding levels after 2 weeks. Creatinine clearance tended to decrease while blood pressure and total body water increased 2 weeks after banding. This indicates that high‐flow AVF is associated with increased natriuretic peptides and hormones of the renin–angiotensin–aldosterone system, that may balance each other regarding fluid retention and hypertension and support remaining kidney function.
A patient with end‐stage kidney disease and an arteriovenous fistula with extreme access flow of >4 L/min underwent flow reduction to 1 L/min by banding. Flow reduction was associated with increased total body water and blood pressure and reduction in natriuretic peptide hormones along with temporary decreased hormones of the renin—angiotensin—aldosterone system and a small decrease in creatinine clearance. This indicates that a high‐flow arteriovenous fistula is associated with hormonal changes that may balance each other regarding fluid retention and hypertension and support remaining kidney function.
Abstract
Background and Aims
Fluid overload is a major challenge in haemodialysis (HD) patients and might cause hypervolaemia. We speculated that HD patients reaching dry weight could have undetected ...hypervolaemia and low haemoglobin concentration (Hb) due to haemodilution.
Method
The study included HD patients (n = 22) and matched healthy controls (n = 22). Blood volume, plasma volume, red blood cell volume, and total haemoglobin mass (Hb mass) were determined using a carbon monoxide (CO)-rebreathing method in HD patients reaching dry weight and controls. Blood volume measurements were also obtained by a dual-isotope labelling technique in a subgroup for validation purposes.
Results
Blood volume was higher in 16 out of the 22 HD patients compared to controls. In the HD group, the median blood volume was 89.3 mL/kg (interquartile range (IQR) 76.7–95.4 mL/kg) and was higher than in the control group (79.9 mL/kg (IQR 70.4–88.0 mL/kg); P < 0.037) (Table 1). The median plasma volume was 54.7 mL/kg (IQR 47.1–61.0 mL/kg) and 44.0 mL/kg (IQR 38.7–49.5 mL/kg) in the HD and control groups, respectively (P < 0.001). Hb was lower in HD patients (P<0.001), whereas no difference in total Hb mass was observed between groups (P = 0.11). Changes in Hb levels during and after dialysis were observed in the HD group and is shown in Fig. 1. A correlation was found between blood volume measured by the CO-rebreathing test and the dual-isotope labelling technique in the control group (r = 0.83, P = 0.015), but not the HD group (r = 0.25, P = 0.60).
Conclusion
The HD group had increased blood volume at dry weight due to high plasma volume, indicating a hypervolaemic state. The total Hb mass was similar between HD patients and controls, unlike Hb, which emphasizes that Hb is an inaccurate marker of anaemia among HD patients.
Background:
The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD) treatment and preservation of a stable vascular access is crucial. Long term Far Infrared Radiation ...(FIR) has been found to increase access flow together with an enhanced maturation and patency of the AVF. The acute effects of FIR on access flow have been sparsely described and the results are contradictory, perhaps due to differences in measurement conditions and other factors of importance for access flow.
Methods:
Twenty patients in HD with an AVF were included. Each patient was randomized to receive either FIR (FIR group) or no FIR (control group). The acute changes in access flow were investigated in both groups on the second dialysis day of the week and during the first 1.5 h of the dialysis session. Concomitant changes in hemodynamic parameters of importance for access flow were also explored.
Results:
There was no significant change in access flow in the FIR group compared with the control group (median (Interquartile Range)) (−10 (−413.8; 21.3) ml/min vs −17.5 (−83.8; 76.3) ml/min, p = 0.58). There was no significant difference in any of the hemodynamic parameters between the FIR and the control group; cardiac output (−0.7 (−1.2; −0.2) l/min vs −0.4 (−0.9; 0.1) l/min, p = 0.58), cardiac index (−0.3 (−0.5; −0.1)) l/min/m2 vs −0.3 (−0.4; 0) l/min/m2, p = 0.68), mean arterial pressure (5.5 (−1.8; 8.4) mmHg vs 1.5 (−3; 6.3) mmHg, p = 0.35) and total peripheral resistance (2 (1.8; 3.4) mmHg × min/l vs 1 (−0.3; 3.1) mmHg × min/l, p = 0.12).
Conclusion:
In this trial, with a highly standardized set-up, one session of FIR did not result in any acute changes in access flow. This was not due to differences in the hemodynamic parameters between the groups.
A patient on maintenance hemodialysis asked his physician if it would be safe for him to run a marathon. For healthy persons, studies show that it is relatively safe. Very few data are available on ...patients on hemodialysis performing out of center endurance exercise. To address this question, we conducted a clinical study to investigate the electrolyte derangements during different running distances. Our main concern was development of hyperkalemia. We present a case of an anuric hemodialysis patient, who ran eight different runs with a maximum distance of 32.2 km. Blood was analyzed before and after the runs. We did not find severe hyperkalemia at any point. According to this study, we found no signs of increased risk.
The effects and side effects of medical cannabis are not well-established. In 2018, cannabis was approved as a medical drug in Denmark - giving all doctors the opportunity to subscribe medical ...cannabis to their patients. In this case report a 64-year-old kidney-transplanted woman started cannabis droplets due to chronic back pain, which resulted in increased appetite, weight gain and development of diabetes mellitus. Patients with an increased risk of developing diabetes may be more prone to this under the treatment with cannabis. Further studies are needed.
Introduction
Fluid overload is a major challenge in hemodialysis patients and might cause hypervolemia. We speculated that hemodialysis patients reaching dry weight could have undetected hypervolemia ...and low hemoglobin (Hb) concentration (g/dL) due to hemodilution.
Methods
The study included hemodialysis patients (n = 22) and matched healthy controls (n = 22). Blood volume, plasma volume, red blood cell volume, and total Hb mass were determined using a carbon monoxide (CO)‐rebreathing method in hemodialysis patients reaching dry weight and controls. Blood volume measurements were also obtained by a dual‐isotope labeling technique in a subgroup for validation purposes.
Findings
In the hemodialysis group, the median specific blood volume was 89.3 mL/kg (interquartile range IQR: 76.7–95.4 mL/kg) and was higher than in the control group (79.9 mL/kg IQR: 70.4–88.0 mL/kg; p < 0.037). The median specific plasma volume was 54.7 mL/kg (IQR: 47.1–61.0 mL/kg) and 44.0 mL/kg (IQR: 38.7–49.5 mL/kg) in the hemodialysis and control groups, respectively (p < 0.001). Hb concentration was lower in hemodialysis patients (p < 0.001), whereas no difference in total Hb mass was observed between groups (p = 0.11). A correlation was found between blood volume measured by the CO‐rebreathing test and the dual‐isotope labeling technique in the control group (r = 0.83, p = 0.015), but not the hemodialysis group (r = 0.25, p = 0.60).
Discussion
The hemodialysis group had increased specific blood volume at dry weight due to high plasma volume, suggesting a hypervolemic state. However, correlation was not established against the dual‐isotope labeling technique underlining that the precision of the CO‐rebreathing test should be further validated. The total Hb mass was similar between hemodialysis patients and controls, unlike Hb concentration, which emphasizes that Hb concentration is an inaccurate marker of anemia among hemodialysis patients.
ABSTRACT
Introduction
There is a substantial risk of developing stenosis and dysfunction in the arteriovenous fistula (AVF) in patients on hemodialysis (HD). Far infrared radiation (FIR) is a ...non-invasive local intervention with a potentially beneficial effect on AVF patency. The underlying mechanism is not clear. It was hypothesized that a single FIR treatment reduces factors of inflammation and promotes endothelial vasodilators in the AVF.
Methods
Forty HD patients with an AVF were included in an open-label intervention study. Patients were randomized to receive either FIR (FIR group) or no FIR (control group). Blood samples were drawn directly from the AVF and from a peripheral vein in the non-AVF arm before (T0) and 40 min after (T40) treatment during a HD session. The changes median (interquartile range) in circulating factors of inflammation, endothelial function and vasoreactivity during FIR were measured.
Results
In the AVF a single FIR treatment during dialysis resulted in a significantly diminished decrease in soluble vascular cell adhesion molecule, sVCAM −31.6 (−54.3; 22.1) vs −89.9 (−121.6; −29.3), P = .005 and soluble intercellular adhesion molecule, sICAM −24.2 (−43.5; 25.3) vs −49 (−79.9; −11.6), P = .02 compared with the control group. Other factors, such as interleukins, nitrite, nitrate and tumor necrosis factor 1, also declined during dialysis, but with no significant differences related to FIR in either the AVF or the non-AVF arm.
Conclusion
A single FIR treatment attenuated the decrease in sVCAM and sICAM in the AVF compared with a control group during HD. Findings do not support the hypothesis of a vaso-protective effect of FIR. The long-term effects of FIR on the AVF are unknown.
Graphical Abstract
Graphical Abstract
Rationale & Objective: Patients with kidney failure need kidney replacement therapy to maximize survival. Kidney transplant is a superior mode of kidney replacement therapy for most individuals with ...kidney failure. Patients with obesity often are not approved for kidney transplant until they lose sufficient weight, as obesity may complicate the surgical procedure, and the risk of graft loss increases with a higher body mass index. To help potential kidney transplant recipient candidates lose weight, further knowledge of their thoughts, feelings, and attitudes is needed. Study Design: Qualitative study with semistructured interviews and an exploratory research design, guided by qualitative content analysis. Setting & Participants: Patients at a hospital in Denmark required to lose weight to achieve kidney transplant eligibility. Analytical Approach: From patients’ responses, we identified descriptive themes using a phenomenological approach. The factors affecting outcomes were derived reflexively from these themes. Results: Ten interviews were analyzed. Experiences of obesity and weight-loss attempts were described across 4 themes; (1) restrictions and exhaustion, (2) hope and hopelessness, (3) support and self-discipline, and (4) motivation based on severity. A major motivating factor to achieving weight loss in the studied group of patients was their declining kidney function and the fact that kidney transplant cannot be considered until sufficient weight loss is achieved. Limitations: Thematic saturation was reached after an unexpectedly low number of participants. The patients were only interviewed once and over the phone. Conclusions: Patients with obesity who are seeking kidney transplant need additional help with the dietary restrictions brought on by kidney disease. They need assistance bridging between a kidney-friendly diet and a sustainable diet that will ensure weight loss. These patients also express not wanting to feel alone in their weight-loss battle. They are looking for help and support to achieve weight loss.
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