Patient activation is the product of knowledge, skills, and confidence that enables a person to manage their own healthcare. It is associated with healthy behaviors and improved patient outcomes. We ...surveyed prevalent hemodialysis (HD) patients at 10 centers using the Patient Activation Measure 13-item instrument (PAM-13). Activation was reported as scores (0-100) and corresponding levels (1-4). Of 1149 eligible patients, surveys were completed by 925 patients (92% response rate). Mean age was 62 ± 14 years, 40% were female, median vintage was 41 (IQR 19-77) months, and 66% had diabetes. Mean PAM score was 56 ± 13, with 14%, 50%, 25%, and 10% in levels 1 to 4, respectively. In adjusted analysis, older age and having diabetes were associated with lower activation, whereas higher educational levels and female gender were associated with higher scores. Significant variation in activation was observed among participants from different centers even after adjustment for other variables. In conclusion, low activation is common among prevalent HD patients.
People with end-stage kidney disease receiving peritoneal dialysis (PD) are generally physically inactive and frail. Exercise studies in PD are scarce and currently there are no PD exercise programs ...in the United States. The primary objective of this study was to test the feasibility of a combined resistance and cardiovascular exercise program for PD patients under the care of a dedicated home dialysis center in the United States.
Parallel randomized controlled feasibility study.
PD patients were recruited from a single center and randomly assigned to the intervention (exercise; n = 18) or control (nonexercise; n = 18) group.
The intervention group received monthly exercise physiologist consultation, exercise prescription (resistance and aerobic exercise program using exercise bands), and 4 exercise support telephone calls over 12 weeks. The control group received standard care.
The primary outcome was study feasibility as measured by eligibility rates, recruitment rates, retention rates, adherence rates, adverse events, and sustained exercise rates. Secondary outcome measures were changes in physical function (sit-to-stand test, timed-up-and-go test, and pinch-strength tests) and patient-reported outcome measures.
From a single center with 75 PD patients, 57 (76%) were deemed eligible, resulting in a recruitment rate of 36 (63%) patients. Participants were randomly assigned into 2 groups of 18 (1:1). 10 patients discontinued the study (5 in each arm), resulting in 26 (72%) patients, 13 in each arm, completing the study. 10 of 13 (77%) intervention patients were adherent to the exercise program. A t test analysis of covariance found a difference between the treatment groups for the timed-up-and-go test (P = 0.04) and appetite (P = 0.04). No serious adverse events caused by the exercise program were reported.
Single center, no blinded assessors.
A resistance and cardiovascular exercise program appears feasible and safe for PD patients. We recommend that providers of PD therapy consider including exercise programs coordinated by exercise professionals to reduce the physical deterioration of PD patients.
None.
NCT03980795.
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Since December of 2019, infection with SARS-CoV-2, the virus that causes COVID-19, has led to the most serious infectious disease pandemic since the influenza pandemic of 1918-1920. In the United ...States, over 49.2 million cases of COVID-19 were diagnosed from February 2020 to December 6, 2021, resulting in 788,315 deaths. In the state of California, over 5.1 million cases of COVID-19 were diagnosed in the same time period, resulting in 75,102 deaths and 3,562 individuals presently hospitalized. While the majority of individuals affected by COVID-19 exhibit only mild symptoms that do not require hospitalization, many require hospitalization, with the most ill patients needing intensive care unit admission, mechanical ventilation, and extracorporeal membrane oxygenation (ECMO) treatment.End stage renal disease (ESRD) is caused when nephrons in the kidneys are damaged over time, the kidneys lose their ability to remove impurities in the blood, and kidney dialysis is required on a regular basis. Infection is the second most reported cause of death in the ESRD population. Annual death rates from pneumonia and sepsis are substantially higher among ESRD patients than among the general population. ESRD patients have a compromised and poorly regulated immune system, which may increase susceptibility to bacterial and viral infections, including the SARS-COV-2 virus. Research studies of ESRD patients who are hospitalized with Covid-19 are needed so that these patients can be risk stratified to appropriate therapeutic treatment regimens and receive the best possible in-hospital care.A retrospective cohort study was conducted to explore 6 clinical outcomes for individuals with and without ESRD, hospitalized with Covid-19 at one of the 5 tertiary care, academic hospitals of the University of California (UC Davis, UC Irvine, UC Los Angeles, UC San Diego, and UC San Francisco). The University of California COVID Research Database (UC CORDS), a large, harmonized database provided by the UC Health Data Warehouse (UCHDW), was utilized for this purpose. In Chapter 1, logistic regression analysis was used to investigate the risks for in-hospital death and hospital length of stay of 7 days or longer. In Chapter 2, the risks of ICU admission and ICU length of stay of 7 days or longer were also explored using logistic regression analysis. In Chapter 3, Cox proportional hazards regression analysis was used to investigate the risks for death and readmission within 30 days post-hospitalization for COVID-19. Factors associated with each of the above clinical outcomes were also explored in separate analyses.
Increased mortality and morbidity are reported in association with high ultrafiltration rate (UFR) and with long dialysis recovery time (DRT). We studied the association between UFR and DRT.
This is ...a cross-sectional, observational study was conducted. Patients on thrice-weekly hemodialysis (HD) with self-reported DRT between August and December 2014 were included. We examined the association of 30-day average UFR with recovery time.
The total number of patients included in this study was 2,689. DRT in categories of immediate recovery, >0-≤2, >2-≤6, >6-≤12, and >12 h, were reported in 27, 28, 17, 9, and 20% of the patients respectively. In multivariable analysis, longer DRT was associated with female gender, non-black race, higher body weight, lower serum albumin, chronic heart failure, cerebrovascular disease, missed dialysis sessions, higher pre-dialysis systolic blood pressure, and larger UF volume. Compared to UFR of <10, UFR ≥13 mL/kg/h was associated with longer DRT, OR of 1.16 (95% CI 0.99-1.36), and 1.28 (95% CI 1.06-1.54) in the unadjusted and the adjusted analyses respectively. Intradialytic hypotension was also associated with longer DRT in the unadjusted (per 10% higher frequency, OR 1.04 95% CI 1.01-1.07) and adjusted analyses (OR 1.03 95% CI 1.00-1.07).
Long recovery time is common after HD. Rapid fluid removal is associated with longer DRT.
Introduction
People with end‐stage renal disease undergoing hemodialysis are at increased risk for stress, anxiety, and depression. The study objective was to measure the effect of intradialytic ...group laughter therapy on depressive symptoms in people on hemodialysis (HD).
Methods
Pragmatic randomized controlled trial conducted with prevalent HD patients in 10 centers in Northern California. The intervention group received a once weekly, 30‐minute group laughter therapy session for 8 weeks. Primary outcome was the number of people with depressive symptoms as measured using the four Item Patient Health Questionnaire. Secondary outcomes were anxiety, subjective well‐being, and patient‐reported outcome measures.
Findings
In all, 151 participants completed both predepression and postdepression symptom measures (72 intervention and 79 control). The proportion of patients with self‐reported depressive symptoms changed from 17 (22%) to 16 (20%), in the control and from 11 (17%) to 5 (8%) in the intervention arms, respectively (P = 0.04). In the control arm, 7 out of the 17 patients with self‐reported depressive symptoms at baseline continued to report depressive symptoms at follow up compared to the intervention arm where only 1 of 12 patients continued to report depressive symptoms. No differences were noted between the groups for reported anxiety, patient‐reported dialysis symptoms, and subjective well‐being.
Discussion
This study found intradialytic group laughter can decrease the number of people with depressive symptoms receiving hemodialysis. Larger and long‐term studies are required to evaluate the effect of intradialytic laughter on patient related outcomes and quality of life.
Introduction
Increased patient activation is associated with improved health outcomes; however, little is known about patient activation in people with end‐stage kidney disease at the start of their ...dialysis journey. This study aimed to measure activation status changes over the first 4 months of dialysis.
Methods
Prospective, longitudinal, and observational study. Incident patients initiating dialysis at 25 in‐center hemodialysis and 17 home dialysis programs across three US states managed by the same dialysis provider completed the 13‐item Patient Activation Measure (PAM‐13) survey at baseline (month 1 after commencement of dialysis) and follow‐up (month 4). The survey yields a score (0–100) that corresponds to four levels (1–4), with higher scores or levels indicating higher activation.
Findings
One hundred eighty‐two participants (139 center, 43 home) completed both baseline and follow‐up surveys. Mean age was 60 ± 15 years, 40% female. Mean PAM‐13 scores were 65.1 ± 16.8 and 64.8 ± 17.8 at baseline and follow‐up, respectively; mean intraindividual change: −0.3 ± 17.3. The proportions of patients at levels 1–4 at baseline were 11%, 23%, 35%, and 31% respectively. At follow‐up, 50%, 64%, 52%, and 37% of participants at levels 1–4, respectively, changed to a different PAM level (Spearman correlation = 0.47; p < 0.001). Home dialysis was associated with higher PAM scores when compared to in‐center hemodialysis in multivariable analyses, adjusted for sociodemographic variables, comorbidities, and predialysis nephrology care (β = 5.74, 95% confidence intervals CI: 0.11–11.37 and 9.02, 95% CI: 3.03–15.02, at baseline and follow–up, respectively).
Discussion
Although aggregated group scores and levels remained stable, intra‐individual patient activation changed significantly during the first 4 months of dialysis. This novel finding is foundational to future projects aiming to design interventions to improve patient activation.
Introduction: A majority of patients with end‐stage renal disease (ESRD) on in‐center hemodialysis (HD) require several hours to recover from an HD session. Patients and caregivers identify fatigue ...as a high priority for improvement. However, evidence for practical interventions to improve recovery time from conventional in‐center HD is lacking. The effect of blood flow rate reduction on dialysis recovery time (DRT) is unknown.
Methods: Multicenter, single‐blinded, randomized, parallel‐design controlled trial of blood flow rate reduction vs. usual care. One‐hundred two patients with ESRD undergoing maintenance HD in 18 centers with baseline DRT of greater than 6 hours were included as subjects. The intervention was a blood flow rate reduction of 100 mL/min, to a minimum of 300 mL/min. The primary outcome was the between‐group difference in change in DRT. Secondary outcomes were changes in London Evaluation of Illness (LEVIL) survey responses from baseline.
Findings: Baseline median DRT was 720 (IQR 360–1013) minutes in controls and 720 (IQR 360–1106) minutes in the intervention group. DRT decreased in both groups. Mean change from baseline (95% confidence interval) at Week 4 in the study was −324 (−473, −175) minutes in the control group and −120 (−329, 90) minutes in the intervention group. The change from baseline was more profound in the control group (P = 0.05). Secondary outcomes of measures of quality of life reported on the LEVIL survey showed more improvement in patients’ feelings of general well‐being in the control group (P = 0.01). Differences between groups in pain, feeling washed out or drained, sleep quality, shortness of breath, and appetite were not statistically significant.
Discussion: Blood flow rate reduction did not improve DRT over usual care. Though more work needs to be done to address patient‐reported fatigue, a significant positive impact may not be achieved without substantial changes in dialysis prescription.
To test the hypothesis that firefighter exposures may increase cancer risk, mortality rates were calculated for 3,066 San Francisco Fire Department firefighters employed between 1940 and 1970. Vital ...status was ascertained through 1982, and observed and expected rates, rate ratios (RR), and 95% confidence intervals (CI) were computed using United States death rates for comparison. The total number deceased (1,186) was less than expected and there were fewer cancer deaths than expected. However, there were significant excess numbers of deaths from esophageal cancer (12 observed, 6 expected), cirrhosis and other liver diseases (59 observed, 26 expected), and accidental falls (21 observed, 11 expected). There were 24 line-of-duty deaths, which were primarily due to vehicular injury, falls, and asphyxiation. Heart disease and respiratory disease deaths occurred significantly less often than expected. It was concluded that the increased risks of death from esophageal cancer and cirrhosis and other liver diseases may have been due to firefighter exposures, alcohol consumption, or interaction between alcohol and exposures. Because this was an older cohort and firefighter exposures have changed due to the increasing use of synthetic materials, it is recommended that the effects of modern-day exposures be further studied.
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