Insomnia, muscular cramps and pruritus have low intensity in hemodialysis patients with good dialysis efficiency, low inflammation and arteriovenous fistula

Orășan, Olga Hilda; Saplontai, Aniela Pop; Cozma, Angela; Racasan, Simona; Kacsó, Ina Maria; Rusu, Crina; Moldovan, Diana; Tirinescu, Dacian; Potra, Alina; Paţiu, Ioan Mihai; Orășan, Remus

doi:10.1007/s11255-017-1624-9

Cited by 13 publications

(9 citation statements)

References 20 publications

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“…In accordance with previous studies, recovery time was unrelated to age [7,9] and some clinical variables such as the Charlson comorbidity index [7] and insomnia [36].…”

Section: Discussionsupporting

confidence: 91%

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate

Bossola¹,

Stasio

Monteburini³

et al. 2018

Blood Purif

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Introduction: The present study aimed to determine the variables that are associated with a longer dialysis recovery time (DRT) and to define the relationship that exists between DRT and the ultrafiltration rate (UFR) in prevalent chronic hemodialysis (CHD) patients. Methods: We studied 210 prevalent CHD of 5 hemodialysis units in Central Italy. Patients were invited to answer to the question: “How long does it take you to recover from a dialysis session?” Answers to this question were subsequently converted into minutes. Demographic, clinical and laboratory parameters were recorded for each patient as well as the UFR (mL/kg/h), the dialysate sodium concentration and temperature. Results: Median DRT was 180 min (60–420). Ninety five (45%) patients had a DRT ≥ the median value. Mean UFR was 9.2 ± 3.0 mL/kg/h. Patients with a lower DRT had a less prevalent disability in the instrumental activities daily living, had a higher UFR, and a lower dialysate temperature, as compared with subjects with higher DRT. According to the logistic regression model, UFR was associated with a DRT below the median (i.e., 180) in the unadjusted model (OR 1.12; 95% CI 1.02–1.23; p = 0.019), after adjusting for age and sex (OR 1.11; 95% CI 1.01–1.22; p = 0.025), and in the fully adjusted model (OR 1.11; 95% CI 1.04–1.22; p = 0.040). UFR increase was associated with increasing probability of DRT below the median (p for trend = 0.035). The highest tertile of DRT was associated with UFR below the mean value (i.e., 9.2 mL/kg/h) in multinomial logistic regression having the lowest DRT tertile as reference. DRT was significantly lower in patients with UFR > 13 mL/kg/h than in patients with UFR 10–13 or < 10 mL/kg/h. Conclusion: DRT is inversely associated with UFR in CHD patients. Whether a high UFR should be recommended to reduce the DRT needs to be elucidated through an adequate prospective randomized study.

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“…In accordance with previous studies, recovery time was unrelated to age [7,9] and some clinical variables such as the Charlson comorbidity index [7] and insomnia [36].…”

Section: Discussionsupporting

confidence: 91%

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate

Bossola¹,

Stasio

Monteburini³

et al. 2018

Blood Purif

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“…Pruritus and insomnia are common disorders in hemodialysis (HD) patients. Pruritus affects up to 40% of end-stage renal disease (ESRD) patients and has a major clinical impact, being associated strongly with poor quality of life, impaired sleep, depression, and increased mortality [1,2]. Sleep disorders are experienced by approximately 50-75% of ESRD patients [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…Pruritus affects up to 40% of end-stage renal disease (ESRD) patients and has a major clinical impact, being associated strongly with poor quality of life, impaired sleep, depression, and increased mortality [1,2]. Sleep disorders are experienced by approximately 50-75% of ESRD patients [2][3][4]. Insomnia reduces overall quality of life and may lead to other complications including impaired immune system and risk for cardio- vascular disease [2,5].…”

Section: Introductionmentioning

confidence: 99%

“…Sleep disorders are experienced by approximately 50-75% of ESRD patients [2][3][4]. Insomnia reduces overall quality of life and may lead to other complications including impaired immune system and risk for cardio- vascular disease [2,5]. Insomnia is a significant source of stress and has been associated with increased mortality among ESRD patients [6], but this association was not confirmed in one study, where patients with the best sleep quality had a similar risk of death compared with those with the worst sleep quality [7].…”

Section: Introductionmentioning

confidence: 99%

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Hemodialysis Patients with Pruritus and Insomnia Have Increased Risk of Death

et al. 2020

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Background: Pruritus and insomnia are common disorders in hemodialysis (HD) patients, with a major clinical impact as they are associated with poor quality of life and increased mortality. Their coexistence and impact on survival in HD patients have rarely been investigated. Our aim is to investigate the survival of HD patients presenting either none, one, or both disorders and to compare certain features between these groups. Methods: After the inclusion/exclusion criteria, 170 patients treated by HD or online hemodiafiltration were assigned in 4 study groups depending on the presence of either, neither, or both pruritus and insomnia. We analyzed the survival difference between groups after 20 months, and we searched if there were significant differences in terms of clinical and laboratory features. Results: Survival at 20 months was lower in patients with both pruritus and insomnia. Patients with pruritus alone had a lower Kt/V than those with no complaints or insomnia alone. Those with no complaints had lower C-reactive protein and higher albumin levels than patients with insomnia alone or both conditions. Conclusion: Pruritus and insomnia should be actively investigated and correlated with some clinical and laboratory features as they have a significant impact on survival in HD patients.

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“…Previous reports have linked various aspects of the dialysis prescription with intra-dialytic and post-dialysis symptom reporting, including the choice of dialysate sodium, potassium and temperature [7][8][9]. Whereas others have reported that the prevalence of intra-dialysis symptoms and post-dialysis fatigue is reduced by achieving greater urea clearance [10], or by changing from the standard thrice weekly dialysis schedule to shorter but more frequent daily dialysis sessions [11], or low-efficiency continuous dialysis [12]. Whether adding convective clearance or switching from haemodialysis to haemofiltration improves intra-dialytic symptoms and post-dialysis recovery times remains unclear, with some studies reporting a benefit and others no effect [9,12,13].…”

Section: Introductionmentioning

confidence: 99%

Patient-reported intra-dialytic symptoms and post-dialysis recovery times are influenced by psychological distress rather than dialysis prescription

2019

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Background: Dialysis is a life-sustaining treatment, but many patients suffer symptoms during dialysis and take time to recover. Previous reports have linked recovery time to intra-dialytic hypotension and rapid solute clearances, whereas others have reported an association with psychological factors. As such, we wished to investigate which factors were important in determining symptom self-reporting and delayed recovery times. Methods: We recorded self-reported patient intra-dialytic symptoms, recovery times along with sessional dialysis prescriptions, blood pressure and urea clearance, and distress thermometer scores to assess psychological factors. Findings: Six hundred twenty-three dialysis patients were studied; 621 treated by haemodiafiltration, 60.8% male, mean age 64.5 ± 16.2 years, and 46.1% diabetic. Almost half (49.6%) reported recovery within 1 h. On multivariate analysis, patient self-reported symptom scores were associated with longer post-dialysis recovery times (odds ratio (OR) 1.61, 95% confidence limits (CL) 1.33-1.95), higher distress thermometer scores (OR 1.3 CL (1.3-1.39), but lower hand grip strength (OR 0.85 CL (0.93-0.94), all p < 0.001, and younger rather than older patients (OR 0.98 CL (0.97-0.99) p = 0.005. We found no association with ultrafiltration rates or weight loss.Discussion: Compared to earlier studies, our patients treated by haemodiafiltration reported fewer symptoms and shorter recovery times. Patients with higher self-reported distress thermometer scores had both longer post-dialysis recovery times and greater dialysis symptom scores. Younger patients reported more dialysis symptoms and longer recovery times than older patients. Future studies investigating patient self-reported recovery times and dialysis-associated symptoms should also consider interventions to reduce patient psychological factors as well as dialysis practices.

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Insomnia, muscular cramps and pruritus have low intensity in hemodialysis patients with good dialysis efficiency, low inflammation and arteriovenous fistula

Cited by 13 publications

References 20 publications

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate

Hemodialysis Patients with Pruritus and Insomnia Have Increased Risk of Death

Patient-reported intra-dialytic symptoms and post-dialysis recovery times are influenced by psychological distress rather than dialysis prescription

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