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Lack of exercise may reduce the quality of life, physical capability, and functional capability of dialysis patients. Home-based exercise seems to be a desirable form of low-cost intervention. But the effectiveness of this intervention in the dialysis population is still unclear. The purpose of this meta-analysis is to provide effective evidence to determine the impact of home-based exercise on functional capacity, physical capacity, muscular strength, biochemical parameters, and health-related quality of life among dialysis patients with end-stage renal disease (ESRD). PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to May 2023, to identify potential randomized controlled trials (RCTs) assessing the effectiveness of home-based exercise in dialysis patients with ESRD. Two independent reviewers selected studies, extracted data, and assessed the risk of bias using the Cochrane tool. Evidence summary using fixed or random effects for meta-analysis. Twelve RCTs including 1008 dialysis patients met the inclusion criteria. The meta-analysis showed significant effects of home-based exercise on physical capacity. Seven studies reported the results of the 6-min walking test, compared with short-term (0–3 months) home-based exercise (P = 0.76), long-term (3–6 months) interventions (P < 0.001) can significantly improve the results of the 6-min walking test. The results showed that home-based exercise did significantly improve patients' VO 2 peak (P = 0.007). Compared with center-based exercise or usual care, home exercise did not significantly improve handgrip strength, quality of life or CRP and other biochemical parameters (P > 0.05). The results showed that long-term home-based exercise can improve walking ability. In addition, home-based exercise had the benefit on the VO 2 peak of ESRD patients receiving dialysis patients. However, there was no statistically significant difference in handgrip strength, health-related quality of life, CRP, and other biochemical parameters. • This is the first article to evaluate the impact of home-based exercise in dialysis patients with end-stage renal disease. • Home-based exercise improves physical capacity and functional capacity. • The long-term (3–6 months) home-based exercise can significantly improve walking ability compared to short-term exercise at home. [ABSTRACT FROM AUTHOR]

The CK/PCr-system, with creatine (Cr) as an energy precursor, plays a crucial role in cellular physiology. In the kidney, as in other organs and cells with high and fluctuating energy requirements, energy-charged phospho-creatine (PCr) acts as an immediate high-energy source and energy buffer, and as an intracellular energy transport vehicle. A maximally filled total Cr (Cr plus PCr) pool is a prerequisite for optimal functioning of the body and its organs, and health. Skeletal- and cardiac muscles of dialysis patients with chronic kidney disease (CKD) are depleted of Cr in parallel with the duration of dialysis. The accompanying accumulation of cellular damage seen in CKD patients lead to a deterioration of musculo-skeletal and neurological functioning and poor quality of life (QOL). Therefore, to counteract Cr depletion, it is proposed to supplement CKD patients with Cr. The anticipated benefits include previously documented improvements in the musculo-skeletal system, brain and peripheral nervous system, as well as improvements in the common comorbidities of CKD patients (see below). Thus, with a relatively simple, safe and inexpensive Cr supplementation marked improvements in quality of life (QOL) and life span are likely reached. To avoid Cr and fluid overload by oral Cr administration, we propose intradialytic Cr supplementation, whereby a relatively small amount of Cr is added to the large volume of dialysis solution to a final concentration of 1-10mM. From there, Cr enters the patient's circulation by back diffusion during dialysis. Because of the high affinity of the Cr transporter (CRT) for Cr affinity for Cr (Vmax of CRT for Cr=20-40μM Cr), Cr is actively transported from the blood stream into the target cells and organs, including skeletal and cardiac muscle, brain, proximal tubules of kidney epithelial cells, neurons, and leukocytes and erythrocytes, which all express CRT and depend on the CK/PCr system. By this intradialytic strategy, only as much Cr is taken up by the body as is needed to fill the tissue Cr pools and no excess Cr has to be excreted, as is the case with oral Cr. Because aqueous solutions of Cr are not very stable, Cr must be added immediately before dialysis either as solid Cr powder or from a frozen Cr stock solution to the dialysate, or alternatively, Cr could become an additional component of a novel dry dialysate mixture in a cartridge device. [ABSTRACT FROM AUTHOR]

Fine particulate matter (PM 2.5) has been reported to be associated with increased risk of chronic kidney disease (CKD) and progression to end-stage renal disease (ESRD). However, studies on whether long-term exposure to PM 2.5 negatively impacts the survival of patients with ESRD are very limited. To conduct this study, we linked Taiwan Air Quality-Monitoring Database (TAQMD) and the National Health Insurance Research Database (NHIRD) by zip-code. A retrospective population-based cohort of 34,088 adult patients initiating dialysis over six months was formed. Cox proportional regression models were used to estimate the risk of mortality in dialysis patients per 10-μg/m3 increase of PM 2.5 and by PM 2.5 levels divided into quintiles. Restricted cubic spline analysis was performed to delineate the concentration-response relationship between PM 2.5 and mortality. The adjusted hazard ratio (aHR) per 10-μg/m3 increase of PM 2.5 for mortality was 1.11 (95% confidence interval [CI] = 1.08–1.13). When analyzing PM 2.5 exposure divided into quintiles, patients with mean PM 2.5 exposure over 29.33 μg/m3, including level III (aHR 1.00, 95% CI = 0.94–1.07), level IV (aHR 1.09; 95% CI = 1.03–1.16), and level V (HR 1.11; 95% CI = 1.05–1.19), were at stepwise higher risks of mortality compared with level I. Spline analysis showed a non-linear concentration-response function between PM 2.5 and mortality, with the lowest mortality aHR identified at a mean PM 2.5 of 26 μg/m3, followed by a concentration interval with a gradual increase of aHR, and finally a steep rise of mortality risk when mean PM 2.5 exceeded 37 μg/m3. Individuals with older age, those were male, with selected comorbidities, and with low socioeconomic status (SES) were at higher mortality risk. Male and non-diabetics participants were more sensitive to the effect of a 10-μg/m3 of PM 2.5 increase on mortality than their counterparts. In conclusion, long-term exposure to PM 2.5 exceeding a threshold was observed to be associated with increased risk of mortality among dialysis patients. [Display omitted] • Asia's first dialysis-population-based cohort study on PM 2.5 -mortality association. • Positive PM 2.5 -mortality relation per 10-μg/m3 increase in Taiwan's dialysis patients. • Non-linear dose-mortality relation in dialysis patients with long-term PM 2.5 exposure. • A PM 2.5 threshold (26 μg/m3) after which mortality in dialysis patients increases. [ABSTRACT FROM AUTHOR]

Studies addressing the nature of relationship between psychological symptoms and quality of life among dialysis patients in Malaysia are scarce. Hence, this study is intended to investigate the association between psychological symptoms such as depression, anxiety and stress on the quality of life in dialysis patients. A cross sectional multicentre study was conducted from May to October 2012 at 15 centres that provide haemodialysis and/or peritoneal dialysis. Apart from socio-demographic profile data collection, WHOQOL-BREF and DASS21 questionnaires were administered to study subjects. All three psychological symptoms had significant impact on quality of life domains of physical health, psychological health, social impact, perceived environment and overall quality of life. These findings suggest that subjects with symptoms of depression, anxiety and stress had poorer quality of life than those without, highlighting the negative impact of psychological symptoms. [ABSTRACT FROM AUTHOR]

Background: Patients on dialysis are particularly vulnerable to meticillin-resistant Staphylococcus aureus (MRSA) infections and MRSA colonization is associated with increased risk for severe infections in this population.Aim: Determination of risk factors for MRSA colonization among dialysis patients.Methods: This is a systematic review and meta-analysis of studies reporting risk factors of MRSA colonization. We performed a PubMed and EMBASE literature search to identify all studies on risk factors for MRSA colonization among patients undergoing dialysis treatment. Previous hospitalization, type of dialysis access, comorbid conditions, dialysis vintage, gender, length of time on dialysis, and previous antibiotic use were extracted and assessed for possible association with MRSA colonization in this population.Findings: Ten out of 8252 articles, presenting data on 2364 dialysis patients, were included. We found that hospitalization within the previous 12 months [odds ratio (OR): 1.93; 95% confidence interval (CI): 1.04-3.58] and the use of temporary dialysis access (relative risk: 1.66; 95% CI: 1.06-2.60) were associated with a significantly higher risk of MRSA colonization. MRSA carriage was associated with lower serum albumin levels compared to non-carriage (OR: 0.8; 95% CI: 0.68-0.95) and was higher among patients with chronic lung disease (OR: 2.16; 95% CI: 1.04-4.51). There were no data on patients undergoing peritoneal dialysis.Conclusion: Active surveillance approaches, including potential decolonization strategies, are suggested to focus on these subgroups of haemodialysis patients with hospitalization within the previous year, temporary dialysis access, lower serum albumin levels, and chronic lung disease comorbidity. [ABSTRACT FROM AUTHOR]

Résumé Contexte Les troubles anxieux et du sommeil sont fréquents chez les patients dialysés et justifient l’utilisation de benzodiazépines. Bien que la durée de traitement ne doive pas excéder 3 mois, beaucoup de patients dialysés utilisent ces molécules au long cours. Les risques d’une telle consommation sont bien connus. Les néphrologues doivent fréquemment initier ou poursuivre des traitements par benzodiazépines chez les patients dialysés. Cette prescription est complexe et les études relatives aux facteurs associés à leur prise chez cette population particulière sont pauvres. Objectifs Déterminer la prévalence et les facteurs associés à une utilisation au long cours des benzodiazépines chez les patients dialysés, ainsi que la prévalence et les motivations des patients désirant entamer une démarche d’arrêt suite à l’apport d’une information sur les risques d’une telle consommation. Méthodes L’étude a inclus 91 patients dialysés chroniques. Les données sont recueillies à partir du dossier médical informatisé et au moyen d’entretiens avec les patients. Résultats Au total, 50,5 % des patients (âge moyen : 65,8 ans) consomment une benzodiazépine. La prévalence d’utilisation au long cours est de 78,3 %. Les patients utilisateurs chroniques sont (a) plus âgés, (b) moins actifs, (c) plus fréquemment atteints de diabète, (d) de dépression, (e) plus fréquemment en incapacité de marche, (f) moins souvent inscrits sur la liste d’attente de greffe rénale, et (g) ont moins souvent bénéficié d’une greffe rénale préalable. Les doses de benzodiazépines des patients consommateurs au long cours étaient plus élevées que celles des consommateurs sur une courte période. De plus, 60 % des patients consommateurs chroniques ayant bénéficié de l’information désirent entreprendre une démarche d’arrêt. La constatation d’effets indésirables, l’impression d’inefficacité et la peur de la dépendance constituent les motivations les plus souvent identifiées pour justifier le désir d’arrêt. Conclusions La prévalence de la consommation chronique de benzodiazépines chez les patients dialysés est élevée. L’apport d’une information concernant l’utilisation de ces molécules semble avoir un impact positif sur la démarche d’arrêt. Background Dialysis patients frequently have anxiety and sleeping disorders and that explains a benzodiazepine treatment. A significant proportion of dialysis patients are long-term users even though it is not recommended to take benzodiazepine for more than 3 months. Risks of such a use are well identified. Nephrologists frequently have to prescribe benzodiazepines. This prescription is complex and there are few studies regarding the factors of benzodiazepine use among this population. Objectives To determine the prevalence and the factors related to a long-term benzodiazepine use by dialysis patients. To determine the prevalence and the motivation of patients to stop taking medication among the long-term users who got information about the risk of such a use. Method The study includes 91 dialysis chronic patients. Their characteristics were collected from medical records and interviews with the patients. Results The average age of patients is 65,8 years. In all, 50.5% take benzodiazepines. Among benzodiazepine users, the prevalence of long-term use is 78.3%. Long-term benzodiazepine users (a) are older, (b) less active, (c) frequently diabetic, (d) depressive, (e) unable to walk, (f) less often registered on the kidney transplant waiting list, and (g) had less kidney transplant previously. Benzodiazepine doses of long-term users were higher than the doses of short-term users. Moreover, 60% of patients who are chronic users want to take action and stop the treatment. Observation of side effects, impression of ineffectiveness and fear of addiction are the most identified motivation to stop treatment. Conclusion The prevalence of benzodiazepine chronic use by dialysis patients is high. Giving information to the patient about the use of these molecules seems to have a positive impact on the decision to stop. [ABSTRACT FROM AUTHOR]

Hemodialysis patients in Japan are aging and thus more patients need support for attending hemodialysis facilities. This study aimed to clarify how dialysis patients utilize the services covered by Japan's public long-term care insurance (LTCI) system. This cross-sectional study was based on LTCI data of March 31, 2009, the latest available data provided by Niigata City, located on the northwest coast of Honshu. Among 30,349 LTCI users in Niigata City, there were 234 dialysis patients. To clarify the characteristics of the dialysis patients, we compared the utilization of LTCI services between the dialysis patients (234 users) and randomly selected 765 non-dialysis users. We also calculated the annual transportation service costs per patient for dialysis patients who continued home care (home care group) and those who switched to longterm hospital care at LTCI care levels 4 and 5 (hospital admission group). These care levels indicate difficulty in walking or maintaining a sitting posture without assistance. The dialysis group more frequently utilized home care and equipment services, such as renting or purchasing care-support products and support for home equipment repair, and utilized facility services and short-stay services (respite care) less frequently (both p < 0.001). Cost per patient was higher in the home care group than in the hospital admission group, because the transportation services for dialysis patients at care levels 4 and 5 involve higher costs. These findings indicate that LTCI services usable for dialysis patients were limited. Therefore, instead of merely subsidizing transportation expenses, transportation services must be improved. [ABSTRACT FROM AUTHOR]

Abstract: Dyslipidemia is a well-established metabolic disorder in patients with chronic kidney diseases (CKD), on dialysis and renal transplant recipient. The elevated serum cholesterol levels have a definite role in the development and progression of atherosclerosis and the correlation between elevated serum LDL cholesterol as a risk factor for development of CHD has been firmly established. The HMG-CoA reductase inhibitors (statins) are the current drugs of choice for the treatment of hypercholesterolemia. The treatment with statins effectively lower total and LDL-cholesterol levels, moderately decreases triglycerides (TGs) levels, and have a little effect in increasing HDL-cholesterol levels. The statins therapy reduces the morbidity and mortality associated with CHD in patients with normal renal function. However, the beneficial effect of statin therapy on CVD morbidity and mortality in patients with CKD and advanced ESRD are controversial. Statin therapy reduces CVD mortality in patient with early CKD (not yet requiring dialysis) and their use is recommended for patients with early CKD. However, the recent results from the AURORA and SHARP studies have revealed statins treatment provide no CV mortality benefit in patient with advanced CKD or on long-term dialysis. This may be because athermatous coronary artery disease account for a small proportion of the CVD observed in patients with ESRD and/or on dialysis. In addition, advanced CKD result in structural and functional abnormalities of HDL, impaired cholesterol and chylomicron metabolism which leads to accelerated atherosclerosis and CVD in such patients. Collectively, these abnormalities are largely independent of cholesterol biosynthesis, and consequently are not corrected by statin therapy. Therefore lipid lowering therapy in patient with ESRD should be individualized. Atorvastatin and Rosuvastatin are most potent agents among the available statins in cholesterol lowering but are the most expensive. Simvastatin (20mg/day) should be considered the drug of choice for most patients with chronic kidney disease because it is less expensive. Pravastatin and fluvastatin are the most suitable agents for transplant patients to achieve target cholesterol levels because of the reduced risk of drug interactions. [Copyright &y& Elsevier]

Background: Aspects of quality of life (QoL) is considering the important indicator to reflect the significant problems for patients receiving hemodiodalys (HD) therapy. Aim: To assess the quality of life using kidney disease quality of lif sort form (KDQOL TM) of patient on HD. Methods: The cross-sectional study was carried out in security forces hospital-Saudi Arabia-dialysis unit, from July 2010 to March 2011, All prevalent chronic HD patient (N =50), mean age 46.6(14.0) years on maintenance hemodiodialys duration ranged from −24 to +60 months. Results: In the study sample the characteristics of patients on hemodiodialys therapy both sexes were represented in nearly with the mean age was 46.0 (14.0) year on maintenance hemodiodialysis duration ranged from −24 to +60 months and the caregivers were mostly female, Unemployed, housewife, with basic/intermediate level of education. They were mostly married, and have children. With an age 52.0% more the 40 of years According to KDQOL-SF, the mean of overall QOL was 56.6, the effects of kidney disease score was 58.0(18.9), sleep score was 60.5(22.4), work status score was 46.0(38.9)and pain score was 52.0(28.2) Furthermore the overall QoL score statistically significant positive correlation with level of education (r =465) an negative correlation with the patients’ age (r =439). Conclusions: Our results suggest that more than half of these patients might be considered for rehabilitation program including exercise program and counseling to improve overall QoL of HD patients in Saudi Arabia. [Copyright &y& Elsevier]