Perimortem changes in clinical parameters in patients undergoing maintenance hemodialysis
Abstract Background End-of-life medical care for patients receiving maintenance hemodialysis (HD) therapy has become an increasingly important issue worldwide. Thus far, no clear indicators and/or biomarkers exist regarding the timing of HD therapy withdrawal. Methods To clarify the perimortem circu...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-12-01
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| Series: | Renal Replacement Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41100-021-00388-y |
| _version_ | 1819102695338803200 |
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| author | Tadashi Yoshida Kohkichi Morimoto Takashin Nakayama Takuto Torimitsu Shotaro Kosugi Takuma Oshida Nobuko Yamaguchi Mototsugu Oya |
| author_facet | Tadashi Yoshida Kohkichi Morimoto Takashin Nakayama Takuto Torimitsu Shotaro Kosugi Takuma Oshida Nobuko Yamaguchi Mototsugu Oya |
| author_sort | Tadashi Yoshida |
| collection | DOAJ |
| description | Abstract Background End-of-life medical care for patients receiving maintenance hemodialysis (HD) therapy has become an increasingly important issue worldwide. Thus far, no clear indicators and/or biomarkers exist regarding the timing of HD therapy withdrawal. Methods To clarify the perimortem circumstances, we examined temporal changes in multiple clinical parameters during the last 10 serial HD sessions of 65 terminal patients with end-stage renal disease who had undergone maintenance HD and died in our hospital. Results The results showed that, while most of the laboratory data were unaltered, the physical parameters, such as systolic blood pressure and consciousness levels, gradually and significantly deteriorated toward the last HD session prior to death. The frequency of the use of vasopressors and O2 inhalation tended to increase. The accumulation of such severe conditions was observed at the last HD session. Of interest, the accumulation of severe conditions at the last HD session in patients with malignancies was significantly less than those with cardiovascular diseases or infectious diseases. The accumulation of severe conditions at the last HD session did not differ between patients who withdrew HD versus those who continued HD. Conclusion The results of the present study suggest that predicting the timing of maintenance HD therapy withdrawal is likely to be difficult and that the timing of maintenance HD therapy termination may differ among patient groups with distinct comorbid conditions. |
| first_indexed | 2024-12-22T01:38:39Z |
| format | Article |
| id | doaj.art-d788428088014755bc02cdfc023cecc2 |
| institution | Directory Open Access Journal |
| issn | 2059-1381 |
| language | English |
| last_indexed | 2024-12-22T01:38:39Z |
| publishDate | 2021-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Renal Replacement Therapy |
| spelling | doaj.art-d788428088014755bc02cdfc023cecc22022-12-21T18:43:18ZengBMCRenal Replacement Therapy2059-13812021-12-017111010.1186/s41100-021-00388-yPerimortem changes in clinical parameters in patients undergoing maintenance hemodialysisTadashi Yoshida0Kohkichi Morimoto1Takashin Nakayama2Takuto Torimitsu3Shotaro Kosugi4Takuma Oshida5Nobuko Yamaguchi6Mototsugu Oya7Apheresis and Dialysis Center, Keio University School of MedicineApheresis and Dialysis Center, Keio University School of MedicineDivision of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of MedicineDivision of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of MedicineDivision of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of MedicineDivision of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of MedicineApheresis and Dialysis Center, Keio University School of MedicineApheresis and Dialysis Center, Keio University School of MedicineAbstract Background End-of-life medical care for patients receiving maintenance hemodialysis (HD) therapy has become an increasingly important issue worldwide. Thus far, no clear indicators and/or biomarkers exist regarding the timing of HD therapy withdrawal. Methods To clarify the perimortem circumstances, we examined temporal changes in multiple clinical parameters during the last 10 serial HD sessions of 65 terminal patients with end-stage renal disease who had undergone maintenance HD and died in our hospital. Results The results showed that, while most of the laboratory data were unaltered, the physical parameters, such as systolic blood pressure and consciousness levels, gradually and significantly deteriorated toward the last HD session prior to death. The frequency of the use of vasopressors and O2 inhalation tended to increase. The accumulation of such severe conditions was observed at the last HD session. Of interest, the accumulation of severe conditions at the last HD session in patients with malignancies was significantly less than those with cardiovascular diseases or infectious diseases. The accumulation of severe conditions at the last HD session did not differ between patients who withdrew HD versus those who continued HD. Conclusion The results of the present study suggest that predicting the timing of maintenance HD therapy withdrawal is likely to be difficult and that the timing of maintenance HD therapy termination may differ among patient groups with distinct comorbid conditions.https://doi.org/10.1186/s41100-021-00388-yHemodialysisForgoingWithdrawalBlood pressure |
| spellingShingle | Tadashi Yoshida Kohkichi Morimoto Takashin Nakayama Takuto Torimitsu Shotaro Kosugi Takuma Oshida Nobuko Yamaguchi Mototsugu Oya Perimortem changes in clinical parameters in patients undergoing maintenance hemodialysis Renal Replacement Therapy Hemodialysis Forgoing Withdrawal Blood pressure |
| title | Perimortem changes in clinical parameters in patients undergoing maintenance hemodialysis |
| title_full | Perimortem changes in clinical parameters in patients undergoing maintenance hemodialysis |
| title_fullStr | Perimortem changes in clinical parameters in patients undergoing maintenance hemodialysis |
| title_full_unstemmed | Perimortem changes in clinical parameters in patients undergoing maintenance hemodialysis |
| title_short | Perimortem changes in clinical parameters in patients undergoing maintenance hemodialysis |
| title_sort | perimortem changes in clinical parameters in patients undergoing maintenance hemodialysis |
| topic | Hemodialysis Forgoing Withdrawal Blood pressure |
| url | https://doi.org/10.1186/s41100-021-00388-y |
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