Browsing by Author "MacRae, Jennifer"
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Item Open Access A comparison of temporal artery thermometers with internal blood monitors to measure body temperature during hemodialysis(2018-06-14) Lunney, Meaghan; Tonelli, Bronwyn; Lewis, Rachel; Wiebe, Natasha; Thomas, Chandra; MacRae, Jennifer; Tonelli, MarcelloAbstract Background Thermometers that measure core (internal) body temperature are the gold standard for monitoring temperature. Despite that most modern hemodialysis machines are equipped with an internal blood monitor that measures core body temperature, current practice is to use peripheral thermometers. A better understanding of how peripheral thermometers compare with the dialysis machine thermometer may help guide practice. Methods The study followed a prospective cross-sectional design. Hemodialysis patients were recruited from 2 sites in Calgary, Alberta (April – June 2017). Body temperatures were obtained from peripheral (temporal artery) and dialysis machine thermometers concurrently. Paired t-tests, Bland-Altman plots, and quantile-quantile plots were used to compare measurements from the two devices and to explore potential factors affecting temperature in hemodialysis patients. Results The mean body temperature of 94 hemodialysis patients measured using the temporal artery thermometer (36.7 °C) was significantly different than the dialysis machine thermometer (36.4 °C); p < 0.001. The mean difference (0.27 °C) appeared to be consistent across average temperature (range: 35.8–37.3 °C). Conclusions Temperature measured by the temporal artery thermometer was statistically and clinically higher than that measured by the dialysis machine thermometer. Using the dialysis machine to monitor body temperature may result in more accurate readings and is likely to reduce the purchasing and maintenance costs associated with manual temperature readings, as well as easing the workload for dialysis staff.Item Open Access Blood Volume Monitoring Guided Ultrafiltration Biofeedback on the Reduction of Intradialytic Hypotensive Episodes in Hemodialysis(2016) Leung, Kelvin Cheuk-Wai; MacRae, Jennifer; Quinn, Robert; Ravani, Pietro; Duff, HenryThe majority of patients with end stage renal disease rely on hemodialysis (HD) to maintain fluid balance. Unfortunately, rapid fluid removal [ultrafiltration (UF)] often results in symptomatic, intradialytic hypotension (IDH). Our objective was to perform a randomized controlled crossover trial to evaluate the effectiveness of a blood volume monitoring guided UF biofeedback in the reduction of symptomatic IDH. Over the study period, symptomatic patients first had their dialysis prescription and dry weight optimized over a four-week period before being randomized to an eight-week biofeedback intervention or standard control HD. There was a two-week washout period before patients crossed over for a second eight-week study period. There were no differences in the rate of symptomatic IDH, volume status (as measured by electrical bioimpedance), or biomarkers of cardiac stress between the two groups.Item Open Access Comparing Nutrition Status of In-Centre Nocturnal Hemodialysis Patients to Conventional Hemodialysis Patients: a Prospective Cohort Study(2017) Holmes, Rebecca; Fenton, Tanis; MacRae, Jennifer; Nelson, CarolanneBackground: Malnutrition is prevalent in patients receiving hemodialysis (HD). Compared to conventional HD (CHD), in-centre nocturnal hemodialysis (ICND) has shown improvements in patients’ dietary intake, body composition and mortality risk. Methods: We assessed the feasibility of some nutrition assessment tools (MIS, dietary intake, and anthropometric, functional and biochemical measurements) among 10 CHD and 9 ICND patients for a future study to investigate whether ICND is associated with an improvement in nutrition status compared to CHD. Results: Lean tissue mass was higher at baseline (p=0.007), handgrip strength was higher at 6 months (p=0.04) among ICND patients. Dietary intakes were non-significantly higher at both time points and phosphate binder dosage non-significantly declined in the ICND group. The ICND group had a high attrition rate (44%) over 6 months. Conclusion: These potentially clinically important findings merit further investigation with a more comprehensive study to determine whether ICND offers a nutritional advantage over CHD.Item Open Access How Do Transitions Within End-Stage Renal Disease Impact Health-Related Quality of Life?(2018-08-31) Dumaine, Chance Skylar; MacRae, Jennifer; Ravani, Pietro; Santana, Maria Jose; Samuel, Susan M.Dialysis is used to sustain life for patients with end-stage renal disease (ESRD). While dialysis prolongs length of life, numerous studies have shown that dialysis patients have significantly reduced health-related quality of life (HRQoL). The degree of impairment seems to be partially related to dialysis modality [in-centre hemodialysis (IHD), peritoneal dialysis (PD), or home hemodialysis (HHD)], as patients on PD/HHD often have higher HRQoL scores than IHD patients. Patients may change dialysis modalities a number of times during their life. Each change is accompanied by a “transition period” (period of time in which patients adapt to life on their new modality). These transition periods are often marked by high rates of anxiety, depression, morbidity, and mortality, and are periods when HRQoL may change rapidly. However, few studies have examined the magnitude of change in HRQoL during transition periods or what the drivers of change are. Such studies are necessary to ensure that patients are provided with the necessary supports during their modality transition to prevent declines in HRQoL. In this pilot project, we tested the methodology of combining kidney disease-specific HRQoL questionnaires (Kidney Disease Quality of Life surveys) with semi-structured interviews in patients undergoing dialysis modality transitions. Patients completed KDQOL surveys prior to and 3 months after initiating a new dialysis modality and participated in semi-structured interviews to describe changes in HRQoL that occurred during the transition period. Regardless of dialysis modality being initiated, mean HRQoL scores as measured by the five domains of the KDQOL-36 improved over the initial 3 months of the transition period. Scores in additional domains of the KDQOL-Short Form were more variable, with improvements in some domains but reductions in others. Patient interviews highlighted many factors that negatively impacted HRQoL which may be amenable to intervention. Overall, combining the KDQOL tools with semi-structured patient interviews proved to be an effective method of studying changes in HRQoL that occur during modality transitions. Future studies may consider implementation of this model on a larger scale in order to better understand transition periods and to test interventions to prevent declines in HRQoL.Item Open Access Overview of the Alberta Kidney Disease Network(BioMed Central, 2009-10-19) Hemmelgarn, Brenda; Clement, Fiona; Manns, Braden J.; Klarenbach, Scott; James, Matthew T.; Ravani, Pietro; Pannu, Neesh; Ahmed, Sofia B; MacRae, Jennifer; Scott-Douglas, Nairne; Jindal, Kailash; Quinn, Robert; Culleton, Bruce F.; Wiebe, Natasha; Krause, Richard; Thorlacius, Laurel; Tonelli, Marcello