Age, hyperglycemia, inflammation, and comorbidities (hypertension, diabetes, coronary disease) independently increase HF risk in hemodialysis patients. Targeted risk management reduces psychological distress, complications, and enhances care outcomes.
To identify risk factors for heart failure (HF) in hemodialysis patients and assess the efficacy of targeted risk management strategies in improving prognosis and care quality. A total of 170 hospitalized dialysis patients from January 2022 to January 2024 were enrolled. They were divided into two groups based on the presence or absence of heart failure: the heart failure group (n=80) and the non-heart failure group (n=90). The inducing factors were analyzed, and targeted risk management strategies were implemented, with the participants further divided into a conventional group (n=40) and a study group (n=40) to explore the effect of these strategies.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
170
Patients in this group received conventional hemodialysis care, including: Continuous monitoring of vital signs (blood pressure, respiratory rate, pulse, heart rhythm); Supplemental oxygen therapy as needed; Instruction on effective coughing techniques; Strict fluid and electrolyte management; Metabolic support therapies; Positional adjustments (upright posture with lower limb dependency); Environmental regulation (temperature: 22-24°C; humidity: 50-60%); Individualized dietary counseling.
Patients in this group received standard care plus targeted risk management interventions: System Enhancement: Standardized nursing protocols and accountability frameworks Competency-based staff training (emergency response, fluid management) Individualized care plans (e.g., intensified glycemic control for diabetics, optimized BP monitoring for hypertensives) Risk Stratification: Admission assessments and follow-up evaluations to identify high-risk patients Hemodynamic monitoring with alert thresholds for early deterioration detection Strict pharmacological supervision and fluid balance protocols Environmental Modification: Optimized dialysis unit conditions (temperature: 22-24°C; humidity: 50-60%) Dedicated cardiac care zones for HF patients Quality Control: Quarterly audits of critical care domains (patient education, vital signs documentation, protocol compliance, satisfaction metrics) Corrective actions for identified deficiencies
Changsha Fourth Hospital
Changsha, China
Incidence of Major Adverse Cardiac Events (MACE) in Hemodialysis Patients with Heart Failure
Composite endpoint including: Cardiovascular mortality (death due to heart failure, myocardial infarction, or arrhythmia). Hospitalization for worsening heart failure (requiring IV diuretics, vasodilators, or mechanical support). Dialysis-related cardiovascular complications (e.g., intradialytic hypotension, arrhythmias).
Time frame: From enrollment until first occurrence of any MACE component, assessed over 12 months.
Change in Inflammatory Biomarkers
Reduction in serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels from baseline to 6 months.
Time frame: Baseline, 3 months, and 6 months.
Glycemic Control Improvement
Absolute change in glycated hemoglobin (HbA1c) levels in diabetic patients.
Time frame: Baseline and 6 months.
Change in Psychological Distress (SAS/SDS Scores)
Reduction in anxiety/depression scores post-intervention: Self-rating Anxiety Scale (SAS; range 0-100, higher = worse) Self-rating Depression Scale (SDS; range 0-100, higher = worse)
Time frame: Baseline, 6, 12, and 24 months
Complication Rates
Incidence of dialysis-related complications (hypotension, pulmonary edema, infections).
Time frame: Over 12 months.
Nursing Satisfaction Score
Patient-reported satisfaction (25-item Likert scale; 1-4 per item, total 25-100; higher = better), categorized as: Very satisfied (\>90) Satisfied (70-90) Dissatisfied (\<70)
Time frame: 24 months
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