4 results found
Kourtellidou S, Ashby D, Johansson L, 2021, Oral sodium bicarbonate in haemodialysis patients: a randomised controlled trial, BMC Nephrology, Vol: 22, Pages: 1-11, ISSN: 1471-2369
Background: Adverse events and mortality tend to cluster around dialysis sessions, potentially due to the impact of the saw-toothed profile of uraemic toxins such as potassium, peaking pre-dialysis and rapidly dropping during dialysis. Acidosis could be contributing to this harm by exacerbating a rise in potassium. The objectives of this study were to investigate the effects of oral bicarbonate treatment on reducing inter-dialytic potassium gain as well as other clinical consequences of preserving muscle mass and function and reducing intradialytic arrhythmia risk in people on haemodialysis. Methods: Open-label randomised controlled trial in a single-centre (London, UK). Forty-three clinically stable adults on haemodialysis were recruited, with a 6 month average pre-dialysis serum bicarbonate level <22mmol/l and potassium >4mmol/l. Thirty-three participants completed the study. Oral sodium bicarbonate tablets titrated up to a maximum of 3g bd (6g total) in intervention group for 12 weeks versus no treatment in the control group. Outcomes compared intervention versus non-intervention phases in the treated group and equivalent time points in the control group: pre- and post-dialysis serum potassium; nutritional assessments: muscle mass and handgrip strength and electrocardiograms (ECGs) pre and post dialysis. Results: Participants took an average of 3.7±0.5g sodium bicarbonate a day. In the intervention group, inter-dialytic potassium gain was reduced from 1.90±0.60 to 1.69±0.49mmol/l (p=0.032) and pre-dialysis potassium was reduced from 4.96±0.62 to 4.79±0.49mmol/l without dietary change. Pre-dialysis bicarbonate increased from 18.15±1.35 to 20.27±1.88mmol/l, however with an increase in blood pressure. Nutritionally, lean tissue mass was reduced in the controls suggesting less catabolism in the intervention group. There was no change in ECGs. Limitations are small sample size and unblinded study design
Judah G, Mullan B, Yee M, et al., 2020, A habit-based randomised controlled trial to reduce sugar-sweetened beverage consumption: the impact of the substituted beverage on behaviour and habit strength, International Journal of Behavioral Medicine, Vol: 27, Pages: 623-635, ISSN: 1070-5503
BackgroundExcess sugar consumption has been linked to numerous negative health outcomes, such as obesity and type II diabetes. Reducing sugar-sweetened beverage (SSB) consumption may reduce sugar intake and thus improve health. The aim of the study was to test the impact of the potentially different rewarding nature of water or diet drinks as replacements for SSB, using a habit and implementation intention–based intervention.MethodAn online randomised, two-arm parallel design was used. One hundred and fifty-eight participants (mainly from the UK and USA) who regularly consumed SSBs (Mage = 31.5, 51% female) were advised to create implementation intentions to substitute their SSB with either water or a diet drink. Measures of SSB consumption, habit strength and hedonic liking were taken at baseline and at 2 months. Water or diet drink consumption was only measured at 2 months.ResultsThere was a large and significant reduction in SSB consumption and self-reported SSB habits for both the water and diet drink groups, but no difference between groups. There were no differences in hedonic liking for the alternative drink, alternative drink consumption and alternative drink habit between the two groups. Reduction in SSB hedonic liking was associated with reduced SSB consumption and habit.ConclusionThis study demonstrates that an implementation intention–based intervention achieved substantial reductions in SSB consumption and habits. It also indicates that hedonic liking for SSBs and alternative drinks are associated with changes in consumption behaviour. Substituting SSBs with water or diet drinks was equally as effective in reducing SSB consumption.
Johansson L, Hickson M, Brown EA, 2013, Influence of Psychosocial Factors on the Energy and Protein Intake of Older People on Dialysis, JOURNAL OF RENAL NUTRITION, Vol: 23, Pages: 348-355, ISSN: 1051-2276
Brown EA, Johansson L, Farrington K, et al., 2010, Broadening Options for Long-term Dialysis in the Elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients, Nephrology Dialysis Transplantation, Vol: 25, Pages: 3755-3763, ISSN: 1460-2385
Background. Health-related quality of life (QOL) is an importantoutcome for older people who are often on dialysisfor life. Little is, however, known about differences in QOLon haemodialysis (HD) and peritoneal dialysis (PD) in olderage groups. Randomising patients to either modality toassess outcomes is not feasible.Methods. In this cross-sectional, multi-centred study weconducted QOL assessments (Short Form-12 Mental andPhysical Component Summary scales, Hospital Anxietyand Depression Scale and Illness Intrusiveness RatingsScale) in 140 people (aged 65 years or older) on PDand HD.Results. The groups were similar in age, gender, time ondialysis, ethnicity, Index of Deprivation (based on postcode),dialysis adequacy, cognitive function (Mini-MentalState Exam and Trail-Making Test B), nutritional status(Subjective Global Assessment) and social networks.There was a higher comorbidity score in the HD group.Regression analyses were undertaken to ascertain whichvariables significantly influence each QOL assessment.All were influenced by symptom count highlighting thatthe patient’s perception of their symptoms is a criticaldeterminant of their mental and physical well being.Modality was found to be an independent predictorof illness intrusion with greater intrusion felt in thoseon HD.Conclusions. Overall, in two closely matched demographicgroups of older dialysis patients, QOL was similar, if notbetter, in those on PD. This study strongly supports offeringPD to all suitable older people.
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