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Depression and osteoporosis are common diseases in dialysis patients. In addition, patients with osteoporosis are more susceptible to depression. Contrary to previous anti-osteoporosis agents, denosumab and romosozumab could be used in dialysis patients and have similar action mechanisms for blocking RANKL. RANKL causes bone resorption after binding RANKL, but binding with OPG leads to suppress of bone resorption. In recent mice study, inhibition of RANKL with denosumab improved depressive-like phenotype. Besides, it was found that OPG was associated with depression. Therefore, this study aimed to investigate the association of depressive symptoms with RANKL and OPG in hemodialysis patients. We conducted a cross-sectional study with a total of 172 hemodialysis patients. The participants were measured for plasma RANKL, OPG, MMP-2, and MMP-9 levels. Logistic regression analysis was performed to evaluate the effect of RANKL and OPG on the presence of depressive symptoms. The depressive symptoms were observed in 90 (52.3%) subjects. RANKL tertile 3 had negative association with BDI score (β − 4.527, 95% CI − 8.310 to − 0.743) in univariate analysis, and this association persisted even after multivariate adjustments (β − 5.603, 95% CI − 9.715 to −1.491) in linear regression. In logistic regression between RANKL tertiles and depressive symptoms, RANKL tertile 3 had significantly lower unadjusted OR (0.40, 95% CI 0.19–0.86), and multivariate-adjusted OR (0.31, 95% CI 0.12–0.82) for depressive symptoms. OPG was not significantly associated with depressive symptoms. Higher plasma RANKL concentrations were significantly associated with lower depressive symptoms in HD patients. Trial registration WHO registry, No. KCT0003281, date: January 12, 2017. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19, caused by SARS-CoV-2, has resulted in significant mortality and morbidity worldwide. Patients of chronic kidney disease who are on maintenance hemodialysis represent a vulnerable population cohort that is susceptible to severe disease. Hence, it is of utmost importance to prioritize vaccination in this population and to assess their response to said vaccination. Methods: This prospective analytical study was conducted at the Institute of Nephrology, Madras Medical College, between August 2021 and February 2022. Patients of chronic kidney disease stage 5 dialysis (CKD5D) who were on maintenance hemodialysis and who consented to receive COVID-19 vaccine were studied. Serum samples were obtained before vaccination, ≥28 days after receiving the first dose of the vaccine, and ≥28 days after receiving the second dose. Antibody titers against the spike protein were estimated using the Roche chemiluminescent immunosorbent assay. Patients were grouped into non-responders/seronegative (<0.8 U/ml) and responders/seropositive (≥0.8 U/ml), with a value ≥250 U/ml considered as robust response. Results: A total of 96 patients were included. The mean age was 36.70 (±11.53) years and 77.1% of them were male. The median dialysis vintage was 2 (IQR: 0.95-5) years. Twelve patients (9.9%) had a prior COVID-19 infection. Sixty-seven (69.8%) patients had received Covaxin and 29 (30.2%) had received Covishield vaccines. Among the 17 patients who were seronegative at baseline, 4 (23.52%) became seropositive after the first dose of the vaccine, and 11 (64.7%) were seropositive after the second dose, with high titers ("robust response") achieved in two patients (11.76%). No antibody response, despite two doses of the vaccine, was noted in six patients (35.29%). Conclusion: Our study showed a high baseline seropositivity rate, even prior to vaccination, which indicated a high rate of subclinical COVID infection. Among those who were seronegative at baseline, the seroconversion rate after two doses of Covaxin or Covishield was 64.70%. [ABSTRACT FROM AUTHOR]

Objective: We sought to evaluate the left atrial (LA) strain parameters of maintenance hemodialysis (MHD) patients before and after dialysis by two dimensional speckle tracking imaging (2D‐STI), and to explore the effect of volume load change on LA function. Methods: Seventy‐six patients with end stage renal disease (ESRD) on hemodialysis (HD) were enrolled in the study protocol. The median duration of dialysis was 24.0 (7.5, 59.5) months. In addition, 30 healthy subjects were selected as control group. Comprehensive echocardiography was performed immediately before and after hemodialysis to compare the changes in left atrial function. Results: Regarding LA strain parameters in patients of pre‐HD, the median (25th, 75th) LA reservoir, LA conduit, and LA contractile reserve were 28.0 (23.0, 34.5), −15.5 (−10.0, −21.5), −12.0 (−9.0, −16.0) respectively; the post‐HD were 26.0 (21.0, 29.0), −12.0 (−9, −15.5), −12.5 (−9, −15.5) respectively; and controls were 43.0 (36.0, 48.0), −24.0 (−18.0, −32.0), −17.0 (−15.0, −22.0) respectively. The left atrial strain parameters before HD were lower than controls, the differences were statistically significant, the p‐value were.000,.025, and.000, respectively. The reservoir function and conduit function of LA strain decreased after hemodialysis, the differences were statistically significant, the p‐value were.003 and.006, respectively. Regarding the contraction of LA, the differences between pre‐ and post‐HD were not statistically significant (p =.965). Conclusion: Hemodialysis removes excess water in human body, while LVGLS and Doppler parameters are greatly affected by reduced preload. New echocardiographic parameters, such as left atrial strain, can quantitatively evaluate the changes in left atrial function before and after hemodialysis in ESRD patients, which can provide valuable information for the overall cardiac evaluation in this specific population. [ABSTRACT FROM AUTHOR]

Introduction: Ocular manifestations of Haemodialysis (HD) are one of the important causes of morbidity in End-stage Renal Disease (ESRD) patients. According to studies, the incidence rate of glaucoma in the dialysis group was higher than that in the non dialysis group. Angle-closure glaucoma was found to be more common, which depends on anterior chamber morphology. Aim: To assess the effect of HD on Intraocular Pressure (IOP), Anterior Chamber Depth (ACD), and Lens Thickness (LT) in patients with ESRD. Materials and Methods: This was a single-centre crosssectional observational study conducted in the Department of Ophthalmology on 170 eyes of 87 patients undergoing HD for at least three months. The study was conducted between October 2020 and October 2022 at the Dialysis Centre of Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, Maharashtra, India. These patients underwent ophthalmological evaluation pre- and postdialysis. IOP, ACD, and LT were measured 30 minutes prior to and 30 minutes after the HD session. The paired t-test was used to compare differences in means, and a p-value of <0.05 was considered significant. Results: The mean age of the study participants was 57.63±11.95 years. There was a decrease in mean ACD by 0.08±0.29 mm (p=0.0001) and an increase in mean LT by 0.06±0.42 mm (p-value=0.0001) postdialysis. The changes in IOP were variable and not statistically significant (p=0.45). Conclusion: Postdialysis, a significant increase in LT was observed corresponding to a decrease in ACD. Although the change in IOP was variable, this change might be more significant in pre-existing narrow-angle patients undergoing dialysis. As a result, the present study underscores the urgency of refining screening protocols for HD patients to effectively address these identified ocular changes and associated risks. [ABSTRACT FROM AUTHOR]

End stage renal disease (ESRD) patients on renal replacement therapy (RRT) have an increased risk of morbidity and mortality due to healthcare associated infections (HCAIs). The aim of this study is to determine the prevalence, microbial etiology, and risk factors associated with HCAIs among ESRD patients on RRT. A multicenter, retrospective study was conducted from June to December 2019. ESRD patients with minimum of 6 months on RRT were included, while pregnant patients and patients <18 years were excluded. To reduce the risk of selection bias, all patients were randomly selected using a simple random sampling technique. The prevalence showing the proportion of patients that acquired HCAI since the initiation of dialysis until 2019 was calculated using the European patients' academy (EUPATI) formula. Risk factors were assessed using univariate and multivariate regression analysis. The prevalence of HCAI among ESRD patients was 174/400 (43.5%). Catheter related bloodstream infection (CRBSI) was the most common infection [64(36.8%)], followed by peritonitis [45(25.8%)] and pneumonia [37(21.2%)]. Out of 382 total pathogens identified, 204 (53.4%) were Gram positive and 162 (42.4%) were Gram negative. Both methicillin sensitive staphylococcus aureus (MSSA) and methicillin resistant staphylococcus aureus (MRSA) showed statistically significant associations (p<0.05) with CRBSI. Use of multiple accesses, increased blood sugar levels, low serum sodium levels and higher CRP concentration increased the occurrence of HCAIs. The burden of HCAIs among the patients undergoing RRT is high. Preventive strategies and optimum empirical therapy of antibiotics should be used to reduce the risk of these infections among ESRD patients. [ABSTRACT FROM AUTHOR]

Reliable models of renal failure in large animals are critical to the successful translation of the next generation of renal replacement therapies (RRT) into humans. While models exist for the induction of renal failure, none are optimized for the implantation of devices to the retroperitoneal vasculature. We successfully piloted an embolization-to-implantation protocol enabling the first implant of a silicon nanopore membrane hemodialyzer (SNMHD) in a swine renal failure model. Renal arterial embolization is a non-invasive approach to near-total nephrectomy that preserves retroperitoneal anatomy for device implants. Silicon nanopore membranes (SNM) are efficient blood-compatible membranes that enable novel approaches to RRT. Yucatan minipigs underwent staged bilateral renal arterial embolization to induce renal failure, managed by intermittent hemodialysis. A small-scale arteriovenous SNMHD prototype was implanted into the retroperitoneum. Dialysate catheters were tunneled externally for connection to a dialysate recirculation pump. SNMHD clearance was determined by intermittent sampling of recirculating dialysate. Creatinine and urea clearance through the SNMHD were 76–105 mL/min/m2 and 140–165 mL/min/m2, respectively, without albumin leakage. Normalized creatinine and urea clearance measured in the SNMHD may translate to a fully implantable clinical-scale device. This pilot study establishes a path toward therapeutic testing of the clinical-scale SNMHD and other implantable RRT devices. [ABSTRACT FROM AUTHOR]

Background: Autogenous Arterivenous (AV) access is the preferred choice for hemodialysis access in chronic kidney patients. Cimino fistulas are currently accepted as the best mode of vascular access for hemodialysis. The present study was planned to look for the presence of on table bruit and thrill and to know the postoperative outcome and patency. Material and Methods: This single center, prospective study was done in the department of vascular surgery at SMC, from January 2020 - January-2021. Dominance of hand was noted, and preference was given to non- dominant hand. Physical examination of the arterial system along with venous system was done. Preoperative color Doppler of upper limb veins and arteries was done in all the patients. Results: In study of 291 AV access, there were 161(55.3%) AV access which were successfully used for hemodialysis and 83(28.5%) were not. Arterial diameters was significantly found to be higher in those patients with patent AVFs. Conclusion: Creating and maintaining an autogenous AV access for hemodialysis is a complex process subject to patient specific characteristics and surgical expertise. This study suggests that patency rates and functional outcomes of dialysis access procedures are better in patients who are non-smokers, without comorbidities, without previous H/O AVF failure. [ABSTRACT FROM AUTHOR]

Introduction: Chronic inflammation is one of the underlying causes of cardiovascular disease which is commonly seen in patients with chronic kidney disease (CKD) and especially in end-stage renal disease (ESRD), as well as the patients on stable dialysis. Hemodialysis patients suffer from high mortality due to cardiovascular diseases. Objectives: Therefore, the present study aimed to evaluate the effect of atorvastatin and aspirin on C-reactive protein (CRP) concentration in hemodialysis patients and compare the effect of these two drugs on CRP concentration in these patients. Patients and Methods: In this descriptive-analytical study, the dialysis patients who had been on dialysis for more than four months were selected through medical records (N=75). Serum CRP was checked and those who had positive CRP entered in the analysis (n=20). Ten patients had been used atorvastatin at a dose of 20 mg daily and the other 10 patients received aspirin at a dose of 80 mg daily for two months. Serum CRP concentration was measured in all patients at the end of these two months. Results: The mean age of the patients was 65.6 years and the mean number of years on dialysis was three years. In addition, 65% of patients were male and 35% were female. The only significant relationship was between the effect of atorvastatin and CRP concentration and the effect of aspirin on CRP concentration while no statistically significant relationship was found between the two groups of aspirin and atorvastatin in terms of serum CRP value after the intervention. Conclusion: The results indicated that the effect of aspirin and atorvastatin on CRP concentration was positive in hemodialysis patients and reduced the serum level of CRP, indicating the anti-inflammatory role of these two drugs in hemodialysis patients. It should be noted that drug preference was not determined in the present study. [ABSTRACT FROM AUTHOR]

Objective: Continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) are main modalities for end stage renal disease (ESRD) patients, and those have been covered by National Health Insurance (NHI) scheme since 2014 in Indonesia. This study aims to update the cost-effectiveness model of CAPD versus HD in Indonesia setting. Results: Compared to HD, CAPD provides good value for money among ESRD patients in Indonesia. Using societal perspective, the total costs were IDR 1,348,612,118 (USD 95,504) and IDR 1,368,447,750 (USD 96,908), for CAPD and HD, respectively. The QALY was slightly different between two modalities, 4.79 for CAPD versus 4.22 for HD. The incremental cost-effectiveness ratio (ICER) yields savings of IDR 34,723,527/QALY (USD 2460). [ABSTRACT FROM AUTHOR]

Background: Clonidine is a frequently prescribed long-term antihypertensive medication in hemodialysis (HD) patients in the USA, but its safety and efficacy has not been clearly established in the HD population. Objective: To evaluate, we conducted a systematic review and meta-analysis on the safety and efficacy of clonidine in HD patients. Methods: Keyword search of "clonidine" and "dialysis" was conducted through April 2021 in PubMed, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov databases. Inclusion criteria were as follows – study design: randomized controlled trials, cohort studies, prospective studies, retrospective studies, or case series; subjects: adult HD patients; main outcome: blood pressure (BP) and safety; language: English; and article type: peer-reviewed publications. Studies that examined the effects of clonidine in populations other than adult HD patients were excluded. Meta-analysis was performed on BP reduction outcomes. Results: Eight studies met the inclusion criteria for the systematic review, including prospective pre-post studies (2), double-blind controlled trial (1), single-blinded placebo-controlled trial (1), crossover open-label clinical trial (1), retrospective analysis (1), and case report series (2). Three studies included in the meta-analysis ranged from 2 to 12 weeks duration, with a collective sample size of 24 (ages 12–77 years). Risk of bias, assessed using the ROBINS-1 tool, was high for all included studies. Significant adverse effects reported included hypotension, light-headedness, drowsiness, dry mouth, rebound hypertension, and contact dermatitis from patch application. Short-term clonidine use was associated with significant improvement in systolic BP (pooled effect: −12.985 mm Hg, 95% CI [−7.878, −18.092], p < 0.001), while changes in diastolic BP were not statistically significant (−11.119 mm Hg, 95% CI [−22.725, 0.487], p = 0.060). No data currently support the long-term efficacy of clonidine in HD patients. This study was unfunded and was developed using PRISMA guidelines and registered on PROSPERO (CRD42018112042). Conclusions: There is no evidence supporting the long-term use of clonidine in the HD population and a significant side-effect profile. There is low-quality evidence demonstrating the efficacy of clonidine in lowering BP in HD patients in short-term use, but significant safety concerns remain. Fluid removal strategies and other antihypertensives should be used over clonidine for long-term BP control in the HD population. [ABSTRACT FROM AUTHOR]

Background: Right ventricular dysfunction is a major cause of heart failure and mortality in end‐stage renal disease patients. Scarce data is available regarding the comparison of echocardiographic right ventricular function in end‐stage renal disease patients on hemodialysis (HD) and peritoneal dialysis (PD). The aim of the study was to evaluate the long‐term impacts of different dialysis modalities on right ventricular function assessed by conventional echocardiography, in end‐stage renal disease patients with preserved left ventricular function. Methods: The study included 120 patients grouped as follows: PD (n = 40), HD with arterio‐venous fistula (n = 40), and healthy control subjects (n = 40). Conventional echocardiography was performed on all patients. A classification of right ventricular function was defined in HD patients by using tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index (RV‐MPI), fractional area change (FAC), and tricuspid lateral annulus systolic velocity (Sa) values. Correlation analysis was performed by using the right ventricular dysfunction score, clinical, and echocardiographic parameters. Results: The mean age of the study population was 51.9 ± 13.1 years and 47.5% were females. TAPSE and Sa velocity were found to be significantly lower and RV‐MPI was significantly higher in patients undergoing HD, compared with control and PD patients. Logistic regression analysis showed that HD treatment was an independent risk factor for developing right ventricular dysfunction. Conclusion: RV function was impaired in patients undergoing HD compared with patients on PD. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the presence of elbow pain and its relationship with vascular access site for hemodialysis in end-stage renal disease patients. Methods: One-hundred and nine chronic end-stage renal disease patients over 18 years of age undergoing hemodialysis treatment were enrolled in the study. Patients who had undergone surgery of the upper extremity in the last three months and patients with cancer, chronic hearing loss, or neurologic diseases were excluded. Sociodemographic features were evaluated. The Beck Depression Inventory, the Nottingham Health Profile, the Disabilities of the Arm, Shoulder and Hand Score, and the Visual Analogue Scale were administered to all patients. Results: One-hundred and nine patients (38 women, 71 men) participated in the study. The mean age of the patients was 62.22 ± 11.64. The patients were grouped based on the presence of elbow pain into Group 1 (elbow pain positive, n=30) and Group 2 (elbow pain negative, n=79). There was a statistically significant difference between the groups in terms of vascular access site and elbow pain site (p=0.002). In addition, the patients with elbow pain were mostly women, and this result was statistically significant (p<0.05). Conclusions: According to the results of this study, there may be a relationship between elbow pain and hemodialysis vascular site. [ABSTRACT FROM AUTHOR]

Introduction: Tuberous sclerosis complex (TSC) is a rare genetic disease, affecting TSC1 or TSC2 gene, that manifests as a multisystem disorder defined by the development of numerous benign tumors, called angiomyolipomas (AMLs). Due to TSC, mutations in the genes cause permanent activation of the mTOR pathway, leading to tumorogenicity, cellular proliferation distributed around blood vessels and lastly is mostly manifested in hemorrage. Renal complications due to TSC can lead to chronic kidney disease (CKD) and, in severe cases, endstage renal disease (ESRD), requiring renal replacement therapy. Case Report: A 35-year-old female patient known with CKD and a 10-year history of TSC, presented to Nephrology department for monthly check-up with lack of appetite, asthenia, nausea, vomiting, fatigue suggesting uremic syndrome. In 2013 an abdominal CT showed a right renal AML, giant left AML with retroperitoneal hemorrhage, indicating a mandatory left total nephrectomy. Renal AMLs can lead to complications such as local growth, mechanical pressure that is imposed on the renal parenchyma, and bleeding. In 2018, the patient was treated with Everolimus (immunosuppressant) with right kidney AML not growing further. The presence of AML on a solitary kidney, hypertension and the reduced number of nephrons precipitated the onset and progression of CKD. She developed proteinuria, possible glomerulosclerosis due to hyperfiltration on the remaining nephrons. Given all the facts, ESRD was established and a vascular access via an AV fistula was created. She was initiated in chronic hemodialysis because of severe azotemia associated with clinical symptoms. Discussions : Population-based studies found that 48-to-80 percent of patients, between ages 15-30, with TSC have kidney complications with the presence of AMLs and progression towards renal insufficiency. In patients undergoing maintenance hemodialysis, the mortality rate and morbidity burden are markedky elevated, accompanied by a diminished quality of life. Conclusions: Due to its infrequency, this case highlights the need to spread further awareness. Vigilant surveillance and therapeutic intervention targeting these renal manifestations are imperative to mitigate the risk of CKD in TSC patients. [ABSTRACT FROM AUTHOR]

Introduction: Parathormone (PTH) and phosphorus, which are considered as uremic toxins, are associated with reduced red cell survival, yet with unproven mechanism. We aimed to assess the relation between PTH and phosphorus levels and eryptosis in patients with CKD5d treated by hemodialysis. Methods: In a cohort of 85 patients with CKD5d treated by conventional hemodialysis, the percent of annexin V‐binding RBCs was assessed by flow cytometry to indicate the percent of eryptotic RBCs. Findings The median percent of annexin V‐binding RBCs was 2.3 (1.4–4.7)%. On linear regression analysis, PTH was independently associated with the percent of annexin V‐binding RBCs (β = 0.003; 95% CI: 0.002–0.004; p < 0.001). The percent of annexin V‐binding RBCs differed significantly in patients with low PTH (<150 pg/mL; 27/85, 31.8%), target PTH (150–600 pg/mL; 32/85, 37.6%), and high PTH (>600 pg/mL; 26/85, 30.6%) groups (1.24 [0.65–1.85]; 2.46 [1.73–4.05]; and 4.82 [3.45–5.61]%, respectively; p < 0.001). Considering the tertiles of the percent of annexin V binding RBCs, PTH increased significantly from 85 (50.6–273) in the 1st to 298.3 (172.8–606.8) in the 2nd and 827.6 (357.4–1171.3) pg/mL in the 3rd tertiles (p < 0.001). Phosphorus and calcium levels as well as the CaxPh product were similar among the three tertiles (p > 0.05). Discussion: Patients with CKD5d express high rates of eryptosis. PTH excess in those patients may result in further eryptosis enhancement, and this represents a potential pathogenic mechanism linking hyperparathyroidism with the anemia of CKD. [ABSTRACT FROM AUTHOR]

Background: Worldwide, data are conflicting on the prevalence of Helicobacter pylori (Hp) infection in Hemodialysis (HD) population. In Egypt, the data on this population are rather limited. Objectives: The aim of this cross-sectional study was to screen HD patients with Gastrointestinal (GI) symptoms for the prevalence of Hp infection using non-invasive serological testing for Immunoglobulin G (IgG) antibody and then to compare the screening data with the confirmatory esophagogastroduodenoscopy (EGD) findings. Patients and Methods: From January 2020 to June 2021, the sera of one hundred patients with GI complaints were screened for IgG antibody against Hp, among them fifty patients underwent EGD as per indication. Univariate and multivariate analysis were performed to compare serological versus invasive testing performance for Hp infection. Results: In the present study, (60%) of the screened study population demonstrated a positive IgG against Hp, whereas the EGD findings confirmed Hp infection in (50%) of the fifty patients who underwent a confirmatory EGD. In comparison to EDG findings, IgG Antibody sensitivity and specificity for diagnosis of Hp infection was 65.5 % and 52.4 % respectively. Conclusion: Among the one hundred HD patients screened for IgG against Hp, we found a seroprevalence of 60%; however, the performance characteristics of IgG antibody were limited. Further studies are warranted to explore these findings. [ABSTRACT FROM AUTHOR]

Sexual dysfunction (SD) is common in end stage renal disease (ESRD) patients, affecting their quality of life. Sexuality is not a subject that patient's, particularly Muslim women, discuss when they require assistance. They need to develop strategies to cope with SD. The qualitative study explored how Muslim women with ESRD cope with SD. A phenomenological approach was adopted and data were collected using semistructured individual interviews. Purposive sampling was used to recruit 20 participants from two southern regional hospitals in Thailand between September and December, 2018. Recruitment continued until data saturation was reached. Data were analysed using Colaizzi's phenomenological approach. Participants were aged between 30 and 63 years (mean = 45.25, SD = 8.50). Ten were receiving haemodialysis (HD) and 10 were receiving continuous ambulatory peritoneal dialysis (CAPD). Five themes were identified: (1) receiving compassion and understanding from their partner, (2) being afraid of sin if not taking responsibility as a wife's role, (3) denying and ignoring sexuality, (4) being patient to keep their family together and (5) accepting SD associated with God's will. The findings suggest that understanding Islamic views on SD and how the religion's beliefs and practices influence SD and the way Muslim women cope with it. Hence, it is critical in opening lines of communication with patients and their partners to help them cope with SD. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life (HRQOL) has a direct association with increased morbidity and mortality among end stage renal disease patients. Valid and reliable instruments to measure the HRQOL of patients with end stage renal disease are therefore required. This study aimed to translate, culturally adapt and evaluate the psychometric properties of the Amharic version of the Kidney Disease Quality of Life-36 (KDQOL-36) instrument in Ethiopian patients with end stage renal disease undergoing hemodialysis.Methods: The KDQOL-36 instrument was developed for individuals with kidney disease who are being treated with dialysis and includes both generic and disease-specific components. The KDQOL-36 was translated to Amharic language and distributed to a cross-sectional sample of 292 hemodialysis patients. The psychometric evaluation included construct validity through corrected item-total correlation, confirmatory factor analysis and known group analysis. Convergent validity was evaluated by correlations between each of the three kidney disease targeted scales (symptoms/problems list, burden of kidney disease and effects of kidney diseases) and the European Quality of Life 5D-5L and Visual Analog Scales. Regarding reliability, internal consistency and test-retest reliability were assessed.Results: Two hundred ninety-two patients with a mean age of 48 (SD ± 14.7) completed the questionnaire. Corrected item- total correlation scores were > 0.4 for all items. Confirmatory factor analysis revealed a two χ2 /df was 4.4, Root Mean Square Error of Approximation (RMSEA) = 0.108 (90% CI 0.064-0.095), Comparative Fit Index (CFI) = 0.922, Tucker Lewis Index (TLI) = 0.948 and Standardized Root mean-squared residual (SRMR) = 0.058) and three χ2 /df = 3.1, RMSEA = 0.085 (90% CI 0.064-0.095), CFI = 0.854, TLI = 0.838 and SRMR = 0.067) factor models for the generic and disease specific components respectively. The mean scores of the three kidney disease targeted domains were correlated to the EQ-5D-5L & VAS with correlation coefficients of large magnitude (0.55-0.81). The reliability of the instrument was satisfactory (Cronbach's alpha = 0.81-0.91) and Intra-class correlation (ICC) = 0.90-0.96).Conclusion: The Amharic version of the KDQOL-36 is a reliable and valid instrument recommended for assessment of HRQOL of Ethiopian patients on hemodialysis. [ABSTRACT FROM AUTHOR]

Background: All patients with chronic renal failure need vascular access for hemodialysis that is possible with CVP line but it shorter life. The most suitable and effective vascular access on long term basis is the creation of arteriovenous fistula (AVF). The objective of this study was to compare the patency rate of Radiocephalic vs. Brachiocephalic AVFs in population of D.I.Khan division, Pakistan. Materials & Methods: This randomized control trail was conducted in Department of Surgery Gomal Medical College, D.I.Khan, Pakistan from January 2017 to December 2019. 266 patients were equally randomly allocated into Brachiocephalic AVF (BCAVF) and Radiocephalic AVF (RCAVF). Sex, age groups and patency of AVT were nominal variables. Data for sample was described by count & percentages and for population as confidence interval at 80% confidence level. McNemar chi-square test was used to test hypothesis to compare patency rate of Brachiocephalic AVF vs. Radiocephalic AVF. Results: Patency was present in 129 (97%, 80% CI 94.45-98.39%) and absent in four (3%, 80% CI 1.61-5.55%) cases in Brachiocephalic, while it was present in 107 (80.5%, 80% CI 76.04-84.86%) cases and absent in 26 (19.5%, 80% CI 15.52-24.32%) cases in Radiocephalic AVF group. McNemar chi-square test showed p <.0001, so the null hypothesis was rejected, showing higher patency rate in BCAVF. Conclusion: Brachiocephalic AVF creation is more ideal in terms of patency and maturation as compare to Radiocephalic AVF because of increased vessel diameter and increased arterial pressure at proximal site below elbow joint. [ABSTRACT FROM AUTHOR]

Hemodialysis affects the socio-economic status of patients with end stage renal disease (ESRD) resulting in a large number of psychological disorders for both the patients and their families. The purpose of this study is to explore the experiences of patients undergoing dialysis at Greater Regional Hospital in Ghana. The researchers employed a qualitative phenomenological research design using and analyzed using Interpretive Phenomenological Analysis. A purposive sampling technique was employed by the researchers to select 16 participants who were engaged in face-to-face in-depth interviews conducted. The socio-demographic characteristics revealed that majority were males (n = 11; 69%)and more than half of the participants (n = 14; 87.5%), were over 40 years. Again, most of the participants indicated spending between 150USD to 180USD weekly on dialysis treatment alone. The study revealed 3 themes and 13 subthemes emerged from the analysis of this data. The main themes were the Physical experiences of patients prior to starting dialysis, personal experiences during dialysis and socioeconomic burden on the participants. Participants faced challenges prior to and whilst on dialysis however the symptoms were better whilst on dialysis. It is therefore recommended that participants with ESRD are supported to go through dialysis treatment to enhance their quality of life. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis (HD) seems to be the most often used Renal Replacement Therapy (RRT) modality worldwide, and it is the primary modality in the majority of instances with extended RRT. The ability to provide our patients with high-quality HD treatment while also increasing their chances of survival is heavily reliant on the functionality of the vascular access (VA). Despite the fact that it is a very necessary component of all clinical practise standards, it is the most expensive individual component of RRT. Objectives: This study was aimed at comparing between the group with Angio access failure and group without Angio access failure and predicting Angio access failure among end stage renal failure patients in Southern Egypt. Subjects and Methods: a prospective cohort study among 125 patients with end stage renal failure at Aswan University. The research comprised patients who had NCVA placement [intra-atrial catheter (IAC) and trans-lumbar catheter (TLC)] between January 1, 2020, and December 31, 2020. Results: The duration of previous RRT was significantly higher among the Angio access failure than the group without Angio access failure. In multivariate analysis using logistic regression, the age, duration of previous RRT, diabetes, IHD (ischemic heart disease), PVD (peripheral vascular disease) and CVD (cardiac vascular disease) were significantly direct predictors of the Angio access failure in the first one year. Conclusion: In conclusion the failure of Angio access was positively associated with age, previous RRT and other comorbidities. [ABSTRACT FROM AUTHOR]

Background: Pretherapeutic screening for dihydropyrimidine dehydrogenase (DPD) deficiency is recommended prior to the administration of fluoropyrimidine-based chemotherapy. However, the best strategy to identify DPD deficiency in End Stage Renal Disease (ESRD) patients is unknown.Methods: We assessed the characteristics of both DPD phenotypes and DPYD genotypes in 20 dialyzed patients before and after dialysis session. The extent to which the concentrations of uracil [U] and dihydrouracil [UH2] were affected by dialysis was evaluated.Results: Mean [U] was 14 ± 3.3 ng/ml before the dialysis session, and 7.9 ± 2.7 ng/ml after. Notably, mean [U] in 119 non-ESRD patients during the same timeline was 8.7 ± 3.9 ng/ml, which is similar to [U] values after dialysis session (p = 0.38). [U] values > 16 ng/ml were measured in 4 ESRD patients (20%), whereas the rate was 3.3% in the non-ESRD cohort. Whole gene sequencing did not reveal DPYD deleterious allelic variants in the 4 ESRD patients with [U] values > 16 ng/ml. The profile of [UH2] values during dialysis was similar to that of [U]: 385 ± 86 ng/ml before, and 185 ± 62 ng/ml after (mean reduction rate 42.5%). Thus, [UH2]:[U] ratio remained unaffected by dialysis, and was similar to the values in non-ESRD patients (22.4 ± 7.1).Conclusion: Phenotyping based on measuring plasma [U] before a dialysis sessions in ESRD patients is associated with an unacceptable high rate of false positives. The optimal strategy for the identification of patients with DPD deficiency in this population would be the monitor the [UH2]:[U] ratio, which remains unaffected. [ABSTRACT FROM AUTHOR]

Introduction: Decannulation of the arteriovenous fistula (AVF) after each hemodialysis session requires a precise compression on the needle puncture site. The objective of our study was to evaluate the bleeding time (BT) needed to achieve hemostasis using WoundClot, an innovative hemostatic gauze, and to assess whether its long-term use can improve AVF preservation. Methods: This is a prospective single center study. Initially, the time to hemostasis after AVF decannulation was compared between WoundClot and cotton gauze in 24 prevalent hemodialysis patients. Thereafter, the patients continued to use WoundClot for 12 months and were compared to a control group consisting of 25 patients using regular cotton gauze. Follow-up data included parameters of dialysis adequacy, AVF interventions, and thrombotic events. Results: WoundClot use shortened significantly the time needed for hemostasis. Mean venous BT decreased by 3.99 (±4.6) min and mean arterial BT by 6.38 (±4.8) min when using WoundClot compared to cotton gauze (p < 0.001). At the end of the study, dialysis adequacy expressed by spKt/V was higher in the WoundClot group compared to control (1.73 vs. 1.53, respectively, p = 0.047). Although patients in WoundClot group had a higher baseline BT, arterial and venous pressures did not differ between the groups after a median follow up of 10.8 months. AVF thrombosis rate was similar between the groups. Conclusions: WoundClot hemostatic gauze significantly reduced the time required for hemostasis after AVF decannulation and may be associated with better AVF preservation. We suggest using WoundClot for arterial BT longer than 15 min and for venous BT longer than 12.5 min. [ABSTRACT FROM AUTHOR]

Introduction. Kidney transplantation is the treatment of choice in the majority of end-stage renal disease (ESRD) patients. However, most of the incident ESRD patients are not given the necessary information regarding kidney transplantation. The aim of this study was to evaluate awareness and knowledge about kidney transplantation in ESRD patients who were on dialysis. Methods. In this cross-sectional study, a total of 300 ESRD patients who underwent hemodialysis or peritoneal dialysis and could be eligible for kidney transplant, were included. A questionnaire with 15 multiple choice questions (MCQs) was designed to collect the data. SPSS version 16 was used for data analysis and a P value less than .05 was considered statistically significant. Results. Two hundred thirty-four patients participated in the study (response rate of 78%). Among them 58.1% were male with the mean age (SD) of 52.5 (12.1) years. The majority of the patients (94.0%) were on hemodialysis. About 87.6% wanted to receive kidney transplant; but despite the desire of the patients, this method was initially offered to about 11.5 % of the patients as a possible method of renal replacement therapy. Patients who had desire to receive kidney transplantation were significantly younger, male, married, employed, and had high level of education (P < .05). Conclusion. Although most of the patients wanted to receive a kidney transplant, it was initially offered to a small population. Age, gender, marital status, employment condition, and level of education were significant factors for the patient's tendency to receive a kidney transplant. [ABSTRACT FROM AUTHOR]

Introduction: CKD5D is a high risk subgroup with high comorbidity burden, need for frequent visits to dialysis centre and a compromised immune system. The effect of SARS COV2 virus on this population is not well known. Methods: This prospective study enrolled, all CKD5D with COVID 19 infection, admitted to our hospital, from 23rd April to 30th June 2020 & whose outcome as discharge/mortality was known. Their clinical profile, investigations, treatment and outcome in terms of mortality or discharge after clearing infection was noted and analysed. Results: Total 203 dialysis patients with COVID 19 were referred to our institute. Of these total, 131 were analysed. Median age was 50 years (19-80 years) with 57% were males. Hypertension (76%) was the commonest comorbidity followed by diabetes (29%) and coronary artery disease (22%). Dyspnoea, fever and cough were present in 50%, 40%, and 33% patients respectively. 26% were asymptomatic. None had dialyser clotting. Mortality was 20.6%. Time to turn RT PCR negative was 14 days (3-40 days). Comparing deceased vs survivors: Age [56 vs 49 yrs], diabetes [56% vs 22%], duration of symptoms at admission [5 vs 4 days], dyspnea [85% vs 40%] and encephalopathy [30% vs 1%] at admission, bilateral opacities on Chest X ray [93% vs 20%] and high leucocyte count [11,059 ± 5,929 vs 7,022 ± 2,935/cmm] were statistically significant variables associated with mortality. Conclusion: Asymptomatic group was 26% of the total CKD5D with COVID 19 infection population analysed. Mortality was 20.61%. Higher age, later presentation to hospital, diabetes, dyspnoea, & encephalopathy at presentation, bilateral opacities on Chest X- Ray & higher leukocyte counts were significantly associated with mortality. [ABSTRACT FROM AUTHOR]

Introduction: In End Stage Renal Disease (ESRD), the patient needs alternative treatments such as dialysis for survival. To perform hemodialysis, proper vascular access is required. At emergency situations, the Central Venous Catheters (CVC) are used; however, they are not ideal for long-term dialysis. Hence, the permanent methods of hemodialysis should be replaced as soon as possible. This study aimed to investigate the causes of delay in the establishment of permanent vascular access in patients undergoing hemodialysis in Guilan in 2014 to 2015. Methods: The study was performed on 420 patients with ESRD who had been undergone hemodialysis through a CVC for more than three weeks in Razi Educational Remedial and Research Center. Data collection was done through checklist and interviews with the patients. All information entered into the SPSS 21 and analyzed by descriptive and inferential tests. Results: Totally, 56.4% of patients were male and 25.5% were 61 to 70 years old. 42.1% had delay between 1 and 2 months. The most important predictors of delay were: Patient's unwillingness, high costs of surgery, patient's inadequate knowledge about the need to establish AVF (Arterio Venous Fistula), Patient's fear of risks of AVF, lack of proper insurance coverage, Old age, Lesions at the insertion site of vascular access and lack of access to a nephrologist. Conclusion: Promoting the patients scientific information about establishing a permanent vascular access can have a significant role in reducing the delays in establishing permanent vascular access. [ABSTRACT FROM AUTHOR]

Objective: To investigate the proportion of arterial stiffness in patients on twice weekly maintenance hemodialysis and the factors affecting it. Methodology: This observational study with a cross-sectional design was performed in the Haemodialysis Unit, Kidney and Hypertension Division, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia. The study enrolled 83 End Stage Renal Disease (ESRD) patients undergoing hemodialysis two times a week for at least three months. Patients with acute disease were excluded from the study. Arterial stiffness was measured as pulse wave velocity (PWV) using SphygmoCor® with PWV cut-off of 10m/s. SPSS 21.0 was used as an analysis tool; descriptive and inferential statistics were applied where needed. Results: In the sample, 42 (50.6%) were male and 41 were female (49.4%). Among all participants, 22 (26.5%) patients were with arterial stiffness and 61 (73.5%) were without arterial stiffness. Factors independently affecting arterial stiffness were fasting glucose level (odds ratio 6.842 [CI95% 1.66-28.24]) and LDL level (odds ratio 4.887 [CI95% 1.59-16.58]). Conclusion: The proportion of arterial stiffness in ESRD patients undergoing hemodialysis two times a week was about one third of all patients. In factors affecting arterial stiffness among ESRD patients, fasting glucose level and LDL level were found to have higher odds. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a common medical problem with well‐known dermatologic manifestations, some of which highly disturb the patients' quality of life. This cross‐sectional study was designed to identify the prevalence and type of cutaneous involvement in CKD patients. The skin manifestations of 49 patients with CKD undergoing hemodialysis at Akhavan Hospital in Kashan, Iran, were recorded over 2 months. Diabetes (35%) was the most common cause of chronic renal failure in the patients, and the most common skin manifestations were xerosis (95.9%), uremic pigmentation (89.8%), scleral discoloration (87.8%), dental discoloration (85.2% among the patients with natural teeth), dry mouth (65.3%), varicosity (61.2%), pruritus (57.1%), skin atrophy (49%), lentigo (46.9%), subungual hyperkeratosis (42.9%), half and half nail dystrophy (34.7%), and purpura (26.5%). Mucocutaneous involvement has a very high prevalence in CKD patients undergoing hemodialysis, and some of the cases are medically and cosmetically disturbing; therefore, with better knowledge about the type and prevalence of these involvements, the consequences can be better predicted and managed. Further studies are recommended to be conducted on the association between these signs and CKD grade, and clinical trials are also required for establishing the treatment options available for these signs and then assessing the patients' quality of life as a primary outcome measure. [ABSTRACT FROM AUTHOR]

Introduction. Nail changes occur as part of a single organ disease, multisystemic diseases or because of the intake of some medications. Chronic kidney disease (CKD) is associated with various nail abnormalities. To identify Lindsay's nails and Terry's nails in patients with end stage renal disease (ESRD) on maintenance hemodialysis (HD) and to determine the common anamnestic, clinical and/or laboratory parameters that would help elucidate the etiopathogenesis of these nail pathology. Methods. Twenty patients with ESRD on hemodialysis were included into the study. Dermatological examination took place during the dialysis session. Lindsay's nails were identified when the distal part of the nail bed is red/rose-brown, clearly separated from the proximal part of the nail bed, occupying 20-60% of the entire length of the nail bed. The proximal part of the nail bed is whitish, resembling grounded glass. When pressing the nail, the discoloration of the distal part of the nail bad does not fade completely. Terry's nails were identified by a 0.5-3.0 mm wide distal band, pinkbrown in color, with a proximal part of the nail bed that is white and occupies 80% of the entire nail bed. Data on demographic characteristics, history of the disease and the laboratory values were noted for each patient. Results. Out of 20 patients, all males, we diagnosed Half-and-Half nails, also called Lindsay's nails, and Terry's nails in 6(30%) patients [5 Half-and-Half nails (25%), and 1 with Terry's nails (5%)]. All patients had sideropenic-free anemia, elevated urea and creatinine values and elevated parathyroid hormone (PTH) values (>190 pg/L, range 190.3-387.5 pg/L). Conclusion. After searching the relevant literature (MEDLINE, PubMed), we found this is the first study to link elevated PTH values and Half-and-Half nails (also called Lindsay's nails), and Terry's nails in patients with ESRD on HD. [ABSTRACT FROM AUTHOR]

Background: Public–private partnership (PPP) in hemodialysis delivery in Nigeria is a new concept. We set out to compare the performance of Specialist Hospital Sokoto's (SHS) renal center operating with this model with four other neighboring government-operated dialysis centers. Materials and Methods: We reviewed the 6-year records (May 2011 to April 2017) of Dialysis Center of SHS, operated under a PPP and compared some performance indicators with four government-operated dialysis centers over the same period. Comparisons were made using Chi-square and corresponding P values were reported accordingly. P < 0.05 was considered significant. Results: A total of 1167 patients' data were studied. Of these, 252 (21.6%) patients with end-stage renal disease were dialyzed at SHS. The SHS dialysis center experienced 5 months of interruption in dialysis service. Only 38 (15.1%) patients sustained dialysis beyond 90 days and 105 (41.7%) patients had more than three sessions of hemodialysis. Only one patient was referred for kidney transplant from the dialysis center during the review period. SHS performed better than Federal Medical Center and Sir Yahaya Hospitals in terms of service availability, duration on hemodialysis, and greater number of hemodialysis sessions (χ2 = 29.06, df = 3, P < 0.001). Conclusion: PPP has improved the availability of dialysis service, mean duration on dialysis, and mean number of dialysis sessions but did not improve the kidney transplant referral rate at SHS. There is a need to encourage the current arrangement in the Hospital as well as other centers offering similar partnerships. [ABSTRACT FROM AUTHOR]

Background: Secondary hyperparathyroidism is a common complication of end-stage renal disease (ESRD), which may be associated with cardiovascular diseases. Thus, this study aimed to explore myocardial damage using non-contrast cardiovascular magnetic resonance (CMR) in ESRD patients undergoing hemodialysis and further investigate its relationship with parathyroid hormone (PTH) toxicity. Methods: Seventy-two adult ESRD patients receiving regular hemodialysis and 30 healthy subjects underwent CMR examination. Continuous CMR cine sections from the mitral valve level to the left ventricular (LV) apex in the short-axis plane, cine series of vertical two-chamber long-axis plane, and horizontal four-chamber plane were acquired. Native T1 mapping was obtained using modified Look-Locker inversion recovery (MOLLI) sequences. Native T1 values and myocardial strain were analyzed. Immunoreactive parathyroid hormone (iPTH) was obtained from all enrolled patients. Results: Forty (55.6%) hemodialysis ESRD patients were found to have increased iPTH levels. LV ejection fraction (LVEF) of both ESRD patients with targeted and increased iPTH levels was decreased compared with healthy subjects (55.9 ± 12.0% vs. 65.0 ± 4.5%; 51.7 ± 12.8 vs. 65.0 ± 4.5%, both P < 0.05). The mean peak radial strain (PRS), peak circumferential strain (PCS), and peak longitudinal strain (PLS) were lowest in ESRD patients with increased iPTH; however, no significant difference was observed among these three groups. Segmentally, from base to apex, the native T1 of ESRD patients with increased iPTH levels tended to be higher than those with targeted iPTH and healthy subjects (all P < 0.05). In ESRD patients with targeted iPTH, both native T1 of basal and middle segments were significantly higher than normal subjects (basal, 1304 ± 41 ms vs. 1238 ± 36 ms, P = 0.001; middle, 1300 ± 43 ms vs. 1242 ± 50 ms, P < 0.001). Comparing global native T1 values in the three groups, ESRD patients with targeted and increased iPTH level showed increased native T1 (1305 ± 41 ms vs. 1251 ± 49 ms, P = 0.001; 1334 ± 40 ms vs. 1251 ± 49 ms, P < 0.001, respectively). Native T1 values of the basal segment and global native T1 were moderately associated with iPTH (r = 0.4, P < 0.001; r = 0.5, P < 0.001). Multiple linear regression analysis showed that global native T1 values (beta = 1.0, P = 0.01) were independently associated with iPTH. Conclusions: Elevated iPTH level was associated with and was an independent risk factor for myocardial damage in ESRD patients undergoing maintenance hemodialysis. Trial registration: Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) ChiCTR-DND-17012976, 13/12/2017, retrospectively registered. [ABSTRACT FROM AUTHOR]

Severe metabolic alkalosis is rarely seen in end stage renal disease (ESRD) patients on long‐term hemodialysis. This can be life threatening and mortality is exponentially increased when the pH exceeds 7.60. Persistent vomiting, ingestion of alkali for dyspepsia and pica behavior are all potential causes of such severe metabolic alkalosis. The prevalence of pica is increased in chronic kidney disease and ESRD patients, with ice being the most commonly ingested substance. It can cause a myriad of complications including death, but the diagnosis may be elusive unless the pica behavior is witnessed firsthand by others since patients do not typically disclose their behavior. We present the case of a hemodialysis patient with severe alkalemia, hypernatremia, and excessive interdialytic weight gains resulting in recurrent hospitalizations for fluid overload due to baking soda pica behavior. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Kidney Disease (CKD) has become a major health issue worldwide. CKD patients require Renal Replacement Therapy (RRT) throughout their life. Haemodialysis is one of the options for RRT. Arterio-Venous Fistula (AVF) creation is required for haemodialysis. The radio cephalic fistula is the initial option for creating vascular access. Fistula can be created by anastomosing cephalic vein to radial artery either by End-To-Side (ETS) or Side-To-Side (STS) techniques. Aim: To compare the efficacy rate of radio cephalic AVF using ETS or STS anastomotic methods. Materials and Methods: This was a retrospective analytical study conducted at SDM college of medical sciences and hospital, Dharwad from March 2017 to February 2020. A total of 43 CKD patients were enlisted for the above duration from the hospital records. These patients were included in the study since they underwent radio cephalic AVF creation. AVF creation at other anatomical sites for rest of the CKD patients was excluded. Out of 43 patients, 24 of them underwent ETS technique and 19 STS technique; 15 patients from the former group and 17 from the latter were followed-up for a period of three months. Eleven patients were lost to follow up. Demographic variables were analysed with frequency, mean and standard deviation. Its association with two different operative techniques was analysed using Fisher’s-exact test. Outcome of the two operative procedures was analysed using Student’s t-test. Results: Effectively 15 patients from ETS group and 17 from STS group were compared. Three (20%) in ETS group and 5 (29.41%) in STS group had primary failure. Mean of maturation time in weeks in ETS group was 4.73±2.73 weeks and in STS group was 5.29±3.75 weeks. Three months patency rate in ETS group was 12 (80%) and in STS group was 12 (70.58%). Student’s t-test was performed comparing the above parameters and no statistical significance was noted. Conclusion: Comparison of two techniques of radio cephalic AVF creation proves that both the techniques are beneficial with no superiority of one over other. [ABSTRACT FROM AUTHOR]

INTRODUCTION The chronic kidney disease (CKD) patient's calcium phosphate product, alkaline phosphatase (ALP), vitamin-D and 2 human growth hormone (hGH) are altered under haemodialysis. This study aimed to evaluate these biochemical variables in conjunction with haemoglobin and blood pressure to find out their association in End Stage Renal Disease (ESRD) patients. MATERIAL AND METHODS This cross-sectional study comprised of 104 patients with ESRD undergoing haemodialysis. The estimated glomerular filtration rate (eGFR) was calculated by Cockcroft-Gault (CG) equation and calcium, phosphorus, ALP were measured by fully automated analyzer whereas vitamin-D and hGH were measured by sandwich and competitive enzyme linked 2 immune sorbent assay (ELISA) techniques. RESULTS The mean age of patients was 53.12 ±16.37 years comprising 68% male. The hypovitaminosis D was 57.7% deficiency and 23.1% insufficiency states whereas hGH insufficiency was 22.1%. The calcium phosphate product was found to be increased in only 39.9% cases. The increased ALP level was observed in 64.4% cases. There was statistically significant association between hGH and Hb status (p=0.03). The significant difference in mean sodium and Ca×P of ESRD cases was observed with hypertension status (p=0.03 and p=0.01) respectively. Moreover, the significant difference in mean eGFR and hGH was observed with haemoglobin status (p=0.0001and p=0.01) respectively. CONCLUSION Increased level of ALP and hypovitaminosis-D was very common in ESRD patients undergoing dialysis with less prevalence of hGH insufficiency and calcium phosphate product increment. The anaemia and hypertension status can be pre-existing condition with ESRD which are cumbersome to control if not monitor in these patients. [ABSTRACT FROM AUTHOR]

Fatigue is a prevalent symptom associated with decreased quality of life and increased mortality in individuals with end stage renal disease (ESRD), yet causes of fatigue in individuals with ESRD remain poorly understood. We examined gene expression of Neuronal PAS Domain Protein 2 (NPAS2) in relation to patient-reported fatigue in 122 individuals with ESRD. Independent samples t-tests were used to examine NPAS2 gene expression profiles of: non-fatigue versus fatigue. Multivariable regression analyses were used to examine the relationship between fatigue and numerous variables including depression. Participants were approximately 58 years old (+/- 13.2 years), 78% African American (n = 95), and 72% male (n = 88). The phenotype of fatigue was not significantly associated with gene expression of NPAS2 but was significantly associated with depression (p <.001). This study suggests that further research should examine the causal mechanism between depression and fatigue in order to identify genetic factors that could explain the high comorbidity of depression and fatigue. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is the major cause of mortality in end stage renal disease (ESRD) patients on dialysis and myocardial infarction constitutes almost 20% of such deaths. We assessed the trends, characteristics and in-hospital outcomes in patients with ESRD.Methods: We used national inpatient sample (NIS) to identify patients with ESRD presenting with ST-segment elevation myocardial infarction (STEMI) for calendar years 2012-2016. Multiple logistic regression analysis and propensity matched data was used to compare outcomes for the purpose of our study.Results: Patients on dialysis who presented with STEMI were less likely to be treated with emergent reperfusion therapies including percutaneous coronary intervention, bypass graft surgery and thrombolytics with in first 24 h. In propensity-matched cohort, the mortality was nearly double in patients who have ESRD compared to patients without ESRD (29.7% vs. 15.9%, p < 0.01). In-patient morbidity such as utilization of tracheostomy, mechanical ventilation and feeding tubes was also more prevalent in propensity matched ESRD cohort. In multivariate regression analysis, ESRD remains a strong predictor of increased mortality in STEMI patients (OR 2.65, 95% CI, 2.57-2.75, p < 0.01).Conclusion: Our study showed low utilization of evidence-based prompt reperfusion therapies in ESRD patients with STEMI along with concomitant increased poor outcomes and resource utilization. Future research specifically targeting this extremely high-risk patient population is needed to identify the role of prompt reperfusion therapies in improving outcomes in these patients. [ABSTRACT FROM AUTHOR]

One of the risk factor of cardiovascular disease in patients of maintenance hemodialysis is abnormalities in lipid profile. Deranged levels of cholesterol are related to increased risk of cardiovascular mortality and morbidity in hemodialysis patients. Objectives: To determine the frequency of dyslipidemia under going maintenance hemodialysis at BVH, Bahawalpur. Study Design: Cross Sectional study. Setting: Dialysis unit at Bahawal Victoria Hospital, Bahawalpur. Period: January to May 2019. Material & Method: A total of 220 patients who were undergoing maintenance hemodialysis at dialysis unit BVH, Bahawalpur were included in the study. Pre-dialysis blood samples were taken for assessment of Sr. Cholesterol (Total), Sr. Triglycerides & Sr. HDL and were sent to Chemical Pathology Lab of QAMC, Bahawalpur on same day for processing. Results: Out of 220 patients, most of the patients were male (66.8%), history of smoking was present in 7.3% & mean duration of dialysis was 27.12 + 25.85 months. The mean of Sr. Cholesterol (Total), Sr. Triglycerides, Sr. HDL were 155.51+37.72 mg/ dl, 135.54+89.27 mg/dl & 35.22+7.77 mg/dl respectively. Dyslipidemia was present in 80% of patients with most common being low HDL (71.8%). Conclusion: Patients of maintenance hemodialysis are having significant number of dyslipidemia leading to inflammation, accelerated atherosclerosis and increased cardiovascular events. [ABSTRACT FROM AUTHOR]

In the dialysis center in Ramallah, we investigated the attitudes and perceived barriers to having arteriovenous fistula (AVF) in 156 patients. The current method of HD access was AVF in 52% and central venous catheter in 47%. Perceived causes of no or delayed AVF were: patient's refusal of AVF in 54.5%, late referral to a surgical evaluation in 31.3% and too long to surgical appointments in 14.2%. Among those who refused AVF, reasons were: concern about the surgical procedure in 42.5%, poor understanding of disease/access in 23.3%, fear of needles in 15.1%, denial of disease or need for HD in 17.8%, and cosmetic reasons in 1.4%. Forty six percent of patients believed they received education about AVF prior to the creation of HD access, and 73.7% would recommend AVF as the method of access due to the lower risk of infection (96%), easier to care for (16%), easier showering (14%), and better-associated hygiene (3%). In conclusion, the majority would recommend an AVF as the mode of vascular access for HD. The most common barrier to having an AVF was patient's refusal to undergo AVF creation because of their concern about the surgical procedure. A systematic evaluation of the process that precedes the creation of AVF may allow for better utilization. [ABSTRACT FROM AUTHOR]

End Stage Renal Disease (ESRD) patients receiving hemodialysis are at a higher risk of developing dyslipidemia which is undoubtedly a predisposing factor of cardiac related disease in these patients. Objectives: To assess serum lipid profile in subjects having end stage renal disease and receiving maintenance hemodialysis and to compare it with normal healthy controls and also to assess the effects of duration of hemodialysis on the lipid profile. Study Design: Case-control study. Setting: Executed in the Nephrology Department of JPMC. Period: January 2018 to January 2019. Material and Methods: Blood samples were obtained from a total of 90 subjects. Subjects were stratified into 3 groups including cases of ESRD receiving maintenance hemodialysis and matched healthy controls. Analysis for serum triglyceride, serum VLDL, total cholesterol, LDL and HDL was done. Results: A significant rise in serum triglyceride content and total serum cholesterol of hemodialysis patients (p < 0.01) was detected as compared to healthy controls. A statistically significant decrease was found in serum HDL level (p < 0.01) in hemodialysis patients in comparison to healthy controls. The impact of the hemodialysis duration was found to deteriorate the lipid profile of patients having longer duration of hemodialysis. Conclusion: Dyslipidemia was found to be evident in hemodialysis patients. The duration of hemodialysis sessions was found to affect the lipid profile of ESRD patients, which may play a role in higher incidence of atherosclerotic related cardiac events among these patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Chronic kidney disease (CKD) is a long standing debilitating medical condition. CKD patients who are undergoing hemodialysis commonly experience depressive and anxiety symptoms because of various physical and psychosocial factors. The present study aimed to assess psychiatric morbidities i.e., depression and/or anxiety in patients with CKD undergoing hemodialysis. The objective of study was to evaluate depressive and anxiety disorders and their relation to socio-demographic factors in patients with CKD. Materials and Methods: A cross-sectional study was conducted at Nephrology department of a tertiary care institution on 100 CKD patients undergoing hemodialysis; who fulfilled the inclusion criteria. Diagnosis of depression and anxiety disorder was made as per WHO (ICD-10) criteria. Hospital Anxiety and Depression scale (HADS) was applied to study severity of the disorders. Data collected was subjected to suitable statistical analysis (mean, standard deviation and Chi-square test). Results: Majority (54 percent) of the CKD patients belonged to age group of 41 to 60 years, were Hindus, married and had low monthly income. The prevalence of depressive disorder and anxiety disorder among CKD patients was around 66% and 61%, respectively. Depression and anxiety were significantly associated with gender, occupation, income and duration of haemodialysis in these patients. Conclusion: Depression and anxiety are highly prevalent in CKD patients and have varying relations with different socio-demographic characteristics of patients. Clinicians should focus on these morbidities while managing such patients and provide holistic treatment using multidisciplinary approaches to improve the overall quality of life. [ABSTRACT FROM AUTHOR]

Aim: This study assessed the determinants of quality of life among chronic kidney disease patients and the socio -demographic variables contributing to the quality of life of chronic kidney disease patient attending Renal Clinics of two Tertiary Hospitals in Ondo State. Material and Methods: Descriptive cross sectional research design was utilized. Total enumeration method was used to select 140 respondents for the study. Adapted World Health Organization quality of life - BREF Version questionnaire was used to collect data, data generated were processed and analyzed using the Statistical Package for Social Sciences (SPSS) version 20; both descriptive and inferential statistics were used. Results: Finding revealed that the mean age of the respondent was 47.81±1.69 years. More (57.1%) of the respondents were males. The mean quality of life score of the respondents was found to be (38. 51±13.45). Results further showed that highest quality of life were observed in the environmental domain (mean score 16.21±5.66) followed by physical health (mean score 9.08±3.98) and the lowest in the social relation domain (mean score 5.13±3.31). Result showed that only family type is a significant determinant contributing to quality of life of patients (p = 0.038). There is no significant relationship between the socio demographic variable of respondent’ (age p= 0.12, gender p= 0.627, marital status p=0.167, educational qualification p=0.131) and their quality of life. Conclusion: Quality of life was poor among the respondents. To enhance the quality of life in patients with CKD, Good family and social relationships are of great importance and are the source of positive feelings and self-esteem as they improve the quality of life of patients. [ABSTRACT FROM AUTHOR]

Iron overload is a common complication in patients with chronic renal failure treated with dialysis prior to the availability of recombinant human erythropoietin therapy. Iron overload was the result of hypoproliferative erythroid marrow function coupled with the need for frequent red blood cell transfusions to manage symptomatic anemia. The repetitive use of intravenous iron with or without the use of red blood cell transfusions also contributed to iron loading and was associated with iron deposition in liver parenchymal and reticuloendothelial cells. Here we report a 56-year-old female with end-stage renal failure who underwent kidney transplant twice and found to have iatrogenic iron overload with excess intravenous iron treated conservatively. [ABSTRACT FROM AUTHOR]

Introduction: Heterotopic vascular calcification is a common complication of maintenance hemodialysis (MHD) patients. Galectin 3 (Gal‐3) has been reported to be associated with cardiovascular calcification. The current study aims to explore the potential predictive value of serum Gal‐3 for severe abdominal aortic calcification (AAC) and AAC progression in MHD patients. Methods: A prospective cohort who underwent hemodialysis during July 2014 at the Blood Purification Center of Ruijin Hospital were followed up for 3 years. Two AAC assessments were performed: one at baseline and one after the 3‐year follow‐up period. Serum Gal‐3 was detected with quantitative ELISA kits. SPSS 23.0 and MedCalc 11.4.2.0 were used to analyze the data. Findings One hundred and fifty‐two patients were recruited. Approximately 59.9% were male, the median age was 60 (50–67) years. Logistic regression analysis indicated that serum Gal‐3 was an independent risk factor for both follow‐up severe AAC and AAC progression. Receiver operating characteristic (ROC) curve analysis revealed significant prognostic value of serum Gal‐3 for predicting severe AAC and AAC progression within 3 years. Discussion: We found serum Gal‐3 is correlated to vascular calcification in ESRD patients. Gal‐3 may be a potential biomarker of vascular calcification for MHD patients. [ABSTRACT FROM AUTHOR]

Patients living with end stage renal disease (ESRD) who are undergoing hemodialysis experience frequent hospitalizations associated with complications of care and exacerbations of illness. Efforts to reduce hospitalizations have had limited success. The purpose of this study was to explore why hospitalizations occur from the perspectives of patients undergoing hemodialysis treatment, their caregivers, and health care providers. Semi-structured interviews and focus groups were conducted with 21 patients living with ESRD, 10 caregivers, and three focus groups with health care professionals. Findings are discussed under four main themes: Graft site/Catheter/Access issues, "My resistance is low," "I could not breathe," and "The perfect storm." Results highlight the complexity of care and vulnerability of patients with ESRD. Further interprofessional research is needed to improve transitional care and care delivery for patient populations receiving hemodialysis. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac implantable electronic device (CIED) infections are associated with a high mortality. Our aim was to identify key predictors of survival in patients with CIED infections as to be able to detect high‐risk patients and possibly affect modifiable factors. Methods and Results: In this observational study, we collected data from 277 patients with CIED infections treated in our department between 2001 and 2017; predictors of survival were evaluated. The median time since the last CIED procedure was 0.83 years (interquartile range [IQR]: 0.25‐3.01), median time since initial CIED implant was 4.79 years (IQR: 0.90‐11.0 years). Survival at 30 days was 94.9% (95% confidence interval [CI]: 92.3‐97.5) and survival at 1 year was 80.9% (CI: 76.4‐85.7). Age (odds ratio [OR]: 1.05, CI: 1.01‐1.09; P =.009), end stage renal disease (ESRD) with dialysis (OR: 5.14, CI: 1.87‐14.11; P =.001), positive blood cultures (OR: 2.19, CI: 1.08‐4.45; P =.030), and thrombocytopenia (OR: 2.3, CI, 1.03‐5.15; P =.042) were identified as predictors of death within 1 year of treatment of CIED infection. Conclusion: Patients with CIED infection with prior ESRD with dialysis or preoperative thrombocytopenia are at an increased risk of 1‐year mortality. We suggest that these patients be evaluated critically and resources be allocated to these patients more liberally. A greater understanding of the role of platelets in immunity may improve treatment of advanced infection in the future. [ABSTRACT FROM AUTHOR]

BACKGROUND: Various studies have highlighted the correlates to health literacy and quality of life among patients receiving hemodialysis therapy. However, evidence of how these two outcomes could influence each other is not clear. OBJECTIVE: This study aimed to assess the correlation between health literacy and quality of life among patients receiving hemodialysis. METHODS: This is an integrative review of correlational studies. This study conforms to the preferred reporting items for integrative reviews described by Whitemore and Knafl. We search for studies reporting on the correlation of health literacy and quality of life among patients receiving hemodialysis in six databases, that is PubMed, Web of Science/Knowledge, Scopus and Embase, Google Scholar and Ovid MEDLINE. RESULTS: In this review five studies were included after screening them against the inclusion criteria. Two studies were identified from Iran, and one study was identified each from Australia, Turkey, and the USA. Most studies were descriptive comparative in nature, while two studies were experimental. Shayan's study had the highest number of participants. This study reports on 1,063 patients receiving dialysis. Most studies were conducted at different centers. Findings from three studies showed that there was a significant relationship between health literacy and quality of life among patients receiving hemodialysis. CONCLUSION: There is a relationship between health literacy and quality of life among patients receiving hemodialysis. Conclusively, addressing health literacy may improve the quality of life among patients receiving hemodialysis. [ABSTRACT FROM AUTHOR]

Hemodialysis adversely affects many dimensions of the patients. So this study was carried out to assess the impact of hemodialysis on livelihood of the patients. Objectives: To study the socio-economic characteristics of Hemodialysis (HD) dependent patients, to explore the impact of hemodialysis on the livelihood of the patients, and to suggest some suitable policy measures. Study Design: Cross sectional study. Setting: At Dialysis Center of DHQ Hospital Faisalabad, Punjab, Pakistan. Period: May 2018 November 2018. Material & Methods: Multistage sampling technique was used, at 1st step a public sector dialysis center was selected through simple random sampling and then 109 adult patients were conveniently selected and interviewed through self-designed interview schedule. Data analysis and interpretation was executed using (SPSS version 24). Multiple linear regression was applied to study the relevant significance of predicting variables and to check the impact of different variables on respondent's livelihood (response variable). Conclusion: It was found that due to rigorous schedule of HD most of the respondents were unable to perform their economic, social and religious activities; also they were depending on their caregivers for their routine activities. Resultantly, lower SES (socio-economic) has a negative effect on health in patients with undergoing dialysis involving fewer personal resources and lower levels of social support to deal with stress imposed by HD. Hence HD was negatively affecting their livelihood, so there is dire need to address these problems of HD dependent segment. [ABSTRACT FROM AUTHOR]

Background: Mineral and bone disorder (MBD) in hemodialysis patients is associated with increased morbidity and mortality. Studies on the MBD status of hemodialysis patients at high altitudes are extremely limited. Methods: A total of 146 hemodialysis patients from 5 local hospitals across all districts with hemodialysis centers in the Tibetan Plateau were enrolled in this cross-sectional study. Parameters related to MBD, including serum phosphorus (P), calcium (Ca), and intact parathyroid hormone (iPTH) levels, were measured. The achievement of MBD goals was compared with the achievement in the Dialysis Outcomes and Practice Study (DOPPS) 3, DOPPS 4 and a multicenter study of MBD in China. Factors associated with hyperphosphatemia were examined. Results: Altogether, 146 hemodialysis patients were recruited from the Tibetan Plateau. According to the K/DIGO guidelines, there were low achievement rates for serum Ca (40.4%), P (29.7%), and iPTH (47.1%). As for the (KDOQI) guidelines, the rates of achievement of defined targets were 38.4%, 33.7% and 16.4% for serum Ca, P and iPTH, respectively. The percentages of patients reaching the KDOQI targets for corrected Ca, P, and iPTH were significantly lower for Tibetan patients than the percentages found in DOPPS 3 (38.4% vs. 50.4%, 33.7% vs. 49.8%, and 16.4% vs. 31.4%, respectively, all p <.001) and DOPPS 4 (38.4% vs. 56.0%, 33.7% vs. 54.5%, and 16.4% vs. 35.3%, respectively, all p <.001). The percentage of patients reaching the KDOQI targets for iPTH was significantly lower in Tibet than in the plain areas of China (16.4% vs. 26.5%, p <.001). The proportion of patients with hypocalcemia was higher in Tibet than in the plain areas (44.5% vs. 19.4%, p <.001). The percentage of local patients with optimal P was significantly higher for patients with an activated vitamin D prescription than for patients without an activated vitamin D prescription (45.3% vs. 19.3%, p <.001). Age and the activated vitamin D prescription were independently associated with hyperphosphatemia. Conclusion: The MBD status of hemodialysis patients in Tibet is far from the ideal level. High altitude is one of the possible causes of the differences found, but not the principal one. It is necessary for medical staff in Tibet to improve the detection and treatment of MBD. [ABSTRACT FROM AUTHOR]

Purpose: Ranolazine is a novel anti-angina treatment approved in the United States for chronic stable angina. Ranolazine pharmacokinetics have not been studied previously in patients who receive maintenance hemodialysis. This study describes the pharmacokinetics of ranolazine and three major metabolites (CVT-2738, CVT-2512, CVT-2514) in patients receiving thrice weekly hemodialysis. Methods: Eight participants receiving maintenance hemodialysis completed this prospective, open-label study (study identifier NCT01435174 at Clinicaltrials.gov). Three participants received a single tablet of ranolazine 500 mg (followed by an interim analysis), and five received 2 tablets of ranolazine 500 mg. Blood samples were collected over 65 h to determine the pharmacokinetic characteristics during and between hemodialysis sessions. Non-compartmental analysis was used to determine the individual pharmacokinetic parameters. Results: Ranolazine off-hemodialysis elimination phase half-lives were 3.6 and 3.9 h for 500 mg and 1000 mg doses, respectively. The time to maximum concentration ranged from 2 to 18 hours and the average maximum concentration was 0.65 ± 0.27 mcg/mL and 1.18 ± 0.48 mcg/mL for ranolazine 500 mg and 1000 mg dose, respectively. The mean hemodialysis percent reduction ratio for the ranolazine 500 mg dose was 52.3 ± 8.1% and for the ranolazine 1000 mg dose was 69.2 ± 37.6%. Conclusions: Data on ranolazine dosing in patients receiving maintenance hemodialysis is almost non-existent. Given the extent of pharmacokinetic variability observed with the 500 mg and 1000 mg oral doses of ranolazine, neither can be recommended as a starting dose in patients receiving maintenance hemodialysis. Guided by the information gained form this study about the extent of hemodialytic drug clearance, further multi-dose clinical trials of ranolazine are needed to optimize therapeutic outcomes in this patient population. [ABSTRACT FROM AUTHOR]

Introduction: Patients with end‐stage renal disease (ESRD) experience frequent hemodialysis (HD) complications. Intradialytic hypotension (IDH) is a common complication presenting in approximately between 20 and 50% of HD sessions. Available interventions such as volume replacement or vasoactive medications are associated with significant side effects. Intermittent pneumatic compression (IPC) has been proposed as a feasible intervention for the prevention of IDH, treatment of peripheral arterial disease and venous ulcers. These devices apply intermittent pressure to the legs improving arterial blood flow, mobilization of pooled blood with an increase in venous return increasing the effective circulatory volume. Our goal was to identify the published clinical evidence on whether IPC has a circulatory benefit and is it well‐tolerated among patients receiving HD. Methods: We conducted a systematic review to identify studies assessing the efficacy and safety of IPC in patients with ESRD. Our primary outcome was IDH. Secondary outcomes such as HD comfort, ultrafiltration volume, and physical activity were collected. No restrictions where used and we included all observational and interventional studies. Two reviewers performed screening and study quality assessment. Findings: We included seven studies. Out of the seven studies, five addressed IDH, and the rest were included for secondary outcomes such as physical capacity and HD comfort. In one randomized crossover trial comparing exercise against IPC, 21 patients were randomized to 3 different arms (no intervention, cycling, IPC) a decrease in the rates of IDH with IPC was described (43%, 38%, and 24% respectively P = 0.014). The smaller studies corroborated these results. All studies where at high risk of bias. Discussion: IPC might offer significant benefits for patients undergoing HD not limited to prevention of IDH but also improvement of hemodialysis comfort and physical capacity. However, our results should be interpreted in the context of its limitations. [ABSTRACT FROM AUTHOR]