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Introduction: Health‐related quality of life (HRQoL) studies demonstrate the impact of end‐stage renal disease (ESRD) on the physical and psychosocial development of children. While several instruments are used to measure HRQoL, few have standardized domains specific to pediatric ESRD. This review examines current evidence on self and proxy‐reported HRQoL among pediatric patients with ESRD, based on the Pediatric Quality of Life Inventory (PedsQL) questionnaires. Methods: Following PRISMA guidelines, we conducted a systematic review and meta‐analysis on HRQoL using the PedsQL 4.0 Generic Core Scale (GCS) and the PedsQL 3.0 ESRD Module among 5‐ to 18‐year‐old patients. We queried PubMed, Embase, Web of Science, CINAHL, and Cochrane databases. Retrospective, case‐controlled, and cross‐sectional studies using PedsQL were included. Findings: Of 435 identified studies, 14 met inclusion criteria administered in several countries. Meta‐analysis demonstrated a significantly higher total HRQoL for healthy patients over those with ESRD (SMD:1.44 [95% CI: 0.78–2.09]) across all dimensional scores. In addition, kidney transplant patients reported a significantly higher HRQoL than those on dialysis (PedsQL GCS, SMD: 0.33 [95% CI: 0.14–0.53]) and (PedsQL ESRD, SMD: 0.65 [95% CI: 0.39–0.90]) concordant with parent‐proxy reports. Discussion: Patients with ESRD reported lower HRQoL in physical and psychosocial domains compared with healthy controls, while transplant and peritoneal dialysis patients reported better HRQoL than those on hemodialysis. This analysis demonstrates the need to identify dimensions of impaired functioning and produce congruent clinical interventions. Further research on the impact of individual comorbidities in HRQoL is necessary for developing comprehensive, integrated, and holistic treatment programs. [ABSTRACT FROM AUTHOR]

A patient with end‐stage renal disease experienced severe headaches exclusively during dialysis that were bilateral and throbbing with photophobia, weakness, and lightheadedness. The patient had no history of headaches, and dialysis was determined to be the cause of the severe headaches. More than 10 treatments were attempted without success. Headaches were successfully treated and prevented by addition of 100% oxygen (2 L via nasal cannula) for over 12 months without recurrence at time of publication. This case study indicates that oxygen therapy may be a valuable intervention for headaches during dialysis. [ABSTRACT FROM AUTHOR]

Introduction: Metformin is widely considered a first‐line antiglycemic agent due to its cost‐effectiveness and favorable adverse effect profile. However, its use is prohibited in patients with an estimated glomerular filtration rate <30 mL/min/1.73 m2, due to the risk of potentially lethal metformin‐associated lactic acidosis (MALA). We sought to evaluate MALA cases and outcomes at our institution. Methods: In this observational, retrospective case series, we reviewed our EMR for all patients who had a metformin level drawn between January 2013 and May 2022 to identify individuals who met the diagnostic criteria for MALA. We evaluated risk factors for MALA, the relationship between metformin level, blood pH, serum bicarbonate, and lactate level and clinical outcomes of ventilator dependency, renal replacement therapy requirement, renal recovery in acute kidney injury (AKI) patients, and survival. Findings: A total of 107 patients had metformin levels drawn, of which 19 patients met the diagnostic criteria for MALA. In our case series, MALA was primarily seen in AKI (15 patients) secondary to dehydration and sepsis, followed by end‐stage renal disease (ESRD) (4 patients). Intubation was required in 17 patients, of whom 8 were successfully extubated after a mean duration of 14 days. Sixteen patients received renal replacement therapy (RRT). Intermittent hemodialysis (IHD) was performed in nine, continuous renal replacement therapy (CRRT) in four, and sequential therapy of IHD and CRRT in three patients. Seven patients, all in the AKI group (46.7%), died while all ESRD patients survived, accounting for an overall mortality rate of 36.8%. Among the eight surviving AKI patients, four had complete renal recovery with renal function returning to baseline, three had partial renal recovery, and one continued to require IHD at the time of discharge to a rehabilitation facility. Discussion: MALA may be an underrecognized entity. A high level of clinical suspicion leading to prompt and aggressive treatment with RRT may improve mortality rates. Provider and patient education is of paramount importance for safe use of metformin. [ABSTRACT FROM AUTHOR]

Introduction: Hemodiafiltration (HDF) and high‐flux hemodialysis (hf‐HD) are different methods of kidney replacement therapy (KRT) used for the treatment of kidney failure patients. A debate has raged over the last decade about the survival benefit of patients with the use of HDF compared with hf‐HD, but with divergent results from randomized controlled trials. Therefore, this study aimed to perform a meta‐analysis to compare HDF and hf‐HD regarding all‐cause and cardiovascular mortality. Methods: PubMed and Cochrane databases were searched until July 19, 2023, for randomized clinical trials comparing HDF and hf‐HD in patients on maintenance dialysis. A meta‐analysis was performed using Stata 16.1, applying fixed or random effect models according to the heterogeneity between studies. Findings: Of the 496 studies found, five met the inclusion criteria. Compared with the hf‐HD group, the risk ratio (RR) for all‐cause mortality with HDF use was 0.76 (95% CI: 0.67–0.88, I2 = 0%). HDF was associated with lower cardiovascular mortality, although the sensitivity analysis showed that the result differed between scenarios. Subgroup analysis showed lower all‐cause mortality among patients without diabetes in the HDF group compared with hf‐HD (RR 0.66, 95% CI: 0.51–0.81, I2 = 0%), but not in diabetic patients (RR = 0.89, 95% CI: 0.65–1.12, I2 = 0.0%). A subgroup analysis considering convection volumes was not performed, but the studies with the highest weight in the meta‐analysis described convection volume as more than 20 L/session. Discussion: More clinical studies considering critical risk factors, such as advanced age and preexisting cardiovascular disease, are needed to confirm the supremacy of HDF over hf‐HD on the survival of patients treated by these two forms of kidney replacement therapy. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence rates of hepatosteatosis and gallstones are increasing owing to the multifactorial causes of chronic kidney disease, and the prevalence may change with the availability of different forms of renal replacement therapy. We aimed to determine the incidence or prevalence rates of hepatosteatosis, cholelithiasis, and acute cholecystitis in patients with chronic kidney disease and compare them between renal replacement therapy modalities. Methods: A total of 270 patients (90 with chronic kidney disease stages III–V, 90 undergoing peritoneal dialysis, and 90 undergoing hemodialysis) were included and categorized into the pre‐dialysis, hemodialysis, and peritoneal dialysis groups. The patients were questioned about previous gallbladder surgeries and chronic diseases. The results of abdominal ultrasonography, tomography, and magnetic resonance imaging were retrospectively evaluated with respect to the findings on the hepatobiliary system. Hepatosteatosis and cholelithiasis were diagnosed by expert radiologists on the basis of abdominal ultrasonography, tomography, and magnetic resonance imaging findings. The prevalence rates of hepatosteatosis, cholelithiasis, and other liver findings were compared between the groups. Findings: Hepatosteatosis and cholelithiasis were detected in 16.7% and 21.5% of the 270 cases, respectively. Hepatosteatosis was present in 17.8%, 25.6%, and 6.7% of patients in the pre‐dialysis, hemodialysis, and peritoneal dialysis groups, respectively. The prevalence of hepatosteatosis was significantly higher in patients undergoing hemodialysis than in patients undergoing peritoneal dialysis (p = 0.002). However, no statistically significant difference was found between the peritoneal dialysis and pre‐dialysis groups or between the hemodialysis and pre‐dialysis groups (p >0.05). The prevalence rates of cholelithiasis were 15.6%, 28.9%, and 20.0%, in the pre‐dialysis, hemodialysis, and peritoneal dialysis groups, respectively, and there were no statistically significant differences among the groups. The incidence of acute cholecystitis was significantly higher in the hemodialysis group than in the pre‐dialysis group (p = 0.006). Discussion: Our study showed that the hepatobiliary system is frequently affected in chronic kidney disease and that the findings may differ depending on the renal replacement therapy modality. [ABSTRACT FROM AUTHOR]

Adrenal insufficiency is an uncommon disorder and presents with non‐specific symptoms. Identifying adrenal insufficiency in patients with chronic kidney disease requiring dialysis is increasingly difficult as there is a significant overlap of the signs and symptoms of adrenal insufficiency with those seen in chronic kidney failure. We highlight this diagnostic uncertainty in a case series of three patients with chronic kidney disease requiring hemodialysis as renal replacement therapy from a single center identified as hypoadrenal. Steroid replacement improved symptoms and hemodynamic parameters. Increased vigilance for adrenal insufficiency in dialysis patients is necessary. It is likely under recognized in hemodialysis patients given their multi‐morbidity. [ABSTRACT FROM AUTHOR]

Value‐based primary care has reduced health care costs, improved the quality of rendered care, and enhanced the patient experience. Value‐based care emphasizes prevention, outreach, follow‐up, patient engagement, and comprehensive, whole‐person health. Primary care Accountable Care Organizations have leveraged technology‐enabled workflows, practice transformation, and cutting‐edge data and analytics to achieve success. These efforts are increasingly aided by predictive modeling used in the context of patient identification and prioritization algorithms. Value‐based kidney care programs can glean salient takeaways from successful value‐based primary care methods and models. The kidney care community is experiencing unprecedented transformation as novel payer programs and financial models burgeon. The authors contend these efforts can be accelerated by the adoption of techniques honed in value‐based primary care. To optimize value‐based kidney care, though, nephrology thought leaders must transcend the archetype of value‐based primary care. To do so, the nephrology community must: (1) impel behavioral change among fee‐for‐service adherents; (2) harness emerging policy, guidelines, and quality measures; (3) adopt innovative tools, technologies, and therapies. In aggregating lessons from value‐based primary care—and leveraging novel methodologies and approaches—the kidney care community will be better equipped to achieve the quadruple aim for kidney care. [ABSTRACT FROM AUTHOR]