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ABSTRACT Vascular accesses for hemodialysis are considered the patient’s lifeline and their maintenance is essential for treatment continuity. Following the example of institutions in other countries affected by the Covid-19 pandemic, the Brazilian Society of Nephrology developed these guidelines for healthcare services, elaborating on the importance of carrying out procedures for the preparation and preservation of vascular accesses. Creating definitive accesses for hemodialysis, grafts and arteriovenous fistulas are non-elective procedures, as well as the transition from the use of non-tunneled catheters to tunneled catheters, which cause less morbidity. In the case of patients with suspected or confirmed coronavirus infection, one may postpone the procedures for the quarantine period, to avoid spreading the disease.

Background: Depression is prevalent across the spectrum of Chronic Kidney Disease and associated with poorer outcomes. There is limited evidence regarding the most effective interventions and care pathways for depression in Chronic Kidney Disease. Objectives: To investigate how depression is identified and managed in adults with Chronic Kidney Disease. Design: Scoping review. Methods: Systematic search of eight databases with pre‐defined inclusion criteria. Data relevant to the identification and/or management of depression in adults with Chronic Kidney Disease were extracted. Results: Of 2147 articles identified, 860 were included. Depression was most identified using self‐report screening tools (n = 716 studies, 85.3%), with versions of the Beck Depression Inventory (n = 283, 33.7%) being the most common. A total of 123 studies included data on the management of depression, with nonpharmacological interventions being more frequently studied (n = 55, 45%). Cognitive Behavioural Therapy (n = 15) was the most common nonpharmacological intervention, which was found to have a significant effect on depressive symptoms compared to controls (n = 10). However, how such approaches could be implemented as part of routine care was not clear. There was limited evidence for antidepressants use in people with Chronic Kidney Disease albeit in a limited number of studies. Conclusions: Depression is commonly identified using validated screening tools albeit differences exist in reporting practices. Evidence regarding the management of depression is mixed and requires better‐quality trials of both pharmacological and nonpharmacological approaches. Understanding which clinical care pathways are used and their evidence, may help facilitate the development of kidney care specific guidelines for the identification and management of depression. [ABSTRACT FROM AUTHOR]

In this consensus paper, the Belgian Bone Club aims to provide a state of the art on the epidemiology, diagnosis, and management of osteoporosis in frail individuals, including patients with anorexia nervosa, patients on dialysis, cancer patients, persons with sarcopenia, and the oldest old. All these conditions may indeed induce bone loss that is superimposed on physiological bone loss and often remains under-recognized and under-treated. This is of particular concern because of the major burden of osteoporotic fractures in terms of morbidity, mortality, and economic cost. Therefore, there is an urgent need to appreciate bone loss associated with these conditions, as this may improve diagnosis and management of bone loss and fracture risk in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease is a significant cause of global deaths. Those who progress to end-stage kidney disease often commence dialysis as a life-extending treatment. For cognitively impaired patients, the decision as to whether they commence dialysis will fall to someone else. This scoping review was conducted to map existing literature pertaining to how decisions about dialysis are and should be made with, for, and on behalf of adult patients who lack decision-making capacity. In doing so, it forms the basis of a larger body of work that is exploring how these decisions ought to be made.Methods: To identify relevant papers, searches were conducted on Ovid MEDLINE(R), Embase, PsychINFO, The Cochrane Library, and Web of Science. Inclusion criteria were then applied, requiring that papers: report on empirical studies about how decisions about dialysis are made and/or discuss how decisions about dialysis should be made with, for, and on behalf of adult patients who lack decision-making capacity; be published from 1961 onwards; and be published in English. This resulted in 27 papers eligible for inclusion.Results: Of note, the majority of papers originated in the United States. There was wide variation across the included papers. Extracted data were grouped under the following themes: involving various parties (patient involvement, family dominance, and wider communication); objectivity about care options (including difficulties with family detachment); cultural sensitivity; medical versus non-medical factors; managing nonadherent patients; and the role and prevalence of substituted judgement. The literature shows that there is inconsistency in the principles and processes surrounding decisions made about dialysis with, for, and on behalf of adult patients who lack decision-making capacity.Conclusions: This scoping review demonstrates that there is significant variation in both the practice and theory of dialysis decision making with, for, and on behalf of cognitively impaired adult patients. Complexity arises in considering who should get a say, how influential their say should be in a decision, and what factors are most relevant to the decision. A lack of up-to-date literature exploring this issue is highlighted, with this scoping review providing a useful groundwork from which further research can be undertaken. [ABSTRACT FROM AUTHOR]

Copyright of GeoHumanities is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hemodialysis patients frequently require ambulance transport to the hospital for dialysis. Some patients require urgent dialysis (UD) within 24 hours of transport to hospital to avoid morbidity and mortality. UD is not available in all hospitals; therefore, predicting patients who need UD prior to hospital transport can help paramedics with destination planning. In this paper, we developed machine learning models for paramedics to predict whether a patient needs UD based on patient characteristics available at the time of ambulance transport. This paper presented a study based on ambulance data collected in Halifax, Canada. Given that relatively few patients need UD, a class imbalance problem is addressed by up-sampling methods and prediction models are developed using multiple machine learning methods. The achieved prediction scores are F1-score=0.76, sensitivity=0.76, and specificity=0.97, confirming that models can predict UD with limited patient characteristics. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Renal Failure (CRF) is a public health problem that tends to take dimensions of epidemic and has serious impact on the quality of life of patients undergoing haemodialysis, as it affects significally their social life. Specific variables, such as age, gender, frequency and duration of dialysis, education, family, financial and professional status, physical and social functioning, mental health, health effects and symptoms of the disease, can affect either favorably or adversely the quality of life (QoL) of these patients. Aim: The aim of this literature review was to explore the impact of haemodialysis on social life of people with chronic end stage renal failure. Methodology: Literature review based on studies and reviews derived from international (Medline, PubMed, Cinahl, Scopus) and Greek (Iatrotek) data bases concerning social problems of people with renal failure. The collection of data conducted from March to December 2012. Also, were used some keywords haemodialysis, psychosocial factors, social status, economic status, renal failure, quality of life, as well as articles by the National Documentation Centre, which provided valid and documented data from global research and epidemiology. Results: Chronic kidney failure is associated with long-term effects on social life of patients. Many demographic factors such as age, male, socioeconomic profile and education level affect their ability to work, their role in family, friends and society, their social relationships and their general health. Furthermore, unemployment is highly responsible for the occurrence of sexual problems in a high percentage of them. Conclusions: Providing social support, support of the family and support of the friendly environment in patients with CRF is associated with reduction in depressive symptoms, positive perception of their illness, general satisfaction of life and increased compliance to the treatment regimen. [ABSTRACT FROM AUTHOR]

Background The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD). This paper is a summary of the ERA Registry Annual Report 2021, including a comparison across treatment modalities. Methods Data was collected from 54 national and regional registries from 36 countries, of which 35 registries from 18 countries contributed individual patient data and 19 registries from 19 countries contributed aggregated data. Using this data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities and expected remaining lifetimes were calculated. Result In 2021, 533.2 million people in the general population were covered by the ERA Registry. The incidence of KRT was 145 per million population (pmp). In incident patients, 55% were 65 years or older, 64% were male, and the most common primary renal disease (PRD) was diabetes (22%). The prevalence of KRT was 1040 pmp. In prevalent patients, 47% were 65 years or older, 62% were male, and the most common PRDs were diabetes and glomerulonephritis/sclerosis (both 16%). On 31 December 2021, 56% of patients received haemodialysis, 5% received peritoneal dialysis, and 39% were living with a functioning graft. The kidney transplantation rate in 2021 was 37 pmp, a majority coming from deceased donors (66%). For patients initiating KRT between 2012–2016, 5-year survival probability was 52%. Compared to the general population, life expectancy was 65% and 68% shorter for males and females receiving dialysis, and 40% and 43% shorter for males and females living with a functioning graft. [ABSTRACT FROM AUTHOR]

Calciphylaxis, a rapidly progressive and potentially life-threatening vascular calcification syndrome that clinically presents with persistently painful, ulcerative, or necrotizing skin lesions in multiple parts of the body, is predominantly observed in patients treated with dialysis. Early diagnosis of calciphylaxis is a key measure for reducing high disability and mortality. At present, there is no unified diagnostic standard for calciphylaxis, and there is a lack of effective early screening strategies. This paper summarized and discussed the diagnostic accuracy of calciphylaxis based on the latest research worldwide. We propose a modified strategy for the early diagnosis of calciphylaxis, which is suitable for dialysis patients to help clinicians better identify such disease and improve prognosis. [ABSTRACT FROM AUTHOR]

Purpose: Being on dialysis is a traumatic situation particularly during adolescence. Therefore, adolescents must have self-care support according to their special needs. The goal of this study was to describe the adolescents´ self-care practices when they are on dialysis. This paper reports only the adolescents´ selfcare practices based on the health care team guidelines but adjusted to their beliefs and habits. Methods: The methodology of the study was interpretive phenomenology. In-depth interviews were conducted with 15 adolescents; Smith´s IPA procedure was used for data analysis. Results: Being on dialysis meant to the adolescents living in a different and broken world. Self-care practices included: 1) coexisting with the dialysis slavery or being attached to a machine day or night, 2) struggling with the maddening thirst experience, 3) Deciding what, when and how much food to eat, 4) taking care of an alien that helps to survive, 5) taking the medicines when feeling in need of them. Conclusion: The adolescents tried to care for themselves adjusting their care activities to the health team´s recommendations. However, they also adjusted those practices to their beliefs and habits, which allows them to live with dialysis in a less traumatic way. [ABSTRACT FROM AUTHOR]

Background: Patients with diabetes on dialysis experience wide variations in glucose levels and an increased risk of hypoglycaemia. Due to the inaccuracies of HbA1c in dialysis patients, JBDS-IP and KDIGO recommend the use of continuous glucose monitoring (CGM). We conducted a systematic review to examine the current evidence for CGM use and its impact on clinical outcomes in patients with diabetes on dialysis. Methods: A search of MEDLINE(R) ALL, Ovid Emcare, Journals@Ovid Full Text and Embase databases were conducted. Clinical or observational trials in adults with Type 1(T1D) or Type 2 (T2D) diabetes on dialysis and CGM intervention reporting on glycaemic outcomes were included. Results: Of the 936 citations identified, 49 duplicates were removed. 887 citations were screened by title and abstract. 9 full texts were reviewed and a further 7 excluded due to duplications or failure to meet to selection criteria. Data was extracted for 2 studies, both prospective before-and-after interventional studies with no control group. Joubert et al. (2015) showed results for 15 participants with T1D. Mean CGM glucose level decreased from 8.37mmol/L at baseline to 7.7mmol/L at the end of the CGM period (p < 0.05) while HbA1c decreased from 6.9 to 6.5% (p < 0.05) during the same period. Mean CGM was lower on dialysis days (7.68mmol/L vs. 7.8mmol/L, p < 0.05). Képénékian et al. (2014) reported on data from 29 T2D patients. Following a 3 month CGM-adapted insulin regimen, HbA1c decreased from 8.4% at baseline to 7.6% (p < 0.01) by the end of study. Mean CGM values decreased from 9.9mmol/L to 8.9mmol/L (p = 0.05) and the frequency of glucose values > 10mmol/L decreased from 41 to 30% (p < 0.05), without a significant increase in hypoglycaemia frequency. Both studies were deemed to be of 'good' quality. Conclusion: Evidence demonstrating the benefits of CGM in patients with diabetes receiving dialysis is lacking. There is a need for well-designed randomised controlled trials to ascertain the benefits of this technology in this patient group. Trail registration: PROSPERO registration number: CRD42023371635, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=371635. Key learning points: What is known Due to the inaccuracies of HbA1c in dialysis patients, JBDS-IP and KDIGO recommend the use of CGM. Despite this, there is limited evidence for the clinical benefits of CGM in patients on dialysis. What this study adds We undertook this systematic review to examine the current evidence around the use of CGM and its effects in patients with diabetes and ESRD on dialysis. Two before-and-after studies have been conducted regarding the use of CGM in dialysis patients met out selection criteria. Potential impact This study highlights the limited evidence surrounding CGM use in dialysis patients, with no large-scale randomised control trials available to demonstrate glycaemic or clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Infants with chronic kidney disease (CKD) form a vulnerable population who are highly prone to mineral and bone disorders (MBD) including biochemical abnormalities, growth retardation, bone deformities, and fractures. We present a position paper on the diagnosis and management of CKD-MBD in infants based on available evidence and the opinion of experts from the European Society for Paediatric Nephrology (ESPN) CKD-MBD and Dialysis working groups and the Pediatric Renal Nutrition Taskforce. Methods: PICO (Patient, Intervention, Comparator, Outcomes) questions were generated, and relevant literature searches performed covering a population of infants below 2 years of age with CKD stages 2–5 or on dialysis. Clinical practice points (CPPs) were developed and leveled using the American Academy of Pediatrics grading matrix. A Delphi consensus approach was followed. Results: We present 34 CPPs for diagnosis and management of CKD-MBD in infants, including dietary control of calcium and phosphate, and medications to prevent and treat CKD-MBD (native and active vitamin D, calcium supplementation, phosphate binders). Conclusion: As there are few high-quality studies in this field, the strength of most statements is weak to moderate, and may need to be adapted to individual patient needs by the treating physician. Research recommendations to study key outcome measures in this unique population are suggested. [ABSTRACT FROM AUTHOR]

In the United States, there are a large number of incarcerated individuals, resulting in high numbers of previously incarcerated individuals out on parole undergoing reentry into society. An aging prison population translates to an older parolee population and increased incidence of kidney disease requiring either long‐term dialysis or transplantation. This paper argues that due to challenges specific to the parolee population as well as societal biases and priorities, Transplant Centers and healthcare professionals face an ethical imperative to attend to the needs of parolees as a class and take steps to address challenges related to access to Centers for renal transplantation evaluation for this disadvantaged group. It will first review the regulatory context of kidney transplantation and highlight the specific ways it effects parolees. The paper will then discuss the broader social context of parolee reentry into society and barriers faced by parolees in this process. This ethical analysis examines the complexity of these issues, and deliberates on ways to balance the competing priorities of justice, respect for this patient population as individuals and as a disadvantaged class, and the societal interests regarding organ allocation and considerable economic burdens of end‐stage renal disease on parolees, the justice system, and the public. [ABSTRACT FROM AUTHOR]

Aluminium exposure is associated with bone disease (an elevated bone content of aluminium and reduced bone formation on bone biopsy) and neurotoxicity (features of altered brain functions and/or typical spike and slow wave waveforms on electroencephalogram) in patients with elevated blood aluminium concentrations. To critically analyse the literature to determine the dose-toxicity relationships between aluminium exposure and related bone disease and aluminium neurotoxicity. A systematic review of the literature with collation and analysis of individual data of human cases of aluminium exposure was conducted between 1 January 1966 and 30 December 2020. Embase, MEDLINE (OVID MEDLINE), PubMed and TOXNET were searched with the following strategies: "Aluminium AND toxicity OR aluminium AND poisoning OR aluminium AND dialysis OR aluminium AND chronic renal failure OR aluminium AND intravenous" limited to "(human)". Inclusion criteria required individual data relating to aluminium exposure in humans. Papers in which features of aluminium toxicity and analytical confirmation of aluminium exposure could not be determined in individual patients were excluded. Thirty-seven papers were identified, which included data on 179 individuals exposed to aluminium. The sources of aluminium exposure (median duration of exposure) were: dialysis fluid (48 months) in 110 cases; oral aluminium hydroxide (20 months) in 20 cases; plasma exchange (2 months) in 16 cases; infant formula feed (minimal duration of 2 weeks) in 14 cases; intravesical exposures (2 days) in 13 oncology patients and potable water exposure in six cases. Of the 110 patients exposed to dialysis fluid, 99 were adults and 11 children, who were analysed separated. Of the adults, 50 with aluminium neurotoxicity had a median aluminium concentration of 467 µg/L (IQR 230 − 752), 28 with aluminium bone disease had a median aluminium concentration of 142 µg/L (IQR 46–309) and 21 with asymptomatic aluminium overload had a median aluminium concentration of 35 µg/L (IQR 26–51). Median aluminium concentrations were significantly greater in patients with aluminium neurotoxicity compared to those with aluminium bone disease (p < 0.0001) or asymptomatic aluminium overload (p < 0.0001). Of the 20 cases, 11 were adults and nine were children. Of the 11 adults, eight with aluminium neurotoxicity had a median aluminium concentration of 682 µg/L (IQR 438–770) and three with aluminium bone disease had a median aluminium concentration of 100 µg/L (IQR 62–138) (p = 0.007). Of the nine children, five had aluminium neurotoxicity with a median aluminium concentration of 335 µg/L (IQR 229–601), one had aluminium bone disease and an aluminium concentration of 1030 µg/L and three had asymptomatic aluminium overload with a median aluminium concentration 98 µg/L (IQR 65–365). Three patients with stage 5 chronic kidney disease developed aluminium bone disease during plasma exchange; their median blood or serum aluminium concentration was 73 µg/L (IQR 59–81). Asymptomatic aluminium overload was reported in six patients receiving outpatient plasma exchange who had a median creatinine clearance of 71 mL/min (IQR 40–106) and a median aluminium concentration of 49 µg/L (IQR 34–116), and in seven intensive care patients with acute kidney injury whose median aluminium concentration was 30 µg/L (IQR 17–35); (p = 0.02). All 13 intravesical exposures developed aluminium neurotoxicity and had a median aluminium concentration of 157 µg/L (IQR 45–276). All six patients developed aluminium bone disease and their median blood aluminium concentration was 17 µg/L (IQR 13–100). Toxic aluminium exposure can result in neurotoxicity and bone disease, especially in patients with chronic kidney disease. Adults with stage 5 chronic kidney disease chronically exposed to aluminium developed aluminium neurotoxicity at higher concentrations than those with aluminium bone disease or with asymptomatic aluminium overload. Aluminium neurotoxicity was reported at lower concentrations following acute exposure to intravesical aluminium. Extrapolating the relevance of these concentrations to the general population is problematic in that the data were derived from oncology patients, however, the possibility that aluminium neurotoxicity may occur at concentrations lower that those reported historically in patients with stage 5 chronic kidney disease cannot be excluded. [ABSTRACT FROM AUTHOR]

Excessive dietary phosphorus is a concern among patients with kidney failure undergoing dialysis treatment because it may contribute to hyperparathyroidism and hyperphosphatemia. A long‐standing but untested component of the low‐phosphorus diet is the promotion of refined grains over whole grains. This paper reviews the scientific premise for restricting whole grains in the dialysis population and estimates phosphorus exposure from grain products based on three grain intake patterns modeled from reported intakes in the general US population, adjusting for the presence of phosphorus additives and phosphorus bioavailability: (1) standard grain intake, (2) 100% refined grain intake, and (3) mixed (50/50 whole and refined grain) intake. Although estimated phosphorus exposure from grains was higher with the mixed grain pattern (231 mg/day) compared to the 100% refined grain pattern (127 mg/day), the amount of additional phosphorus from grains was relatively low. Given the lack of strong evidence for restricting whole grains in people with CKD, as well as the potential health benefits of whole grains, clinical trials are warranted to address the efficacy and health impact of this practice. [ABSTRACT FROM AUTHOR]

The following cases demonstrate a proof of concept for the safe and effective use of the glucagon‐like‐peptide‐1 receptor agonist (GLP‐1 RA) semaglutide for weight loss in obese, non‐diabetic, end stage kidney disease (ESKD) patients on haemodialysis (HD), who are unable to undergo renal transplantation due to obesity. Obesity is a common barrier to wait‐listing for renal transplantation with effective, broadly applicable weight loss strategies lacking. GLP‐1 RAs have been shown to be effective adjuncts to achieve weight loss in non‐diabetic obese people. However, the major clinical trials excluded patients with ESKD on dialysis. This paper outlines the successful use of semaglutide to achieve a target body mass index (BMI) prior to renal transplant wait‐listing in two obese, non‐diabetic, HD patients. These patients achieved a 16% and 12.6% weight loss in under 9 months with one now waitlisted and the other transplanted. This strategy has the potential for broader use in this patient cohort to improve wait‐list times by overcoming this common barrier to renal transplantation. [ABSTRACT FROM AUTHOR]

Background The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with ESKD. This paper is a summary of the ERA Registry Annual Report 2020, also including comparisons among primary renal disease (PRD) groups. Methods Data were collected from 52 national and regional registries from 34 European countries and countries bordering the Mediterranean Sea: 35 registries from 18 countries providing individual level data and 17 registries from 17 countries providing aggregated data. Using this data, KRT incidence and prevalence, kidney transplantation rates, expected remaining lifetimes and survival probabilities were calculated. Results A general population of 654.9 million people was covered by the ERA Registry in 2020. The overall incidence of KRT was 128 per million population (p.m.p.). In incident KRT patients, 54% were older than 65 years, 63% were men and the most common PRD was diabetes mellitus (21%). Regarding initial treatment modality in incident patients, 85% received haemodialysis (HD), 11% received peritoneal dialysis (PD) and 4% received a pre-emptive kidney transplant. On 31 December 2020, the prevalence of KRT was 931 p.m.p. In prevalent patients, 45% were older than 65 years, 60% were men and glomerulonephritis was the most common PRD (18%). Of these patients, 58% were on HD, 5% on PD and 37% were living with a kidney transplant. The overall kidney transplantation rate in 2020 was 28 p.m.p. with a majority of kidney grafts from deceased donors (71%). The unadjusted 5-year survival, based on incident dialysis patient from 2011–15, was 41.8%. For patients having received a deceased donor transplant, the unadjusted 5-year survival probability was 86.2% and for patients having received a living donor transplant it was 94.4%. When comparing data by PRD group, differences were found regarding the distribution of age groups, sex and treatment modality received. [ABSTRACT FROM AUTHOR]

The coronavirus disease-2019 (COVID-19) pandemic has had a profound impact on the world, causing loss of life, economic damage, and social disruption. Individuals with chronic kidney disease (CKD) are prone to complications and increased mortality related to COVID-19. Efforts have been made to increase understanding of the effects of COVID-19 in individuals with CKD. This paper aims to gather and discuss the state-of-the-art in the COVID-19 and CKD literature, involving the early history of COVID-19, the immunological aspects of CKD (such as abnormalities in neutrophilicand dendritic cells functions), the mechanisms of kidney injury by SARS-CoV-2 (for example, viral tropism to kidney tissue and direct cytotoxicity), the clinical course of the disease and consequences for CKD individuals (including kidney transplant recipients), and the emerging treatments (such as the use of Remdesivir, nirmatrelvir, and monoclonal neutralizing antibodies) and immunization for the CKD population. [ABSTRACT FROM AUTHOR]

Dialysis refers to the procedure of removing waste products and excess fluids from the blood stream. This is the main form of treatment for both acute and chronic renal failure. The need for hemodialysis process optimization is increasing. More than 10% of adults are affected by chronic kidney disease, and it is the nineth leading cause of deaths worldwide. Critically ill patients are particularly at risk, and their mortality is significantly affected by the hemodialysis procedures. This is the reason why the design and control of the hemodialysis process is studied by many researchers. The present paper proposes a fractional-order control of the fluid composition conductivity in this process. Fractional-order PI and PID controllers are designed with different imposed performances in order to establish the best performing controller for this medical process. The proposed fractional-order controllers are compared to the classical controller's results in different real-world scenarios, including process parameter changes, flow changes, and priming sequences. The results are compared with a classical PID controller used in current clinical practice. The simulation results show the robustness and advantages of the proposed fractional-order PID controller over other controllers. These results could improve the clinical use of the hemodialysis process. [ABSTRACT FROM AUTHOR]

Background: End stage renal disease (ESRD) is a major health concern and a large drain on healthcare resources. A wide range of payment methods are used for management of ESRD. The main aim of this study is to identify current payment methods for dialysis and their effects. Method: In this scoping review Pubmed, Scopus, and Google Scholar were searched from 2000 until 2021 using appropriate search strategies. Retrieved articles were screened according to predefined inclusion criteria. Data about the study characteristics and study results were extracted by a pre-structured data extraction form; and were analyzed by a thematic analysis approach. Results: Fifty-nine articles were included, the majority of them were published after 2011 (66%); all of them were from high and upper middle-income countries, especially USA (64% of papers). Fee for services, global budget, capitation (bundled) payments, and pay for performance (P4P) were the main reimbursement methods for dialysis centers; and FFS, salary, and capitation were the main methods to reimburse the nephrologists. Countries have usually used a combination of methods depending on their situations; and their methods have been further developed over time specially from the retrospective payment systems (RPS) towards the prospective payment systems (PPS) and pay for performance methods. The main effects of the RPS were undertreatment of unpaid and inexpensive services, and over treatment of payable services. The main effects of the PPS were cost saving, shifting the service cost outside the bundle, change in quality of care, risk of provider, and modality choice. Conclusion: This study provides useful insights about the current payment systems for dialysis and the effects of each payment system; that might be helpful for improving the quality and efficiency of healthcare. [ABSTRACT FROM AUTHOR]

Treatment for kidney failure, such as dialysis, can result in a tremendously high physical and psychosocial symptom burden on patients and their families. Kidney supportive care (KSC), including advance care planning, involves early identification and treatment of symptoms that improve the quality of life for people receiving dialysis. The delay or lack of engagement in KSC by dialysis nurses until the end of life may result in people dying without receiving optimal palliative care services. Purpose and Questions: Our overarching purpose is to develop a theory about the process of engagement in KSC by dialysis nurses, and this paper is about a sub-question: What are the personal, professional, organizational, and environmental factors that shape nurses' attitudes/beliefs toward and knowledge of supportive care in dialysis? Methods: We followed Charmaz's constructivist grounded theory method. Through initial purposeful and subsequent theoretical sampling, 23 nurses with work experience in outpatient hemodialysis, home hemodialysis, and peritoneal dialysis settings from across Canada were recruited to participate in two interviews, each using the Zoom© teleconferencing platform. Concurrent data collection and analysis were undertaken. Results: Findings at the focused coding stage comprise contextual factors impacting such engagement. The core category of Fragmenting Care is explained by four categories of contextual factors and their related concepts and sub-concepts: (1) structural (lack of dedicated time, language barrier, knowledge gap); (2) inter-relational (patientrelated factors; nurse-related factors [discomfort with having the conversation, lack of selfconfidence, multi-dimensional tensions--them versus us]); (3) cultural-dialysis (biomedical focus, ambiguous responsibility, inopportune conversations); and (4) systemic (lack of conceptual clarity). Implications: These collective factors have not been illuminated previously, and while challenging, they help to better understand and therefore address engagement in KSC by dialysis nurses. Conclusion: Effecting change to normalize KSC is a priority requiring solutions compatible with complex systems. [ABSTRACT FROM AUTHOR]

Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique with proven efficacy in a variety of conditions, including in the intensive care setting. It is not uncommon for a critically ill patient to require more than one extracorporeal procedure in addition to TPE. This review focuses on the combination of TPE with other extracorporeal circuits in a critical care setting via a single vascular access (either in‐series, parallel, or a hybrid mode) which is often referred to as performing procedures "in tandem." Authors performed literature review via pubmed.gov using search terms: plasma exchange, plasmapheresis, apheresis, tandem circuits, combined circuits, critical care, ICU, CRRT, hemodialysis, and ECMO. Thirty‐eight English‐language, peer‐reviewed papers were appraised that satisfied the content of this review on techniques for combining circuits with plasma exchange, as well as describing the advantages of tandem procedures and potential complications that can arise. Performing these procedures simultaneously can be advantageous in reducing total procedure and staffing time, avoiding placement of additional central lines, reducing overall need for anticoagulation, and limiting multiple blood primes in certain populations. However, the described combined circuits are complex, associated with higher complications, and require a skilled team to understand and mitigate the potential complications associated with these combined procedures. [ABSTRACT FROM AUTHOR]

This meta-analysis had the aim of studyingthe available studies on comparison betweenHemodialysis and Peritoneal Dialysis in theelderly. The final objective was to reach, ifpossible, evidence for potential differences.In the case that no differences could bedemonstrated, contribute to accept that HD andPD are similar techniques to be offered toelderly people requiring dialysis.The question formulated was this: Do we haveadequately contrasted data on results forsurvival, hospitalization rate, quality of lifeand morbidity on hemodialysis and peritonealdialysis in the elderly (more than 65 yearsold)?As data sources we selected eight papers thatcompared the general results of these twodialysis techniques. Different elements wereconsidered in this selection because nonereached the two first levels in the hierarchyof sources of evidence, and only two reachedthe third level – that of prospective studies;this is because an oral presentation of datahas been included in a meta-analysis. Anotherfour papers – uni- or multicenter retrospectivestudies compared the results obtained with PDand HD. The remaining two papers – reports fromnationwide registries that compare of mortalityrates, adjusted for co-morbid conditions andage, present specific results on groups ofelderly patients. Three papers compareparticular aspects of the two techniques,including nutritional status, psychiatric andpsychosocial aspects and rehabilitation, inthis case comparing PD with home hemodialysispatients. Finally, we have included theopinions of healthy elderly people on dialysisissues.This meta-analysis of these different studiessuggests that the mortality and hospitalizationrate of elderly people treated by PD is similarto that of similar people treated by HD. Inconsequence, we have no reasons to selecteither therapy on behalf of the patient. Thenephrologist should consider and inform thepatient and family about the relativeadvantages and disadvantages of both techniquesand tailor dialysis technique choice to thespecific individual to assure the best results.Local circumstances should also be considered.protection. [ABSTRACT FROM AUTHOR]

Background: The reported prevalence of sleep disorders in children with chronic kidney disease (CKD) varies greatly. A quantitative meta-analysis to estimate the prevalence of sleep disorders among pediatric CKD patients may provide further information. Objectives: The objective of this study is to estimate the prevalence of sleep disorders in children with CKD. The study protocol was registered on PROSPERO (registration number CRD42021268378). Data sources: Two authors independently searched the PubMed, MEDLINE, EMBASE, and Cochrane review databases up to June 2021. Study eligibility criteria: Eligible studies include data of prevalence of sleep disorders in children with CKD. Study appraisal and synthesis methods: The prevalence of restless legs syndrome, sleep-disordered breathing, pediatric obstructive sleep apnea (i.e., apnea–hypopnea index > 1 event/h in polysomnography), excessive daytime sleepiness, and insomnia/insufficient sleep was estimated using a random-effects model. Subgroup analyses were conducted to compare the prevalence of sleep disorders between children on dialysis and not on dialysis. This meta-analysis included 12 studies with 595 children (mean age: 12.9 years; gender ratio: 55.6% boys; mean sample size: 49.6 patients). Results: The prevalence of restless legs syndrome in children with CKD was 21% (95% confidence interval [CI], 14–30%). The prevalence of sleep-disordered breathing, pediatric obstructive sleep apnea, excessive daytime sleepiness, and insomnia/insufficient sleep was 22% (95% CI, 12–36%), 34% (95% CI, 19–53%), 27% (95% CI, 17–41%), and 14% (95% CI, 7–27%), respectively. Subgroup analysis revealed the pooled prevalence of excessive daytime sleepiness was significantly higher in children on dialysis than in children not on dialysis (43.3% vs. 11.2%; P = 0.018). Children on dialysis also had a high prevalence of other sleeping disorders, although the differences did not reach statistical significance. Children with CKD exhibited a 3.9-fold (95% CI, 1.37 to 10.93) increased risk of restless legs syndrome and a 9.6-fold (95% CI, 3.57 to 25.76) increased risk of excessive daytime sleepiness compared with controls. Limitations: The selected papers are of small sample size, lack of a control group, and exhibit substantial heterogeneity. Conclusions: Sleep disorders are common in children with CKD. Our results indicate that while the prevalence rates of various sleep disorders were higher in children on dialysis than in children not on dialysis, the prevalence of excessive daytime sleepiness was statistically significant in children on dialysis. A higher resolution version of the Graphical abstract is available as Supplementary information. [ABSTRACT FROM AUTHOR]

This research examined the seismic behavior of medical equipment，which supports advanced hospital functions through shaking table testing and numerical analysis，and derived evaluation index for mitigating damage. The shaking table test observed the rocking and overturning of neonatal beds and a dialysis liquid feeding apparatus under sine waves and the building floor responses during earthquakes. The rocking and overturning damage occurred only when the casters of equipment were all locked，and the ratio between the equipment's gravity center height (h) and leg width (b), b/h, is smaller than a certain threshold. The influence of equipment dimensions and weight on the seismic behavior was studied by parametric analysis using a distinct element method (DEM) model of equipment. The probability of damage decreased significantly when the ratio between the b/h becomes large. For the floor velocity response of 80 cm/s, which is assumed for the approximate return period of 500 years and with the response amplification factor (the ground to floor response ratio) of 1.6, the probability of overturning became negligible when the b/h is 0.4 or larger. This paper also presents an analytical equation to calculate sufficient safety weights added to existing equipment for conforming to the above thresholds of b/h. [ABSTRACT FROM AUTHOR]

Background Employment is important for the quality of life and financial security of patients of working age receiving kidney replacement therapy (KRT). We aimed to examine self-reported work status and general, physical and mental work ability and to determine associations between demographic, disease-related, work-related and macroeconomic factors and employment.  Methods Europeans from 37 countries, ages 19–65 years, treated with dialysis or kidney transplantation, filled out the web-based or paper-based cross-sectional EDITH kidney patient survey between November 2017 and January 2019. We performed descriptive analyses and multivariable generalized logistic mixed models. Results Of the 3544 patients, 36.5% were employed and working [25.8% of dialysis patients, 53.9% of kidney transplant recipients (KTRs)]. The mean general work ability was 5.5 out of 10 (dialysis: 4.8, KTRs: 6.5). Non-working patients (all: 4.1, dialysis: 3.9, KTRs: 4.7) scored lower than working patients (all: 7.7, dialysis 7.3, KTRs: 8.0). Working dialysis patients scored lower on physical and mental work ability (7.1 and 8.1) than working KTRs (8.0 and 8.4; P < 0.001). Impaired physical work ability (42.7%) was more prevalent than impaired mental work ability (26.7%). Male sex, age 40–49 years, higher education, home dialysis or kidney transplantation as current treatment, treatment history including kidney transplantation, absence of diabetes mellitus, better general work ability and higher country gross domestic product were positively associated with employment (P < 0.05). Conclusions Low employment rates and impaired work ability were prevalent among European patients receiving KRT. Demographic, disease-related, work-related and macro-economic factors were associated with employment. [ABSTRACT FROM AUTHOR]

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Background: Kidney failure and dialysis treatment have a large impact on a patient's life. Patients experience numerous, complex symptoms and usually have multiple comorbid conditions. Despite the multitude of problems, patients often have priorities for improvement of specific aspects of their functioning, which would be helpful for clinicians to become informed of. This highlights a clear need for patient-centered care in this particular patient group, with routine screening as a vital element to timely recognize symptoms and tailored treatment to match individual patients' needs and priorities. By also providing feedback on patient's screening results to the patient itself, the patient is empowered to actively take control in one's mostly uncontrollable disease process. The current paper describes the study design of a multicenter randomized controlled trial evaluating the effectiveness of the "E-HEealth treatment in Long-term Dialysis" (E-HELD) intervention. This therapist-guided Internet-based cognitive-behavioral therapy (ICBT) intervention is focused on and personalized to the myriad of problems that dialysis patients experience and prioritize. Methods: After a screening procedure on adjustment problems, 130 eligible dialysis patients will be randomized to care as usual or the E-HELD intervention. Patients will complete questionnaires on distress (primary outcome measure), several domains of functioning (e.g., physical, psychological, social), potential predictors and mediators of treatment success, and the cost-effectiveness of the intervention, at baseline, 6-month follow-up, and 12-month follow-up. In addition, to take account of the personalized character of the intervention, the Personalized Priority and Progress Questionnaire (PPPQ) will be administered which is a personalized instrument to identify, prioritize, and monitor individual problems over time. Discussion: The present study design will provide insight in the effectiveness of tailored ICBT in patients with kidney failure who are treated with dialysis. When proven effective, the screening procedure and the subsequent ICBT intervention could be implemented in routine care to detect, support, and treat patients struggling with adjustment problems. Trial registration: NL63422.058.17 [Registry ID: METC-LDD] NL7160 [Netherlands Trial Register; registered on 16 July 2018] [ABSTRACT FROM AUTHOR]

Background. The UK Renal Registry quotes a 1-year death rate for patients established on dialysis of 19.4 per 100 patient years. Clinical experience, reflected in the UK Renal Association Standards Document (RASD), recognizes qualitatively that age, diabetes, and other comorbidities increase the risk of death. The aim of this paper is to provide quantitative estimates of the relative risk of death associated with particular patient characteristics. [ABSTRACT FROM PUBLISHER]

Background Access to various kidney replacement therapy (KRT) modalities for patients with end-stage kidney disease differs substantially within Europe. Methods European adults on KRT filled out an online or paper-based survey about factors influencing and experiences with modality choice (e.g. information provision, decision-making and reasons for choice) between November 2017 and January 2019. We compared countries with low, middle and high gross domestic product (GDP). Results In total, 7820 patients [mean age 59 years, 56% male, 63% on centre haemodialysis (CHD)] from 38 countries participated. Twenty-five percent had received no information on the different modalities, and only 23% received information >12 months before KRT initiation. Patients were not informed about home haemodialysis (HHD) (42%) and comprehensive conservative management (33%). Besides nephrologists, nurses more frequently provided information in high-GDP countries, whereas physicians other than nephrologists did so in low-GDP countries. Patients from low-GDP countries reported later information provision, less information about other modalities than CHD and lower satisfaction with information. The majority of modality decisions were made involving both patient and nephrologist. Patients reported subjective (e.g. quality of life and fears) and objective reasons (e.g. costs and availability of treatments) for modality choice. Patients had good experiences with all modalities, but experiences were better for HHD and kidney transplantation and in middle- and high-GDP countries. Conclusion Our results suggest European differences in patient-reported factors influencing KRT modality choice, possibly caused by disparities in availability of KRT modalities, different healthcare systems and varying patient preferences. Availability of home dialysis and kidney transplantation should be optimized. [ABSTRACT FROM AUTHOR]

Purpose: End-stage renal disease (ESRD) patients often report a combination of disturbing physical symptoms and psychological distress which result in significantly reduced quality of life (QoL). Coping with a chronic disease is a complex matter involving also the family and a multi-disciplinary team. Recently, observational studies suggested that spirituality (S) and religiosity (R) are two important determinants in coping with a chronic/terminal disease. Both concepts were studied in various settings, involving ESRD and QoL. This systematic review aims to synthesize all instruments used to assess R/S, to examine the strategies evaluating QoL of dialysis patients and to analyse their correlations. Methods: In accordance with the PRISMA, a systematic search was conducted in PubMed and SCOPUS (between Jan 1980—Dec 2018, PROSPERO number CRD42019116837). Eligible studies included patients on dialysis therapy, religiously/spiritually assessed and contained QoL evaluation. Results: Of the initial 311 studies, 261 papers were excluded. Consequently, 50 papers with a total 9265 patients were available for inclusion. From a list of 177 R/S scales available worldwide, we identified 24 tools. We organized all QoL parameters into 10 classes. In all studies, R/S variables were positively correlated with at least one QoL variable. Conclusions: In this systematic review, we synthesized the studies involving R/S assessment in dialysis patients and their benefit on QoL. R/S has a positive impact on most QoL parameters in 5D-CKD. We suggest that nephrology guidelines on palliative care and/or elderly should include specific recommendations on R/S support and opportunities for integrated specific therapies. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Caring for patients with diabetes undergoing dialysis often proves challenging for staff working in haemodialysis units as they are not experts in diabetes and unfamiliar with insulin dosing regimens and the impact dialysis can have on blood sugar levels and lifestyle adjustment. There is a need to improve the knowledge base of renal healthcare professionals to better understand the physiology of diabetes, its relationship with end stage kidney disease, and potential changes that can take place when commencing dialysis. Objectives: The aim of this paper is to improve the understanding of the epidemiology of diabetes, associated risk factors, and complications associated with combined kidney disease & diabetes. In addition, readers will learn about the impact of dialysis on this complex patient group; adjustments which need to be made to accommodate haemodialysis schedules e.g. timing of meals and insulin requirements; treatment time including travel; the monitoring of blood glucose levels: increased risk of hypoglycaemia; review of oral glycaemic medication and the need to maintain regular health checks and contact with diabetes teams. Recommendations for practice: Specialist evidence based guidelines for the management of patients with diabetes receiving haemodialysis are readily available and can be used to support clinical practice. One of the key components to improving the patient experience is to maintain collaborative working relationship between renal and diabetes teams. Learning outcomes: After reading this paper the reader will be able to Understand the risk factors and complications of diabetes and relate to patients in their careCritically review the management of patients undergoing dialysis with diabetesGain knowledge and understanding of changes in the dosing of insulin needed for patients receiving dialysisUnderstand how clinical guidelines can be applied in practice [ABSTRACT FROM AUTHOR]

Sleep disorders are common in patients with kidney disease. The relationship between sleep disorders and kidney disease is complex and bidirectional. Many renal disease-related factors such as anaemia, fluid and uraemic toxin accumulation are found to cause poor sleep quality. Inadequate sleep and reduced sleep time increases risk of hypertension and proteinuria, and exaggerates kidney failure. The consequences of sleep disorders such as fatigue and depression have a profound impact on the patient's quality of life and survival, yet sleep is not routinely assessed in current renal practice. The purpose of this paper is to explain the definition and clinical symptoms of different types of sleep disorders that are commonly reported by patients with kidney disease. The potential causes of each sleep disorder and the risk factors associated with kidney failure are also a focus of this paper. We have reviewed commonly used screening tools and summarised some useful strategies that can be initiated by a nurse when caring for a patient with kidney disease and a co-exisitng sleep disorder [ABSTRACT FROM AUTHOR]

Miniaturized systems based on the principles of microfluidics are widely used in various fields, such as biochemical and biomedical applications. Systematic design processes are demanded the proper use of these microfluidic devices based on mathematical simulations. Aggregated proteins (e.g., inclusion bodies) in solution with chaotropic agents (such as urea) at high concentration in combination with reducing agents are denatured. Refolding methods to achieve the native proteins from inclusion bodies of recombinant protein relying on denaturant dilution or dialysis approaches for suppressing protein aggregation is very important in the industrial field. In this paper, a modeling approach is introduced and employed that enables a compact and cost-effective method for on-chip refolding process. The innovative aspect of the presented refolding method is incorporation dialysis and dilution. Dilution-dialysis microfluidic chip (DDMC) increases productivity folding of proteins with the gradual reduction of the amount of urea. It has shown the potential of DDMC for performing refolding of protein trials. The principles of the microfluidic device detailed in this paper are to produce protein on the dilution with slow mixing through diffusion of a denatured protein solution and stepwise dialysis of a refolding buffer flowing together and the flow regime is creeping flow. The operation of DDMC was modeled in two dimensions. This system simulated by COMSOL Multiphysics Modeling Software. The simulation results for a microfluidic refolding chip showed that DDMC was deemed to be perfectly suitable for control decreasing urea in the fluid model. The DDMC was validated through an experimental study. According to the results, refolding efficiency of denaturant Hen egg white lysozyme (HEWL) (EC 3.2.1.17) used as a model protein was improved. Regard to the remaining activity test, it was increased from 42.6 in simple dilution to 93.7 using DDMC. [ABSTRACT FROM AUTHOR]

Purpose: The present paper will review the impact of different therapeutic interventions on the autonomic dysfunction characterizing chronic renal failure. Methods: We reviewed the results of the studies carried out in the last few years examining the effects of standard pharmacologic treatment, hemodialysis, kidney transplantation, renal nerve ablation and carotid baroreceptor stimulation on parasympathetic and sympathetic control of the cardiovascular system in patients with renal failure. Results: Drugs acting on the renin–angiotensin system as well as central sympatholytic agents have been documented to improve autonomic cardiovascular control. This has also been shown for hemodialysis, although with more heterogeneous results related to the type of dialytic procedure adopted. Kidney transplantation, in contrast, particularly when performed together with the surgical removal of the native diseased kidneys, has been shown to cause profound sympathoinhibitory effects. Finally, a small amount of promising data are available on the potential favorable autonomic effects (particularly the sympathetic ones) of renal nerve ablation and carotid baroreceptor stimulation in chronic kidney disease. Conclusions: Further studies are needed to clarify several aspects of the autonomic responses to therapeutic interventions in chronic renal disease. These include (1) the potential to normalize sympathetic activity in uremic patients by the various therapeutic approaches and (2) the definition of the degree of sympathetic deactivation to be achieved during treatment. [ABSTRACT FROM AUTHOR]