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• AV grafts had significantly higher thrombosis risk than AV fistulas (OR = 10.93, 95 % CI: 9.35-12.78, P = 0.001). • Hemodialysis patients had 3.60 times higher thrombosis risk than non-hemodialysis patients (OR = 3.60, 95 % CI: 3.54-4.19, P = 0.001). • Single-stage basilic vein transposition increased thrombosis risk by 1.89 times compared to two-stage transposition (OR = 1.89, 95 % CI: 1.04-3.46, P = 0.038). To identify the factors associated with thrombosis in dialysis patients. Thrombosis is a leading cause of vascular access failure in dialysis patients. Numerous risk factors contribute to thrombosis in this population. A systematic search was conducted across international databases using standardized keywords. The quality of the selected studies was assessed using the STROBE and CONSORT checklists. The findings were summarized in a Garrard table. Meta-analysis was performed using CMA software. The study adhered to the guidelines outlined in the PRISMA statement. A total of 180 articles were reviewed. The odds ratio for thrombosis in patients with arteriovenous grafts compared to arteriovenous fistulas was 10.93 (95 % CI: 9.35-12.78), demonstrating statistical significance (P = 0.001). Similarly, hemodialysis patients had an odds ratio of thrombosis 3.60 times higher than non-hemodialysis patients (95 % CI: 3.54-4.19), with statistical significance (P = 0.001). Patients undergoing single-stage basilic vein transposition had a 1.89 times higher risk of thrombosis compared to those undergoing two-stage transposition (95 % CI: 1.04-3.46), also demonstrating statistical significance (P = 0.038). Thrombosis in patients with end-stage renal disease undergoing dialysis was significantly associated with various factors, including graft access, single-stage basilic vein transposition, and hemodialysis. Additional contributing factors to thrombosis included diabetes, elevated homocysteine levels, female gender, age over 50, access location, and low access blood flow velocity. The analysis revealed a higher incidence of thrombosis in end-stage renal disease patients undergoing hemodialysis compared to those not undergoing dialysis, as well as in patients with arteriovenous grafts compared to those with arteriovenous fistulas. These findings underscore the importance of recognizing and managing these risk factors to prevent thrombotic events and enhance patient care within the dialysis setting. [ABSTRACT FROM AUTHOR]

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]

The objective of this study was to analyze the nutritional status of hemodialysis patients with end stage renal disease, and to select oral nutritional support agents with high tolerance. In this experiment, 94 hemodialysis patients with end stage renal disease who were treated in our hospital from August 2020 to July 2022 were selected as research objects. The nutritional status of the patients was evaluated by counting their 24-hour dietary status and using MQSGA (Modified Quantitative Subjective Nutrition Assessment) scale, and was analyzed in combination with the determination of biochemical indicators and body weight. The factors influencing hemodialysis malnutrition of end stage renal disease by single factor linear regression included age, dialysis time, Hb, TG, hs-CRP, BMI, Alb, BUN and Kt/v ratio. The multiple stepwise regression analysis showed that the independent risk factors of malnutrition included age>65 years old, HS-CRP>5 mg/ml and Kt/v<1.2. It was concluded that the incidence of malnutrition in hemodialysis patients with end stage renal disease is relatively high, which is closely related to the age, inflammatory state and dialysis adequacy of the patients. According to nutritional risk characteristics of hemodialysis patients with end stage renal disease, Yixusu (whole nutrient) + whey protein powder can be selected to ensure the demand and consumption of protein during dialysis, improve the immune defense ability of patients and avoid a series of complications caused by malnutrition. [ABSTRACT FROM AUTHOR]

Background: Inadequate nutrition is common for both sarcopenia and frailty. We investigated whether hemodialysis patients with sarcopenia and frailty have reduced dietary intakes. Methods: Dietary intake, and physical activity were analyzed, along with body composition and relevant clinical data. Results: We studied 51 hemodialysis patients; 52.9% male, age 60 ± 15 years; 33.3% sarcopenic, and 72.5% frail. Dietary protein and calories were similar for sarcopenic and non-sarcopenic patients 0.68 (0.38–3.5) vs. 0.68 (0.18–2.9) g protein/kg/day and 19.2 (8.2–77.5) vs. 15.2 (6.2–38.5) kcal/kg/day. More sarcopenic patients had low physical activity (88.2% vs. 58.8%, X 2 4.6, p =.03). Frail and non-frail patients had similar intakes 0.67 (0.28–3.5) versus 0.83 (0.18–1.6) g protein/kg/day and 15.5 (8.1–77.5) vs. 18.8 (6.2–45.4) kcal/kg/day. Sarcopenia was associated with age [Odds ratio (OR) 1.09, 95% confidence interval (CI) [1.02, 1.18], p =.017], body mass index [OR 0.84, 95% CI [0.71, 0.99], p =.042] and lack of exercise [OR 7.62, 95% CI [1.16, 50.29], p =.035]. Frailty was associated with female gender [OR 17.79, 95% CI [2.09, 151.59], p =.008], age [OR 1.13, 95% CI [1.04, 1.22], p =.006], and dialysis vintage [OR 1.55, 95% CI [1.06, 2.26], p =.024]. Conclusion: Hemodialysis patients with sarcopenia and frailty did not have lower dietary protein and calorie intake. Frailty was associated with age and sarcopenia with a sedentary lifestyle. [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 Background Globally, there are regional and time-based variations in the prevalence, etiology, and prognosis of rapidly progressive glomerulonephritis (RPGN). Prognosis of RPGN is poor, with a higher risk of death and end stage renal disease (ESRD) even with immunosuppressive medications. In the Middle East and North Africa, the studies on this disease are very limited. Therefore, we determined the predictors of outcome of RPGN. Methods We retrospectively assessed 101 adult patients over age of 18, diagnosed with RPGN based on renal biopsy illustrating crescents in ≥ 50% of the glomeruli. Patients who had crescents in their renal biopsies that were

Background Globally, there are regional and time-based variations in the prevalence, etiology, and prognosis of rapidly progressive glomerulonephritis (RPGN). Prognosis of RPGN is poor, with a higher risk of death and end stage renal disease (ESRD) even with immunosuppressive medications. In the Middle East and North Africa, the studies on this disease are very limited. Therefore, we determined the predictors of outcome of RPGN. Methods We retrospectively assessed 101 adult patients over age of 18, diagnosed with RPGN based on renal biopsy illustrating crescents in ≥50% of the glomeruli. Patients who had crescents in their renal biopsies that were <50% and those who refused to consent to a renal biopsy were excluded. We categorized the patients into 3 groups based on immunohistochemistry; type I, type II and type III. Then, depending on renal loss, we divided them into ESRD and non-ESRD groups. The clinical history and physical examination were retrieved. Additionally, 24-hour urine protein, urine analysis, renal function tests, serum albumin, complete blood count, antinuclear antibodies, anti-double stranded DNA antibodies, ANCA antibodies and serum complement levels were checked. Each patient underwent a kidney biopsy for immunohistochemistry and light microscopy. The percentage of crescentic glomeruli, number of sclerosed glomeruli, tertiary lymphoid organ (TLO), neutrophil infiltration, endocapillary or mesangial hypercellularity, interstitial fibrosis with tubular atrophy (IFTA) were analyzed. Primary outcomes (remission, ESRD and mortality) and secondary outcomes were assessed. Results Type II was the most frequent cause of RPGN (47.5%), followed by type III (32.7%) and type I (19.8%). 32 patients (31.7%) died during follow up, whereas 60 patients (59.4%) developed ESRD. In 41 patients (40.6%), remission occurred. Oliguria, serum creatinine, and need for HD at presentation were significantly increased in ESRD group compared to non-ESRD group (P<0.001 for each). Mesangial proliferation, IFTA, TLO formation, sclerotic glomeruli and fibrous crescents were also significantly increased in ESRD group in comparison to non-ESRD group (P<0.001 for each). Glomerulosclerosis (P=0.036), and IFTA (P=0.008) were predictors of ESRD. Infections (P=0.02), respiratory failure (P<0.001), and heart failure (P=0.004) were mortality risk factors. Conclusion Type II RPGN was the most common. Infection was the most frequent secondary outcome. Oliguria, glomerulosclerosis, the requirement for hemodialysis at presentation, IFTA and TLO formation were predictors of ESRD. Respiratory failure, heart failure and infections were significant predictors of mortality. [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]

Patients with chronic kidney disease (CKD) undergoing hemodialysis often experience significant itch secondary to their condition and a subsequent reduction in their overall quality of life. Current treatments are underwhelming, necessitating the search for new, effective therapeutic options to combat itch in this population. The purpose of this review is to explore the available data for the use of intravenous difelikefalin in patients with CKD undergoing hemodialysis. The pathophysiology of CKD-associated itch is multifactorial, with one proposed mechanism involving an imbalance in the endogenous opioid system, favoring upregulation of itch-activating μ-opioid receptors (MORs) and downregulation of itch-inhibiting κ-opioid receptors (KORs). Dysregulation of the immune system is also involved. Difelikefalin is a recent FDA approved treatment that functions as peripherally acting KOR agonist, targeting this imbalance in the endogenous opioid system seen in CKD patients with itch and having an anti-inflammatory effect on immune cells. Clinical data on intravenous difelikefalin is promising regarding its ability to reduce itch in CKD patients on hemodialysis and improve patient quality of life, with few, mild adverse side effects. As intravenous difelikefalin becomes more widely used in the clinical setting, further studies assessing long-term efficacy and safety will be needed. [ABSTRACT FROM AUTHOR]

Background: Hyperuricemia and hypouricemia have been implicated as a cause of high mortality in haemodialysis patients. Our study is designed to determine the frequency of abnormal Uric Acid levels in haemodialysis patients and to identify those at risk of increasing mortality. Methods: 140 End Stage Renal Disease (ESRD) patients undergoing haemodialysiswere enrolled in a retrospective cross sectional study. Uric Acid levels done as routine sampling was noted and data analyzed using SPSS for windows, version 23. All data are presented as mean ±SD. A relationship was considered statistically significant at p-values less than 0.05. Patient’s age and comorbidities like Diabetes and Hypertension were noted. Patients with mean UA levels between 2.4-6 mg/dl were specified as normouricemic, above this range as hyperuricemic and below this range as hypouricemic. Results: Out of 140 patients, 71(50.7%) were males and 69(49.3%)were females. Mean age of our patient population was 56.64 ± 12.207. 56 (40%) patients were hyperuricemic and 8 (5.7%) hypouricemic. 87 (62.1%) were diabetic,122 (87.1%) were hypertensive whereas 83 (59.3%) were both hypertensive and diabetic but no notable (p> 0.05) link was found to exist between hyperuricemia and these co-morbidities. Conclusion: We report a very high frequency of abnormal Uric Acid levels in haemodialysis patients. Nearly half of our haemodialysis population is at high risk of all-cause mortality based on Uric Acid levels alone.

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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]

Introduction: Chronic kidney disease is a widespread medical problem that leads to higher morbidity, mortality, and a decrease in the overall well-being of the general population. This is especially expressed in patients with end-stage renal disease (ESRD) undergoing maintenance haemodialysis. Several variables could be used to evaluate those patients' well-being and mortality risk. One of them is the presence of residual urine output.Materials and Methods: The study was conducted on 485 patients treated with maintenance haemodialysis. After enrollment in the study, which consisted of medical history, physical examination, hydration assessment, and blood sampling, each patient was followed up for 24 months. We used residual urine output (RUO) as a measure of residual renal function (RRF). The entire cohort was divided into 4 subgroups based on the daily urinary output (<=100mL per day, > 100mL to <=500mL, > 500mL to <=1000mL and > 1000mL).Results: The data show that the mortality rate was significantly higher in groups with lower RUO, which was caused mainly by cardiovascular events. Also, patients with higher RUO achieved better sodium, potassium, calcium, and phosphate balance. They were also less prone to overhydration and had a better nutritional status. Preserved RRF also had a positive impact on markers of cardiovascular damage, such as NT-proBNP as well as TnT.Conclusion: In conclusion, preserving residual urine output in ESRD patients undergoing maintenance haemodialysis is invaluable in reducing their morbidity and mortality rates and enhancing other favourable parameters of those patients. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is a common complication of hemodialysis that needs to be prevented, properly diagnosed and treated. Intra-dialytic feeding is a controversial yet effective method to help < br />improve nutritional status. Objective(s): To assess intradialytic dietary pattern and nutritional status of hemodialysis patients and determine the energy and protein adequacy on hemodialysis and non-hemodialysis days. Methods: A cross sectional study was conducted using a predesigned interview questionnaire, 3-day 24-hour diet recall, anthropometric measurements, serum albumin and total iron binding capacity measurements, and malnutrition inflammation score (MIS) for 150 hemodialysis patients. Results: More than three quarters of the patients reported eating during the hemodialysis session with 71.3% of them eating due to the long session hours. Mean energy and protein intake on hemodialysis days was 1743.0 ± 718.1 kcal and 73.78 ± 37.15 g, respectively, which was significantly higher among patients who eat than those who don’t eat during the hemodialysis session (p < 0.001). Although mean serum albumin was higher in patients who eat during dialysis session and MIS was lower, there was no statistically significant difference between both groups. Conclusion: Intradialytic feeding is a common practice in chronic hemodialysis patients. Both energy and protein intakes and their adequacies were found to be higher in patients who eat during the dialysis session. This hints at the importance of utilization of dialysis session time to enhance the patients’ nutritional status. Therefore, it is recommended to individualize the advice of intradialytic feeding according to the patient’s needs.

ABSTRACTVaricella Zoster Virus (VZV) infection is a common childhood exanthematous disease, which in adults and immunocompromised people may result in severe neurologic complications. Up to one-third of infected subjects may have VZV clinical reactivation particularly if immunocompromised. Patients affected by end-stage renal disease on hemodialysis present immunodepression that contributes to their higher incidence of VZV infections and reactivation. While antiviral treatment in these patients shows low efficacy, the prevention of VZV through vaccination avoids the primary infection and the risk of reactivation. Two VZV vaccines are currently available: the live attenuate Zoster Vaccine (LZV) and a Recombinant Zoster Vaccine (RZV), with the latter appearing to provide greater efficacy. Given the higher incidence of VZV infection and reactivation, the lesser response to antivirals and the lower impact of VZ vaccine in hemodialysis patients in terms of side effects, a higher diffusion of VZV vaccination should be promoted by nephrologists in these patients in particular in those with future transplant opportunities.

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]

Objective: To determine the frequency of catheter related bacterial infections among the patients on hemodialysis due to end stage renal disease. Study Design: Cross sectional study Place and Duration of Study: Department of Nephrology, Sharif Medical City Hospital, Lahore Pakistan, from 6 Months i.e., Jun 2021 to Oct 2021. Methodology: After meeting the inclusion and exclusion criteria 171 patients were enrolled. Tips of the catheters were removed by the surgeon and transferred to laboratory in a sterile container, while at least two blood culture samples were taken before removing the catheter. Catheter related bacterial infections were noted. Results: In this study the most common catheter related bacterial infection in ESRD cases on hemodialysis was blood stream tunnel infection noted in 48.5% patients followed by, infective endocarditis noted in 28.1%, echo vegetation in 26.3% patients, tunnel infection in 25.1% and exit site infection in 23.4% patients. Conclusion: The most common catheter related bacterial infection in ESRD cases on hemodialysis was blood stream tunnel infection followed by, infective endocarditis, echo vegetation, tunnel infection and exit site infection patients.

Introductioin : Intradialytic complications are still being debated among health workers in the Hemodialysis Unit in Hospitals, many factors can cause patients to experience complications during dialysis. This study aims to identify the factors that contribute to the incidence of intradialytic complications in order to minimize the incidence of complications. Methode : This study used a research design in the form of analytic descriptive with cross-sectional. The sampling technique was a consecutive sampling of 120 patients. The chi-square statistical test aims to examine differences in proportions. If the results of the bivariate test have p

SGLT-2i are the new standard of care for diabetic kidney disease (DKD), but previous studies have not included patients on kidney replacement therapy (KRT). Due to their high risk of cardiovascular, renal complications, and mortality, these patients would benefit the most from this therapy. Residual kidney function (RKF) conveys a survival benefit and cardiovascular health among hemodialysis (HD) patients, especially those on incremental hemodialysis (iHD). We retrospectively describe the safety and efficacy of SGLT2i regarding RKF preservation in seven diabetic patients with different clinical backgrounds who underwent iHD (one or two sessions per week) during a 12-month follow-up. All patients preserved RKF, measured as residual kidney urea clearance (KrU) in 24 h after the introduction of SGLT2i. KrU levels improved significantly from 4.91 ± 1.14 mL/min to 7.28 ± 1.68 mL/min at 12 months (p = 0.028). Pre-hemodialysis blood pressure improved 9.95% in mean systolic blood pressure (SBP) (p = 0.015) and 10.95% in mean diastolic blood pressure (DBP) (p = 0.041); as a result, antihypertensive medication was modified. Improvements in blood uric acid, hemoglobin A1c, urine albumin/creatinine ratio (UACR), and 24 h proteinuria were also significant. Regarding side effects, two patients developed uncomplicated urinary tract infections that were resolved. No other complications were reported. The use of SGLT2i in our sample of DKD patients starting iHD on a 1–2 weekly regimen appears to be safe and effective in preserving RKF. [ABSTRACT FROM AUTHOR]

Background: Patients with end stage renal disease under hemodialysis are at increased risk for morbidities and mortality. Cardiovascular diseases are independent risk for death among those patients. Echocardiography is a non-invasive method that helps identification of the problem and risk stratification.Aim of the work: The study aimed to determine whether left ventricular function differs in pre-dialytic compared with post-dialytic periods, and to recognize relationship between hemodialysis and left ventricular function.Patients and Methods: Patients undergoing hemodialysis in the duration between August 2022 and February 2023 in Alhussein University Hospitals were eligible to participate. They underwent echocardiographic assessment in 2 times; pre- and immediately after dialysis session.Results: Fifty patients undergoing regular hemodialysis were recruited in the study. Their mean age was 48.92 ± 6.93 years old. 70% of patients [35 patients] were males. All patients were hypertensive, while 46% of them [23 patients] were diabetic. We found that there was a slight improvement of both systolic and diastolic functions assessed by M-mode, Simpson method, 3D and Doppler study. however, none of this improvement was statistically significant.Conclusion: No significant change in both cardiac structure and function can occur immediately after the dialysis sessions. That is why longer follow up period is recommended for future research.

Background: Chronic kidney disease (CKD) refers to abnormalities in kidney structure and/or function for more than three months; cardiac autonomic neuropathy (CAN) is an indicator of cardiovascular death due to various abnormalities such as cardiac arrhythmias. Heart rate variability (HRV) is an important component of CAN and has been shown to be related to CAN. This study aims to evaluate cardiac autonomic neuropathy at different stages of CKD with the Bellavere score and to correlate CAN with lipids, plasma, electrolytes and blood pressure in patients with CKD at different stages. Methods: Consent of 95 patients who met the diagnosis of chronic kidney disease according to Modification of Diet in Renal Disease (MDRD) criteria were included in the study. All subjects will have blood tests for lipids, anaemia, and electrolytes. All participants' blood pressure will be monitored. All subjects will also be scored based on the Bellevere scoring system, the Valsava ratio, and the 30:15 ratio. Data will be analyzed using SPSS version 21 and appropriate statistical tests will be used depending on the study objectives and the data collected. Expected results: Based on the literature review and previous studies, the results of this study should demonstrate the relationship between CAN and CKD at this stage. The study also expects to find higher Bellavere scores in patients with different stages of CKD.

Brain microbleeds are increased in chronic kidney disease (CKD) and their presence increases risk of cognitive decline and stroke. We examined the interaction between CKD and brain microhemorrhages (the neuropathological substrate of microbleeds) in mouse and cell culture models and studied progression of microbleed burden on serial brain imaging from humans. Mouse studies: Two CKD models were investigated: adenine-induced tubulointerstitial nephritis and surgical 5/6 nephrectomy. Cell culture studies: bEnd.3 mouse brain endothelial cells were grown to confluence, and monolayer integrity was measured after exposure to 5-15% human uremic serum or increasing concentrations of urea. Human studies: Progression of brain microbleeds was evaluated on serial MRI from control, pre-dialysis CKD, and dialysis patients. Microhemorrhages were increased 2-2.5-fold in mice with CKD independent of higher blood pressure in the 5/6 nephrectomy model. IgG staining was increased in CKD animals, consistent with increased blood-brain barrier permeability. Incubation of bEnd.3 cells with uremic serum or elevated urea produced a dose-dependent drop in trans-endothelial electrical resistance. Elevated urea induced actin cytoskeleton derangements and decreased claudin-5 expression. In human subjects, prevalence of microbleeds was 50% in both CKD cohorts compared with 10% in age-matched controls. More patients in the dialysis cohort had increased microbleeds on follow-up MRI after 1.5 years. CKD disrupts the blood-brain barrier and increases brain microhemorrhages in mice and microbleeds in humans. Elevated urea alters the actin cytoskeleton and tight junction proteins in cultured endothelial cells, suggesting that these mechanisms explain (at least in part) the microhemorrhages and microbleeds observed in the animal and human studies.

BackgroundMortality in patients with end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) remains exceptionally high. While traditional risk factors such as obesity are paradoxically associated with better survival, nontraditional risk factors including cachexia increase the likelihood of poor outcomes. There is accumulating evidence that the endocannabinoid (ECB) system plays a major role in energy preservation and storage, factors which can prevent the deleterious effects of cachexia. Hence, in this study, we evaluated the association of circulating ECB levels with mortality in MHD patients.MethodsSerum concentrations of anandamide (AEA) and 2-arachidonoyl-sn-glycerol (2-AG), major ECB ligands, were measured in MHD patients. Their correlation with various clinical/laboratory indices and association with 12-month all-cause mortality were examined.ResultsSerum 2-AG levels positively correlated with body mass index, serum triglycerides and body anthropometric measures. Meanwhile, serum AEA levels correlated positively with serum interleukin-6, and negatively with serum very low-density lipoprotein levels. While increased serum 2-AG levels were associated with reduced risk of all-cause mortality (hazard ratio [HR] 0.52, 95% CI 0.28-0.98), there was no clear association between serum AEA levels and mortality (HR 0.91, 95% CI 0.48-1.72).ConclusionsIn MHD patients, the circulating levels of ECB ligand, 2-AG, may play an important role in determining body mass and risk of mortality. These observations were unique to 2-AG as similar findings were not obtained with serum AEA. Future studies need to investigate the mechanisms responsible for these associations and examine the modulation of the ECB system as a potential target for therapy in ESRD.

Abstract 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).

Background and Objective: Hemodialysis is an important replacement therapy for 70-90% of patients with end-stage renal disease (ESRD). Arteriovenous fistula (AVF) is the vascular access of choice in these patients due to its higher efficiency and lower risk of mortality compared to arteriovenous grafts. This study was conducted to determine the frequency of vascular access types used in hemodialysis centers of Gorgan, Iran. Methods: This descriptive-analytical study was done on 200 hemodialysis patients (101 men and 99 women) at 5 Azar and Sayyad Shirazi hospitals in Gorgan, north of Iran, during April 2020 to July 2021. The subjects were selected by the census method. Information including age, sex, education level, duration of dialysis, the initial and current types of vascular access, site of vascular access, history of diabetes or hypertension, race, and history of smoking were recorded in a checklist. Results: The mean age of women and men was 58.34±4.71 and 57.95±13.76 years, respectively. In addition, 61.5% of the patients were under 3 years old. The most commonly used vascular access to initiate dialysis was non-cuffed temporary catheters (69%) and AVF (24%). Smoking, ethnicity, diabetes, hypertension, and gender had no significant association with the type of vascular access used. In addition, there was no significant relationship between the duration of dialysis and the type of vascular access. Conclusion: Considering the diversity of catheters and fistulas, it is necessary to emphasize that the use of AVF in patients undergoing dialysis for the first time and the timely placement of AVF in ESRD patients can improve the quality of life of the patients. It is also recommended to use jugular catheters instead of subclavian catheters when required.

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Background and Aim: Patients with end-stage renal disease (ESRD) are at risk for fractures and bone disorders approximately 17 times more than the general population. Evaluating fracture risk in patients with ESRD in the dialysis department of the hospital, can provide useful information to the treatment for staff and researchers. The Fracture Risk Assessment Tool (FRAX®) algorithm is used along with dual-energy x-ray absorptiometry (DXA) or bone densitometry and is capable in predicting the rate of 10-year probability of hip and major osteoporotic fracture (MOF) in a certain group of patients. Methods: This cross-sectional study was conducted to evaluate the fracture risk in 107 hemodialysis patients, who underwent hemodialysis three times a week for 4 hours in 2018 in Baqiyatullah Hospital. Patients who have done bone densitometry and for whom the standardized FRAX questionnaire of the World Health Organization was filled were included in the study. Results: The mean age of the participants was 59.95 ± 14.18 years and 58.2% of them were male. The average levels of calcium, phosphorus, parathyroid hormone, albumin, and vitamin D were determined to be 8.40 ± 1.14 mg/dL, 4.97 ± 1.41 mg/dL, 269.40 ± 297.66 ng/ml, 3.86 ± 0.49 g/dL, 22.15 ± 13.93 nmol/L and -2.08 ± 1, respectively. The minimum, mean and maximum values of BMD were found to be -5.30, -2.09, and -2.20, respectively. The FRAX scores of hip fracture and MOFs with BMD were 5.01 and 8.81, respectively, while the corresponding values for FRAX scores of hip fracture and MOFs without BMD were determined 2.23 and 5.82, respectively. A significant difference was observed between FRAX scores with and without BMD. Furthermore, a statistically significant difference was found between MOFs and hip fracture risk values calculated with and without BMD. In our study, the patient's previous fracture history predicts a higher hip FRAX score in the future, but the parents' hip fracture history had no effect on the hip FRAX score. We also found that the increase in PTH level had an increasing effect on the FRAX score of the hip joint. The results demonstrated that increasing the height and BMD of patients can significantly reduce the FRAX score related to MOFs and tight, while this index increases with increasing age of patients and PTH. In our study, thin and short patients are prone to more fractures in the hip joint. Conclusion: Our finding suggests that FRAXB with MD may be a valuable tool for clinicians in this center to accurately assess fracture risk in ESRD patients and ultimately reduce treatment costs. We encourage nephrologists to pay close attention to this algorithm information. [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]

End stage renal disease (ESRD) is a significant health problem worldwide. Nearly 220000 patients are diagnosed with end stage renal disease every year, which calls for an additional demand of 34 million dialysis sessions in India. There is a rapid increase in the ESRD population worldwide. Furthermore approximate 70% of those who starts dialysis in India given up dialysis due financial constraints or death. Considering the need of the Satellite haemodialysis unit (SHD) for ESRD patients, ‘A studyto develop a costing model for SHD unit” was undertaken. A prospective study was conducted in a tertiary care hospital.The aim of the research was to analyse the need of SHD unit among dialysis patients and to suggest costing model for the tertiary care hospital. The methodology involved survey to address the patients need and perception towards SHD unit, direct observation, informal interview, bottom –up approach of costing method to identify the various cost involved in SHD unit and expert opinions. A total sample size of 120 ESRD patients in in - centre dialysis unit was selected for the study. As per the survey 30 patients need satellite haemodialysis unit. The study provides a cost analysis of 5 bedded SHD unit in the chosen tertiary care hospital. The author provides costing model recommendation for the development of SHD unit based on interpretation of data and expert opinions. [ABSTRACT FROM AUTHOR]

Patients receiving hemodialysis (HD) are at risk of TB development. IGRA-positive patients showed significant decrease in quantitative IGRA result with alterations in CD3+CD4+CD45RO+, NK cell, and monocyte subsets immediately upon HD procedure. Our result suggested that the timing of IGRA testing is crucial in end-stage renal disease population.

Abstract Background Adherence of patients with End-Stage Renal Disease (ESRD) to Hemodialysis (HD), prescribed medications, diet and fluid restrictions is essential to get the desirable outcome and prevent complications. During COVID-19 pandemic, ESRD patients became more concerned with attending the HD sessions and following the protective measures because of the potential for increased susceptibility to COVID-19. The aim of this study was to evaluate the impact of the pandemic on patients' adherence to HD and medical regimens. Methods Two hundred five ESRD patients on HD were interviewed with the ESRD Adherence Questionnaire (ESRD-AQ) and the Fear-of-COVID-19 Scale (FCV-19S). Clinical and laboratory correlates of adherence were retrieved from patients' records. Results Self-reported adherence to HD showed that 19.5% were not adherent to HD during the pandemic compared to 11.7% before the pandemic (p

INTRODUCTION:Systemic inflammation and oxidative stress play a central role in the pathogenesis of cardiovascular disease and numerous other complications of CKD. Recent studies demonstrated that consumption of a diet enriched with amylose (HAM-RS2), attenuates oxidative stress and inflammation, and improves intestinal microbiome in CKD rats. The present study was designed to explore the effect of dietary amylose supplementation in hemodialysis patients. METHODS:Forty-six stable hemodialysis patients were randomized to receive biscuits containing 20 g/day during the first four weeks and 25 g/day in the next four weeks of either HAM-RS2 or wheat-flour. Fasting predialysis blood samples obtained before, during and at the end of trial were processed for biomarkers of oxidative stress and inflammation. FINDINGS:There was no significant difference in baseline clinical or biochemical parameters between the two groups. Serum levels of TNF-α, IL-6, and malondialdehyde declined significantly (P

INTRODUCTION:Systemic inflammation and oxidative stress play a central role in the pathogenesis of cardiovascular disease and numerous other complications of CKD. Recent studies demonstrated that consumption of a diet enriched with amylose (HAM-RS2), attenuates oxidative stress and inflammation, and improves intestinal microbiome in CKD rats. The present study was designed to explore the effect of dietary amylose supplementation in hemodialysis patients. METHODS:Forty-six stable hemodialysis patients were randomized to receive biscuits containing 20 g/day during the first four weeks and 25 g/day in the next four weeks of either HAM-RS2 or wheat-flour. Fasting predialysis blood samples obtained before, during and at the end of trial were processed for biomarkers of oxidative stress and inflammation. FINDINGS:There was no significant difference in baseline clinical or biochemical parameters between the two groups. Serum levels of TNF-α, IL-6, and malondialdehyde declined significantly (P

Background: The quality of autonomic blood pressure (BP) control can be assessed by the entropy of serial BP data. The aim of this study was to evaluate the effect of hemodialysis (HD) and glucose infusion (GI) on amplitude aware permutation entropy (AAPE) of hemodynamic variables during HD in chronic kidney disease patients with and without type-2 diabetes mellitus (DM). Methods: Twenty-one patients without DM (NDO) and ten with DM were studied. Thirty minutes after the start of HD, a 40% glucose solution was administered. Hemodynamic data were extracted from continuous recordings using the Portapres® system. Results: AAPE decreased during HD in all patients and all hemodynamic signals with the exception of AAPE of mean and diastolic BP in DM patients. GI led to an increase in AAPE for cardiac output in all patients, while AAPE for heart rate and ejection time increased only in DM studies, and AAPE for systolic, diastolic, and mean arterial pressure, as well as total peripheral resistance, increased only in NDO patients. Conclusions: The reduction in entropy during HD indicates impaired autonomic control in response to external perturbations. This state is partially reversed by the infusion of glucose with differences in central and peripheral responsiveness in DM and NDO patients. [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]

This study aimed to explore the lived experiences of patients receiving maintenance hemodialysis in Pakistan. Purposive sampling was used to recruit 24 patients and six healthcare professionals, each participated in a semi-structured interview. Interpretive Phenomenological Analysis was used to analyze interviews' data. Two superordinate themes, "The experience of hemodialysis" and "The conceptualizations of hemodialysis" as well as six sub-themes were identified. The experience of hemodialysis was related to, the implications of HD procedure on everyday life, social, cognitive, emotional, financial, and occupational influences. While all participants recognized the importance of hemodialysis for their survival, their conceptualizations of the treatment varied. Despite facing multiple challenges, optimism and independence were observed among participants. Stigma related to hemodialysis, and role adaptation, which appear unique to the Pakistani context, highlight a need for tailored interventions designed to enhance and maintain the mental health of patients receiving hemodialysis in Pakistan. [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: Restless leg syndrome (RLS) is one of the problem hemodialysis patients may encounter. This study was done to find out the association of restless legs syndrome (RLS) in end stage renal disease patients with serum calcium, phosphorus and parathyroid hormone levels. Methods: This cross-sectional observational study was done at The Kidney Centre, postgraduate Training Institute Karachi, Pakistan from Jan to June 2020. One hundred and twelve patients on three per week hemodialysis for more than three months at our hemodialysis centre were face to face interviewed as per International Restless Legs Syndrome Study Group criteria (IRLSSG) for the presence of RLS symptoms. Their demographic data and laboratory values were recorded from history chart and computer records. The bone mineral profile in this study includes serum calcium (corrected for albumin), serum phosphate levels and serum intact Parathyroid hormone (iPTH) levels. Statistical analyses were done by using SPSS-21. Results: In our study, 38.4% patients had RLS. Serum phosphorus levels were significantly higher in patients with RLS as compared to those who didn't have RLS. No significant association of serum calcium and Parathyroid hormone (PTH) levels with RLS was found. Conclusion: There is a high prevalence of RLS in ESRD patients as compared to general population. Serum phosphorus levels need to be observed and corrected along with maintenance of calcium and PTH levels to improve symptoms of RLS in these patients. [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]