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Introduction: Combined hemodialysis (HD) and hemadsorption (HA) therapy has shown the highest clearance rates for middle and large-sized uremic toxin molecules and reduced mortality rates among maintenance HD (MHD) patients. This study aimed to investigate the effectiveness of combined HD and HA therapy in patients undergoing MHD. Methods: Forty patients with end-stage renal disease (ESRD) were divided into three groups: HD only (14), HD + biweekly HA (14), and HD + weekly HA (12). The duration of the study was 8 weeks. Uremic toxins (β2-microglobulin, leptin, parathyroid hormone), inflammatory markers (interleukin-6, C-reactive protein), and symptoms (appetite, pruritus, sleep quality) were assessed before the start and at the completion of therapy. Changes in the parameters were compared between the three groups. Mean differences of parameters in each group were also compared between before and after therapy. Results: Decrease in BUN level (−61.34 mg/dL [95% CI: −71.33 to −51.34], p < 0.0001) and pruritus score (−3.93 [95% CI: −6.89 to −0.97], p = 0.013) was significantly larger in HD + biweekly HA group compared to the others. Only HD + biweekly HA group showed significant reductions in CRP level (−0.10 mg/L [95%: −0.18 to −0.01], p = 0.034), VAS appetite score (10.43 [95% CI: 4.99–15.87], p = 0.001), and pruritus score (−3.93 [95% CI: −6.89 to −0.97], p = 0.013) after therapy. Both HD + biweekly HA (−2.79 [95% CI: −4.97 to −0.60], p = 0.016) and HD + weekly HA group (−2.33 [95% CI: −4.59 to −0.08], p = 0.044) exhibited a significant improvement in sleep quality score after therapy. Conclusions: HD combined with a biweekly HA is associated with a greater reduction in BUN level and better improvement of pruritus in ESRD patients compared to HD alone. HD + biweekly HA can significantly reduce CRP levels, alleviate pruritus, improve appetite, and enhance sleep quality. [ABSTRACT FROM AUTHOR]

Background: Pulmonary hypertension (PH) has been recently reported to be a common comorbidity in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The present study was conducted to analyze the prevalence of PH in patients with CKD, its severity in different stages of CKD, and risk factors for it. Method: A total171 patients of age >18 years, diagnosed with CKD were included in the study and were classified in various stages of CKD (1-5) according to eGFR. eGFR was calculated by the MDRD formula (KDIGO-2010). Result: Among total CKD patients, 53.22% were in stage V, 26.9% in stage IV and 19.88% in Stage III. Low hemoglobin, high phosphorus, high Ca-po4 product, and high serum creatinine were significantly associated with higher stages of CKD, (P<0.05). Prevalence of PH in CKD patients was 39.18%. Among these 59 had mild PH, 8 had moderate PH. Maximum patients with PH were having etiology of combined diabetes mellitus with hypertension, (P<0.05). Patients of CKD having duration of >5 years, patients on hemodialysis and patients with AV fistula had a greater number of PH with significant p value, (P<0.05). The relation of PH according to stage of CKD showed that Stage V had greater PH compared to Stage III, (P<0.05). Patients with Stage V had more patients with moderate PH compared to patients with Stage III, (P<0.05) Conclusion: PH is more prevalent in patients with CKD. The severity of PH directly correlates with Stages of CKD i.e., an increase in severity of PAH occurs with deterioration of renal function in CKD cases. [ABSTRACT FROM AUTHOR]

Background and Objectives: The assessment of cardiac function in patients with end-stage renal disease (ESRD) is vital due to their high cardiovascular risk. However, contemporary echocardiographic indices and their association with hemodialysis-to-hemodiafiltration transfer are underreported in this population. Materials and Methods: This prospective cohort study enrolled 36 ESRD patients undergoing hemodialysis-to-hemodiafiltration transfer, with baseline and 3-month post-transfer comprehensive echocardiographic assessments. The key parameters included the global work index, global constructed work, global wasted work (GWW), global work efficiency (GWE), and global longitudinal strain (GLS), with secondary measures from conventional echocardiography. The baseline measures were compared to general population reference values and changes pre- to post-transfer were analyzed using the Mann–Whitney U test. Results: Patients exhibited significant deviations from reference ranges in GWW (179.0 vs. 53.0–122.2 mmHg%), GWE (90.0 vs. 53.0–122.2%), and GLS (−16.0 vs. −24.0–(−16.0)%). Post-transfer left ventricular myocardial work and longitudinal strain remained unchanged (p > 0.05), except for increased GWW (179.0, IQR 148.0–217.0 to 233.5, IQR 159.0-315.0 mmHg%, p = 0.037) and improved mid-inferior peak systolic longitudinal strain ((−17.0, IQR −19.0–(−11.0) to −18.7, IQR −20.0–(−18.0)%, p = 0.016). The enrolled patients also showed higher left atrial diameters, left ventricular volumes, and mass, with impaired systolic function in both ventricles compared to reference values. Conclusions: This study highlights baseline impairments in contemporary echocardiographic measures (GWW, GWE, GLS) in ESRD patients versus reference values, but found no association between hemodialysis-to-hemodiafiltration transfer and most myocardial work and strain parameters. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) poses a significant clinical challenge, especially among patients with end-stage renal disease (ESRD) undergoing dialysis, and is associated with high morbidity and mortality rates. This review provides a contemporary discussion of the epidemiology, risk factors, diagnostic challenges, and management strategies for IE among ESRD patients, including a literature review of recent studies focused on this vulnerable population. The review highlights the multifactorial nature of IE risk in ESRD patients, emphasizing the roles of vascular access type, dialysis modality, and comorbid conditions. It also explores the diagnostic utility of different imaging modalities and the importance of a multidisciplinary approach in managing IE, including both medical and surgical interventions. The insights from this review aim to contribute to the improvement of patient outcomes through early recognition, appropriate antimicrobial therapy, and timely surgical intervention when necessary. [ABSTRACT FROM AUTHOR]

Introduction: Chronic kidney disease (CKD), which progresses to end-stage renal disease (ESRD) is cause the sixth-leading of death worldwide. Patients with ESRD receiving hemodialysis (HD) typically engage in low levels of physical activity, which is linked to higher rates of morbidity and mortality. Aim: of This systematic review analyzes the efficacy of Intra Dialytic Exercise (IDE) as intervention for end-stage renal disease patients, to increase physical function, mobility, and decreased levels of dependency. Design: The scope of the review covers full-text articles published between December 2019 to April 2023 on data base: PubMed, EBSCO, Wiley, Science direct, ProQuest, Web of Science, Springer. The review was conducted following the PRISMA guideline statement based on PICO (Population, Intervention, Comparison, Outcome). To determine which study to include in the analysis, a set of criteria were applied, including requiring that the study includes adult ESRD patients has received at least 3 months of hemodialysis. The review article was assessed using the JBI critical appraisal tool. Results: A total of 30 studies were selected from more than 900 articles but only 11 randomized controlled trial (RCT) studies are included in this systematic review. IDE shown significantly to improve physical function, increase muscular strength, improve quality of life (QoL). Conclusion: IDE practiced in Renal Unit were shown to have significant positive effect on physical function, increase muscles strength, and improve QoL. There is a lack of the types, modality of exercises investigated, therefore data was limited for several outcomes. [ABSTRACT FROM AUTHOR]

Background: Implantable cardioverter defibrillators (ICD) prevent sudden cardiac death (SCD). Patients with end-stage renal disease (ESRD) requiring dialysis are at a very high risk of infection from cardiac implantable electronic device (CIED) implantation as well as mortality. In the present study, we compared the long-term complications and outcomes between subcutaneous ICD (S-ICD) and transvenous ICD (TV-ICD) recipients. Methods: In this retrospective analysis, we analyzed a total of 43 patients with ESRD requiring dialysis who received either a prophylactic S-ICD (26 patients) or a single right ventricular lead TV-ICD (17 patients) at seven experienced centers in Germany. Follow-up was performed bi-annually, at the end of which the data concerning comorbidities and, if applicable, reason for death were checked and confirmed with patients' general practitioner, nephrologist and cardiologist. Results: The median follow up duration was 95.6 months (range 42.8–126.3 months). Baseline characteristics were without noteworthy significant differences between groups. During follow-up (FU), there were significantly more device-associated infections (HR 8.72, 95% confidence interval (CI), 1.18 to 12.85, p < 0.05) and device-associated hospitalizations (HR 10.20, 95% CI 1.22 to 84.61, p < 0.001), as well as a higher cardiovascular mortality (HR 9.17, 95% CI 1.12 to 8.33, p < 0.05), in the TV-ICD group. The number of patients requiring hospitalization for any reason was significantly higher in the TV-ICD group (HR 2.59, 95% CI 1.12 to 6.41, p < 0.05). There was no significant difference in overall mortality (HR 1.92, 95% CI 0.96 to 6.15, p = 0.274). Conclusions: Our data suggest that, in this extended follow-up in seriously compromised renal patients on dialysis, the S-ICD patients have statistically fewer device infections and hospitalizations as well as lower cardiac mortality compared with the TV-ICD cohort. [ABSTRACT FROM AUTHOR]

Abstract Background End-stage renal disease is a risk factor for renal cell carcinoma. However, mucinous tubular and spindle cell carcinoma of the kidney is rare. We report a patient on hemodialysis who had high-grade mucinous tubular and spindle cell carcinoma of the kidney. Case presentation A 62-year-old Japanese woman had end-stage renal disease and had been on hemodialysis for the previous 4 years. However, periodic imaging examinations to detect kidney cancer had not been conducted. The patient visited our department of urology complaining of general fatigue and dyspnea. Computed tomography with enhancement revealed a solid renal mass with a diameter of 66 mm. It had invaded the right psoas muscle and had multiple lymph node metastases. In addition, the patient had massive ascites and right-sided predominant pleural effusion. We drained the pleural effusion, but she died 11 days after admission. An autopsy was performed. Pathological examination revealed high-grade mucinous tubular and spindle cell carcinoma of the right kidney; multiple organ metastases to the bilateral lungs, liver, gall bladder, uterus, ovary, and inferior vena cava; cancerous pleuritis; and cancerous peritonitis. Our case indicates that high-grade mucinous tubular and spindle cell carcinoma emerging in end-stage kidney causes a detrimental clinical course. Conclusion High-grade mucinous tubular and spindle cell carcinoma of the kidney had a severe clinical course. We recommend periodic screening of patients with end-stage renal disease, using computed tomography or ultrasound.

Abstract Background Constipation is a common complication in hemodialysis patients and can impact their quality of life. Elobixibat selectively inhibits ileal bile acid transporter to suppress bile acid reabsorption, increase the amount of bile acid entering the colonic lumen, and promote water secretion and colonic motility in the large intestine. While the efficacy and safety of elobixibat in hemodialysis patients up to 12 weeks after administration have been reported, the long-term efficacy and safety of elobixibat in hemodialysis patients with chronic constipation are yet to be elucidated. This study evaluates the efficacy and safety of long-term treatment with elobixibat in hemodialysis patients with chronic constipation. Methods This was a single-center observational study. A total of 54 patients who had received elobixibat for at least 24 weeks were enrolled. Data on the frequency of spontaneous bowel movements (SBM), Bristol stool form scale (BSFS), patient satisfaction, constipation scoring system (CSS), interdialytic weight gain, laboratory values including blood electrolyte levels, controlling nutritional status (CONUT) score, and adverse events were collected and retrospectively compared between baseline and the last observation. Results Long-term elobixibat treatment in the 54 hemodialysis patients with chronic constipation significantly increased (p

This review aims to evaluate the safety and efficacy of apixaban vs. vitamin K antagonists (VKAs) in patients on dialysis. All types of studies published on PubMed, Embase, CENTRAL, and Web of Science up to 10 September 2023 and comparing outcomes of apixaban vs. VKA in dialysis patients were eligible. Two randomized controlled trials (RCTs) and six retrospective studies were included. Apixaban treatment was associated with significantly lower risk of major bleeding (RR: 0.61; 95% CI: 0.48, 0.77; I2 = 50%) and clinically relevant non-major bleeding (RR: 0.82, 95% CI: 0.68, 0.98, I2 = 9%) compared to VKA. Meta-analysis also showed that the risk of gastrointestinal bleeding (RR: 0.74, 95% CI: 0.64, 0.85, I2 = 16%) and intracranial bleeding (RR: 0.64, 95% CI: 0.49, 0.84, I2 = 0%) was significantly reduced with apixaban. Meta-analysis showed no difference in the risk of ischemic stroke (RR: 0.40, 95% CI: 0.06, 2.69, I2 = 0%), mortality (RR: 1.26, 95% CI: 0.74, 2.16, I2 = 94%) and recurrent venous thromboembolism (RR: 1.02, 95% CI: 0.87, 1.21, I2 = 0%) between the two groups. Subgroup analysis of RCTs showed no difference in bleeding outcomes. Low-quality evidence from a mix of RCTs and retrospective studies shows that apixaban may have better safety and equivalent efficacy as compared to VKA in dialysis patients. Apixaban treatment correlated with significantly reduced risk of major bleeding and clinically relevant nonmajor bleeding in observational studies but not in RCTs. The predominance of retrospective data warrants caution in the interpretation of results. [ABSTRACT FROM AUTHOR]

Hemodialysis (HD) and peritoneal dialysis (PD) are effective ways to treat end-stage renal disease (ERSD). This study aimed to investigate the differences in survival and the factors that influence it in patients with end-stage renal disease treated with HD or PD. We retrospectively analyzed factors related to all-cause death with renal replacement therapy and compared the long-term mortality between HD and PD strategies in patients with ESRD who started HD or PD treatment in our renal HD center between January 1, 2008, and December 1, 2021. Overall, 1,319 patients were included, comprising 690 and 629 patients in the HD and PD groups, respectively, according to the inclusion criteria. After propensity matching, 922 patients remained, with 461 (50%) patients each in the two groups. There were no significant differences in the 1-, 2-, 3-, and 4-year mortality rates between the HD and PD groups (all p >.05). However, the 5- and 10-year mortality rates of the matched patients were 15.8%. 17.6% in the HD group and 21.0%. 27.3% in the PD group, respectively. The 5- and 10-year mortality rates were significantly lower in the HD group (all p <.05) as compared to the PD group. After matching, Kaplan–Meier curve analysis with log-rank test was performed, which showed a significant difference in the survival rates between the two groups (p =.001). Logistic multifactor regression analysis revealed that age, weight, hypertension, serum creatinine, and combined neoplasms influenced the survival rate of patients with ESRD (p <.05). In contrast, age, hypertension, parathyroid hormone (PTH), serum creatinine, and peripheral vascular diseases (PVD) influenced the survival rate of patients in the HD group (p <.05), and age and weight influenced the survival rate of patients in the PD group (p <.05). This study found that long-term mortality rates were higher in the PD group than that in the HD group, indicating that HD may be superior to PD. [ABSTRACT FROM AUTHOR]

Introduction Few studies have reported on administering enfortumab vedotin to patients with metastatic urothelial carcinoma and end‐stage renal disease requiring hemodialysis. Case presentation Case 1: An 85‐year‐old man underwent hemodialysis for progressive renal failure 4 months after right laparoscopic radical nephroureterectomy. Case 2: A 73‐year‐old man underwent hemodialysis after two laparoscopic radical nephroureterectomies for recurrent urothelial carcinoma. In both cases, enfortumab vedotin was administered due to postoperative recurrence and progression despite platinum‐based chemotherapy and pembrolizumab. Partial response and disease progression were observed in cases 1 and 2, respectively. Adverse events included a mild skin rash in both patients and neutropenia in Case 1, both of which resolved with symptomatic treatment. Conclusion The efficacy and safety of enfortumab vedotin in patients with metastatic urothelial carcinoma, and end‐stage renal disease undergoing hemodialysis, were confirmed.

Abstract Despite numerous studies on the effect of each dialysis modality on mortality, the issue remains controversial. We investigated the hazard rate of mortality in patients with incident end-stage renal disease (ESRD) concerning initial dialysis modality (hemodialysis vs. peritoneal dialysis). Using a nationwide, multicenter, prospective cohort in South Korea, we studied 2207 patients, of which 1647 (74.6%) underwent hemodialysis. We employed the weighted Fine and Gray model over the follow-up period using inverse probability of treatment and censoring weighting. Landmark analysis was used for identifying the changing effect of dialysis modality on individuals who remained event-free at each landmark point. No significant difference in hazard rate was observed overall. However, the peritoneal dialysis group had a significantly higher hazard rate than the hemodialysis group among patients under 65 years after 4- and 5- year follow-up. A similar pattern was observed among those with diabetes mellitus. Landmark analysis also showed the higher hazard rate for peritoneal dialysis at 2 years for the education-others group and at 3 years for the married group. These findings may inform dialysis modality decisions, suggesting a preference for hemodialysis in young patients with diabetes, especially for follow-ups longer than 3 years.

Abstract Background Oxidative stress, an imbalance between reactive oxygen species production and antioxidant capacity, increases in patients with coronavirus disease (COVID-19) or renal impairment. We investigated whether combined COVID-19 and end-stage renal disease (ESRD) would increase oxidative stress levels compared to each disease alone. Methods Oxidative stress was compared among three groups. Two groups comprised patients with COVID-19 referred to the hospital with or without renal impairment (COVID-ESRD group [n = 18]; COVID group [n = 17]). The third group (ESRD group [n = 18]) comprised patients without COVID-19 on maintenance hemodialysis at a hospital. Results The total oxidative stress in the COVID-ESRD group was lower than in the COVID group (p = 0.047). The total antioxidant status was higher in the COVID-ESRD group than in the ESRD (p

The quality of life (QoL) and sleep quality are closely linked to the physical and psychological health of end-stage renal disease (ESRD) patients, especially those underwent hemodialysis (HD) therapy. This study aims to investigate the impact of 830 nm laser treatment on improving QoL and sleep quality in HD patients. Forty ESRD patients participated in this study. 830 nm laser was used to radiate on the palm (at dose of 256.10 J/cm2), ST 36 and KI 1 acupoints (at dose of 109.76 J/cm2) of HD patients, and QoL and sleep quality questionnaires were utilized to assess changes following the treatment. After 830 nm laser radiation, lower global Pittsburgh Sleep Quality Index and Athens Insomnia Scale scores were observed, accompanied by higher physical and mental component summary scores in MOS 36-item short-form health survey version 2 and a global World Health Organization Quality of Life Brief Version score. The laser group also showed significant improvements in QoL and sleep quality indicators. Additionally, pain levels decreased on the third day and after one month according to visual analogue scale. This study revealed the positive effects of 830 nm laser on palm, KI 1 and ST 36 acupoints for improving the QoL and sleep quality in ESRD patients underwent HD treatment. The results suggest that 830 nm laser applied to specific targets could be used as a complementary and alternative approach to increase the QoL and sleep quality in ESRD patients. [ABSTRACT FROM AUTHOR]

Introduction: Poor prognosis and higher mortality of chronic kidney disease are linked with cultural beliefs and practices. This study explored cultural beliefs and practices of Javanese people with end-stage renal disease undergoing hemodialysis for ≥5 years. Methods: A qualitative narrative inquiry was applied in this study. Data were collected through in-depth narrative interviews, followed by text messages, calls, and audio-visual calls for 6 weeks. Results: There were 14 participants; their mean age was 51.15 years and hemodialysis duration was 5 years and 2 months up to 10 years and 9 months. Four themes emerged: life-and-death acceptance, expectation of end-of-life care, contemplation of withdrawal from hemodialysis, and wishing for a good death. Discussion: Life values guided the ability to survive for the individual. Adherence to renal disease management regimen clashed with cultural values on occasions, such as social gatherings. Therefore, the unmet needs of patients should be addressed with a transcultural approach to modify personal health behaviors. [ABSTRACT FROM AUTHOR]

Background: Nursing home residents with end-stage renal disease (ESRD) are an understudied, yet growing population within nursing homes. Purpose: To describe hospital transfers for nursing home residents diagnosed with ESRD and receiving hemodialysis. Methods: Data were analyzed for residents with ESRD transferred to the hospital between October 2016 and September 2020 (n = 219). Descriptive statistics, bivariate analyses, logistic regression, and content analysis were used for analysis. Results: Clinical factors associated with transfers included abnormal vitals, altered mental state, and pain. Other factors included lack of care planning and advance directives, provider communication, resident/family preferences, missing/refusing dialysis, and facility resources. The odds of an observation/emergency department only visit was 2.02 times larger when transferred from the dialysis clinic. Conclusions: Advance care planning and coordinated care between nursing home and dialysis clinics are needed along with proactive planning when residents miss dialysis or experience a condition change at the dialysis clinic. [ABSTRACT FROM AUTHOR]

Background: Patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) have reduced vascular compliance and are likely to develop heart failure (HF). In this study, we estimated the prevalence of HF pre- and post-HD in ESRD using the current guidelines. Methods: We prospectively investigated HF in ESRD patients on HD using echocardiography pre- and post-HD. We used the structural and functional abnormality criteria of the 2021 European Society of Cardiology guidelines. Results: A total of 54 patients were enrolled. The mean age was 62.6 years, and 40.1% were male. Forty-five patients (83.3%) had hypertension, 28 (51.9%) had diabetes, and 20 (37.0%) had ischemic heart disease. The mean N-terminal-pro brain natriuretic peptide BNP (NT-proBNP) level was 12,388.8 ± 2,592.2 pg/dL. The mean ideal body weight was 59.3 kg, mean hemodialysis time was 237.4 min, and mean real filtration was 2.8 kg. The mean left ventricular ejection fraction (LVEF) was 62.4%, and mean left ventricular end-diastolic diameter was 52.0 mm in pre-HD. Post-HD echocardiography showed significantly lower left atrial volume index (33.3 ± 15.9 vs. 40.6 ± 17.1, p = 0.030), tricuspid regurgitation jet V (2.5 ± 0.4 vs. 2.8 ± 0.4 m/s, p < 0.001), and right ventricular systolic pressure (32.1 ± 10.3 vs. 38.4 ± 11.6, p = 0.005) compared with pre-HD. There were no differences in LVEF, E/E′ ratio, or left ventricular global longitudinal strain. A total of 88.9% of pre-HD patients and 66.7% of post-HD patients had either structural or functional abnormalities in echocardiographic parameters according to recent HF guidelines (p = 0.007). Conclusions: Our data showed that the majority of patients undergoing hemodialysis satisfy the diagnostic criteria for HF according to current HF guidelines. Pre-HD patients had a 22.2% higher incidence in the prevalence of functional or structural abnormalities as compared with post-HD patients. [ABSTRACT FROM AUTHOR]

The purpose of the study was to examine the quality of life and illness acceptance among ESRD patients with the moderating effects of death anxiety. The cross-sectional design was incorporated. The sample was comprised of 240 participants. Individuals with ESRD on hemodialysis were approached above 20 years of age. A self-administered questionnaire was used for data collection. The results revealed that COVID-19 has a significant impact on the quality of life of patients and their illness acceptance. Covid-19 affected the general health of patients, their psychological health, as well as their social relationships. The results also confirmed that death anxiety negatively moderates the relationship between quality of life and illness acceptance among ESRD patients. This study will shed light on the need to provide appropriate psychosocial care as well as supportive therapies to people with end-stage renal disease who are experiencing mental distress during and after the COVID-19 outbreak. [ABSTRACT FROM AUTHOR]

Microbiota tryptophan metabolism and the biosynthesis of indole derivatives play an important role in homeostasis and pathogenesis in the human body and can be affected by the gut microbiota. However, studies on the interplay between gut microbiota and tryptophan metabolites in patients undergoing dialysis are lacking. This study aimed to identify the gut microbiota, the indole pathway in tryptophan metabolism, and significant functional differences in ESRD patients with regular hemodialysis. We performed the shotgun metagenome sequencing of stool samples from 85 hemodialysis patients. Using the linear discriminant analysis effect size (LEfSe), we examined the composition of the gut microbiota and metabolic features across varying concentrations of tryptophan and indole metabolites. Higher tryptophan levels promoted tyrosine degradation I and pectin degradation I metabolic modules; lower tryptophan levels were associated with glutamate degradation I, fructose degradation, and valine degradation modules. Higher 3-indoxyl sulfate concentrations were characterized by alanine degradation I, anaerobic fatty acid beta-oxidation, sulfate reduction, and acetyl-CoA to crotonyl-CoA. Contrarily, lower 3-indoxyl sulfate levels were related to propionate production III, arabinoxylan degradation, the Entner–Doudoroff pathway, and glutamate degradation II. The present study provides a better understanding of the interaction between tryptophan, indole metabolites, and the gut microbiota as well as their gut metabolic modules in ESRD patients with regular hemodialysis. [ABSTRACT FROM AUTHOR]

Objective: Uremic pruritus is a distressing complication of chronic kidney disease (CKD), associated with mortality, and negatively impacts quality of life. The 5D-Itch Scale (5D-IS) is an easy-to-apply technique that evaluates 5 different dimensions of itching such as duration, severity, course, disability, and prevalence. We aimed to investigate the prevalence of itching in different CKD stages using the 5D-IS and to investigate the factors associated with itching in CKD patients. Materials and Methods: 5D-IS was used to evaluate itching in chronic hemodialysis (HD) and Stage 3–5 CKD patients. Total itching score and sub-scores consist of duration, severity, course, disability and distribution were obtained. Itching scores and prevalence according to CKD stages were investigated. Also the relationships between itching scores and some laboratory and clinical parameters such as iPTH, Ca, P, CRP levels were examined. Results: 158 CKD patients included in the study included (110 Stage 3–5 and 48 HD). The frequency of itching was higher in HD patients than in predialysis patients (62.5% vs 46.4%; p = 0.04). The total itching score increased along with CKD stages 3 to 5 (7.75 ± 3.39, 7.82 ± 4.11 and 9.08 ± 5.12 respectively; p = 0.14). The severity, duration and course scores of itching were similar between the groups, but the distribution scores increased as the CKD stage increased. The laboratory and clinical characteristics of patients with and without itching were not different. Even if a significant positive correlation was detected between the parathyroid hormone levels and both the total 5D-IS scores and all of the sub-scores, Ca and P values were not correlated with itching scores. In the multiple regression analysis, the only parameter that had an effect on the total 5D-IS Score was the parathyroid hormone level. Conclusion: In CKD, itching affects 40–70% of patients from the early stages. As the CKD stage increases, itching spreads throughout the body. The only parameter that seems to be associated with itching is the PTH level. [ABSTRACT FROM AUTHOR]

Purpose: Patients with atrial fibrillation (AF) and end-stage renal disease on chronic hemodialysis are at risk for thromboembolic and bleeding events. We aimed to perform a meta-analysis to evaluate the safety and efficacy of direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in this population. Methods: We systematically searched PubMed, Excerpta Medica Database (EMBASE) and Cochrane Library for randomized controlled trials (RCTs) comparing DOACs with VKAs in patients with AF on chronic hemodialysis from inception to February 2023 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes were reported using risk ratios (RRs) with 95% confidence intervals (CIs). Statistical analyses were performed using R version 4.2.2. Results: We selected three RCTs including 341 patients, of whom 176 (51.6%) were randomized to DOACs. Follow-up ranged from 174 days to 3.38 years. There was no significant difference between groups in terms of cardiovascular mortality (RR 1.34; 95% CI 0.69–2.60; p = 0.39), all-cause mortality (RR 0.96; 95% CI 0.72–1.27; p = 0.77), ischemic/uncertain type of stroke or transient ischemic attack (RR 0.50; 95% CI 0.19–1.35; p = 0.17), or major or life-threatening bleeding (RR 0.70; 95% CI 0.39–1.25; p = 0.22). Conclusion: In this meta-analysis of three RCTs, no significant difference was observed between DOACs and VKAs in cardiovascular mortality, all-cause mortality, ischemic/uncertain type of stroke or transient ischemic attack, or major or life-threatening bleeding in patients with AF on chronic hemodialysis. [ABSTRACT FROM AUTHOR]

Background: Oxidative stress, an imbalance between reactive oxygen species production and antioxidant capacity, increases in patients with coronavirus disease (COVID-19) or renal impairment. We investigated whether combined COVID-19 and end-stage renal disease (ESRD) would increase oxidative stress levels compared to each disease alone. Methods: Oxidative stress was compared among three groups. Two groups comprised patients with COVID-19 referred to the hospital with or without renal impairment (COVID-ESRD group [n = 18]; COVID group [n = 17]). The third group (ESRD group [n = 18]) comprised patients without COVID-19 on maintenance hemodialysis at a hospital. Results: The total oxidative stress in the COVID-ESRD group was lower than in the COVID group (p = 0.047). The total antioxidant status was higher in the COVID-ESRD group than in the ESRD (p < 0.001) and COVID (p < 0.001) groups after controlling for covariates. The oxidative stress index was lower in the COVID-ESRD group than in the ESRD (p = 0.001) and COVID (p < 0.001) groups. However, the three oxidative parameters did not differ significantly between the COVID and COVID-ESRD groups. Conclusions: The role of reactive oxygen species in the pathophysiology of COVID-19 among patients withESRD appears to be non-critical. Therefore, the provision of supplemental antioxidants may not confer a therapeutic advantage, particularly in cases of mild COVID-19 in ESRD patients receiving hemodialysis. Nonetheless, this area merits further research. [ABSTRACT FROM AUTHOR]

Background and Objectives: Peripheral arterial stiffness (PAS), assessed by brachial-ankle pulse wave velocity (baPWV), is an independent biomarker of cardiovascular diseases (CVD) in patients on maintenance hemodialysis (HD). Malondialdehyde-modified low-density lipoprotein (MDA-LDL), an oxidative stress marker, has been linked to atherosclerosis and CVD. However, the association between serum MDA-LDL and PAS among HD patients has not been fully elucidated. This study aimed to examine the association of serum MDA-LDL with PAS in HD patients and to identify the optimal cutoff value of serum MDA-LDL for predicting PAS. Materials and Methods: A cross-sectional study was conducted in 100 HD patients. Serum MDA-LDL was quantified using an enzyme-linked immunosorbent assay (ELISA), and baPWV was measured using a volume plethysmographic device. Patients were divided into the PAS group (baPWV > 18.0 m/s) and the non-PAS group (baPWV ≤ 18.0 m/s). The associations of baPWV and other clinical and biochemical parameters with serum MDA-LDL were assessed by multivariable logistic regression analyses. A receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff value of serum MDA-LDL for predicting PAS. Results: In multivariable logistic regression analysis, higher serum MDA-LDL, older age, and higher serum C-reactive protein [odds ratios (ORs) and 95% confidence intervals: 1.014 (1.004–1.025), 1.044 (1.004–1.085) and 3.697 (1.149–11.893)] were significantly associated with PAS. In the ROC curve analysis, the optimal cutoff value of MDA-LDL for predicting PAS was 80.91 mg/dL, with a sensitivity of 79.25% and a specificity of 59.57%. Conclusions: Greater serum MDA-LDL levels, particularly ≥80.91 mg/dL, were independently associated with PAS in HD patients. The findings suggest that oxidative stress plays a crucial role in the pathogenesis of PAS, and targeting MDA-LDL may be a potential therapeutic strategy for reducing cardiovascular risk in HD patients. [ABSTRACT FROM AUTHOR]

Sameer A Alkubati,1,2 Khaled M Al-Sayaghi,3,4 Basma Salameh,5 Abdulsalam M Halboup,6,7 Waled AM Ahmed,8 Mohannad J. Alkuwaisi,1 Mohamed A Zoromba9,10 1Department of Medical Surgical Nursing, University of Hail, Hail, Saudi Arabia; 2Department of Nursing, Hodeida University, Hodeida, Yemen; 3Department of Medical Surgical Nursing, Taibah University, Al‐Madinah Al‐Munawarah, Saudi Arabia; 4Nursing Division, Sana’a University, Sana’a, Yemen; 5Department of Nursing, Arab American University, Jenin, Palestine; 6Department of Clinical Pharmacy and Pharmacy Practice, University of Science and Technology, Sana’a, Yemen; 7Discipline of Clinical Pharmacy, Universiti Sains Malaysia, Penang, Malaysia; 8Community Health Nursing Department, Al-Baha, Saudi Arabia; 9Department of Nursing, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia; 10Department of Psychiatric and Mental Health Nursing, Mansoura University, Mansoura, EgyptCorrespondence: Abdulsalam M Halboup, Departments of Clinical Pharmacy and Pharmacy Practice, University of Science and Technology, Sana’a, Yemen, Tel +967774960247, Email a.halboup@ust.edu.yeBackground: Depression has a negative impact on the health outcomes of hemodialysis (HD) patients, including decreased quality of life and increased morbidity and mortality rates. Therefore, this study aimed to determine the prevalence of depression and its associated factors among HD patients in Hodeida city, Yemen.Methods: A cross-sectional study involving 200 HD patients at the Dialysis Center in Hodeida was conducted from February to May 2022. Data on depression were collected using the 9-item Patient Health Questionnaire (PHQ-9). Association of sociodemographic characteristics of patients with depression were assessed using chi-square, subsequently by multivariable logistic regression. Statistical significance was set at P-values < 0.05.Results: The response rate was 98% (200/204). Depression was prevalent among 63% of HD patients at the Dialysis Center in Hodeida city. Sex was significantly associated with depression, where female patients were more frequently depressed than males (82.4% vs 56.4%, P < 0.001). In addition, employment status and medical insurance were significantly associated with depression, where unemployed patients were more frequently depressed than employed patients (67.6% vs 52.5%, P = 0.041) and patients with medical insurance were less frequently depressed than their counterparts (47.1% vs 66.3%, P = 0.035).Conclusion: Depression is highly prevalent among HD patients in Hodeida city. Female sex, unemployment and lack of medical insurance are predictors of depression among HD patients. These findings emphasize the urgent need for targeted interventions.Implications for practice: Depression is common among HD patients, so that, psychiatric physicians and nurses are increasingly needed in HD centers to implement mental health assessment of patients for depression signs and symptoms to help in early diagnosis and management of depression in order to improve patients’ quality of life and preventing negative outcomes.Keywords: depression, end-stage renal disease, hemodialysis, patient health questionnaire, PHQ-9, Yemen

Background: Pain has an adverse effect on HRQoL and has social, psychological, and physical repercussions for ESRD patients. In the present study, we assessed chronic pain in ESRD patients on HD in terms of severity and interference with activity. We also assessed the impact it has on these patients, along with looking at the factors that were linked to QoL in this population. Methods: A multicenter, cross-sectional study carried out between April and July of 2023 in the hemodialysis units of Asir Central Hospital and Khamis Mushait General Hospital. Brief Pain Inventory and European Quality of Life scale 5 dimensions (EQ-5D) scale, including its European Quality of Life visual analogue scale (EQ-VAS) component, were used to assess pain and QoL, respectively. Results: A total of 97 participants were included in the final study. The average interference level of pain with daily functions was 22.5 ± 15.0 out of 70. The mean interference score was significantly higher among patients at rural areas (28.2 ± 16.3; P = 0.012), and those who undergone dialysis session for ≥ 4 times per week (31.6 ± 16.7; P = 0.026). The overall score of quality of life ranged from 20% to 92% with mean score of 36.5 ± 12.8%. The multiple linear regression analysis revealed that patients with higher BMI, more frequent dialysis sessions per week, and higher level of pain interference with daily functions demonstrated lower QoL (B= – 2.36, – 1.46, and – 0.64, respectively. Conclusions: Pain has a significant negative impact on QoL in ESRD patients undergoing HD. Patients with higher BMI, more frequent dialysis sessions, and higher level of pain interference with daily functions are at higher risk of lower QoL. These findings provide valuable information for educators, physicians, and other healthcare providers working with patients undergoing HD.

Objectives Patients with end-stage renal disease (ESRD) on hemodialysis (HD) are at risk for hyperkalemia (HK), associated with cardiac arrhythmia and sudden death. Data on the burden of HK and management techniques among HD patients in China are still scarce. This study assessed the treatment modalities, recurrence, and prevalence of HK in Chinese HD patients.Methods In this prospective cohort study conducted from May 2021 to July 2022, patients aged ≥18 years who had ESRD and were on HD were enrolled from 15 centers in China (up to 6 months).Results Overall, 600 patients were enrolled. At the baseline visit, mean (± standard deviation) urea reduction ratio was 68.0% ± 9.70 and Kt/V was 1.45 ± 0.496. Over 6 months, 453 (75.5%) patients experienced HK, of whom 356 (78.6%) recurred. Within 1, 2, 3, 4, 5, and 6 months, 203 (44.8%), 262 (57.8%), 300 (66.2%), 326 (72.0%), 347 (76.6%), and 356 (78.6%) patients had at least one HK recurrence event, respectively. The proportions of patients with ≥1, 2, 3, 4, 5, or 6 HK recurrence events were 356 (78.6%), 306 (67.5%), 250 (55.2%), 208 (45.9%), 161 (35.5%), and 110 (24.3%), respectively. Among the 453 patients who experienced HK, only 24 (5.3%) were treated with potassium binders: seven (1.5%) with sodium polystyrene sulfonate, 13 (2.9%) with calcium polystyrene sulfonate, and six (1.3%) with sodium zirconium cyclosilicate.Conclusion Since HK is a chronic illness, long-term care is necessary. Patients on HD should have effective potassium management on non-dialysis days, yet our real-world population rarely used potassium binders.Trial registration ClinicalTrials.gov Identifier NCT04799067

Background This review aims to evaluate the safety and efficacy of apixaban vs. vitamin K antagonists (VKAs) in patients on dialysis.Methods All types of studies published on PubMed, Embase, CENTRAL, and Web of Science up to 10 September 2023 and comparing outcomes of apixaban vs. VKA in dialysis patients were eligible.Results Two randomized controlled trials (RCTs) and six retrospective studies were included. Apixaban treatment was associated with significantly lower risk of major bleeding (RR: 0.61; 95% CI: 0.48, 0.77; I2 = 50%) and clinically relevant non-major bleeding (RR: 0.82, 95% CI: 0.68, 0.98, I2 = 9%) compared to VKA. Meta-analysis also showed that the risk of gastrointestinal bleeding (RR: 0.74, 95% CI: 0.64, 0.85, I2 = 16%) and intracranial bleeding (RR: 0.64, 95% CI: 0.49, 0.84, I2 = 0%) was significantly reduced with apixaban. Meta-analysis showed no difference in the risk of ischemic stroke (RR: 0.40, 95% CI: 0.06, 2.69, I2 = 0%), mortality (RR: 1.26, 95% CI: 0.74, 2.16, I2 = 94%) and recurrent venous thromboembolism (RR: 1.02, 95% CI: 0.87, 1.21, I2 = 0%) between the two groups. Subgroup analysis of RCTs showed no difference in bleeding outcomes.Conclusions Low-quality evidence from a mix of RCTs and retrospective studies shows that apixaban may have better safety and equivalent efficacy as compared to VKA in dialysis patients. Apixaban treatment correlated with significantly reduced risk of major bleeding and clinically relevant nonmajor bleeding in observational studies but not in RCTs. The predominance of retrospective data warrants caution in the interpretation of results.

Background Hemodialysis (HD) and peritoneal dialysis (PD) are effective ways to treat end-stage renal disease (ERSD). This study aimed to investigate the differences in survival and the factors that influence it in patients with end-stage renal disease treated with HD or PD.Methods We retrospectively analyzed factors related to all-cause death with renal replacement therapy and compared the long-term mortality between HD and PD strategies in patients with ESRD who started HD or PD treatment in our renal HD center between January 1, 2008, and December 1, 2021.Results Overall, 1,319 patients were included, comprising 690 and 629 patients in the HD and PD groups, respectively, according to the inclusion criteria. After propensity matching, 922 patients remained, with 461 (50%) patients each in the two groups. There were no significant differences in the 1-, 2-, 3-, and 4-year mortality rates between the HD and PD groups (all p > .05). However, the 5- and 10-year mortality rates of the matched patients were 15.8%. 17.6% in the HD group and 21.0%. 27.3% in the PD group, respectively. The 5- and 10-year mortality rates were significantly lower in the HD group (all p

Purpose: An overview of the current pharmacological treatment and psychosocial interventions, such as cognitive-behavioral therapy and breathing exercises, for depression and anxiety among hemodialyzed patients (HD). Views: Depression and anxiety are common problems among HD patients, influencing their mortality and morbidity; however, they are often under-recognized and under-treated. Even though the topic is attracting more scientific attention there are still only few studies about methods of treatment for those disorders. Moreover, there are no clear guidelines on pharmacological therapy, which may prove to be difficult among patients with decreased renal function. Psychological interventions such as cognitive-behavioral therapy may be useful in treatment of these mental disorders among HD patients, though reports on the effects of such interventions are scarce. Conclusions: This review outlines some of the current approaches to the treatment of mental disorders among HD patients that use both antidepressants and therapeutic methods. There is an urgent need for randomized clinical trials of both psychosocial and pharmacological interventions in treatment of depressive and anxiety disorders. Currently, both methods seem to be useful; however, they should be implemented with caution until clear guidelines are developed. [ABSTRACT FROM AUTHOR]

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

Pregnancy in patients with end-stage renal disease (ESRD) is considered a very high-risk and is not recommended as it might cause fatal consequences for both the mother and the fetus. Even though chronic kidney disease affects the physiological components of fertility, decreasing the possibility of spontaneous conceptions, unwanted pregnancies still happen, and a small percentage of women with ESRD become pregnant. All women with kidney disease should have access to specialists in renal disease and pregnancy who can support, care for, and monitor them during their pregnancy. We reported a case of a 37-year-old primigravida who has ESRD on hemodialysis. The pregnancy journey was uneasy, but eventually she successfully passed through it. The most challenging issues to treat and manage throughout this pregnancy are anemia, the risks of eclampsia, and uncontrolled hypertension. The management of this patient requires multidisciplinary and shared care monitoring by the nephrologist, obstetrician, and primary care doctor. [ABSTRACT FROM AUTHOR]

The rate of chronic kidney diseases (CKD) is increasing steadily in Sudan, and hypertension remains one of the most common coexisting conditions among the patients. In this meta-analysis, we aimed to answer the review question (what is the prevalence of hypertension among patients with advanced CKD in Sudan?). We applied a guidelines checklist for the literature search about the (PRISMA-P 2015). We searched Google Scholar, PubMed, Cochrane Library, Embase, and Medline electronic databases for all articles on CKD conducted in Sudan. Eventually, we identified 23 studies, and only eight were included in the final meta-analysis. Out of the eight articles, there is a total sample of 2682 patients who were presented and diagnosed with advanced stage CKD; among them, 864 were found to be hypertensive, and the overall pooled prevalent rate of hypertension was 32% (95% CI 25% to 39%) with 91% heterogeneity. The lowest rate of hypertension among patients diagnosed with CKD was falling in the range of (14%-21%). We assessed the heterogeneity among studies using the I2, T2, and Q statistics. The results showed a funnel plot with asymmetrical distribution for effect sizes. The literature and evidence-based data on CKD in Sudan are scarce. However, the eight studies reviewed revealed elevated odds of CKD among patients with hypertension. The burden of the increased rate of CKD associated with prevalent hypertension and DM is a call for authorities for urgent interventional response. [ABSTRACT FROM AUTHOR]

A significant health problem affecting thousands of people worldwide is end-stage renal disease (ESRD). Haemodialysis and kidney transplantation are the two main forms of treatment. Despite the fact that kidney transplantation is a more effective and affordable treatment option, many ESRD patients still undergo haemodialysis due to a variety of reasons, including a lack of opportunity for transplantation, financial limitations and a lack of available donors. By examining the cost and quality of life connected with kidney transplantation and haemodialysis, this research aims to contribute to the economic assessment of ESRD treatments. A total of 268 recipients of kidney transplants and 225 patients receiving haemodialysis made up the study's sample size. It was carried out at Medanta – The Medicity in Gurugram, Haryana. Haemodialysis costs ₹550,000 per year, while the average expense for a kidney transplant is ₹880,000. However, a straightforward projection indicates that in about 20 months, the cost of haemodialysis patients will equal that of transplant patients. In terms of life satisfaction, kidney transplant recipients reported higher levels of general fulfilment with healthcare services than haemodialysis patients. With a ratio of 1.6:1.75 in terms of expenses versus quality of life (QoL), transplantation of kidneys was found to be more advantageous. [ABSTRACT FROM AUTHOR]

It is controversial whether hemodialysis affects the efficacy of the antiplatelet agents. We aimed to investigate the impact of hemodialysis on efficacies of the antiplatelet agents in coronary artery disease (CAD) patients complicated with end-stage renal disease (ESRD). 86 CAD patients complicated with ESRD requiring hemodialysis were consecutively enrolled. After 5-day treatment with aspirin and clopidogrel or ticagrelor, the platelet aggregations induced by arachidonic acid (PLAA) or adenosine diphosphate (PLADP), and the P2Y12 reaction unit (PRU) were measured before and after hemodialysis. The propensity matching score method was adopted to generate a control group with normal renal function from 2439 CAD patients. In patients taking aspirin, the PLAA remained unchanged after hemodialysis. In patients taking clopidogrel, the PLADP (37.26 ± 17.04 vs. 31.77 ± 16.09, p = 0.029) and corresponding clopidogrel resistance (CR) rate (23 [48.9%] vs. 14 [29.8%], p = 0.022) significantly decreased after hemodialysis, though PRU remained unchanged. Subgroup analysis indicated that PLADP significantly decreased while using polysulfone membrane (36.8 ± 17.9 vs. 31.1 ± 14.5, p = 0.024). In patients taking ticagrelor, PLADP, and PRU remained unchanged after hemodialysis. ESRD patients had higher incidences of aspirin resistance (AR) and CR compared to those with normal renal function (AR: 16.1% vs. 0%, p = 0.001; CR: 48.4% vs. 24.8%, p = 0.024). Hemodialysis does not have negative effect on the efficacies of aspirin, clopidogrel and ticagrelor in ESRD patients with CAD. ESRD patients have higher incidences of AR and CR compared with those with normal renal function. Trial registration ClinicalTrials.gov Identifier: NCT03330223, first registered January 4, 2018. [ABSTRACT FROM AUTHOR]

Introduction: Case reports have suggested a causative role between sevelamer use and subsequent gastrointestinal bleeding (GIB), but no large observational studies have evaluated this association. Methods: Using the United States Renal Data System database from 2015 to 2019, we examined the association between initiation of sevelamer (vs. non-sevelamer containing phosphate binders) and GIB hospitalization as well as all-cause mortality among individuals on hemodialysis. We emulated a target trial using Cox regression models and inverse probability of treatment weights to estimate the adjusted hazard ratios (HR) across outcomes and subgroups. Results: Among 21,354 new users of phosphate binders (11,276 sevelamer and 10,078 non-sevelamer) with baseline lab data (calcium, phosphorus, hemoglobin, and albumin), there were 2,811 GIB hospitalizations and 5,920 deaths after a median follow-up of 1.3 years. Compared with the initiation of non-sevelamer binders, sevelamer was not associated with an increased risk of GIB hospitalization (89 vs. 90 events per 1,000 person-years; IPTW-HR: 0.98, 95% CI: 0.91–1.06) or all-cause mortality (220 vs. 224 events per 1,000 person-years; IPTW-HR: 0.98, 95% CI: 0.93–1.03). Subgroup analyses (such as diabetes and anti-coagulation use) were generally consistent, and there was no association between sevelamer dose and GIB hospitalization. Conclusion: Among patients requiring hemodialysis, sevelamer (vs. non-sevelamer) containing phosphate binders was not associated with increased risk of GIB hospitalization. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical effects of hemodialysis (HD) and peritoneal dialysis (PD) in the treatment of end-stage renal disease (ESRD) patients. Methods: Clinical data of ESRD patients who received HD (n=74) and PD (n=77) for more than 12 months in the First People's Hospital of Tonglu County from October 2020 to November 2021 were retrospectively selected. Renal function indexes, blood pressure, and complication rates in the two groups before the first dialysis and at the end of the observation period were compared. Results: After the dialysis, the urea nitrogen (BUN) levels decreased in both groups, and were significantly lower in the PD group compared to the HD group. Urea clearance index (Kt/V) increased, and were significantly higher in the PD group compared to the HD group (P 0.05). After the dialysis, albumin (ALB) and cardiac ejection fraction (EF) levels significantly increased, and ALB levels were significantly higher in the HD group while EF levels were significantly higher in the PD group (P 0.05). Levels of whole parathyroid hormone (iPTH), systolic blood pressure, and diastolic blood pressure indicators in both groups decreased compared to before the dialysis, and were significantly lower in the PD group compared to the HD group of patients (P 0.05). PD was associated with significantly lower total incidence of complications compared to HD (P 0.05). Conclusions: Peritoneal dialysis is more effective in maintaining the hemodynamic stability for ESRD patients, reducing blood pressure level, improving the clearance rate of molecular substances, and protecting the renal function of patients compared to hemodialysis. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical effects of hemodialysis (HD) and peritoneal dialysis (PD) in the treatment of end-stage renal disease (ESRD) patients. Methods: Clinical data of ESRD patients who received HD (n=74) and PD (n=77) for more than 12 months in the First People's Hospital of Tonglu County from October 2020 to November 2021 were retrospectively selected. Renal function indexes, blood pressure, and complication rates in the two groups before the first dialysis and at the end of the observation period were compared. Results: After the dialysis, the urea nitrogen (BUN) levels decreased in both groups, and were significantly lower in the PD group compared to the HD group. Urea clearance index (Kt/V) increased, and were significantly higher in the PD group compared to the HD group (P less then 0.05). After the dialysis, albumin (ALB) and cardiac ejection fraction (EF) levels significantly increased, and ALB levels were significantly higher in the HD group while EF levels were significantly higher in the PD group (P less then 0.05). Levels of whole parathyroid hormone (iPTH), systolic blood pressure, and diastolic blood pressure indicators in both groups decreased compared to before the dialysis, and were significantly lower in the PD group compared to the HD group of patients (P less then 0.05). PD was associated with significantly lower total incidence of complications compared to HD (P less then 0.05). Conclusions: Peritoneal dialysis is more effective in maintaining the hemodynamic stability for ESRD patients, reducing blood pressure level, improving the clearance rate of molecular substances, and protecting the renal function of patients compared to hemodialysis. [ABSTRACT FROM AUTHOR]

World Kidney Day is an annual, global awareness campaign that aims to raise awareness of the importance of kidney health and hopes to alleviate the global burden of kidney diseases. It is observed annually on the second Thursday of March. The campaign focuses on elucidating various aspects of kidney health, including prevention, early detection, and management of kidney diseases. It highlights the risk factors contributing to kidney disease, such as diabetes, hypertension, dyslipidemia, metabolic syndrome, and obesity. By raising awareness about these risk factors, World Kidney Day encourages individuals to make lifestyle modifications and promptly seek medical intervention to reduce their risk factors. [ABSTRACT FROM AUTHOR]

Aims: Renal insufficiency is a common comorbidity in patients with haematological malignancies. This study aimed to assess how end‐stage renal disease (ESRD) might affect the pharmacokinetics of venetoclax, a Bcl‐2 inhibitor, in participants with ESRD undergoing haemodialysis. Methods: Venetoclax was administered as a single 100‐mg dose to 6 female participants with ESRD (estimated glomerular filtration rate <15 mL/min) both prior to haemodialysis and between haemodialysis days and 7 healthy female participants with normal renal function (estimated glomerular filtration rate >90 mL/min). Intensive pharmacokinetic and protein binding samples were collected from all participants. Arterial and venous samples were collected from ESRD participants during haemodialysis to assess the effect of haemodialysis on venetoclax pharmacokinetics. Pharmacokinetic parameters were estimated using noncompartmental methods. Results: There was no difference in plasma venetoclax concentrations between arterial and venous samples, suggesting that haemodialysis did not affect the pharmacokinetics of venetoclax. The fraction unbound (fu) of venetoclax was ~2‐fold higher for participants with ESRD compared to participants with normal renal function. The unbound maximum plasma concentration and area under the plasma concentration–time curve from time 0 to 48 h were comparable between ESRD and normal function groups. The mean half‐life ranged from 10.4 to 12.2 h across groups, demonstrating that ESRD did not affect the half‐life of venetoclax. No new safety signals were observed during this study. Conclusion: ESRD and dialysis do not alter unbound venetoclax plasma concentrations. No pharmacokinetics driven dose adjustment is needed for patients with renal insufficiency. [ABSTRACT FROM AUTHOR]

BACKGROUND Arteriovenous fistula (AVF) is considered the gold standard for vascular access in hemodialysis. However, achieving the successful maturation of AVF remains a challenge. Cilostazol, a phosphodiesterase-3 inhibitor, has shown promise in enhancing AVF maturation. This study aimed to assess the clinical efficacy of cilostazol in promoting AVF maturation. METHODS This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive systematic literature search was performed using PubMed, ScienceDirect, Cochrane Library, ProQuest, and Google Scholar to identify studies investigating the efficacy of cilostazol on the maturation of newly created AVF in patients with end-stage renal disease and published up to August 2023. The intervention group received perioperative cilostazol therapy, while the control group did not receive cilostazol. The outcomes were the maturation rate of AVF and AVF-related complications. Meta-analysis was conducted using Review Manager software version 5.3. RESULTS 5 studies involving 549 patients were included. The intervention group comprised 228 patients, while the control group comprised 321 patients. In the pooled analysis, patients in the intervention group had a significantly higher rate of AVF maturation (odds ratio [OR] = 2.18, 95% confidence interval [CI]: 1.29-3.68, p = 0.003, I² = 47%) and a lower rate of AVF-related complications (OR = 0.46, 95% CI: 0.28-0.77, p = 0.003, I² = 27%) compared to the control. CONCLUSIONS Cilostazol was associated with a higher rate of AVF maturation and a lower rate of AVF-related complications. [ABSTRACT FROM AUTHOR]

Objectives Lupus activity has long been considered to decline after initiation of maintenance dialysis (MD). This assumption is based on limited historical data. We aimed to describe the natural history of lupus in patients undergoing MD. Methods We assembled a national retrospective cohort of lupus patients who started dialysis between 2008 and 2011, included in the REIN registry with a 5-year follow-up. We analysed healthcare consumption from the National Health Data System. We evaluated the proportion of patients 'off-treatment' (i.e. receiving 0–5 mg/d of corticosteroids, without any immunosuppressive therapy) after the start of MD. We describe the cumulative incidences of non-severe and severe lupus flares, cardiovascular events, severe infections, kidney transplantation and survival. Results We included 137 patients (121 females and 16 males), with a median age of 42 years. The proportion of patients 'off-treatment' at dialysis initiation was 67.7% (95% CI: 61.8, 73.8%), and increased to 76.0% (95% CI: 73.3, 78.8) at 1 year and 83.4% (95% CI: 81.0, 85.9%) at 3 years, with a lower proportion in younger patients. Lupus flares mainly occurred in the first year after MD initiation, and at 12 months 51.6% of patients had presented a non-severe lupus flare and 11.6% a severe lupus flare. In addition, 42.2% (95% CI: 32.9, 50.3%) and 23.7% (95% CI: 16.0, 30.7%) of patients at 12 months had been hospitalized for cardiovascular events or infections, respectively. Conclusion The proportion of lupus patients off-treatment increases after MD initiation, but non-severe and severe lupus flares continue to occur, mainly during the first year. This calls for the continued follow-up of lupus patients by lupus specialists after dialysis initiation. [ABSTRACT FROM AUTHOR]

End-stage renal disease (ESRD) in childhood and adolescence is rare, with relatively few published reports of pediatric ESRD vascular access. This study analyzes a 10-year experience creating arteriovenous fistulas (AVFs) in children and adolescents. Our goal is to review our strategy for creating functional autogenous vascular access in younger patients and report our results. We retrospectively reviewed data and outcomes for consecutive vascular access patients aged ≤19 years during a 10-year period. Each patient had preoperative vascular ultrasound mapping by the operating surgeon in addition to physical examination. A distal forearm radiocephalic AVF was the first access choice when feasible, and a proximal radial artery inflow AVF was the next option. Demographic data, inflow artery, venous outflow target, and required transposition vs direct AVFs were variables included in the analysis. Primary and cumulative patency were calculated by Kaplan-Meier analysis. Thirty-seven AVFs were created in 35 patients. No grafts were used. Ages were 6 to 19 years (mean, 15 years), and 20 were male. Causes of ESRD included glomerular disease (n = 18) and urinary obstruction or reflux (n = 7), among others. Three had previous AVFs, and 10 were obese. The proximal radial artery supplied AVF inflow in 25 patients and the brachial artery in only seven. Eleven individuals required a transposition and one a vein translocation to the contralateral arm. No patients developed hand ischemia, although two later required banding procedures for high flow. Eleven patients had successful transplants. A single patient died, unrelated to the vascular access. Five AVFs failed. Of these, two had new successful AVFs created, two regained renal function, one was transplanted, and one declined other procedures. Primary and cumulative patency rates were 75% and 85% at 12 months, 70% and 85% at 24 months, and 51% and 85% at 36 months, respectively. Median follow-up was 16 months. Creating an AVF for hemodialysis is a successful vascular access strategy for pediatric and adolescent patients. Proximal radial artery AVFs provided safe and functional access when a distal AVF was not feasible. Cumulative AVF patency was 85% at 36 months. [ABSTRACT FROM AUTHOR]

Infective spondylodiscitis (ISD), the infection of vertebral bodies and surrounding tissues, is a rare complication with major impact on the long-term survival of hemodialysis (HD) patients. Although the most frequent etiology is staphylococcal, identifying these pathogens in blood cultures and biopsy cultures is often difficult. This paper aims to present suitable antibiotic combinations for the treatment of these patients, which is usually challenging in the case of an unidentified pathogen. We presented the therapies applied for 13 HD patients and 19 patients without chronic kidney disease (CKD), diagnosed with ISD between 2013 and 2023 in Bihor County. The percentage of positive blood cultures was low in both groups (30.78% HD vs. 15.78% non-HD). The average length of antibiotic therapy was 5.15 weeks in HD patients and 6.29 weeks in non-HD patients. The use of Carbapenem alone (e.g., Meropenem) for an average of 19.6 days for patients in HD when the pathogen was not identified has proven to be efficient in most cases, similarly to using Vancomycin and Fluoroquinolone/Cephalosporines in combination. Regarding the non-CKD patients, the use of Clindamycin in various combinations for an average of 30.3 days has proven to be efficient in more than 90% of cases of ISD with a nonidentified pathogen. Within 2 years after ISD was diagnosed, 12 of the 13 HD patients passed away, mainly due to cardiovascular causes. Unfortunately, there are no guidelines in the literature concerning the empiric treatment of ISD in the particular case of HD patients. Upon checking the literature on PubMed and Google Scholar, only 10 studies provided relevant data regarding ISD treatment for HD patients. More data about the treatment and evolution of these patients is needed in order to elaborate a truly relevant metanalysis. [ABSTRACT FROM AUTHOR]

Purpose: Hyperammonemia is a serious adverse effect of 5-fluorouracil (5FU) administration. Hemodialysis can be used for its management, but detailed data on the concentrations and removal rate of 5FU and its metabolites during hemodialysis remain unclear. Here, we present two cases of hemodialysis patients with end-stage renal disease who received concurrent 5FU infusion. Methods: Blood samples were collected from the hemodialysis circuit before and after the dialyzer during day 2 hemodialysis sessions, and from the internal shunt just before and after day 4 hemodialysis sessions. The serum levels of 5FU and its metabolites—α-fluoro-β-alanine (FBAL) and monofluoroacetate (FA)—were measured using liquid chromatography-tandem mass spectrometry. Results: Seven sets of blood samples were collected for case 1; the removal rates (mean ± standard deviation) of 5FU and FBAL by the dialyzer were 81.2 ± 23.2% and 96.1 ± 8.6%, respectively (p < 0.001). Three sets of blood samples were collected for case 2; the removal rates of 5FU and FBAL were 81.7 ± 3.9% and 94.8 ± 2.7%, respectively (p = 0.03). Twenty-seven sets of blood samples were collected for case 1; reductions in blood FBAL and FA levels were 49.3 ± 8.8% (p < 0.001) and 64.2 ± 30.3% (p = 0.04), respectively. Bayesian estimation yielded similar results. Three sets of blood samples were collected for case 2; reductions in the blood FBAL and FA levels were 49.9 ± 6.9% and 50.6 ± 33.0%, respectively. Conclusion: In this study, 5FU and its metabolite FBAL were directly removed from the blood by approximately 90% during hemodialysis, and the blood levels of FBAL and FA were reduced by approximately 50% with a single hemodialysis session. [ABSTRACT FROM AUTHOR]

Pain has an adverse effect on HRQoL and has social, psychological, and physical repercussions for ESRD patients. In the present study, we assessed chronic pain in ESRD patients on HD in terms of severity and interference with activity. We also assessed the impact it has on these patients, along with looking at the factors that were linked to QoL in this population. A multicenter, cross-sectional study carried out between April and July of 2023 in the hemodialysis units of Asir Central Hospital and Khamis Mushait General Hospital. Brief Pain Inventory and European Quality of Life scale 5 dimensions (EQ-5D) scale, including its European Quality of Life visual analogue scale (EQ-VAS) component, were used to assess pain and QoL, respectively. A total of 97 participants were included in the final study. The average interference level of pain with daily functions was 22.5 ± 15.0 out of 70. The mean interference score was significantly higher among patients at rural areas (28.2 ± 16.3; P = 0.012), and those who undergone dialysis session for ≥ 4 times per week (31.6 ± 16.7; P = 0.026). The overall score of quality of life ranged from 20% to 92% with mean score of 36.5 ± 12.8%. The multiple linear regression analysis revealed that patients with higher BMI, more frequent dialysis sessions per week, and higher level of pain interference with daily functions demonstrated lower QoL (B= – 2.36, – 1.46, and – 0.64, respectively. Pain has a significant negative impact on QoL in ESRD patients undergoing HD. Patients with higher BMI, more frequent dialysis sessions, and higher level of pain interference with daily functions are at higher risk of lower QoL. These findings provide valuable information for educators, physicians, and other healthcare providers working with patients undergoing HD. [ABSTRACT FROM AUTHOR]

Non-valvular atrial fibrillation (NVAF) is the most common cardiac arrhythmia in the general population, and its prevalence increases among patients with chronic kidney disease (CKD) undergoing hemodialysis. This population presents high risk of both hemorrhagic and thrombotic events, with little evidence regarding the use of oral anticoagulation treatment (OAT) and multiple complications arising from it; however, stroke prevention with percutaneous left atrial appendage closure (LAAC) is an alternative to be considered. We retrospectively describe the safety and efficacy of percutaneous LAAC in eight patients with NVAF and CKD on hemodialysis during a 12-month follow-up. The mean age was 78.8 years (range 64–86; SD ± 6.7), and seven patients were male. The mean CHA2DS2-VASC and HAS-BLED scores were high, 4.8 (SD ± 1.5) and 3.8 (SD ± 1.3), respectively. Seventy-five percent of the patients were referred for this intervention due to a history of major bleeding, with gastrointestinal bleeding being the most common type, while the remaining twenty-five percent of the patients were referred because of a high risk of bleeding. The percutaneous LAAC procedure was successfully completed in 100% of the patients, with complete exclusion of the appendage without complications or leaks exceeding 5 mm. There was one death not related to the procedure four days after the intervention. Among the other seven patients, no deaths, cardioembolic events or major bleeding were reported during the follow-up period. In our sample, percutaneous LAAC appears to be a safe and effective alternative to anticoagulation in patients with NVAF and CKD on hemodialysis. [ABSTRACT FROM AUTHOR]

End-stage renal disease (ESRD) coexisted with cirrhosis, ascites, and primary liver cancer represents an extraordinarily rare clinical condition that typically occurs in very late-stage decompensated cirrhosis and is associated with an extremely poor prognosis. We present a case of a 68-year-old male patient with ESRD who experienced various decompensated complications of liver cirrhosis, particularly massive ascites and hepatic space-occupying lesions. Peritoneal dialysis (PD) catheter insertion and continuous ambulatory peritoneal dialysis (CAPD) treatment were successfully performed. During meticulous follow-up, the patient survived for one year but ultimately succumbed to complications related to liver cancer. PD can serve as an efficacious therapeutic approach for such late-stage patients afflicted together with severe cirrhosis, massive ascites and primary liver cancer. [ABSTRACT FROM AUTHOR]

BackgroundThe risk factors of cardiovascular disease (CVD) in end-stage renal disease (ESRD) with hemodialysis remain not fully understood. In this study, we developed and validated a clinical-longitudinal model for predicting CVD in patients with hemodialysis, and employed Mendelian randomization to evaluate the causal 6study included 468 hemodialysis patients, and biochemical parameters were evaluated every three months. A generalized linear mixed (GLM) predictive model was applied to longitudinal clinical data. Calibration curves and area under the receiver operating characteristic curves (AUCs) were used to evaluate the performance of the model. Kaplan-Meier curves were applied to verify the effect of selected risk factors on the probability of CVD. Genome-wide association study (GWAS) data for CVD (n = 218,792,101,866 cases), end-stage renal disease (ESRD, n = 16,405, 326 cases), diabetes (n = 202,046, 9,889 cases), creatinine (n = 7,810), and uric acid (UA, n = 109,029) were obtained from the large-open GWAS project. The inverse-variance weighted MR was used as the main analysis to estimate the causal associations, and several sensitivity analyses were performed to assess pleiotropy and exclude variants with potential pleiotropic effects.ResultsThe AUCs of the GLM model was 0.93 (with accuracy rates of 93.9% and 93.1% for the training set and validation set, sensitivity of 0.95 and 0.94, specificity of 0.87 and 0.86). The final clinical-longitudinal model consisted of 5 risk factors, including age, diabetes, ipth, creatinine, and UA. Furthermore, the predicted CVD response also allowed for significant (p