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Rationale & Objective: End-stage kidney disease (ESKD) negatively affects patients' physical, emotional, and social functioning. Furthermore, adjustment to dialysis require substantial lifestyle changes that may further impact on patients physical and emotional well-being. However, the relationship between Health-Related Quality of life impairment with future adverse outcomes in dialysis is not well characterized. Our study aims to investigate the relationship between Health-Related Quality of Life (HRQoL) and patients' survival and hospitalization rates within a large European dialysis network., Methods: A historical cohort study was conducted to evaluate association of HRQoL with hospitalization and mortality rates over a 12-month follow-up period. Patients responded to a self-administered survey as part of a Continuous Quality Improvement Program implemented in clinics affiliated with the Spanish FMC-Nephrocare organization. Health-Related Quality of Life (HRQoL) was measured with the KDQOL-36. Potential confounders included socio-demographic characteristics, comorbidities, biochemical parameters, dialysis treatment. We used Cox's Proportional Hazard regression to assess the hazard of death and Logistic Regression to assess the likelihood of hospital admissions during 12-month follow-up period., Results: A total of 2280 (51.5%) completed the self-administrated survey, and 1838 patients met the inclusion/exclusion criteria of the study. Higher HRQoL scores were associated with significantly lower mortality and hospitalization risk. Risk estimates were robust to adjustment for potential confounders., Conclusions: Several dimensions of HRQoL are associated with patient-centered outcomes (i.e., mortality and hospitalizations at 1 year). Patient-Reported Outcomes contribute unique pieces of information characterizing patients' health. Residual confounding cannot be fully ruled out; moreover, the high attrition rate could result in selection bias, which may limit the generalizability of the findings to a broader population., (© 2024. The Author(s).)

Cystic fibrosis is an autosomal recessive disorder caused by mutations of the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) protein. The most recent therapeutic approach to cystic fibrosis aims to correct structural and functional abnormalities of CFTR protein. CFTR modulators including ivacaftor-tezacaftor-elexacaftor are used in patients with F508del mutation, with clinical improvement. To date, there are no experiences of CFTR modulator therapy in cystic fibrosis patients with organ transplantation and severe renal impairment. We report the case of a patient diagnosed with cystic fibrosis with F508del mutation, who underwent liver transplantation at the age of 19 and started hemodialysis at the age of 24 due to end-stage renal disease secondary to membranous glomerulonephritis. She was treated with Kaftrio (ivacaftor-tezacaftor-elexacaftor) with clinical benefits on appetite, improvement of body mass index, and reduction of pulmonary exacerbations. A reduction of dosage to 75% of the standard dose was required due to alterations of the liver function. Conclusions. Use of CFTR modulators in patient with cystic fibrosis, liver transplant and end-stage renal disease could be considered safe but a clinical and laboratoristic monitoring of hepatic function is needed., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Background. The use of PD depends on economic, structural and organizational factors. The nephrologist's opinion is that peritoneal dialysis is less used than it shold be. In Italy, PD is not carried out in private Centers, but neither is it in around one third of Public Centers. The aim of this study was to investigate the opinions of nephrologists on PD in Public Centers only, thereby nullifying the influence of the economic factors. Materials and Methods. The investigation was carried out by means of an online questionnaire (Qs) via mail, and during meetings and Congresses in 2006-07. The Qs investigated the characteristics of the Centers, the nephrologists interviewed, and opinions on the various aspects of the choice of Renal Replacement Therapy Renal Replacement Therapy (RRT) (26 questions). Responses were received from 454 nephrologists in 270 public Centers. Among these, 205 centers (370 Qs) report PD (PD-YES), 36 (42 Qs) do not (PD-NO) and 29 (42 Qs) do not use it but send patients selected for PD to other Centers (PD-TRANSF). Results. The PD-NO and PD-TRANSF Centers are significantly smaller, with greater availability of beds. In the PD-YES Centers the presence of a pre-dialysis pathway, early referral and nurses dedicated solely to PD are associated with a higher use of PD. The nephrologists in the PD-NO Centers rate PD more negatively in terms of both clinical and non-clinical factors. The belief that more than 40% of patients can do either PD or HD differs among the nephrologists in the PD-YES (74.3%), PD-TRANSF (45.2%) and PD-NO (28.6%) Centers. Likewise, the belief that PD can be used as a first treatment in more than 30% of cases differs among the nephrologists in PD-YES (49.2%), PD-TRANSF (33.3%) and PD-NO (14.3%) Centers. Conclusions. The use of PD in Public Centers is conditioned by both structural and organizational factors, and by the opinions of nephrologists on the use and effectiveness of the technique., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Background: Intradialytic hypotension remains one of the most recurrent complications of dialysis sessions. Inadequate management can lead to adverse outcomes, highlighting the need to develop personalized approaches for the prevention of intradialytic hypotension. Here, we sought to develop and validate two AI-based risk models predicting the occurrence of symptomatic intradialytic hypotension at different time points., Methods: The models were built using the XGBoost algorithm and they predict the occurrence of intradialytic hypotension in the next dialysis session and in the next month. The initial dataset, obtained from routinely collected data in the EuCliD ® Database, was split to perform model derivation, training and validation. Model performance was evaluated by concordance statistic and calibration charts; the importance of features was assessed with the Shapley Additive Explanation (SHAP) methodology., Results: The final dataset included 1,249,813 dialysis sessions, and the incidence rate of intradialytic hypotension was 10.07% (95% CI 10.02-10.13). Our models retained good discrimination (AUC around 0.8) and a suitable calibration yielding to the selection of three classification thresholds identifying four distinct risk groups. Variables providing the most significant impact on risk estimates were blood pressure dynamics and other metrics mirroring hemodynamic instability over time., Conclusions: Recurrent symptomatic intradialytic hypotension could be reliably and accurately predicted using routinely collected data during dialysis treatment and standard clinical care. Clinical application of these prediction models would allow for personalized risk-based interventions for preventing and managing intradialytic hypotension., (© 2023. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Background: Cold hemodialysis (HD) prevented intradialysis hypotension (IDH) in small, short-term, randomized trials in selected patients with IDH. Whether this treatments prevents IDH and mortality in the HD population at large is unknown., Methods: We investigated the relationship between dialysate temperature and the risk of IDH, i.e. nadir blood pressure <90 mmHg (generalized estimating equation model) and all-cause mortality (Cox's regression) in an incident cohort of HD patients (n = 8071). To control for confounding by bias by indication and other factors we applied instrumental variables adjusting for case mix at facility level., Results: Twenty-seven percent of patients in the study cohort were systematically treated with a dialysate temperature ≤35.5°C. Over a median follow-up of 13.6 months (interquartile range 5.2-26.1 months), a 0.5°C reduction of the dialysate temperature was associated with a small (-2.4%) reduction of the risk of IDH [odds ratio (OR) 0.976, 95% confidence interval (CI) 0.957-0.995, P = .013]. In case-mix, facility-level adjusted analysis, the association became much stronger (OR 0.67, 95% CI 0.63-0.72, risk reduction = 33%, P < .001). In contrast, colder dialysate temperature had no effect on mortality both in the unadjusted [hazard ratio (HR) (0.5°C decrease) 1.074, 95% CI 0.972-1.187, P = .16] and case-mix-adjusted analysis at facility level (HR 1.01, 95% CI 0.88-1.16, P = .84). Similar results were registered in additional analyses by instrumental variables applying the median dialysate temperature or the facility percentage of patients prescribed a dialysate temperature <36°C. Further analyses restricted to patients with recurrent IDH fully confirmed these findings., Conclusions: Cold HD was associated with IDH in the HD population but had no association with all-cause mortality., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)

Objectives. The results are reported here of the 8th National Census (Cs-22) of Peritoneal Dialysis in Italy, carried out in 2022-23 by the Italian Society of Nephrology's Peritoneal Dialysis Project Group and relating to 2022. Methods. The Census was conducted in the 227 non pediatric centers which performed Peritoneal Dialysis (PD) in 2022. The results have been compared with the previous Censuses carried out since 2005. Results. Incidence: in 2022, 1350 patients (CAPD=52.1%) started on PD (1st treatment for ESRD). PD was started incrementally by 35.3% in 136 Centers. The catheter was placed exclusively by a Nephrologist in 17.0% of known cases. Prevalence: there were 4152 (CAPD=43.4%) patients on PD on 31/12/2022, with 21.1% of prevalent patients on assisted PD (family member caregiver: 86.3%). Out: in 2022 the PD drop-out rate (ep/100 pt-yrs) was: 11.7 to HD; 10.1 death, down; 7.5 Tx. The main cause of transfer to HD remains peritonitis (23.5%), although its reduction over the years is confirmed (Cs-05: 37.9%). Peritonitis/EPS: the incidence of peritonitis in 2022 was 0.176 ep/pt-yr (696 episodes). The incidence of new cases of EPS fell in 2021-22 (7 cases). Other results: the number of Centers using 3.86% for the peritoneal equilibration test (PET) (57.7%) increased. PD for heart failure continues to be used in 44 Centers (66 pts). Conclusions. Cs-22 confirms PD's good results in Italy., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Background: Treatment of end-stage kidney disease patients is extremely challenging given the interconnected functional derangements and comorbidities characterizing the disease. Continuous quality improvement (CQI) in healthcare is a structured clinical governance process helping physicians adhere to best clinical practices. The digitization of patient medical records and data warehousing technologies has standardized and enhanced the efficiency of the CQI's evidence generation process. There is limited evidence that ameliorating intermediate outcomes would translate into better patient-centred outcomes. We sought to evaluate the relationship between Fresenius Medical Care medical patient review CQI (MPR-CQI) implementation and patients' survival in a large historical cohort study., Methods: We included all incident adult patients with 6-months survival on chronic dialysis registered in the Europe, Middle East and Africa region between 2011 and 2018. We compared medical key performance indicator (KPI) target achievements and 2-year mortality for patients enrolled prior to and after MPR-CQI policy onset (Cohorts A and B). We adopted a structural equation model where MPR-CQI policy was the exogenous explanatory variable, KPI target achievements was the mediator variable and survival was the outcome of interest., Results: About 4270 patients (Cohort A: 2397; Cohort B: 1873) met the inclusion criteria. We observed an increase in KPI target achievements after MPR-CQI policy implementation. Mediation analysis demonstrated a significant reduction in mortality due to an indirect effect of MPR-CQI implementation through improvement in KPI target achievement occurring in the post-implementation era [odds ratio 0.70 (95% confidence interval 0.65-0.76); P < 0.0001]., Conclusions: Our study suggests that MPR-CQI achieved by standardized clinical practice and periodic structured MPR may improve patients' survival through improvement in medical KPIs., (© The Author(s) 2021. Published by Oxford University Press on behalf of the ERA.)

Current equation-based risk stratification algorithms for kidney failure (KF) may have limited applicability in real world settings, where missing information may impede their computation for a large share of patients, hampering one from taking full advantage of the wealth of information collected in electronic health records. To overcome such limitations, we trained and validated the Prognostic Reasoning System for Chronic Kidney Disease (PROGRES-CKD), a novel algorithm predicting end-stage kidney disease (ESKD). PROGRES-CKD is a naïve Bayes classifier predicting ESKD onset within 6 and 24 months in adult, stage 3-to-5 CKD patients. PROGRES-CKD trained on 17,775 CKD patients treated in the Fresenius Medical Care (FMC) NephroCare network. The algorithm was validated in a second independent FMC cohort ( n = 6760) and in the German Chronic Kidney Disease (GCKD) study cohort ( n = 4058). We contrasted PROGRES-CKD accuracy against the performance of the Kidney Failure Risk Equation (KFRE). Discrimination accuracy in the validation cohorts was excellent for both short-term (stage 4-5 CKD, FMC: AUC = 0.90, 95%CI 0.88-0.91; GCKD: AUC = 0.91, 95% CI 0.86-0.97) and long-term (stage 3-5 CKD, FMC: AUC = 0.85, 95%CI 0.83-0.88; GCKD: AUC = 0.85, 95%CI 0.83-0.88) forecasting horizons. The performance of PROGRES-CKD was non-inferior to KFRE for the 24-month horizon and proved more accurate for the 6-month horizon forecast in both validation cohorts. In the real world setting captured in the FMC validation cohort, PROGRES-CKD was computable for all patients, whereas KFRE could be computed for complete cases only (i.e., 30% and 16% of the cohort in 6- and 24-month horizons). PROGRES-CKD accurately predicts KF onset among CKD patients. Contrary to equation-based scores, PROGRES-CKD extends to patients with incomplete data and allows explicit assessment of prediction robustness in case of missing values. PROGRES-CKD may efficiently assist physicians' prognostic reasoning in real-life applications.

Background: Vascular access surveillance of dialysis patients is a challenging task for clinicians. We derived and validated an arteriovenous fistula failure model (AVF-FM) based on machine learning. Methods: The AVF-FM is an XG-Boost algorithm aimed at predicting AVF failure within three months among in-centre dialysis patients. The model was trained in the derivation set (70% of initial cohort) by exploiting the information routinely collected in the Nephrocare European Clinical Database (EuCliD ® ). Model performance was tested by concordance statistic and calibration charts in the remaining 30% of records. Features importance was computed using the SHAP method. Results: We included 13,369 patients, overall. The Area Under the ROC Curve (AUC-ROC) of AVF-FM was 0.80 (95% CI 0.79-0.81). Model calibration showed excellent representation of observed failure risk. Variables associated with the greatest impact on risk estimates were previous history of AVF complications, followed by access recirculation and other functional parameters including metrics describing temporal pattern of dialysis dose, blood flow, dynamic venous and arterial pressures. Conclusions: The AVF-FM achieved good discrimination and calibration properties by combining routinely collected clinical and sensor data that require no additional effort by healthcare staff. Therefore, it can potentially enable risk-based personalization of AVF surveillance strategies.

Background: Citric acid-based bicarbonate dialysate (CiD) is increasingly used in haemodialysis (HD) to improve haemodynamic tolerance and haemocompatibility associated with acetic acid-based bicarbonate dialysate. Safety concerns over CiD have been raised recently after a French ecological study reported higher mortality hazard in HD clinics with high CiD consumption. Therefore, we evaluated the mortality risk associated with various acidifiers (AcD, CiD) of bicarbonate dialysate., Methods: In this multicentre, historical cohort study, we included adult incident HD patients (European, Middle-East and Africa Fresenius Medical Care network; 1 January 2014 to 31 October 2018). We recorded acidifiers of bicarbonate dialysis and dialysate composition for each dialysis session. In the primary intention-to-treat analysis, patients were assigned to the exposed group if they received CiD in >70% of sessions during the first 3 months (CiD70%), whereas the non-exposed group received no CiD at all. In the secondary analysis, exposure was assessed on a monthly basis for the whole duration of the follow-up., Results: We enrolled 10 121 incident patients during the study period. Of them, 371 met the criteria for inclusion in CiD70%. After propensity score matching, mortality was 11.43 [95% confidence interval (CI) 8.86-14.75] and 12.04 (95% CI 9.44-15.35) deaths/100 person-years in the CiD0% and CiD70% groups, respectively (P = 0.80). A similar association trend was observed in the secondary analysis., Conclusions: We did not observe evidence of increased mortality among patients exposed to CiD in a large European cohort of dialysis patients despite the fact that physicians were more inclined to prescribe CiD to subjects with worse medical conditions., (© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)

Erythropoiesis Stimulating Agents (ESAs) have become a standard anemia management tool for End Stage Renal Disease (ESRD) patients. However, dose optimization constitutes an extremely challenging task due to huge inter and intra-patient variability in the responses to ESA administration. Current data-based approaches to anemia control focus on learning accurate hemoglobin prediction models, which can be later utilized for testing competing treatment choices and choosing the optimal one. These methods, despite being proven effective in practice, present several shortcomings which this paper intends to tackle. Namely, they are limited to a small cohort of patients and, even then, they fail to provide suggestions when some strict requirements are not met (such as having a three month history prior to the prediction). Here, recurrent neural networks (RNNs) are used to model whole patient histories, providing predictions at every time step since the very first day. Furthermore, an unprecedented amount of data (∼110,000 patients from many different medical centers in twelve countries, without exclusion criteria) was used to train it, thus allowing it to generalize for every single patient. The resulting model outperforms state-of-the-art Hemoglobin prediction, providing excellent results even when tested on a prospective dataset. Simultaneously, it allows to bring the benefits of algorithmic anemia control to a very large group of patients., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: We report our experience with Videodialysis (VD), a new telemedicine system created in our Center to overcome physical, cognitive and psychological barriers to PD., Methods: We analyzed the technical and clinical care results of VD in the period from 01/01/2009 to 12/31/2018., Results: The VD components are: a Remote Station at the patient's home (video camera, monitor, microphone, technological connectivity box), and a Control Station in the Center (PC with high resolution monitor, webcam, speakerphone) with software that manages 6 audio-video connections simultaneously as well as the Remote Station video cameras. In 2015 a second model of VD was designed to further improve ease of transport, installation, user interface, software functionality and connectivity. VD proved to be highly reliable during 21,000 connections, and easy to use by patients/caregivers without technological skills. During the observational period, 107 patients started PD; of these 77 had barriers to PD: in 15 we overcame the barriers by VD-Assisted PD and in 62 we used other modalities of Assisted PD. During a follow-up of 285 months on VD-Assisted, 5 patients died, 3 were transferred to HD (UFF; leakage; onset of barriers insurmountable with VD), 3 to traditional Assisted PD and 4 remained on VD-Assisted PD. Peritonitis incidence in VD-Assisted PD was 1/84.2 pt/mths, not significantly different to that of the patients not using VD. Sense of confidence was the aspect most highly-appreciated by VD-Assisted PD patients., Conclusions: VD-Assisted PD is a reliable, safe system which requires no technological know-how and it is easy to use when self-care is not possible due to physical, cognitive or psychological barriers.

Objectives: We report here the results of the 6th National Census (Cs-16) of Peritoneal Dialysis in Italy, carried out in 2017-18 by the Italian Society of Nephrology's Peritoneal Dialysis Study Group and relating to 2016., Methods: The Census was conducted using an on-line questionnaire administered to the 237 non pediatric centers which did perform Peritoneal Dialysis (PD) in 2016. The results have been compared with the previous Censuses carried out since 2005., Results: Incidence: In 2016, 1,595 patients (CAPD=56.1%) started on PD (1st treatment for ESRD) and 4,607 on hemodialysis (HD). PD was started incrementally by 32.5% in 144 Centers. 15.6% were late referrals, and 5.1% began within 48-72 hours of insertion. The catheter was positioned exclusively by a Nephrologist in 24.3% of cases. Prevalence: Patients on PD on 31/12/2016 were 4,607 (CAPD=46.6%), with 22.2% of prevalent patients on assisted PD (family member caregiver: 80.5%). Out: In 2016, PD dropout rate (ep/100 pt-yrs: 12.5 to HD; 11.8 death; 7.0 Tx) has not changed. The main cause of transfer to HD remains peritonitis (23.8%), although it is still decreasing (Cs-05: 37.9%). Peritonitis/EPS: The incidence of peritonitis in 2016 was 0.211 ep/pt-yr (939 episodes). The incidence of new cases of EPS in 2015-16 is diminishing too (16 cases=0.176 ep/100 pt-yrs). Other results: In 2016 the number of Centers using 3.86% for the peritoneal equilibration test (PET) (49.8%) increased, and the Centers carrying out home visits diminished (51.5%)., Conclusions: Cs-16 confirms that PD in Italy is having good results., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Atrial fibrillation (AF) is a frequent clinical complication in dialysis patients, and warfarin therapy represents the most common approach for reducing the risk of stroke in this population. However, current evidence based on observational studies, offer conflicting results, whereas no randomized controlled trials have been carried out so far. Additionally, many clinicians are wary of the possible role of warfarin as vascular calcification inducer and its potential to increase the high risk of bleeding among patients on dialysis. Ideally the most promising therapy would be based on direct inhibitors of factor IIa or Xa; however, at the moment, none of these drugs can be safely prescribed in dialysis patients, because of their potentially dangerous accumulation, and the lack of sufficient experience with apixaban or rivaroxaban, two drugs showing a favorable pharmacokinetic profile in end-stage renal disease. Hence, the use of vitamin K inhibitors is currently the only pharmacological option for stroke prevention in dialysis patients with atrial fibrillation, leaving the clinicians in a management conundrum.This review discusses the trade-offs implicated in warfarin use for this population, the promises of newly developed drugs, the role of dialysis as atrial fibrillation trigger, as well as potential non-pharmacological management options suitable in selected clinical situations.

Background: Stroke prevention in dialysis-dependent patients with atrial fibrillation (AF) is an unresolved clinical dilemma. Indeed, no randomized controlled trial evaluating the efficacy and safety of oral anticoagulants in this population, has been conducted so far. Observational research on the use of warfarin in patients on dialysis has shown conflicting results. This uncertainty is mirrored by the wide variations in warfarin prescription patterns across centers. We sought to evaluate the association between the use of vitamin K antagonists (VKAs) and mortality among hemodialysis patient with AF and to assess potential factors affecting the risk-benefit profile of warfarin in this population., Methods: A total of 91,987 patients registered in the European Clinical Dialysis Database® system from January 2004 to January 2015. Of which, 9,238 patients were identified with a diagnosis of AF. After excluding ineligible patients, a 1:1 propensity score matched cohort of 1,324 warfarin users and non-users were assembled., Results: VKA use was associated with both increased 90-day survival (hazard ratio, HR 0.47, p < 0.01) and 6-year survival (HR 0.76, p < 0.01); however, a trend indicated a stronger early benefit (p for time-interaction <0.01). Moderation analysis showed that patients' age and clinical history of stroke strongly influenced warfarin-related benefits on survival., Conclusion: VKA may provide an early survival benefit; however, this is partially offset later during the follow-up. In addition, heterogeneous risk-benefit profiles were observed among subgroups of dialysis-dependent patients with AF, further emphasizing the complexities of tailoring stroke prevention strategies in this population., (© 2016 S. Karger AG, Basel.)

Background: The demand for kidney transplant exceeds organ supply; therefore, understanding patient-related and contextual factors associated with waiting list activation is key in ensuring that organ allocation is efficient and equitable. We sought to assess whether inequalities in wait-listing probability exist across centers and evaluate correlates of wait-listing in Italy., Methods: We linked the MigliorDialisi dataset (1,238 patients enrolled in 54 Italian hemodialysis centers) to administrative data concerning the activity of each participating center and contextual information abstracted from the Italian Institute of Statistics. We modeled the odds of waiting list activation for patients on dialysis by the subjects' sociodemographic, biomedical and psychosocial factors along with center-related and contextual factors., Results: The crude enlistment rate was 26% (95% CI 9-54) distributed as follows: 21, 34 and 33% in northern, central, and southern Italy, respectively (p < 0.01). Older patients with poorer health conditions and lower expectations toward transplantation outcomes were less likely to be wait-listed in multilevel multivariable logistic regression. In the fully adjusted model there was not a statistically significant variation in wait-listing across northern, central, and southern regions. However, the variance explained by center-related factors accounted for 12% (p < 0.01) of total variability in enlistment likelihood (20% in patients >65 years, p < 0.01)., Conclusions: Our results showed that inter-center variation exists after adjusting for case mix. Additionally, we identified individual modifiable factors associated with wait-listing inequalities., (Copyright © 2013 S. Karger AG, Basel.)

Purpose: We sought to determine the association between health-related quality of life (HRQOL) and graft function in renal transplant recipients., Design and Methods: We enrolled 577 kidney transplant recipients aged 18-74 years (response rate 87%). Recipients with multiple or multi-organ transplantation, creatine kinase >200 U/L, acute renal failure or cellular rejection (n = 64), and without creatinine assessments in 3 months pre-enrollment (n = 127) were excluded. The questionnaire included Euro QOL 5 Dimensions (EQ-5D), Health Utility Index III (HUI-III), Kidney Disease Quality of Life-36 (KDQOL36) which include a generic section (RAND SF-12). Data on medical conditions, therapy regimens, and biochemistry results were extracted from clinical charts. We used general linear models adjusted for demographic, socioeconomic, and clinical characteristics to assess the association between HRQOL and severity of chronic kidney disease (CKD)., Results: Patients with more advanced CKD were more likely to be African-American, covered by public insurance, more likely to have shorter time after transplantation, higher phosphorus and lower hemoglobin, serum albumin, and calcium levels. All HRQOL scales were inversely associated with CKD severity. All associations were robust to adjustment for possible confounders., Conclusions: Several health-related quality of life dimensions may be affected by poor renal function after transplantation.

Background: End-stage renal disease (ESRD) disrupts patients' life styles, interests and activities negatively affecting their quality of life. Social support has been previously associated with favorable health outcomes. However, no study has examined the association of social support from health care providers with perceived health and ESRD intrusiveness on patients' lives., Methods: A self-administered questionnaire was completed by 1,238 Italian hemodialysis patients. The Self-Rated Health (SRH) and the Illness Intrusiveness Rating Scale (IIRS) assessed disease burden. 10 items assessed social support from health care providers (SS-HC). The nursing staff of each center provided patients' clinical information. Linear regression was used to assess correlates of SRH and IIRS. Mediational analysis was used to assess direct and indirect associations of SS-HC with SRH through IIRS., Results: Higher SS-HC was associated with smaller IIRS and higher SRH. Further correlates of better SRH were younger age, no post-dialysis hypotension, no diabetes and cardiovascular diseases, better sleep quality, and smaller burden of oral therapy., Conclusions: Our results suggest that social support might reduce illness burden and improve patients' perceived health. Further research should assess the efficacy and cost-effectiveness of structured support programs for dialysis patients.

Objectives: Poor medication adherence is common in end-stage renal disease and may cause suboptimal outcomes and increased healthcare costs. We assessed the association between regimen complexity, perceived burden of oral therapy (BOT) and medication adherence in a large sample of hemodialysis (HD) patients., Methods: 1,238 HD patients in 54 Italian centers participated. Data were collected on patients' socio-demographic characteristics, perceived BOT, quality of life, healthcare satisfaction, social support and medication adherence with a self-administered questionnaire. Data on medication regimen, comorbidities, hospitalizations, and transplant listing status were provided by the nursing staff. We estimated the adjusted association of regimen complexity, BOT and medication adherence with logistic regression., Results: There were 789 (64%) men and the median age was 67 years. Mean daily burden was 9.7 tablets and 48% of patients were adherent to medication prescriptions. The number of tablets prescribed in the medication regimen was associated to adherence likelihood after adjustment for possible confounders. Perceived BOT moderated the association between tablet count and self-reported adherence., Conclusion: Poor adherence was very common in our sample. Reducing tablet burden might help patients be adherent. However, our results suggest that modulating regimen complexity might be ineffective if patients' negative attitudes toward medications are not addressed concurrently., (Copyright © 2011 S. Karger AG, Basel.)

Introduction: Delayed graft function (DGF) is a common complication in kidney transplantation. We sought to evaluate possible correlates for DGF including intraoperative parameters, focusing on fluid replacement and central venous pressure (CVP) values among patients undergoing kidney transplantation at our center., Methods: One hundred fifty-five cadaveric donor transplantations performed at our center between 2001 and 2005 were selected for the study. We compared intraoperative parameters together with 15 other clinical and socio-demographic recipient and donor variables among patients experiencing DGF (n = 58) versus those with immediate graft function (IGF; n = 97). All significant variables at P < .05 upon univariate analysis were entered into a multivariate logistic regression model to identify risk factors for DGF., Results: CVP at awakening of ≤8 mm Hg (odds ratio [OR] = 3.53; 95% confidence interval [CI], 1.63-7.63), fluid input during surgery ≤2.250 mL (OR = 2.12; 95% CI, 1.00-4.51), and recipient age ≥50 years (OR = 2.72; 95% CI, 1.11-6.68) were the strongest correlates of DGF., Conclusions: Our data suggested that reduced intraoperative perfusion as measured using CVP monitoring might increase DGF risk. This study provides the rationale to further investigate the optimal CVP target during this surgery., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: About 300,000 patients in the United States with Chronic Kidney Failure (CKF) are of working age, but up to 70% lose their job within the first year of renal replacement therapy .No study has examined how work ability and perceived health are influenced by the subjects' adjustment to their job. We assessed the association of occupational stress (Effort-Reward Imbalance, ERI),work ability (WAI) and health-related quality of life (QoL) in hemodialysis., Methods: 40 employed hemodialysis patients completed a self-administered questionnaire. Associations between ERI, short Form 12 (sF-12), short Form - 6 Dimensions (sF-6D), Kidney Disease QOL- 36 (KDQOL-36) and WAI were tested with partial Spearman's correlation adjusted for age, income, and comorbidity burden., Results: Study subjects were mainly low-income (82%), african-american (73%), men (75%); 16 were manual laborers and 9 worked in the industrial sector. Study subjects reported low levels of Occupational Stress: ERI scores indicated an imbalance between Job Efforts and Rewards in only 3 subjects. Nevertheless, ERI scores were inversely and strongly associated with WAI (rho=-0.41, p<0.012) and all QoL scales even after adjustment for known confounders., Conclusion: Our study suggests that psychosocial workplace factors may play a substantial role in modulating patients' health perception and ability to continue working. The causal relationship between Occupational stress, perceived health, and work ability should be further investigated. Occupational Health professionals and nephrologists should closely collaborate to meet the needs of occupationally active hemodialysis patients.