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The amylase beta 2-microglobulin (β2m) is a common complication of long-term hemodialysis, mainly responsible for osteo-articular manifestations including carpal tunnel syndrome (CTS). With the aim to study the various parameters involved in the increase of and determine the interest of dosage, we conducted a cross-sectional study of 104 chronic hemodialysis patients for more than 6 months. The mean age of patients was 52.82 years with a male predominance (62.5%). 61, 3% of our patients are anuric. They all have intermittent hemodialysis at 12 hours per week using a low permeability membrane in 52% of patients. The average age of dialysis layout is 42, 18 years. The mean duration of hemodialysis was 74 months. The mean serum β2m is 35, 24 mg / l. regarding complications, there were four confirmed cases of carpal tunnel syndrome and 12 deaths. Our study objectify the parameters involved in the increase of β2m: The current age, age advanced dialysis layout, lack of urine output, low permeability membrane and extended duration hemodialysis. Increased serum levels of β2m in our hemodialysis demonstrate the poor treatment of middle molecules. Its reduction can be made by improving the quality of dialysis and will avoid all the complications.

BACKGROUND: Due to the rise in the number of deaths, the hepatitis C virus remains a public health issue worldwide. During the recovery period, cytokines are known as indicators of chronic liver infection. AIM: In this study, immunological parameters were measured and calculated in chronic hemodialysis patients after more than 6 months of drug administration. METHODS: We have picked 60 patients with hemodialysis who are anti-HCV positive. ELISA and the calculation of alkaline phosphatase (ALP) were used to evaluate IP-10 and IFN-γ. RESULTS: A substantial association between variables and infected cases was found. No worth was considered for genders or age categories. CONCLUSIONS: The serum IP-10 level can be a warning primarily for patients who have taken a variety of prescriptions intermittently. In both the RPT and RST cohorts, IFN-γ serum levels are usually elevated. Serum level ALP is not a particular chronic HCV predictor.

Dialytic clearance of p-cresyl sulfate (pCS) and other protein-bound toxins is limited by diffusive and convective therapies, and only a few studies have examined how to improve their removal by adsorptive membranes. This study tested the hypothesis that high-flux polymethylmethacrylate (PMMA) dialysis membranes with adsorptive capacity increase pCS removal compared to polysulfone membranes, in a postdilution on-line hemodiafiltration (OL-HDF) session. Thirty-five stable hemodialysis patients randomly completed a single study of 4 h OL-HDF with PMMA (BG2.1U, Toray®, Tokyo, Japan) and polysulfone (TS2.1, Toray®) membranes. The primary endpoint was serum pCS reduction ratios (RRs) obtained with each dialyzer. Secondary outcomes included RRs of other solutes such as β2-microglobulin, the convective volume obtained after each dialysis session, and the dialysis dose estimated by ionic dialysance (Kt) and urea kinetics (Kt/V). The RRs for pCS were higher with the PMMA membrane than those obtained with polysulfone membrane (88.9% vs. 58.9%, p &lt, 0.001), whereas the β2-microglobulin RRs (67.5% vs. 81.0%, 0.001), Kt (60.2 ± 8.7 vs. 65.5 ± 9.4 L, p = 0.01), Kt/V (1.9 ± 0.4 vs. 2.0 ± 0.5, p = 0.03), and the convection volume (18.8 ± 2.8 vs. 30.3 ± 7.8 L/session, 0.001) were significantly higher with polysulfone membrane. In conclusion, pCS removal by OL-HDF was superior with high-flux PMMA membranes, appearing to be a good dialysis strategy for improving dialytic clearance of pCS, enabling an acceptable clearance of β2-microglobulin and small solutes.

Background We aimed to describe (1) depressive and anxiety symptom burdens reported by adults on in-centre hemodialysis in Northern Alberta, Canada and (2) patients’ and nurses’ perceptions of managing such symptoms using routine patient-reported outcome measures (PROMs). Methods A longitudinal mixed methods approach was employed. Cluster randomized controlled trial data exposed the prevalence of positive screens (scores ≥ 3) for depressive (PHQ-2) and anxiety (GAD-2) symptoms. A descriptive qualitative approach was used to understand patients’ and nurses’ perceptions of managing these symptoms using the ESAS-r: Renal and EQ-5D-5L. Using purposeful sampling, patients and nurses were invited for interviews. Field notes were documented from 6 dialysis unit observations. Patients’ responses to open-ended survey questions and nurses’ electronic chart notes related to mental health were compiled. Thematic and content analyses were used. Results Average age of patients (n = 408) was 64.0 years (SD 15.4), 57% were male, and 87% were not working; 29% screened positive for depressive symptoms, 21% for anxiety symptoms, and 16% for both. From patient (n = 10) and nurse (n = 8) interviews, unit observations, patient survey responses (n = 779) and nurses’ chart notes (n = 84), we discerned that PROMs (ESAS-r: Renal/EQ-5D-5L) had the potential to identify and prompt management of mental health concerns. However, opinions differed about whether mental health was within kidney care scope. Nonetheless, participants agreed there was a lack of mental health resources. Conclusions Prevalence of depressive and anxiety symptoms aligned with existing literature. Tensions regarding mental health management highlight the need for systemic decisions about how routine PROM use, including mental health assessment, may be optimized to meet patients’ needs.

Introduction:Secondary hyperparathyroidism is considered an unconventional risk factor of vascular calcification in hemodialysis patients (HPs). An important factor of vascular calcification is vitamin D receptor activator used in the treatment of secondary hyperparathyroidism. This study aimed to investigate the change in pulse wave velocity (PWV) and fibroblast growth factor-23 (FGF-23), Klotho, and 25-hydroxyvitamin D [25(OH)D] levels as a result of 1-year treatment with paricalcitol or calcitriol among patients undergoing chronic dialysis.Methods:Eighty HPs were included in the study, and PWV measurements were obtained at the beginning and after 1 year of treatment. Serum Klotho and 25(OH)D levels were evaluated at the end of 1-year treatment with paricalcitol or calcitriol.Results:At the end of 1 year, FGF-23 levels in the paricalcitol group were significantly lower than those in the calcitriol group. Klotho and 25(OH)D levels were significantly higher in the paricalcitol group. The PWV at the beginning of the study was statistically similar between the two groups; in contrast, PWV at 1 year was significantly lower in the paricalcitol group than in the calcitriol group (p=0.002). When the PWV change was considered as the dependent variable, the most powerful determinant in multiple regression analysis was the FGF-23 level.Conclusion:In HPs, paricalcitol has a protective effect against vascular calcification compared with calcitriol treatment, owing to its positive effects on both parathyroid hormone and calcium-phosphorus balance. Therefore, paricalcitol should be the first choice in the treatment of secondary hyperparathyroidism.

Introduction: Determination of dry weight is one of the daily goals to achieve in hemodialysis. The aim of this study was to validate the use of bioelectrical impedance analysis (BIA) in estimation of dry weight in a population of Senegalese chronic hemodialysis patients. Patients and methods: A 9-week cross-sectional study was carried out at the hemodialysis unit of Aristide Le Dantec University Hospital. Adult patients with no previous hospital history were included. The total body water (TBW) was measured with a single frequency bioelectric impedance foot-to-foot analyzer, before and after six successive hemodialysis sessions. These results were compared with those from clinical measurements with the Watson equation using a Student’s t-test and Bland-Altman analysis. Results: 264 measurements were made in 22 patients (46.6 years, 54.5% men, 92.3 months on dialysis, 62.7 kg mean dry weight). A significant reduction in weight (ΔWeight = 2.0 ± 1.1 kg; p < 0.0001) and in TBW measured by the BIA (ΔTBWBIA = 3.3 ± 1.0 liters; p < 0.0001)) or calculated by Watson’s equation (ΔTBWWatson = 0.5 ± 0.2 liter; p = 0.0001) was observed. There was a strong linear correlation and agreement between the 2 TBW measurements in pre-dialysis. In post-dialysis the concordance diagram indicated a bias = –2.2 and wide agreement limits. Conclusion: The BIA allows reproducible and reliable measurements and a fair estimate of the TBW in pre-dialysis.

Background: Aortic valve sclerosis (AVS) is a serious public health issue, particularly among the elderly. It is linked to higher rates of acute cardiovascular events. In addition, cardiovascular diseases are common in chronic hemodialysis patients. Objective: To find out the prevalence of AVS in chronic hemodialysis patients and assess risk factors for AVS in these patients. Patients and Methods: The research involved 58 chronic hemodialysis patients from December 2019 to December 2020. They were categorized into group 1 (22 subjects) who did not have AVS and group 2 (36 subjects) who had AVS. Demographic data were gathered from all patients. Laboratory investigations and echocardiographic examinations were done for all the subjects. Results: Group 2 was older than group 1 (p = 0.002). In addition, diastolic blood pressure (DBP) was higher in group 1 than in group 2 (p = 0.011). In contrast, group 2 had lower serum creatinine, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) than group 1 (p = 0.049, p = 0.038, p = 0.01, and p = 0.01, respectively). On multivariate regression analysis, greater age (p = 0.014), lower DBP (p = 0.049), and lower MCH (p = 0.011) were significantly predictive of AVS. Conclusion: 37.9% of hemodialysis patients had AVS in this study and the predictors for AVS included older age, lower DBP, and lower MCH.

Background: Hemodialysis is the most common method used to treat advanced and permanent kidney failure. Identifying stressors, self-efficacy and coping strategies used by patients undergoing hemodialysis may help nurses and health care providers to gain a clearer understanding of the condition of these patients and thus, institute effective care planning. Aim: Assess relation between stressors, coping strategies and self-efficacy among patients undergoing hemodialysis. Subjects and method: Design: A descriptive correlational research design was used. Subjects: This study implemented among 100 hemodialysis patients. Setting: The study was carried out in hemodialysis unit at El-Salam Hospital in Port-Said city, Egypt. Tools: Three tools were utilized to collect data for this study including; Hemodialysis Stressor Scale, Self-Efficacy for Managing Chronic Disease6-itemScale and Coping Strategies Scale. Results: Most prominent increase in percent score among all stressors associated with chronic hemodialysis treatment was related to social life. Patients were adaptive with stressors by the use of affective-oriented coping strategies more than problem-oriented coping strategies, nearly two thirds of the studied patients had low level of self-efficacy. Conclusion &Recommendations: There were statistically significant negative correlations between total scores of coping strategies, self-efficacy and stressors among the studied patients. While, there was a statistically significant positive correlation between total scores of coping strategies and self-efficacy. So, Continuous educational programs should be held by health professionals for patients about proper coping methods, problem solving strategies and stress management techniques to alleviate stressors associated with chronic hemodialysis treatment and maintain compliance to treatment regimen. This will empower their self-efficacy.

Background: While COVID-19 in chronic hemodialysis patients has high mortality and the pandemic will not end in the near future, effective follow up strategies should be implemented for these patients. Surgeries have been triaged according to their level of urgencies and arteriovenous fistula (AVF) operations were among elective surgeries. This study aimed to analyze the effect of vascular access on the outcomes of hemodialysis patients who had COVID-19. Methods: One hundred four hemodialysis patients who had COVID-19 were retrospectively analyzed. Seventy-two of them had AVF as the vascular access while 32 of them had tunneled catheters. Inflammatory markers and outcomes of patients with AVFs and catheters were compared. A logistic regression analysis was performed in order to define factors that contribute to better outcomes in hemodialysis patients. Results: COVID-19 had high mortality rate in hemodialysis patients (36.5%). Patients with catheters have higher peak ferritin levels ( p = 0.02) and longer hospital stay ( p = 0.00). Having AVF as the vascular access (OR = 3.36; 95% CI: 1.05–10.72; p = 0.041) and using medium cut-off dialyzers (OR = 7.99; 95% CI: 1.53–41.65; p = 0.014) were related to higher survival of the patients. COVID severity was inversely proportional to the survival ( p = 0.000) Conclusions: AVFs contribute to higher survival of hemodialysis patients with COVID-19. Even in the pandemic era, end stage renal disease patients should be given the opportunity to have their vascular access properly created.

Introduction. Vascular access complications are associated with about 30% of patient hospitalizations, and annual costs of vascular access maintenance account for 14–20% of total healthcare costs for dialysis patients. At the same time, current international clinical guidelines emphasize the need to implement a patient-centered approach with planning of possible vascular access complications and selection of optimal surgical interventions (risk/benefit balance) for correction of compromised access.Aim. To present the first experience of endovasal laser obliteration of arteriovenous fistulas for correction of venous hypertension syndrome.Materials and methods. The first experience of complicated arteriovenous fistulas liquidation using endovasal laser obliteration in 6 patients receiving hemodialysis replacement therapy for stage 5 chronic kidney disease (National kidney Foundation (NkF) classification) is presented. In 5 patients due to the presence of venous hypertension of the upper extremity, where the arteriovenous fistula functioned, open intervention was unacceptable because of the high risk of bleeding. In one patient the arteriovenous fistula was closed due to its aneurysmatic transformation. we performed endovasal laser obliteration of four Cimino-type radial artery-cephalic arteriovenous fistulas, one brachial-basilar arteriovenous fistula, and one brachial-cubital arteriovenous fistula. Endovasal laser obliteration was performed with an endovascular light guide under ultrasound navigation using tumescent anesthesia. we used a laser device with a wavelength of 1.56 µm and power of 15 w, working in continuous mode (time 2–4 min, energy density 500 to 1,000 J/cm). The average diameter (Me) of the fistula vein was 8 mm.Results. The course of the early postoperative period in all patients was uncomplicated. The follow-up period was 30 days. Symptoms of venous hypertension were eliminated in all patients, the pain syndrome disappeared completely, there were slight feelings of heaviness and fullness of the limb.Discussion. Experience has shown that standard modes used for varicose vein obliteration for elimination of arteriovenous fistulas in chronic renal failure are ineffective: under conditions of blood flow in the area of arteriovenous anastomosis the energy density is almost 10 times higher. Therefore, other modes were used in our study: energy density from 500 to 1,000 J/cm. This was due to the lack of coagulation of the fistula vein when using standard parameters due to high blood flow rate, despite the use of proximal and distal vascular compression. In all cases we obtained positive results (obliteration of arteriovenous fistulas) without complications along with the correction of venous hypertension within 1 month after the intervention.Conclusion. The advantages of this method are technical simplicity and minimal blood loss, which is especially important for this cohort of patients with initial anemia against chronic renal failure.

Background: Left ventricular (LV) global longitudinal strain (GLS) is a reliable determinant of LV systolic function. The precise relationship between LV wall stress and serum brain natriuretic peptide (BNP) concentrations in hemodialysis (HD) patients require clariϐication. BNP levels are raised in patients with endstage renal disease (ESRD) and could reflect LV impairment amongst HD patients. Objective: This study sought to evaluate the clinical utility of LV–GLS, wall stress and serum BNP levels in chronic HD patients. The correlations between BNP levels with both LV wall stress and LV–GLS were assessed. Methodology: A total of 30 ESRD patients on regular HD – divided into 15 patients with LV ejection fraction (EF) 50% – and 15 agematched healthy subjects were assessed. LV function and structure were measured using conventional echocardiography, including LV meridional wall stress (LVMWS), LV mass index (LVM I) and two-dimensional speckle tracking echocardiography for determination of LV–GLS. Serum BNP levels were evaluated after HD sessions. Results: There were significant increases in LVM SW (189.2 ± 81 vs. 72.2 ± 20.6 dynes/cm 2 2 1000, P < 0.0001), higher levels of BNP (1238 ± 1085.5 vs. 71 ± 23.4 pg/ml, P 50%. Serum levels of BNP were positively correlated with LVM I (r = 0.896, P < 0.0001) and LVMW S (r = 0.697, P < 0.0001), but negatively correlated with LV–GLS (r = 0 0.587, P < 0.0001). Conclusion: LV–GLS and LVMWS are useful imaging markers for detection of LV dysfunction in HD patients. Serum BNP level is influenced by LV structural abnormalities, being regarded as a crucial hemodynamic biomarker in those patients.

Pain is one of the major problems in haemodialysis patients. Regular resistance exercise (RE), as an effective lifestyle modification, may play a role in reducing pain through changes in blood pressure (BP). Therefore, we aimed to evaluate the effect of RE training on pain, BP, and heart rate. In a randomised controlled trial, eighteen sedentary women completed the study in RE (n=10) or control (n=8) groups. In the exercise group, the patients had a circuit RE program in non-dialysis days, two times a week, for six weeks. The RE protocol consisted of six exercises performing with 10 repetitions at 50-60% of 1-repetition maximum. Resting and intradialytic pain threshold (algometer using a 1 kg pressure load), BP, and heart rate were measured 48 h before and after the intervention. There were no significant differences from pre- to post-intervention, or between the groups regarding pain threshold, systolic and diastolic BP, and heart rate at rest and during the haemodialysis process (P>0.05). Although the 6-week low-intensity RE training in non-dialysis days was safe for chronic haemodialysis women, it could not change resting and intradialytic pain and hemodynamic measures.

The determination of Kt/V by ionic dialysance is a technique that has extended its use in hemodialysis clinics. The clinical guidelines have reflected the need to validate this method as a determinant of the dose of dialysis.Determine in daily practice, the influence of hemodialysis characteristics and medication on Kt/V results by ionic dialysance (Kt/V OCM) and compare them with Kt/V measures by serum urea (Kt/V Daugirdas).Cross-sectional and observational study.127 patients on chronic hemodialysis.Descriptive variables, study variables (Kt/VOCM, Kt/VDaugidas), and the variables that modified the effect (patient temperature, serum sodium, vascular access, recirculation, blood flow, hemodialysis technique, dialyzer, acid concentrate, conductivity, dialyzate flow).The mean of Kt/V Daugirdas was 1.84 and the Kt/VOCM mean 1.65; Pearson's was CC r=0.54; P0.001 and Lin CCC=0.48. In the linear regression, the variables related to hemodialysis technique showed no statistical association with the measurement obtained by Kt/VOCM. Monosodium phosphate and 20% sodium chloride dispensing were associated with a higher Kt/VOCM.The different technical aspects noted during HD sessions do not influence Kt/V OCM outcomes. Kt/V determined by ionic dialysance isn't similar to that determined by serum urea. When assessing dialysis doses measured by dialysance, consider that it is not the same as determined with serum urea, but it provides an approximation to estimate dialysis doses in real time. It is necessary to consider if drugs or supplements have been administered that can modify it when interpreting the results.

Background and aims Occult hepatitis C infection is defined as the presence of hepatitis C virus RNA in peripheral blood mononuclear cells (PBMC) ± hepatocytes in the absence of HCV-RNA in serum. It has been a lot of debate and controversy in recent years and not discussed well. This issue has not been discussed or investigated in Egypt, especially in patients on hemodialysis in Ismailia. This study is the first one to investigate the prevalence of occult HCV infection in large populations of chronic hemodialysis (CHD) patients in Ismailia, Egypt. Methods Our study is cross-sectional analytic and included 204 CHD patients; who are negative for HCV infection. Sensitive commercial real-time assay was used to detect HCV-RNA in PBMC. In our study, the presence of genomic HCV-RNA in PBMCs of all these patients was detected by real-time PCR. On the other hand, 22 patients on hemodialysis with an established diagnosis of chronic hepatitis C virus infection were included as a control group and examined by real-time PCR was used to evaluate HCV infection. Results Occult HCV infection is defined as the presence of HCV-RNA in PBMNCs in patients on chronic hemodialysis, and it was found in 14/204 (7%) of the patients. Patients who were on CHD for a longer time are susceptible to occult HCV infection, and their mean alanine aminotransferase levels are significantly higher during the last 3 months before study entry. In comparison, chronic HCV patients have elevated bilirubin, aspartate transferase and alanine transferase than occult HCV infection. Conclusions The prevalence of occult HCV infection was 7% in our CHD patients. No available data are showing the virulence of this form of virus. However, further studies in other geographic populations with high HCV endemicity are needed to clarify the significance of occult HCV infection in these patient groups, in addition to test for the presence of negative antigenomic strand to confirm or disconfirm the reliability of occult HCV.

The article deals with the problem of diagnosing obesity in patients with end-stage renal failure receiving treat-ment with programmed hemodialysis. The aim of the work was to study the indicators of the information content of various methods for diagnosing obesity among dialysis patients. The objective of the study was to compare the sensitivity and specificity of such methods for diagnosing obesity as BMI, OT / OB index, BAI, electronic caliperom-etry, bioimpedance measurement. The possibility of prac-tical application of the study is to optimize the approach to methods of diagnosing obesity in dialysis patients.

ZusammenfassungEs wird über einen 35-jährigen Dialysepatienten nach Herztransplantation berichtet, der eine „pure red cell aplasia“ aufwies. Serologisch fand sich ein positiver Parvovirus-B19-Immunglobulin-M-Titer, im Direktnachweis mittels Polymerase-Kettenreaktion zeigten sich 80 Mrd. IU/ml. In der zytologischen Untersuchung des Knochenmarks gelang der Nachweis von Riesenproerythroblasten, pathognomonisch für eine Parvovirus-B19-Infektion. Zur Therapie erfolgte die hoch dosierte Gabe von Immunglobulinen über 5 Tage. Bei Wiedervorstellung nach vier Wochen zeigte sich die Anämie deutlich gebessert. Bei Patienten nach Organtransplantation mit hyporegenerativer Anämie sollte eine Parvovirus-B19-Infektion stets ausgeschlossen werden.

International audience; Introduction. - There is no feasible benchmark in daily routine to estimate the hydration status of haemodialysis patients, which is essential to their management. Objective. - We performed a study in haemodialysis patients to assess the diagnostic performance of pulmonary ultrasound and clinical examination for the evaluation of fluid overload using transthoracic echocardiography as a gold standard.Methods. - Thirty-one patients receiving chronic haemodialysis patients were included. Evaluation of hydration status was assessed weekly before haemodialysis sessions using clinical and Echo Comet Score from pulmonary ultrasound and transthoracic echocardiography (reference method).Results. - Five patients had a transthoracic echocardiography overload. Compared with transthoracic echocardiography, the diagnostic performance of the clinical overload score has a sensitivity of 100%, a specificity of 77%, a positive predictive value of 50% and a negative predictive value of 100% with a k of 0.79. Only orthopnoea (P = 0.008), jugular turgor (P = 0.005) and hepatic-jugular reflux (P = 0.008) were significantly associated with transthoracic echocardiography overload diagnosis. The diagnostic performance of Echo Comet Score by pulmonary ultrasound has a sensitivity of 80%, a specificity of 58%, a positive predictive value of 26% and a negative predictive value of 94%. Ten patients (32.3%) had an increase of extravascular pulmonary water without evidence of transthoracic echocardiography or clinical overload.Conclusions. - Our clinical score has a convincing diagnostic performance compared to transthoracic echocardiography and could be easily used in daily clinical routine to adjust dry weight. The evaluation of the overload using pulmonary ultrasound seems poorly correlated with the overload evaluated by transthoracic echocardiography. Extravascular pulmonary water undetected by clinical examination and transthoracic echocardiography remains a parameter that requires further investigation. (C) 2020 Societe francophone de nephrologie, dialyse et transplantation.

Background We aimed to analyze the success rates and the access patency rates at 12 months between patients on chronic hemodialysis with symptomatic central venous stenosis (CVS) or occlusion (CVO), receiving high or low balloon inflation pressure for treatment. Methods We performed a retrospective study in which angioplasty balloons were inflated using a low-pressure or a high-pressure for the management of hemodialysis patients with CVS/CVO. The outcomes of this study were the success rate and the access patency rates at 12 months after balloon angioplasty, and the differences between groups were compared. Results We included a total of 74 patients on hemodialysis and assigned them to the low-pressure or the high-pressure groups. Success rates in patients of the high-pressure group (94.12%) were higher than those in patients of the low-pressure group (67.50%) (p = 0.005). With a total of 59 patients with technical success, at 6 and 12 months after angioplasty, the rates of access patency in the low-pressure group were 68 and 48%, respectively; on the other hand, the primary patency rates in the high-pressure group were 86.67% (6-months) and 76.67% (12-months). The 6 and 12 months post-interventional patency rates were higher in patients of the high-pressure group than those in patients of the low-pressure group (p = 0.10 at 6 months and p = 0.03 at 12 months). Conclusions Compared to balloon angioplasty using a low inflation pressure, hemodialysis patients with CVS/CVO receiving angioplasty using a high inflation pressure have significantly higher technical success and 12-month patency rates.

Aim To analyze changes in saliva flow rate and clinical measures from unstimulated whole saliva (UWS) among patients undergoing hemodialysis for end-stage kidney disease (ESKD). Background Chronic hemodialysis causes changes in blood chemistry as well as dry mouth, due to removal of excess fluids. UWS is used to examine saliva flow rate as an indicator of mouth dryness. Whether UWS can be used to measure changes in clinical variables following hemodialysis has not been explored. Design A cross-sectional quantitative study. Methods Patients with ESKD were recruited by purposive sampling (n = 100) between 1 January and 30 June 2015 from a hospital in northern Taiwan. UWS was collected 1-hour pre-dialysis (T1), mid-dialysis (T2), and 1-hour post-dialysis (T3). Saliva flow rate and clinical variables were analyzed. Results Saliva flow rate increased significantly from T1 to T3 (Wald χ2 = 10.40, p

Background While systemic anticoagulation is most widely used in haemodialysis (HD), contraindications to its use might occur in particular settings. The Solacea™ haemodialyser with an asymmetric triacetate membrane claims improved biocompatibility and has already shown promising results when used in combination with only half dose of anticoagulation. To quantify the performance of the Solacea™ when further decreasing anticoagulation to zero, fibre blocking was assessed by micro-computed tomography (micro-CT). Methods Ten maintenance HD patients underwent six dialysis sessions at midweek using a Solacea™ 19H dialyser, consecutively in pre-dilution haemodiafiltration (pre-HDF), HD and post-dilution HDF (post-HDF). After the first three sessions with only a quarter of their regular anticoagulation dose (one-quarter), the last three sessions were performed without anticoagulation (zero). Dialyser fibre blocking was quantified in the dialyser outlet potting using a 3D micro-CT scanning technique post-dialysis. Results Even in case of reduced (one-quarter) anticoagulation, the relative number of open fibres post-dialysis was almost optimal, i.e. 0.96 (0.87–0.99) with pre-HDF, 0.99 (0.97–0.99) with HD and 0.97 (0.92–0.99) with post-HDF. Fibre patency was mildly decreased for pre-HDF and HD when anticoagulation was decreased from one-quarter to zero, i.e. to 0.76 (0.61–0.85) with pre-HDF (P = 0.004) and to 0.80 (0.77–0.89) with HD (P = 0.013). Comparing the results for zero anticoagulation, post-HDF [i.e. 0.94 (0.82–0.97)] performed as well as HD and pre-HDF. Conclusions The Solacea™ dialyser provides promising results for use in conditions where systemic anticoagulation is contraindicated. Post-HDF, although inducing haemoconcentration in the dialyser, is equally effective for fibre patency in case of zero anticoagulation as pre-HDF and HD when using Solacea™.

Background The aim of this study was to evaluate the midterm results of a brachio-axillary arteriovenous graft (BA-AVG) for the provision of vascular access haemodialysis patients. Materials and methods A cohort retrospective consecutive single-centre study of 46 patients undergoing BA-AVG using the Gore Acuseal, from November 2015 to October 2019 was conducted. Data on patient demographics, comorbidities, medical therapy, and complications were collated for the initial endpoints of primary patency, primary assisted patency, and secondary patency. A subgroup analysis included outcomes in patients over 70 years old and events (complications) per AVG per year. Data were subjected to Kaplan-Meier survival estimator with log-rank analysis and test of probability. Results The mean age of the cohort was 63.5 years with male predominance (male, n = 27, 59%). A total of 37 (80%) patient procedures were conducted with elective settings as well as on an emergency basis with a 91.3% technical success rate. The most common complication was grade I steal syndrome (8.7%), followed by graft infections (4.3%), median nerve neuropraxia (4.3%), and postoperative bleeding (2%), demonstrating a 0.1 per AVG complication per 2 years. Median primary patency, primary assisted patency, and secondary patency over a mean follow-up period of 28 months was 5.5, 12.5, and 18 months, respectively, with no associated 30-day mortality. Conclusion BA-AVG with midterm longevity and low complications may serve as an alternative access type when a suitable site is not identified. The AVG patency rate in the elderly or patients with limited life expectancy is promising. However, more robust data are needed to confirm the benefit of AVG in this cohort., Highlights • This series showed that Gore® Acuseal graft can be used as vascular access option in ESRD patients on chronic haemodialysis. • It has reasonable technical success rate comparable to other synthetic access grafts and low complications rates in mid to long-term follow up. • Sub-groups analysis included outcome in patients over 70 years old and events (complications) per AVG per year. • AVG patency rate in elderly or patients with limited life expectancy is promising. However, more robust data needed.

The aim of this study was to determine the effect of motivational interviewing (MI) on adherence to treatment and quality of life in chronic hemodialysis patients. This study was conducted with a randomized controlled pretest, posttest, and follow-up design from March to July 2016 in the hemodialysis center. After the intervention ( n = 30) and control groups ( n = 30) completed a pretest, patients in the intervention group received four individual face-to face MI sessions per month. Then both groups participated in a posttest, 3 months after which a follow-up was conducted. A significant increase in adherence to treatment (according to both subjective and objective data) was observed in the experimental group compared to the control group. No significant difference was found between the two groups in their quality of life scores; however, within the experimental group, there was a significant increase in these scores between the posttest and the 3-month follow-up.

Primary hyperoxaluria (PH) is a rare autosomal recessive metabolic disorder where serum oxalate levels rise due to overproduction. The kidney tubule is a main target for oxalate deposition, resulting in damage to the organ. Kidney failure is rare in these patients. We present a 67-year-old female with hemodialysis-dependent end-stage renal disease likely due to PH type 2 or 3. With extremely high levels of serum oxalate (60.4 μmol/L), this patient had minimal treatment options for her rare disease. This report details a unique presentation of a rare disease where kidney biopsy was instrumental.

Background: The factors associated with the inability to start hemodialysis with an arteriovenous fistula (AVF) in chronic kidney disease patients are not fully understood. Aim: Evaluating factors associated with type of vascular access at the first chronic hemodialysis and at 1 year after it. Methods: The study cohort includes patients registered in the Regional Dialysis and Transplant Registry of Lazio undergoing first hemodialysis between 2008 and 2015. Logistic regression models were used to evaluate the association between socio-demographic, clinical and care/organizational factors, and vascular access at first hemodialysis. Cox regression models were used to assess the odds of switching to AVF during the first year of hemodialysis among patients starting dialysis with central venous catheter (CVC). Results: In the cohort of 6208 incident hemodialysis patients, 52.7% had an AVF and 47.3% had a CVC. Among the 2939 incident patients with CVC, 27.4% switched to FAV after 1 year. A higher probability of starting dialysis with AVF was observed among males (OR = 1.83; 95% CI 1.63–2.06), while a lower probability was observed among patients aged >85 years (OR 0.64; IC 95% 0.51–0.80). Patients with early referral to a nephrologist had a triple probability of start dialysis with AVF. We observed a higher odds of switch to AVF among males (HR = 1.62; 95% CI 1.40–1.89) and a lower odds among patients over 65 years. Conclusion: The observed high rate of AVF at the start of hemodialysis and of the switch from CVC to AVF in the first year, although declining since 2008, is a positive outcome. However, over one-third of patients maintain the CVC as vascular access for the first year because of unmodifiable factors, such as gender, age, comorbidity. The present study suggests that logistics/management and assistance/welfare problems may contribute to the delay or lack of AVF placement in incident hemodialysis patients or within the first year of dialysis.

Background Patients with ESKD who are on chronic hemodialysis have a high burden of comorbidities that may place them at increased risk for adverse outcomes when hospitalized with COVID-19. However, data in this unique patient population are limited. The aim of our study is to describe the clinical characteristics and short-term outcomes in patients on chronic hemodialysis who require hospitalization for COVID-19. Methods We performed a retrospective study of 114 patients on chronic hemodialysis who were hospitalized with COVID-19 at two major hospitals in the Bronx from March 9 to April 8, 2020 during the surge of SARS-CoV-2 infections in New York City. Patients were followed during their hospitalization through April 22, 2020. Comparisons in clinical characteristics and laboratory data were made between those who survived and those who experienced in-hospital death; short-term outcomes were reported. Results Median age was 64.5 years, 61% were men, and 89% were black or Hispanic. A total of 102 (90%) patients had hypertension, 76 (67%) had diabetes mellitus, 63 (55%) had cardiovascular disease, and 30% were nursing-home residents. Intensive care unit (ICU) admission was required in 13% of patients, and 17% required mechanical ventilation. In-hospital death occurred in 28% of the cohort, 87% of those requiring ICU, and nearly 100% of those requiring mechanical ventilation. A large number of in-hospital cardiac arrests were observed. Initial procalcitonin, ferritin, lactate dehydrogenase, C-reactive protein, and lymphocyte percentage were associated with in-hospital death. Conclusions Short-term mortality in patients on chronic hemodialysis who were hospitalized with COVID-19 was high. Outcomes in those requiring ICU and mechanical ventilation were poor, underscoring the importance of end-of-life discussions in patients with ESKD who are hospitalized with severe COVID-19 and the need for heightened awareness of acute cardiac events in the setting of COVID-19. Elevated inflammatory markers were associated with in-hospital death in patients with ESKD who were hospitalized with COVID-19.

Background/Purpose Sarcopenia is prevalent in chronic hemodialysis patients. This prospective cohort study evaluated the impact of sarcopenia and its diagnostic criteria on hospitalization and mortality in 126 chronic hemodialysis patients. Methods Skeletal muscle mass, handgrip strength (HGS), gait speed, and blood parameters were assessed. Sarcopenia was evaluated using the criteria of the European Working Group on Sarcopenia in Older People and the Taiwanese criteria for Sarcopenia. Muscle quality was defined as HGS divided by mid-arm muscle circumference. Results Prevalences of uremic sarcopenia were 8.7% and 13.5% according to Taiwanese and European criteria, respectively. Low HGS and gait speed were much more prevalent than low muscle mass. Within 3 years, 79 (62.7%) patients were hospitalized and 26 (20.6%) died. Low HGS and slow gait speed were associated with hospitalization and mortality, while sarcopenia was associated with mortality but not with hospitalization. Notably, in our patients without sarcopenia, close associations between increased hospitalization and mortality risk with low HGS and slow gait speed remained unchanged. In Cox proportional hazard analysis, muscle quality [hazard ratio (HR) = 0.42, 95% confidence interval (CI) = 0.19–0.93, p = 0.032] and serum creatinine (HR = 0.82, 95% CI = 0.71–0.95, p = 0.009) were independently associated with composite outcome of hospitalization or death. Conclusion Muscle functionality and quality can predict hospitalization and overall survival in chronic hemodialysis patients, better than muscle mass.

Prof. Peter Ivanovich was born in Tacoma, Washington, USA on November 9, 1928, and died in Chicago on November 16, 2019. After being educated by the father of chronic hemodialysis, Belding Scribner, in Seattle, P. Ivanovich devotes himself to the study of hemodialysis and its treatment in patients with chronic terminal renal failure. From 1971 he worked at the Northwestern University School of Medicine in Chicago where he created a hemodialysis unit at the Veteran Affairs Hospital. In the well-equipped hemodialysis unit, the latest hemodialysis techniques were studied and new drugs were tested. Numerous doctors from all over the world, as well as from Macedonia, visited and researched at the unit with P. Ivanovich. P. Ivanovich has frequently visited Macedonia and the former Yugoslavia, where he participated with his lectures. He helped in the development of nephrology in the Balkan Peninsula. Significant is his participation in the First Scientific Meeting of the Nephrologists of Yugoslavia, Struga, 26-28. IX 1977 and in the creation of BANTAO in Ohrid on 9. IX 1993 - during the First Congress of the Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs. Prof. P. Ivanovich is in the lasting memory of the nephrologists of North Macedonia as a renowned nephrologist, cosmopolitan and friend of patients and doctors.

Infective endocarditis is a serious septic disease, and the epidemiological profile has changed over the last decade. However, there is a paucity of data regarding the current outcome and predictor of in-hospital mortality in patients with infective endocarditis.Consecutive patients diagnosed as infective endocarditis based on the modified Duke criteria at Kansai Medical University hospital from January 2006 to June 2019 were prospectively included. The primary outcome was in-hospital mortality. Cox proportional hazards modelling was used to assess risk factors of in-hospital mortality.Of 137 consecutive patients with infective endocarditis (age 60 ± 17 years-old, 62% men, 65% underlying cardiac disease, 11% chronic haemodialysis), 18 (13%) died during hospitalisation. Age and sex were not associated with in-hospital mortality. Patients on chronic haemodialysis exhibited significantly higher in-hospital mortality rate than those without (47 vs. 9%). After adjusting for comorbidities in a multivariate Cox proportional hazards model, chronic haemodialysis was a significant predictor of in-hospital mortality [hazard ratio (HR) 4.22, 95% confidential interval (CI): 1.49-12.0,Infective endocarditis in patients on chronic haemodialysis is a serious life-threatening condition that requires early diagnosis and an effective therapeutic approach.

Background End-stage renal disease yields susceptibility to both ischemia and bleeding. The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is not established in dialysis patients, who are usually excluded from randomized studies. Since recent studies implied the benefits of prolonged DAPT >12 months in chronic kidney disease, we investigated the effectiveness and safety of prolonged DAPT in dialysis patients with higher cardiovascular risks. Methods In this nationwide population-based study, we analyzed dialysis patients who underwent DES implantation from 2008 to 2015. Continued DAPT was compared with discontinued DAPT using landmark analyses, including free-of-event participants at 12 (n = 2246), 15 (n = 1925) and 18 months (n = 1692) after DES implantation. The primary outcome was major adverse cardiovascular events (MACEs): a composite of mortality, nonfatal myocardial infarction, coronary revascularization and stroke. Major bleeding was a safety outcome. Inverse probability of treatment weighting Cox regression was performed. Results Mean follow-up periods were 278.3–292.4 days, depending on landmarks. Overall, incidences of major bleeding were far lower than those of MACE. Continued DAPT groups showed lower incidences of MACE and higher incidences of major bleeding, compared with discontinued DAPT groups. In Cox analyses, continued DAPT reduced the hazards of MACE at the 12- [hazard ratio (HR) = 0.74, 95% confidence interval (CI) 0.61–0.90; P = 0.003], 15- (HR = 0.78, 95% CI 0.64–0.96; P = 0.019) and 18-month landmarks (HR = 0.79, 95% CI 0.63–0.99; P = 0.041), but without a significant increase in major bleeding at 12 (HR = 1.39, 95% CI 0.90–2.16; P = 0.14), 15 (HR = 1.13, 95% CI 0.75–1.70; P = 0.55) or 18 months (HR = 1.27, 95% CI 0.83–1.95; P = 0.27). Conclusions Prolonged DAPT reduced MACE without significantly increasing major bleeding in patients who were event-free at 12 months after DES implantation. In deciding on DAPT duration, prolonged DAPT should be considered in dialysis patients.

Background Hepatitis C virus infection is one of the main causes of chronic liver disease worldwide. Both chronic hepatitis C and chronic kidney disease are common and serious diseases; this work aimed to determine the clinical impact of HCV infection on malnutrition inflammation index score in chronic kidney disease patients. This study was conducted on 96 patients on haemodialysis. They were divided into two groups. The first group was composed of 46 patients who were on maintenance haemodialysis and had chronic hepatitis C. The second group was composed of 50 patients on haemodialysis who were negative for hepatitis C. Results HCV-infected patients were associated with higher malnutrition inflammation score values (10% had MIS 16–20) compared to non-infected patients (2% only had MIS 16–20). Conclusion The prevalence of malnutrition was higher in the HCV-positive than the HCV-negative group.

Background and aims Cardiovascular disease (CVD) is common in patients with end-stage renal disease (ESRD) on hemodialysis (HD). However, antithrombotic therapy to prevent CVD increases the risk of bleeding. We aimed to investigate the prevalence of CVD and the practice patterns of antithrombotic agents in patients with ESRD on HD. Methods In a cross-sectional population based cohort of chronic HD patients (n = 626) from Vienna, Austria, the medical histories of patients and use of antithrombotic treatment were recorded, and the distribution of antithrombotic therapies for primary (n = 260, 41.5%) or secondary (n = 366, 58.5%) prevention of CVD was analyzed. Results Single antiplatelet therapy (SAPT) was used in 234 patients (37.4%), dual antiplatelet (DAPT) in 50 (8.0%), combination of anticoagulation and antiplatelet in 59 (9.4%), anticoagulation monotherapy in 78 (12.5%), and no antithrombotics in 205 patients (32.7%). The prevalence of CVD was 58.5%. In primary CVD prevention, 23.5% (n = 61) of patients were treated with SAPT. For secondary prevention, SAPT was used in 173 (47.3%), DAPT in 49 (13.4%), and dual antithrombotic therapies in 50 patients (13.7%), while 55 (15.0%) patients received no antithrombotics. Age (odds ratio [OR] per 1 year increase 0.96, 95%CI 0.94–0.99, p = 0.004) and hereditary nephropathy (OR 4.13, 95%CI 1.08–15.78, p = 0.038) were independently associated with the absence of antithrombotic therapy in secondary CVD prevention. Conclusion The majority of patients did not receive antithrombotic therapy for primary prevention. Only 15% did not receive antithrombotic agents in the secondary prevention setting. The net-clinical benefit of antithrombotic therapy in ESRD needs to be determined.

Introduction: Chronic hemodialysis (HD) patients are considered to be at high risk for infection. Here, we describe the clinical outcomes of chronic HD patients with influenza A (H1N1) infection and the strategies adopted to control an outbreak of influenza A in a dialysis unit. Methods: Among a total of 62 chronic HD patients, H1N1 infection was identified in 12 (19.4%). Of the 32 staff members, four (12.5%) were found to be infected with the H1N1 virus. Outcomes included symptoms at presentation, comorbidities, occurrence of hypoxemia, hospital admission, and clinical evaluation. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction. Results: The 12 patients who had H1N1 infection did not differ significantly from the other 50 non-infected patients with respect to age, sex, dialysis vintage, dialysis modality, or proportion of comorbidities. Obesity was higher in the H1N1-infected group (41.5 vs. 4%, p

Background: In Chile there are 22,310 people in Chronic Hemodialysis (CHD), 53% of them older adults (OA). Shared decision-making and advance directives (AD) are especially important in OA with end-stage chronic renal failure, since they have greater levels of disability, morbidity and mortality, raising doubts about the benefit of therapy. Aims: To understand the experience in decision making and explore ways to express AD, in OA in CHD. Material and Methods: A qualitative phenomenological study, performing 12 in-depth interviews to OA who had been at CHD for at least one year. Results: The analysis revealed four broad comprehensive categories, two related to participation in the decision to enter CHD, namely the experience of subjects as spectators and their lack of interest for decision support and two referred to the expression of AD, namely the difficulty in facing their own finitude and resistance to express AD. Conclusions: There is little participation of older adults in the decision about their admission to dialysis therapy, and once they enter the CHD program they are not prepared to discuss AD in general, nor an eventual suspension of dialysis in particular.

Thirst has been defined as "the sensation that leads animal's and human's actions toward the goal of finding and drinking water" or as "any drive that can motivate water intake, regardless of cause". Thirst, together with xerostomia, is the main cause of poor adherence to fluid restriction and of excessive intake of fluids in patients on chronic hemodialysis, and consequently of high interdialytic weight gain. Interdialytic weight gain (IDWG) should be lower than 4.0-4.5% of dry weight. Unfortunately, many patients have an IDWG greater than this value and some have IDWG of 10-20%. High IDWG is associated with a higher risk of all-cause and cardiovascular death and increased morbidity, such as ventricular hypertrophy and major adverse cardiac and cerebrovascular events. In addition, high IDWG leads to supplementary weekly dialysis sessions with consequent deterioration of quality of life and increased costs. Thus, the knowledge of thirst in patients on chronic hemodialysis is essential to prompt its adequate management to limit IDWG in the routine clinical practice. The present review aims to describe the physiology of thirst in patients on chronic hemodialysis, as well as the prevalence, its measures, the associated variables, the consequences, and the strategies for its reduction.

Current guidelines recommend complete extraction of cardiovascular implantable electronic devices (CIEDs) in the case of persistent or recurrent fungemia without other identifiable sources, though supporting evidence is lacking. We sought to evaluate the prognosis of patients with candidemia and CIEDs. Twelve consecutive patients (54 ± 12 years, 8 male) with CIED and concurrent candidemia were reviewed. At the time of diagnosis with candidemia, seven patients were immunocompromised, six were on long-term antibacterial therapy, two were intravenous drug users, four were on chronic hemodialysis, and six had a central venous catheter. Four patients were confirmed as definite CIED infection as vegetation was visible on lead by echocardiogram. The other 8 patients were considered possible CIED infection with candidemia of unknown focus. All patients with visible vegetation underwent CIED removal without complications, and other patients were initially managed non-operatively. After 1 year of follow-up, 7 patients had died and at extended follow-up, all patients without lead removal died while 3 of 4 patients with lead extraction survived. Of note, 50% of deaths in the patients without lead removal were associated with fungal sepsis. Candida fungemia is associated with a high mortality. CIED removal should be an early consideration in these patients even if lead vegetations are not seen.

Background Pre-dialysis systolic blood pressure (pre-HD SBP) and peridialytic SBP change have been associated with morbidity and mortality among hemodialysis (HD) patients in previous studies, but the nature of their interaction is not well understood. Methods We analyzed pre-HD SBP and peridialytic SBP change (calculated as post-HD SBP minus pre-HD SBP) between January 2001 and December 2012 in HD patients treated in US Fresenius Medical Care facilities. The baseline period was defined as Months 4–6 after HD initiation, and all-cause mortality was noted during follow-up. Only patients who survived baseline and had no missing covariates were included. Censoring events were renal transplantation, modality change or study end. We fitted a Cox proportional hazard model with a bivariate spline functions for the primary predictors (pre-HD SBP and peridialytic SBP change) with adjustment for age, gender, race, diabetes, access-type, relative interdialytic weight gain, body mass index, albumin, equilibrated normalized protein catabolic rate and ultrafiltration rate. Results A total of 172 199 patients were included. Mean age was 62.1 years, 61.6% were white and 55% were male. During a median follow-up of 25.0 months, 73 529 patients (42.7%) died. We found that a peridialytic SBP rise combined with high pre-HD SBP was associated with higher mortality. In contrast, when concurrent with low pre-HD SBP, a peridialytic SBP rise was associated with better survival. Conclusion The association of pre-HD and peridialytic SBP change with mortality is complex. Our findings call for a joint, not isolated, interpretation of pre-HD SBP and peridialytic SBP change.

Objetivo: Analisar o uso de medicamentos por automedicação em pacientes renais crônicos hemodialíticos. Métodos: Estudo quantitativo, descritivo e transversal, realizado em um centro de tratamento hemodialítico, na região Sudoeste da Bahia, em março de 2015, por meio da aplicação de formulário contendo variáveis sociodemográficas, clínicas e farmacoterapêuticas de 170 pacientes. A amostra compôs-se de pacientes em tratamento hemodialítico crônico há mais de um ano, com idade maior ou igual a 18 anos. Utilizou-se o Epidata 3.1 como banco de dados. Realizou-se análise descritiva e empregou-se o método de regressão logística binária, usado para avaliar a associação entre automedicação e variáveis independentes, utilizando o programa SPSS, versão 21.0. Resultados: Dos participantes, 64,1% (109) eram homens, com idade média de 50,5 anos (± 14,9); 57% (98) possuíam renda menor que um salário mínimo; 20% (34) nunca estudaram; 48,2% (82) estavam dialisando em período de um a cinco anos e 92,9% (158) não possuíam plano de saúde. Contabilizaram-se 104 medicamentos utilizados por automedicação, com destaque para o calcitriol (9,6%) e a clonidina (6,7%). Verificou-se que pacientes com maior escolaridade (OR=1,32; IC95%=1,32-28,72) e que usam sobra de medicamentos em casa (OR=22,48; IC95%=6,53-77,38) têm mais chances de se automedicar. Conclusão: Há baixa frequência de automedicação na população de renais crônicos investigada, sendo associada ao uso de medicamentos guardados em casa e à baixa escolaridade.