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To investigate the genetic relationship between end stage renal disease (ESRD) and human leukocyte antigen (HLA) alleles in the Guangxi Zhuang population. We performed polymerase chain reaction reversed sequence-specific oligonucleotide (PCR-rSSO) in 325 patients with ESRD and genotyped the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci. The direct counting method was used to determine the frequencies of HLA alleles, and Arlequin software (version 3.5.2.2) was used for haplotypic frequency analyses to compare the included ESRD patients with 350 healthy donors from the Guangxi Zhuang population. In our study, 120 HLA alleles, 284 HLA-A-B-DRB1 haplotypes, and 332 HLA-A-C-B-DRB1-DQB1 haplotypes were detected. We found that only A*11:01-B*15:02-DRB1*12:02 had a positive association with ESRD (P = 0.001, Pc = 0.020, OR = 3.106, 95% CI = 1.497–6.446) after Bonferroni correction; thus, individuals with this haplotype may be susceptible to ESRD. A*11:01-B*15:02-DRB1*12:02 is a potentially valuable haplotype for evaluating the risk of ESRD in the Guangxi Zhuang population. [ABSTRACT FROM AUTHOR]

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

Background: Social determinants of health (SDoH) are increasingly recognized as crucial factors affecting the well-being of pediatric chronic kidney disease (CKD) patients. This study explores the impact of SDoH on the quality of life (QoL) of children with CKD in Saudi Arabia. Methods: This observational, descriptive, cross-sectional study included 50 participants with CKD stages three to five, as well as children with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) or hemodialysis (HD) in Riyadh, Saudi Arabia. Data were collected from children and their caregivers using a validated Arabic-adapted version of the Pediatric Quality of Life Inventory (PedsQL) 3.0 and an SDoH survey. Results: The study revealed that access to education significantly affects pediatric QoL (H/Z score 2.825; P-value 0.005), and the lack of dietary recommendations was identified as a critical factor (H/Z score 1.441; P-value 0.029). ESRD patients on PD from larger families reported better QoL, whereas lower family income was associated with reduced QoL in PD patients (P-value 0.048). Compared to those in earlier stages of CKD, ESRD patients showed lower QoL (H/Z score 2.154; P-value 0.031). Conclusion: Our study provides initial insights into the relationship between SDoH and the QoL of children with CKD in Saudi Arabia. It calls for a comprehensive approach that includes these determinants in care strategies to improve patient outcomes and QoL. [ABSTRACT FROM AUTHOR]

Depression and osteoporosis are common diseases in dialysis patients. In addition, patients with osteoporosis are more susceptible to depression. Contrary to previous anti-osteoporosis agents, denosumab and romosozumab could be used in dialysis patients and have similar action mechanisms for blocking RANKL. RANKL causes bone resorption after binding RANKL, but binding with OPG leads to suppress of bone resorption. In recent mice study, inhibition of RANKL with denosumab improved depressive-like phenotype. Besides, it was found that OPG was associated with depression. Therefore, this study aimed to investigate the association of depressive symptoms with RANKL and OPG in hemodialysis patients. We conducted a cross-sectional study with a total of 172 hemodialysis patients. The participants were measured for plasma RANKL, OPG, MMP-2, and MMP-9 levels. Logistic regression analysis was performed to evaluate the effect of RANKL and OPG on the presence of depressive symptoms. The depressive symptoms were observed in 90 (52.3%) subjects. RANKL tertile 3 had negative association with BDI score (β − 4.527, 95% CI − 8.310 to − 0.743) in univariate analysis, and this association persisted even after multivariate adjustments (β − 5.603, 95% CI − 9.715 to −1.491) in linear regression. In logistic regression between RANKL tertiles and depressive symptoms, RANKL tertile 3 had significantly lower unadjusted OR (0.40, 95% CI 0.19–0.86), and multivariate-adjusted OR (0.31, 95% CI 0.12–0.82) for depressive symptoms. OPG was not significantly associated with depressive symptoms. Higher plasma RANKL concentrations were significantly associated with lower depressive symptoms in HD patients. Trial registration WHO registry, No. KCT0003281, date: January 12, 2017. [ABSTRACT FROM AUTHOR]

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

Background and Objectives: We aimed to ascertain the predictive power of the left atrial coupling index (LACI) in patients with end stage renal disease (ESRD) for heart failure with preserved ejection fraction (HFpEF). Materials and Methods: This is a retrospective study including 100 subjects between 18 and 65 years of age with ESRD and not on dialysis treatment. Patients were divided into groups with and without HFpEF. The LACI was defined as the ratio of the left atrial volume index (LAVI) to the a′ wave in tissue Doppler imaging (TDI). Statistical analyses were performed, including univariate and multivariate regression analyses. Results: The mean age of the participants was 47 ± 13.3 years. Individuals with HFpEF exhibited a higher LACI. Univariate and multivariate regression analyses demonstrated that the predictive capacity of the LACI for HFpEF was considerably higher than that of the LAVI and other echocardiographic parameters. Conclusions: Higher LACI levels were consistently related to the presence of HFpEF in ESRD patients. The LACI can be easily obtained in daily practice using conventional Doppler echocardiographic measurements during left atrial functional assessments. [ABSTRACT FROM AUTHOR]

Abstract Background Social determinants of health (SDoH) are increasingly recognized as crucial factors affecting the well-being of pediatric chronic kidney disease (CKD) patients. This study explores the impact of SDoH on the quality of life (QoL) of children with CKD in Saudi Arabia. Methods This observational, descriptive, cross-sectional study included 50 participants with CKD stages three to five, as well as children with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) or hemodialysis (HD) in Riyadh, Saudi Arabia. Data were collected from children and their caregivers using a validated Arabic-adapted version of the Pediatric Quality of Life Inventory (PedsQL) 3.0 and an SDoH survey. Results The study revealed that access to education significantly affects pediatric QoL (H/Z score 2.825; P-value 0.005), and the lack of dietary recommendations was identified as a critical factor (H/Z score 1.441; P-value 0.029). ESRD patients on PD from larger families reported better QoL, whereas lower family income was associated with reduced QoL in PD patients (P-value 0.048). Compared to those in earlier stages of CKD, ESRD patients showed lower QoL (H/Z score 2.154; P-value 0.031). Conclusion Our study provides initial insights into the relationship between SDoH and the QoL of children with CKD in Saudi Arabia. It calls for a comprehensive approach that includes these determinants in care strategies to improve patient outcomes and QoL.

Abstract Patients with end stage renal disease (ESRD) are at high risk of developing upper tract urothelial carcinoma (UTUC). Due to high recurrence rate of UTUC in contralateral kidney and ureter, and high risk of complications related to surgery and anesthesia, whether it’s necessary to remove both kineys and ureters at one time remains in debate. We utilized Taiwanese UTUC Registry Database to valuate the difference of oncological outcomes and perioperative complications between patients with ESRD with unilateral and bilateral UTUC receiving surgical resection. Patients with ESRD and UTUC were divided into three groups, unilateral UTUC, previous history of unilateral UTUC with metachronous contralateral UTUC, and concurrent bilatetral UTUC. Oncological outcomes, perioperative complications, and length of hospital stays were investiaged. We found that there is no diffence of oncological outcomes including overall survival, cancer specific survival, disease free survival and bladder recurrence free survival between these three groups. Complication rate and length of hospital stay are similar. Adverse oncological features such as advanced tumor stage, lymph node involvement, lymphovascular invasion, and positive surgical margin would negatively affect oncological outcomes.

Abstract Introduction Pain is a stressful experience for patients receiving haemodialysis through arteriovenous fistulas. This systematic review assessed the effectiveness of different pharmacological interventions for reducing pain during cannulation of arteriovenous fistulas among adolescents and adult patients with end-stage renal disease. Methods The protocol was prospectively registered with PROSPERO (Registration number CRD42024497355). A PRISMA-compliant systematic literature search was conducted on PubMed, Cochrane CENTRAL and Google Scholar. The primary and secondary outcomes were a reduction in the severity of pain and incidence of side effects respectively. Results In total, 15 studies were included in this review, all of which had some or serious concerns about the risk of bias. Compared with EMLA, cryotherapy with ice packs at the fistula site was superior, with a pain intensity of 1.05 (95% confidence interval 0.21, 1.89) points lower on the visual analogue scale, and there was no difference in the incidence of adverse effects. There was a greater reduction in pain intensity with EMLA cream than with piroxicam gel (mean difference 1.30; 95% confidence interval 0.68, 1.93). No difference in the incidence of adverse effects was noted. Compared with lidocaine spray, EMLA cream was associated with a lesser degree of pain (mean difference 2.09 points; 95% confidence interval 1.81, 2.38). Compared with placebo, cryotherapy with ice packs at the Hoku point was better, with a pain intensity of 2.53 (95% confidence interval 1.23, 3.83) points less on the visual analogue scale. Conclusions Available evidence supports the use of cryotherapy with ice packs and EMLA cream for reducing pain during cannulation of arteriovenous fistulas.

The purpose of this report is to describe via a case example an efficient mechanical thrombectomy technique for hemodialysis access thrombosis using the InThrill Thrombectomy System (Inari Medical, Irvine, CA). A man in his late 60s with end-stage renal disease and a thrombosed femoral arteriovenous graft (AVG) underwent a thrombectomy procedure to remove all thrombotic material including the arterial plug and restore use of the graft for hemodialysis. The InThrill Thrombectomy System used in this procedure consists of a mechanical thrombectomy catheter with a wall-apposing coring element and a sheath with a retractable funnel and aspiration port. The technique starts with gaining wire and sheath access towards the venous outflow. The InThrill Thrombectomy catheter is deployed proximal to the sheath to sequentially remove small segments of thrombus thus avoiding sheath obstruction. A locking syringe is used for rapid aspiration, reducing or eliminating the need to remove the InThrill sheath with every mechanical thrombectomy pass. Finally, the arterial plug is pulled using a Fogarty balloon sheath (Edwards Lifesciences, Irvine, CA) and extracted using the InThrill catheter, removing what may be the nidus for recurrent AV access thrombosis. The technique described here provided a means to remove all thrombotic material including the arterial plug in a planned, sequential manner, without the need for thrombolytics. Patency was restored to the patient's femoral AVG within 60 minutes, and hemodialysis resumed shortly thereafter. Further studies are needed to support long-term efficacy of this thrombolytic-free treatment option.

Background: Obesity is a risk factor for metabolic syndrome with insulin resistance. Its effect on renal and cardiovascular diseases is reported in developed countries, but rarely established among adolescents in developing countries. Subjects and methods: A crosssectional study of 846 adolescents selected from 12 secondary schools in Port Harcourt, Nigeria. Obese subjects with Body Mass Index (BMI) equal to or greater than the 95th percentile for age and sex on the United States CDC growth chart were selected and studied. Urine samples of subjects without overt proteinuria were tested for microalbuminuria using the micral test strips. Results: Seventy-three of the subjects were obese giving the preva lence of obesity to be 8.6%. Microalbuminuria was present in 23 (35.4%) of the 65 obese subjects without overt proteinuria. The proportional prevalence was higher in females (42.9%), in age group 10- 14years (42.2%), in subjects with hypertension (57.1%), and family history of hypertension (50.0%) and diabetes mellitus (37.5%) [p > 0.05]. Conclusion: There is high prevalence of adolescent obesity, and a high prevalence of microalbuminuria among obese adolescents in Port Harcourt. We recommend efforts at reducing obesity as a means of preventing renal disease in adolescents.