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Background: Comprehensive, patient‐specific models are essential to study calcium deposition and mobilization during dialysis. We aim to develop tools to support clinical prescriptions with a more accurate approach for the prediction of calcium mobilization while also considering major electrolytes and catabolites. Methods: We modified a multi‐solute model predicting patient‐specific dialysis response by incorporating a calcium buffer to represent bone exchanges. Data from four centers, involving 127 patients with six sessions each, were utilized. For each patient, three sessions were allocated for model training (ID123), while the remaining sessions were for validation (PRED456). The normalized root mean square error (nRMSE%) was used to evaluate both descriptive and predictive accuracy. Correlations between initial data and calcium exchanges were also assessed. Results: The overall nRMSE% for ID123 was 3.92%. For PRED456, it was 3.46% (ranging from a minimum of 1.17% for [Na+] to a maximum of 6.62% for [urea]). The median nRMSE% for plasma calcium varied between 1.13 and 8.32 for SHD sessions, depending on whether Ca_dialysis fluid (Cad) was ≥ or <1.50 mmol/L, respectively. For HDF sessions, the range was between 2.90 and 5.89. A significant and moderate correlation was found between overall calcium removal and the buffer balance. The most robust correlation observed was between the amount of calcium administered via post‐dilution fluid and the overall calcium removal in the dialysis filter. Conclusions: Identical therapy settings do not uniformly affect calcium mobilization, and our approach offers insight into calcium distribution across body compartments. This understanding will enhance clinical prescription practices. [ABSTRACT FROM AUTHOR]

Background Access to kidney transplantation (KT) remains challenging for patients with end-stage kidney disease. This study assessed women's access to KT in France by considering comorbidities and neighbourhood social deprivation. Methods All incident patients 18–85 years old starting dialysis in France between 1 January 2017 and 31 December 2019 were included. Three outcomes were assessed: access to the KT waiting list after dialysis start, KT access after waitlisting and KT access after dialysis start. Cox and Fine–Gray models were used. Gender–European Deprivation Index and gender–age interactions were tested and analyses were performed among strata if required. Results A total of 29 395 patients were included (35% of women). After adjusting for social deprivation and comorbidities, women were less likely to be waitlisted at 1 year {adjusted hazard ratio [adjHR] 0.91 [95% confidence interval (CI) 0.87–0.96]} and 3 years [adjHR 0.87 (95% CI 0.84–0.91)] after dialysis initiation. This disparity concerned mainly women ≥60 years of age [adjHR 0.76 (95% CI 0.71–0.82) at 1 year and 0.75 (0.71–0.81) at 3 years]. Access to KT after 2 years of waitlisting was similar between genders. Access to KT was similar between genders at 3 years after dialysis start but decreased for women after 4 years [adjHR 0.93 (95% CI 0.88–0.99)] and longer [adjHR 0.90 (95% CI 0.85–0.96)] follow-up. Conclusions In France, women are less likely to be waitlisted and undergo KT. This is driven by the ≥60-year-old group and is not explained by comorbidities or social deprivation level. [ABSTRACT FROM AUTHOR]

Background: Missed medication doses are a common and often preventable medication-related error that have been associated with an increased length of stay and mortality. Hemodialysis is a common, relatively predictable reason that patients are unavailable, resulting in missed doses. Objective: To evaluate the implications of a pharmacist-led intervention to standardize the medication administration times for patients requiring hemodialysis who were prescribed antihypertensives, antiepileptics, apixaban, and/or antimicrobials. Methods: A retrospective preanalysis and postanalysis of a pharmacist-led intervention were performed at a single-center, safety net hospital. Patients receiving dialysis and prescribed one of the targeted medications were included. The primary endpoint was the composite of missed and delayed doses. Results: A total of 25 patients receiving 126 dialysis sessions in the preintervention group and 29 patients receiving 80 dialysis sessions in the postintervention group were included for analysis. For the primary endpoint, 118 (18%) versus 57 (9.3%) doses were missed or delayed in the preintervention versus postintervention group, respectively (P < 0.001). The primary endpoint was driven by fewer delayed doses in the postgroup. The number of antimicrobials given on a correct schedule increased in the postintervention group (98.3% vs 99.1%, P = 0.044). Conclusion and Relevance: A pharmacist-led intervention for standard medication administration times in patients requiring hemodialysis increased the number of prescribed medication doses given and given on time. The intervention also led to more antimicrobials administered at appropriate times relative to dialysis sessions. [ABSTRACT FROM AUTHOR]

Background: The utilization of ultrapure dialysate has been shown to decrease dialysate contamination and mitigate inflammatory responses. The central dialysate delivery system (CDDS) has the potential to attain a level of purity similar to ultrapure dialysate. Nevertheless, there is limited research examining the impact of CDDS on inflammation in comparison to single-patient dialysis fluid delivery system(SPDDS). This study aims to investigate the effects of CDDS utilizing ultrapure dialysate on ameliorating the microinflammatory state in hemodialysis patients. Method: A retrospective cohort clinical study enrolled a total of 125 hemodialysis patients, with 58 patients from the CDDS unit and 67 patients from the SPDDS unit. Each participant was monitored for a period of 6 months, and the repeated measurement data was analyzed using a generalized linear mixed models (GLMM). Results: The average age of the studty cohort was 56.22 ± 12.64 years. The GLMM analysis showed a significant time*group interaction effect on hs-CRP changes over the follow-up period (β = -1.966, FTime* CDDS group = 13.389, P < 0.001). A linear mixed model analysis with random slope showed that a different slope was observed between CDDS group and SPDDS group (βCDDS =—0.793; βSPDDS = 0.791), indicating a decreased hs-CRP levels in CDDS group, while increased in the SPDDS group over the follow-up period. However, no significant time*group interaction effect were observed on albumin and β2-microglobulin levels during follow-up period(β2-microglobulin: β = -0.658, FTime* CDDS group = 1.228, P = 0.269; albumin: β = 0.012, FTime* CDDS group = 1.429, P = 0.233). Conclusion: Using ultrapure dialysate in the CDDS is associated with an improvement in hs-CRP levels compared to standard dialysate, which might confer long-term clinical advantages. [ABSTRACT FROM AUTHOR]

Lipid nanoparticles (LNPs) and their versatile nucleic acid payloads bear great potential as delivery systems. Despite their complex lipid composition, their quality is primarily judged by particle characteristics and nucleic acid encapsulation. In this study, we present a holistic reversed-phase (RP)-charged aerosol detection (CAD)-based method developed for commonly used LNP formulations, allowing for intensified LNP and process characterization. We used an experimental approach for power function value (PFV) optimization termed exploratory calibration, providing a single PFV (1.3) in an appropriate linearity range for all six lipids. Followed by the procedure of method calibration and validation, linearity (10–400 ng, R2 > 0.996), precision, accuracy, and robustness were effectively proven. To complement the commonly determined LNP attributes and to evaluate the process performance across LNP processing, the developed RP-CAD method was applied in a process parameter study varying the total flow rate (TFR) during microfluidic mixing. The RP-CAD method revealed a constant lipid molar ratio across processing but identified deviations in the theoretical lipid content and general lipid loss, which were both, however, entirely TFR-independent. The deviations in lipid content could be successfully traced back to the lipid stock solution preparation. In contrast, the observed lipid loss was attributable to the small-scale dialysis following microfluidic mixing. Overall, this study establishes a foundation for employing RP-CAD for lipid quantification throughout LNP processing, and it highlights the potential to extend its applicability to other LNPs, process parameter studies, or processes such as cross-flow filtration. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Recently, hypoxia‐inducible factor prolyl hydroxylase (HIF‐PH) inhibitors have been used for renal anemia, but side effects have also been reported. We report on the association of central hypothyroidism and cholesterol with roxadustat. Based on this case and previous reports, we believe that patients receiving roxadustat should have their thyroid function and cholesterol levels checked regularly. [ABSTRACT FROM AUTHOR]

Background: Normothermic machine perfusion (NMP) allows for the assessment and resuscitation of ex‐vivo human livers prior to transplantation. Commercially available NMP systems are closed circuits that accumulate metabolic waste and cytokines over time, potentially limiting organ preservation times. Dialysis has been proposed as a method to remove waste and excess fluid from such systems. This study aimed to demonstrate the utility of integrating dialysis into a commercially available system by quantifying solute removal. Methods: A dialysis filter was attached in parallel to a commercially available liver perfusion system. Three livers declined for transplantation were split before undergoing long‐term NMP with blood using the modified system. During perfusion, dialysate flow rates were set in the range of 100–600 mL/h for short periods of time. At each flow rate, perfusate and spent dialysate samples were collected and analyzed for solute clearance. Results: The addition of dialysis to a commercial NMP system removed water‐soluble waste and helped regulate electrolyte concentrations. Interleukin‐6 was successfully removed from the perfusate. Solute clearance was proportional to dialysate flow rate. A guide for our perfusion setup was created for the appropriate selection of dialysis flow rates and duration based on real‐time perfusate composition. Conclusions: Dialysis circuits can efficiently remove waste and regulate perfusate composition, and can be easily incorporated to improve the performance of commercially available systems. Quantification of the effect of dialysis on perfusate composition enables refined dialysis control to optimize electrolyte profiles and avoid the over‐ or under‐correction of key solutes. [ABSTRACT FROM AUTHOR]

This single center retrospective study aimed to describe the variables associated with outpatient dialysis dependence in extracorporeal membrane oxygenation (ECMO) patients who needed continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) during their hospitalization. Retrospective study of patients who required ECMO-CRRT. Between the years of 2016 and 2022, 202 patients required ECMO-CRRT. One hundred and six patients (52.5%) survived their hospitalization and were followed up for a median of 391 [133, 1005] days. Eighty-one patients (76.5%) recovered kidney function and were dialysis-free before hospital discharge. Twenty-five patients (23.5%) were hemodialysis-dependent after hospitalization. On multivariate regression analysis, hyperlipidemia (odds ratio, OR 6.08 [1.67–22]) and CRRT duration (OR 1.09 [1.03–1.15]) were associated with the need for dialysis post-hospitalization. In this group, 16 patients eventually became dialysis-free, after a median of 49 [34.7, 78.5] days. These patients had a higher median baseline glomerular filtration rate (GFR) compared to those who never recovered renal function (93 mL/min/1.73 m2 [82.4, 104.3] vs. 63.8 mL/min/1.73 m2 [37.9, 83], p =.009). Their follow-up GFR was lower compared to those who recovered renal function before hospital discharge; (87 mL/min/1.73 m2 [68.2, 98.9] vs. 99 mL/min/1.73 m2 [79, 118], p =.07). AKI requiring CRRT was associated with high mortality in patients receiving ECMO. Nonetheless, most ECMO survivors became dialysis-free before hospital discharge. Variables associated with the need for outpatient dialysis included hyperlipidemia and prolonged need for CRRT during hospitalization. [ABSTRACT FROM AUTHOR]

Early treatment of kidney disease can slow disease progression and reduce the increased risk of mortality associated with end-stage kidney disease. However, uncertainty exists whether early referral (ER) to nephrological care per se or an optimal dialysis start impacts patient outcome after dialysis initiation. We determined the effect of ER and suboptimal dialysis start on the 3-year mortality and hospitalizations after dialysis initiation. Between January 2015 and July 2018, 349 patients with ≥1 month of follow-up started dialysis at nine Romanian dialysis clinics. After excluding patients with COVID-19 during follow-up, 254 patients (97 ER and 157 late referral) were included in this retrospective study. The observational period was truncated at 3 years, death, or loss to follow-up. Clinical and laboratory data were retrieved from the quality database of the nephrological care providers. Patients were followed for a median (25–75%) of 36 (16–36) months. At dialysis start, ER patients had higher hemoglobin, phosphate, and albumin levels and started dialysis less often via a central dialysis catheter (p < 0.001 for each). Logistic regression analysis demonstrated an independent lower risk for frequent hospitalizations for ER patients (odds ratio 0.22 (95% confidence interval 0.1–0.485), p < 0.001), and Cox regression analysis revealed an improved survival (hazard ratio 0.540 (95% confidence interval 0.325–0.899), p = 0.02), both independent of optimal dialysis start. In conclusion, early referral to nephrological care was associated with improved survival and lower hospitalization rates during the three years after dialysis initiation, independent of optimal dialysis start. These results strongly support the reimbursement of nephrological care before dialysis initiation. [ABSTRACT FROM AUTHOR]

The study aimed to assess the prevalence of executive function impairment among patients with chronic kidney disease (CKD) undergoing dialysis, with no subjective cognitive problems and with normal global cognition on the Mini-Mental State Examination (MMSE). We also investigated the relationship between cardiovascular risk factors and cognitive test results. Patients with CKD, including those undergoing renal replacement therapy, are at a higher risk of developing cognitive impairment (CI) than the general population. Recent research has shown CI to be a growing problem among CKD patients worldwide. Yet, it remains underdiagnosed, even though it may significantly influence the lives of patients. In this cross-sectional, prospective study, 58 dialysis patients with no cognitive decline on the MMSE screening were assessed for executive function impairment using the Executive Clock-Drawing Task (CLOX). Moreover, past medical history, demographic data, and laboratory test results were collected. The mean patient age was 59.47 ± 14.98 years, and the mean duration of dialysis was 45.93 ± 48.49 months. The prevalence of executive function impairment amounted to 8.6%. Moreover, remarkably similar pattern of clock drawing was observed, with numbers written outside the clock face in the CLOX1 test. Executive dysfunctions in dialysis patients may manifest itself before the onset of global cognitive impairment. There appear to be a deficit in the spatial domain as well. Better education may play a protective role. [ABSTRACT FROM AUTHOR]

Acid recovery from acidic waste is a pressing issue in current times. Chemical methods for recovery are not economically feasible and require significant energy input to save the environment. This study reported a semi‐interpenetrating polymer network (semi‐IPN) anion exchange membranes (AEMs) for acid recovery by diffusion dialysis with excellent dimensional stability, high oxidation stability, good acid dialysis coefficient (UH+) and high separation factor (S). Semi‐IPN AEMs are prepared by ring‐open cross‐linked quaternized polybenzoxazine (AQBZ) with poly(vinyl alcohol‐co‐ethylene), where AQBZ is obtained by Mannich reaction and Menshutkin reaction. All four proportions of semi‐IPNs exhibit clear micro‐phase separation, which is conducive to ion transport. The water uptake (WU) of the four semi‐IPNs ranges from 14.2 % to 19.2 %, while the swelling ratio (SR) remains between 8.7 % and 11.3 %. These results indicate that the cross‐linked structure in the designed semi‐IPNs effectively control swelling and ensure dimensional stability. The thermal degradation temperature (Td5) of semi‐IPN4:6 to semi‐IPN7:3 varies from 309 °C to 289 °C, with an oxidation stability weight loss rate (WOX) ranging from 91.5 % to 93.5 %, demonstrating excellent thermal stability and oxidation stability. The semi‐IPNs also show good UH+ values ranging from 11.9–16.3*10−3 m/h and high S values between 38.6 and 45.9, indicating the promising potential of the semi‐IPNs. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Dialysis adequacy is traditionally calculated from pre‐ and post‐hemodialysis session serum urea concentrations and expressed as the urea reduction ratio, or Kt/Vurea. However, with increasing hemodiafiltration usage, we wished to determine whether there were any differences between standard Kt/Vurea equations and directly measured spent dialysate urea clearance.Urea clearance was measured from collected effluent dialysate and compared with various other methods of Kt/Vurea calculation, including change in total body urea from measuring pre‐ and post‐total body water with bioimpedance and the Watson equation, by standard Kt/V equations, and online clearance measurements using effective ionic dialysance (OLC).We compared urea clearance in 41 patients, 56.1% male, mean age 69.3 ± 12.6 years with 87.8% treated by hemodiafiltration. Reduction in total body urea was greater when estimating changes in total body urea, compared to measured dialysate losses of 58.4% (48.5–67.6) vs 71.6% (62.1–78), p < 0.01. Sessional urea clearance (Kt/Vurea) was greater using the online Solute‐Solver program compared to OLC, median 1.45(1.13–1.75) vs 1.2 (0.93–1.4), and 2nd generation Kt/V equations 1.3 (1.02–1.66), p < 0.01, but not different from estimated total body urea clearance 1.36 (1.15–1.73) and dialysate clearance 1.36 (1.07–1.76). The mean bias compared to the Solute‐Solver program was greatest with OLC (−0.25), compared to second‐generation equations (−0.02), estimated total body clearance (−0.02) and measured dialysate clearance (−0.01).This study demonstrated that the result from equations estimating urea clearance indirectly from pre‐ and postblood samples from hemo‐ and hemodiafiltration treatments was highly correlated with direct measurements of dialysate urea clearance. [ABSTRACT FROM AUTHOR]

Background: Debate continues as to the optimum hemodialysis (HD) dialysate calcium concentration. Although current guidelines advocate 1.25–1.5 mmol/L, some investigators have suggested these may cause calcium gains. As such we investigated whether using dialysate calcium of 1.25 mmol/L risked calcium gains, and whether there were differences between hemodiafiltration and high flux HD. Methods: We continuously collect an aliquot of effluent dialysate during dialysis sessions, and calculated dialysis calcium mass balance by the difference between the amount of calcium delivered as fresh dialysate and that lost in effluent dialysate. Results: We studied 106 stable outpatients, 64% male, mean age 64.4 ± 16.2 years, median dialysis vintage 32 (22–60) months. Most sessions (69%) used a 1.0 mmol/L calcium dialysate, with a median sessional loss of 13.7 (11.5–17.1) mmol, whereas using 1.25 mmol/L the median loss was 7.4 (4.9–10.1) mmol, but with 6.9% had a positive balance (p = 0.031 vs dialysate calcium 1.0 mmol/L). Most patients (85.8%) were treated by hemodiafiltration, but there was no difference in sessional losses (11.7 (8.4–15.8) vs 13.5 (8.1–16.8)) with high flux HD. Dialysis sessional calcium balance was associated with the use of lower dialysate calcium concentration (β −19.5, 95% confidence limits (95%CL) −27.7 to −11.3, p < 0.001), and sessional duration (β 0.07 (95% CL) 0.03–012, p = 0.002). Conclusion: Ideally, the choice of dialysate calcium should be individualized, but clinicians should be aware, that even when using a dialysate calcium of 1.25 mmol/L, some patients are at risk of a calcium gain during hemodiafiltration and high‐flux hemodialysis. [ABSTRACT FROM AUTHOR]

Background: Delayed graft function (DGF) after kidney transplantation is associated with adverse patients and allograft outcomes. A longer duration of DGF is predictive of worse graft outcomes compared to a shorter duration. Posttransplant serum β2‐microglobulin (B2M) is associated with long‐term graft outcomes, but its relationship with DGF recovery is unknown. Methods: We included all kidney‐only transplant recipients with DGF enrolled in the E‐DGF trial. Duration of DGF was defined as the interval between the transplant and the last dialysis session. We analyzed the association of standardized serum creatinine (Scr) and B2M on postoperative Days (POD) 1–7 during the subsequent days of DGF with the recovery of DGF. Results: A total of 97 recipients with DGF were included. The mean duration of DGF was 11.0 ± 11.2 days. Higher Scr was not associated with the duration of DGF in unadjusted or adjusted models. Higher standardized B2M, in contrast, was associated with a prolonged duration of DGF. This association remained in models adjusting for baseline characteristics from POD 2 (3.19 days longer, 95% CI: 0.46–5.93; p = 0.02) through Day 6 of DGF (4.97 days longer, 95% CI: 0.75–9.20; p = 0.02). There was minimal change in mean Scr (0.01 ± 0. 10 mg/dL per day; p = 0.32), while B2M significantly decreased as the time to recovery approached (–0.14 ± 0.05 mg/L per day; p = 0.006), among recipients with DGF. Conclusion: B2M is more strongly associated with DGF recovery than Scr. Posttransplant B2M may be an important biomarker to monitor during DGF. Trial Registration: ClinicalTrials.gov identifier: NCT 03864926 [ABSTRACT FROM AUTHOR]

Introduction: Several calcimimetics, other than cinacalcet, are commercially available; however, their effects on calcium and phosphate levels have not yet been fully studied. We conducted a systematic review and meta‐analysis of randomized controlled trials to evaluate the impact of calcimimetics on the management of serum calcium and phosphate levels in patients with secondary hyperparathyroidism undergoing dialysis. Methods: A systematic literature search through October 2023 and a meta‐analysis were conducted on the effects of upacicalcet, etelcalcetide, evocalcet, and cinacalcet on serum calcium and phosphate levels in patients with secondary hyperparathyroidism undergoing dialysis; we searched PubMed, Ovid MEDLINE, and the Cochrane Central Register of Controlled Trials, and 21 studies comprising 6371 patients undergoing dialysis were included. Results: Participants treated with calcimimetics had lower serum calcium and phosphate levels than placebo. Conclusion: Calcimimetics significantly reduced serum calcium and phosphate levels compared to placebo in patients with secondary hyperparathyroidism undergoing dialysis, independent of therapeutic strategy or concomitant vitamin D treatment. [ABSTRACT FROM AUTHOR]

Key Points: Question: Are kidneys from deceased donors who underwent dialysis prior to kidney donation associated with adverse graft outcomes in kidney transplant recipients compared with kidneys from deceased donors who did not undergo dialysis? Findings: In an analysis of 1944 kidney transplant recipients (including 954 who received kidneys from deceased donors who underwent dialysis prior to kidney donation), the incidence of delayed graft function was higher in recipients of kidneys from deceased donors who underwent dialysis prior to kidney donation vs recipients of kidneys from deceased donors who did not undergo dialysis (59.2% vs 24.6%, respectively), but there were no significant differences in the incidence of graft failure (adjusted odds ratio, 0.90) or mortality (adjusted hazard ratio, 0.76) at a median follow-up of 34.1 months. Meaning: Compared with recipients of kidneys from deceased donors who did not undergo dialysis, receiving kidneys from deceased donors who underwent dialysis prior to donation was associated with a higher incidence of delayed graft function, but no difference in graft failure or death at longer-term follow-up. Importance: Recipient outcomes after kidney transplant from deceased donors who received dialysis prior to kidney donation are not well described. Objective: To compare outcomes of transplant recipients who received kidneys from deceased donors who underwent dialysis prior to kidney donation vs recipients of kidneys from deceased donors who did not undergo dialysis. Design, Setting, and Participants: A retrospective cohort study was conducted including data from 58 US organ procurement organizations on deceased kidney donors and kidney transplant recipients. From 2010 to 2018, 805 donors who underwent dialysis prior to kidney donation were identified. The donors who underwent dialysis prior to kidney donation were matched 1:1 with donors who did not undergo dialysis using a rank-based distance matrix algorithm; 1944 kidney transplant recipients were evaluated. Exposure: Kidney transplants from deceased donors who underwent dialysis prior to kidney donation compared with kidney transplants from deceased donors who did not undergo dialysis. Main Outcomes and Measures: The 4 study outcomes were delayed graft function (defined as receipt of dialysis by the kidney recipient ≤1 week after transplant), all-cause graft failure, death-censored graft failure, and death. Results: From 2010 to 2018, 1.4% of deceased kidney donors (805 of 58 155) underwent dialysis prior to kidney donation. Of these 805 individuals, 523 (65%) donated at least 1 kidney. A total of 969 kidneys (60%) were transplanted and 641 kidneys (40%) were discarded. Among the donors with kidneys transplanted, 514 (mean age, 33 years [SD, 10.8 years]; 98 had hypertension [19.1%] and 36 had diabetes [7%]) underwent dialysis prior to donation and were matched with 514 (mean age, 33 years [SD, 10.9 years]; 98 had hypertension [19.1%] and 36 had diabetes [7%]) who did not undergo dialysis. Kidney transplants from donors who received dialysis prior to donation (n = 954 kidney recipients) were associated with a higher risk of delayed graft function compared with kidney transplants from donors who did not receive dialysis (n = 990 kidney recipients) (59.2% vs 24.6%, respectively; adjusted odds ratio, 4.17 [95% CI, 3.28-5.29]). The incidence rates did not significantly differ at a median follow-up of 34.1 months for all-cause graft failure (43.1 kidney transplants per 1000 person-years from donors who received dialysis prior to donation vs 46.9 kidney transplants per 1000 person-years from donors who did not receive dialysis; adjusted hazard ratio [HR], 0.90 [95% CI, 0.70-1.15]), for death-censored graft failure (22.5 vs 20.6 per 1000 person-years, respectively; adjusted HR, 1.18 [95% CI, 0.83-1.69]), or for death (24.6 vs 30.8 per 1000 person-years; adjusted HR, 0.76 [95% CI, 0.55-1.04]). Conclusions and Relevance: Compared with receiving a kidney from a deceased donor who did not undergo dialysis, receiving a kidney from a deceased donor who underwent dialysis prior to kidney donation was associated with a significantly higher incidence of delayed graft function, but no significant difference in graft failure or death at follow-up. This study compares the outcomes of kidney transplant recipients who received kidneys from deceased donors who underwent dialysis prior to kidney donation vs recipients of kidneys from deceased donors who did not undergo dialysis. [ABSTRACT FROM AUTHOR]

Excessive dietary phosphorus is a concern among patients with kidney failure undergoing dialysis treatment because it may contribute to hyperparathyroidism and hyperphosphatemia. A long‐standing but untested component of the low‐phosphorus diet is the promotion of refined grains over whole grains. This paper reviews the scientific premise for restricting whole grains in the dialysis population and estimates phosphorus exposure from grain products based on three grain intake patterns modeled from reported intakes in the general US population, adjusting for the presence of phosphorus additives and phosphorus bioavailability: (1) standard grain intake, (2) 100% refined grain intake, and (3) mixed (50/50 whole and refined grain) intake. Although estimated phosphorus exposure from grains was higher with the mixed grain pattern (231 mg/day) compared to the 100% refined grain pattern (127 mg/day), the amount of additional phosphorus from grains was relatively low. Given the lack of strong evidence for restricting whole grains in people with CKD, as well as the potential health benefits of whole grains, clinical trials are warranted to address the efficacy and health impact of this practice. [ABSTRACT FROM AUTHOR]

Introduction: Many individuals start dialysis in an acute setting with suboptimal pre‐dialysis education. These individuals are often treated with central venous catheter insertion and initiation of in‐center hemodialysis and only a minority will transfer to a home‐based therapy. The dialysis start unit is a program performing in‐center hemodialysis in a separate space while providing support and education on chronic kidney disease and treatment options in the initial weeks of kidney replacement therapy. We aimed to assess the uptake of home dialysis therapies between 2013 and 2021 among patients who started acute inpatient hemodialysis at University Health Network, Toronto and underwent dialysis at the dialysis start unit. Methods: This is a retrospective observational cohort study based on prospectively collected data. Patients' demographics were obtained from electronic charts. In the dialysis start unit, all patients received dialysis modality education by a nurse educator, dedicated home dialysis nurses, and the allied health care team. Findings: During 2013–2021, 122 patients were dialyzed in the dialysis start unit and included in the study. Among those patients, 68 patients ultimately chose home dialysis (57 peritoneal dialysis and 11 home hemodialysis). Fifty‐four patients continued in‐center hemodialysis. Patients adopting home dialysis were less likely to have diabetes and hypertension as the etiology of kidney failure and more likely to have glomerulonephritis or vasculitis. Discussion: Dialysis modality education is implementable in advanced chronic kidney disease. Individualized education and care after unplanned start dialysis can potentially enhance home dialysis choice and utilization. [ABSTRACT FROM AUTHOR]

Background Patients with kidney failure treated with maintenance haemodialysis (HD) require appropriate small molecule clearance. Historically, a component of measuring 'dialysis adequacy' has been quantified using urea kinetic modelling that is dependent on the HD prescription. However, the impact of dialysate flow rate on urea clearance remains poorly described in vivo and its influence on other patient-important outcomes of adequacy is uncertain. Methods We searched Embase, MEDLINE and the Cochrane Library from inception until April 2022 for randomized controlled trials and observational trials comparing a higher dialysate flow rate (800 ml/min) and lower dialysate flow rate (300 ml/min) with a standard dialysis flow rate (500 ml/min) in adults (age ≥18 years) treated with maintenance HD (>90 consecutive days). We conducted a random effects meta-analysis to estimate the pooled mean difference in dialysis adequacy as measured by Kt/V or urea reduction ratio (URR). Results A total of 3118 studies were identified. Of those, nine met eligibility criteria and four were included in the meta-analysis. A higher dialysate flow rate (800 ml/min) increased single-pool Kt/V by 0.08 [95% confidence interval (CI) 0.05–0.10, P  < .00001] and URR by 3.38 (95% CI 1.97–4.78, P  < .00001) compared with a dialysate flow rate of 500 ml/min. Clinically relevant outcomes including symptoms, cognition, physical function and mortality were lacking and studies were generally at a moderate risk of bias due to issues with randomization sequence generation, allocation concealment and blinding. Conclusion A higher dialysate flow increased urea-based markers of dialysis adequacy. Additional high-quality research is needed to determine the clinical, economic and environmental impacts of higher dialysate flow rates. [ABSTRACT FROM AUTHOR]

Objectives: Despite vaccination strategies, people with chronic kidney disease, particularly kidney transplant recipients (KTRs), remained at high risk of poor COVID‐19 outcomes. We assessed serological responses to the three‐dose COVID‐19 vaccine schedule in KTRs and people on dialysis, as well as seroresponse predictors and the relationship between responses and breakthrough infection. Methods: Plasma from 30 KTRs and 17 people receiving dialysis was tested for anti‐Spike receptor binding domain (RBD) IgG and neutralising antibodies (NAb) to the ancestral and Omicron BA.2 variant after Doses 2 and 3 of vaccination. Results: After three doses, KTRs achieved lower anti‐Spike RBD IgG levels (P < 0.001) and NAb titres than people receiving dialysis (P = 0.002). Seropositive cross‐reactive Omicron neutralisation levels were achieved in 11/27 (40.7%) KTRs and 11/14 (78.6%) dialysis recipients. ChAdOx1/viral‐vector vaccine type, higher mycophenolate dose (> 1 g per day) and lower absolute B‐cell counts predicted poor serological responses in KTRs. ChAdOx‐1 vaccine type and higher monocyte counts were negative predictors in dialysis recipients. Among ancestral NAb seroresponders, higher NAb levels positively correlated with higher Omicron neutralisation (R = 0.9, P < 0.001). More KTRs contracted SARS‐CoV‐2 infection (14/30; 47%) than dialysis recipients (5/17; 29%) and had more severe disease. Those with breakthrough infections had significantly lower median interdose incremental change in anti‐Spike RBD IgG and ancestral NAb titres. Conclusion: Serological responses to COVID‐19 vaccines in KTRs lag behind their dialysis counterparts. KTRs remained at high risk of breakthrough infection after their primary vaccination schedule underlining their need for booster doses, strict infection prevention measures and close surveillance. [ABSTRACT FROM AUTHOR]

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This article explores the significance of providing optimal care for Aboriginal and Torres Strait Islander peoples with kidney failure in the Northern Territory of Australia. It emphasizes the importance of addressing health disparities and cultural factors that influence health outcomes in order to improve the well-being of these communities. The article presents a case study of a Torres Strait Islander woman's health journey, highlighting the integration of traditional healing practices with biomedical approaches and the value of patient-centered care. Additionally, the article discusses the role of Storying, a method of knowledge collation and archiving in Aboriginal and Torres Strait Islander cultures, in amplifying marginalized voices and serving as an educational tool for healthcare providers and Indigenous individuals. The article underscores the significance of culturally sensitive care and patient autonomy in achieving positive health outcomes for Indigenous communities, and advocates for a model of care that prioritizes Indigenous self-determination, cultural safety, and acknowledges the social and cultural determinants of health. It also emphasizes the need for sustained support for Indigenous self-determination and the development of a diverse healthcare workforce to comprehensively address Indigenous health needs. [Extracted from the article]

A rapid and online microvolume flow-through dialysis probe designed for sample preparation in the analysis of veterinary drug residues is introduced. This study addresses the need for efficient and green sample preparation methods that reduce chemical waste and reagent use. The dialysis probe integrates with liquid chromatography and mass spectrometry (LC-MS) systems, facilitating automated, high-throughput analysis. The dialysis method utilizes minimal reagent volumes per sample, significantly reducing the generation of solvent waste compared to traditional sample preparation techniques. Several veterinary drugs were spiked into tissue homogenates and analyzed to validate the probe's efficacy. A diagnostic sensitivity of >97% and specificity of >95% were obtained for this performance evaluation. The results demonstrated the effective removal of cellular debris and particulates, ensuring sample integrity and preventing instrument clogging. The automated dialysis probe yielded recovery rates between 27 and 77% for multiple analytes, confirming its potential to streamline veterinary drug residue analysis, while adhering to green chemistry principles. The approach highlights substantial improvements in both environmental impact and operational efficiency, presenting a viable alternative to conventional sample preparation methods in regulatory and research applications. [ABSTRACT FROM AUTHOR]

The demographic profile of patients transitioning from chronic kidney disease to kidney replacement therapy is changing, with a higher prevalence of aging patients with multiple comorbidities such as diabetes mellitus and heart failure. Cardiovascular disease remains the leading cause of mortality in this population, exacerbated by the cardiovascular stress imposed by the HD procedure. The first year after transitioning to hemodialysis is associated with increased risks of hospitalization and mortality, particularly within the first 90–120 days, with greater vulnerability observed among the elderly. Based on data from clinics in Fresenius Medical Care Europe, Middle East, and Africa NephroCare, this review aims to optimize hemodialysis procedures to reduce mortality risk in stable incident and prevalent patients. It addresses critical aspects such as treatment duration, frequency, choice of dialysis membrane, dialysate composition, blood and dialysate flow rates, electrolyte composition, temperature control, target weight management, dialysis adequacy, and additional protocols, with a focus on mitigating prevalent intradialytic complications, particularly intradialytic hypotension prevention. [ABSTRACT FROM AUTHOR]

The article focused on a study of the release of melanin from its gel dosage form and the toxicological properties of the gel. The recorded release of melanin from the gel was fastest during the first 3 h (50.8%). The remaining amount of melanin was subsequently released gradually as the system equilibrium shifted. The photoprotective action of the drug was prolonged because of the slowed melanin release. Symptoms of acute toxicosis and lethal outcomes were not recorded in all experimental animals during studies of the acute toxicity parameters of the developed gel based on melanin isolated from horse chestnut seed episperm with subcutaneous administration and cutaneous application at doses of 1500, 2000, 2500, and 3000 mg/kg. The developed photoprotective gel belonged to class Vof practically harmless substances. The LD50 value for cutaneous application to rats was >2500 mg/kg. [ABSTRACT FROM AUTHOR]

Background Intradialytic hypotension (IDH) and subsequent tissue damage may contribute to the poor outcome of chronic haemodialysis (HD) patients. While the IDH-incidence is lower in high-volume haemodiafiltration (HV-HDF) than in standard HD (S-HD), survival is better in HV-HDF. Tissue injury, as measured by extracellular vesicle (EV)-release, was compared between four modalities. Methods Forty chronic patients were cross-over randomized to S-HD, cool-HD (C-HD), low-volume HDF (LV-HDF), and HV-HDF. Blood pressure was recorded every 15 minutes. EVs from circulating blood-cell-elements (bio-incompatibility-related) and cardiovascular (CV) tissues (CV-related), were measured before and after dialysis. The influence of modalities and IDH on the rate of change of EVs was assessed. Both crude and haemoconcentration-adjusted analyses were performed. Results Leukocyte and erythrocyte-derived EVs increased in all modalities. Platelet-derived EVs increased more in LV-HDF and HV-HDF (68.4 respectively 56.1 × 106/ml) than in S-HD (27.5 × 106/ml), P values for interaction were <.01 respectively.06. Endothelial-derived CD144+ (2.3 × 106/ml in HV-HDF and 9.8 × 106/ml in S-HD) and cardiomyocyte-derived Connexin-43+ (12.0 respectively 31.9 × 106/ml) EVs increased less in HV-HDF than in S-HD (P for interaction.03 respectively.06). Correction for haemoconcentration attenuated all changes, although the increase in platelet-derived EVs remained significant in LV-HDF and HV-HDF, and CD144+ and Connexin-43+ EVs increased most in S-HD. EV release was similar in patients with varying IDH susceptibility and in sessions with and without IDH. Conclusions Most EVs increase during HD and HDF. Regarding platelet-derived EVs, HDF appears less biocompatible than HD. Considering CV-related EVs, tissue injury seems less pronounced in HV-HDF. The finding that EV release is IDH-independent needs confirmation. [ABSTRACT FROM AUTHOR]

Background: Left ventricular global function index (LVGFI) integrates LV volumetric and functional parameters. In patients with end‐stage renal disease (ESRD), cardiac injury manifests as LV hypertrophy and dysfunction. However, the prognostic value of LVGFI in this population remains unclear. Purpose: To investigate the association of LVGFI with major adverse cardiac events (MACE) in patients with ESRD. Study Type: Prospective. Population: One hundred fifty‐eight ESRD patients (mean age: 54.1 ± 14.4 years; 105 male) on maintenance dialysis. Filed Strength/Sequence: 3.0 T, balanced steady‐state free precession (bSSFP) cine and modified Look‐Locker inversion recovery (MOLLI) sequences. Assessment: LV volumetric and functional parameters were determined from bSSFP images. LVGFI was calculated as the ratio of stroke volume to global volume and native T1 was determined from MOLLI T1 maps. MACE was recorded on follow up. Models were developed to predict MACE from conventional risk factors combined with LVGFI, GLS, native T1, and LV mass index (LVMI), respectively. Subgroup analyses were further performed in participants with LVEF above median. Statistical Tests: Cox proportional hazard regression and log‐rank test were used to investigate the association between LVGFI and MACE. The predictive models were evaluated and compared using Harrell's C‐statistics and DeLong tests. A P value <0.05 was considered statistically significant. Results: Thirty‐four MACE occurred during the median follow‐up period of 26 months. The hazard of MACE increased by 114% for each 10% decrease in LVGFI in univariable analysis. The predictive model consisting of LVGFI (C‐statistic: 0.724) had significantly better predictive performance than the others (all P < 0.001). These results were consistent in patients (N = 79) with LVEF > median (63.54%). Data Conclusion: LVGFI is a novel marker for MACE risk stratification in patients with ESRD and was better able to predict MACE than native T1 mapping and GLS. Evidence Level: 2 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Uremia, also known as uremic syndrome, refers to the clinical symptoms in the final stage of renal failure. The definition of the term has changed over time due to an improved comprehension of the kidney's function and the advancement of dialysis technology. Here, we aim to present an overview of the various concepts that have developed regarding uremia throughout the years. We provide a comprehensive review of the historical progression starting from the early days of Kolff and his predecessors, continuing with the initial research conducted by Niwa et al., and culminating in the remote sensing hypothesis of Nigam. Additionally, we explore the subsequent investigation into the function of these toxins as signaling molecules in various somatic cells. [ABSTRACT FROM AUTHOR]

Background Insomnia is a known risk factor for cardio-cerebrovascular disease in the general population; however, its effect on cardio-cerebrovascular outcomes in end-stage kidney disease patients is unclear. Therefore, this study aimed to investigate the association between cardio-cerebrovascular outcomes and insomnia in patients who initiated maintenance dialysis. Methods This study used nationwide Korean health insurance claims data to analyze 79   420 patients who initiated maintenance dialysis from January 2009 to December 2017. Insomnia was defined using claim codes and sleep medication prescription data. Patients were categorized according to the presence of insomnia before and after dialysis initiation: (i) no insomnia, (ii) insomnia before dialysis only (improved insomnia), (iii) insomnia after dialysis only (developed insomnia) and (iv) insomnia in both periods (persistent insomnia). The primary and secondary outcomes were major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality, respectively. The outcome risks were estimated by Cox regression models with inverse probability of treatment weighting. Results The mean age was 61.4 ± 13.4 years, and 39.7% were women. During the transition period from pre-dialysis to maintenance dialysis, 13.2% experienced insomnia. The insomnia groups showed significantly higher risks for MACCE [weighted hazard ratios (95% confidence intervals): developed insomnia, 1.26 (1.25–1.28); improved insomnia, 1.31 (1.29–1.33); persistent insomnia, 1.39 (1.37–1.41)] and higher all-cause mortality risks than the no insomnia group. The insomnia-related cardio-cerebrovascular disease risk elevation was more prominent in younger and male patients. Conclusions Insomnia may increase cardio-cerebrovascular disease and all-cause mortality risk among end-stage kidney disease patients who initiate maintenance dialysis. [ABSTRACT FROM AUTHOR]

Background: Patients with end-stage kidney disease (ESKD) are at high risk of cardiovascular disease including stroke, heart failure, and ischemic heart disease (IHD). To prevent the occurrence and progression of CVD, a reliable prognostic cardiac biomarker is essential. We investigated the prognostic value of NT-proBNP for each incident type of CVD. Methods: Male patients from the Ibaraki Dialysis Initiation Cohort (iDIC) study with preserved serum samples from dialysis initiation day (n = 212) were analyzed. Patients were classified into four groups according to quartiles of baseline NT-pro BNP levels. The relationship between NT-proBNP levels at the initiation of dialysis and the subsequent incidence of hospitalization events due to IHD, heart failure, and stroke was analyzed. Results: The incidence rate for hospitalization due to IHD was significantly higher in the highest NT-proBNP category (Log rank p = 0.008); those of stroke and heart failure showed no significant differences among quartiles. Cox proportional hazards regression analysis revealed that serum NT-proBNT was the only prognostic factor for hospitalization for IHD after adjustment by major known IHD risk factors. (HR, 1.008; 95% confidence interval, 1.002–1.014; p = 0.01) The ROC curve analysis for the incidence of hospitalization due to IHD showed that NT-proBNP had an area under the curve (AUC) of 0.759 (95% CI 0.622–0.897; p = 0.004) at a cut-off value of 956.6 pg/mL. Conclusion: NT-proBNP measurement at the initiation of dialysis therapy is useful to predict later hospitalization for IHD. Trial registration: UMIN000010806. [ABSTRACT FROM AUTHOR]

Aim: Circulating blood volume (BV) during exercise changes depending on the intensity and duration, and post‐exercise hypotension is observed after continuous exercise. We investigated the safety and efficacy of both interval and continuous IDE at anaerobic threshold (AT) levels with respect to hemodynamic stability and dialysis efficiency. Methods: In this crossover randomized controlled trial, 16 patients on haemodialysis were subjected to three trial arms, including non‐IDE, interval‐IDE, and continuous‐IDE arms. Systolic blood pressure (SBP), BV, and ultraviolet absorbance – an indicator of dialysis efficiency – were continuously measured, and each change was compared between the three arms by two‐way analysis of variance. Results: Continuous IDE decreased SBP from post‐exercise to the end of dialysis compared with baseline (pre 142.8 ± 19.0 vs. post 127.5 ± 24.5 mmHg, p =.02), whereas interval IDE maintained better SBP levels post‐exercise (pre 139.9 ± 17.1 vs. post 140.1 ± 15.8 mmHg, p = 1.0) than continuous IDE (non‐IDE 133.2 ± 19.9 vs. interval 140.1 ± 15.8 vs. continuous 127.5 ± 24.5 mmHg, p =.04). Moreover, interval IDE caused less tiredness and few symptoms (p <.05), despite reaching higher intensity than continuous IDE (p =.001). The BV of each IDE arm decreased during exercise and recovered post‐exercise to the same level as non‐IDE. Ultraviolet absorbance was not different between each arm (p =.16). Conclusion: AT‐level interval IDE maintains better hemodynamic stability from post‐exercise to the end of dialysis and may represent a novel approach that can be effectively performed with fewer symptoms. [ABSTRACT FROM AUTHOR]

Dialysis associated reactions presenting with urticarial vasculitis is rarely reported in medical literature. We report a 61‐year‐old gentleman who developed sudden onset dyspnea with diffuse erythema within 20 min of haemodialysis. Patient was started on Azilsartan 3 days prior to this clinical event. Labs revealed features of hemolysis and urine was positive for hemoglobinuria. All dialysis related factors responsible for this reaction were ruled out. Due to non‐resolution of skin rash, skin biopsy was attempted which revealed fibrinoid necrosis of occasional vessels with predominant lymphocytic infiltration suggestive of drug induced urticarial vasculitis. Complement levels were normal. He was managed with steroids, anti‐histaminic, discontinuation of azilsartan and change of dialyzer membrane. This case highlights a rare dermatological presentation of Type A dialysis associated reaction involving azilsartan with differential diagnosis and treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Dialysis disequilibrium syndrome (DDS) is a rare but significant concern in adult and pediatric patients undergoing dialysis initiation with advanced uremia or if done after an interval. It is imperative to gain insights into the epidemiological patterns, pathophysiological mechanisms, and preventive strategies aimed at averting the onset of this ailment. Design: Prospective observational quality improvement initiative cohort study. Setting and Participants: A prospective single‐center study involving 50 pediatric patients under 18 years recently diagnosed with chronic kidney disease stage V with blood urea ≥200 mg/dL, admitted to our tertiary care center for dialysis initiation from January 2017 to October 2023. Quality Improvement Plan: A standardized protocol was developed and followed for hemodialysis in pediatric patients with advanced uremia. This protocol included measures such as lower urea reduction ratios (targeted at 20%–30%) with shorter dialysis sessions and linear dialysate sodium profiling. Prophylactic administration of mannitol and 25% dextrose was also done to prevent the incidence of dialysis disequilibrium syndrome. Measures: Incidence of dialysis disequilibrium syndrome and severe dialysis disequilibrium syndrome, mortality, urea reduction ratios (URRs), neurological outcome at discharge, and development of complications such as infection and hypotension. Long‐term outcomes were assessed at the 1‐year follow‐up including adherence to dialysis, renal transplantation, death, and loss to follow‐up. Results: The median serum creatinine and urea levels at presentation were 7.93 and 224 mg/dL, respectively. A total of 20% of patients had neurological symptoms attributable to advanced uremia at the time of presentation. The incidence of dialysis disequilibrium syndrome was 4% (n = 2) with severe dialysis disequilibrium syndrome only 2% (n = 1). Overall mortality was 8% (n = 4) but none of the deaths were attributed to dialysis disequilibrium syndrome. The mean urea reduction ratios for the first, second, and third dialysis sessions were 23.45%, 34.56%, and 33.50%, respectively. The patients with dialysis disequilibrium syndrome were discharged with normal neurological status. Long‐term outcomes showed 88% adherence to dialysis and 38% renal transplantation. Limitations: This study is characterized by a single‐center design, nonrandomized approach, and limited sample size. Conclusions: Our structured protocol served as a framework for standardizing procedures contributing to low incidence rates of dialysis disequilibrium syndrome. [ABSTRACT FROM AUTHOR]

Developing procedures based on equilibrium dialysis (ED) that allow measuring the free drug concentration in plasma improves therapeutic drug monitoring (TDM) in those cases where its measurement is justified. However, this procedure requires specific sample preparation and presents different pitfalls, which are not error-free. As with any result provided by a clinical laboratory, this one should be as accurate as possible to allow a correct clinical interpretation. The measurement uncertainty (MU) is a parameter that enables the accuracy of results to be known, and that is mandated by ISO 15189. Herein, this study suggests how the MU for the results of the free drug concentrations in serum could be estimated when an ED is used. A combination of the top-down and bottom-up approaches was used to estimate the MU based on the ISO/TS 20914:2019 and JCGM 100:2008 guidelines, including the concentration of free phenytoin in serum, as an example. Different scenarios were incorporated considering or not a significant bias related to the primary drawbacks of ED: the non-specific binding, the volume shift effect and the Gibbs-Donnan effect. The expanded uncertainties estimated ranged between 13.0 and 30.9 %. The highest MU corresponded to the free drug concentrations in serum results when significant biases related to the volume shift and Gibbs-Donnan effects exist. A detailed estimation of MU for free drug concentrations is presented using ED, considering different scenarios. This study could stimulate clinical laboratories to perform MU studies and its application in TDM. [ABSTRACT FROM AUTHOR]

Aim: The objective of this registry study is to assess the utilization of pharmacogenomic (PGx) drugs among patients with chronic kidney disease (CKD). Methods: This study was a retrospective study of patients affiliated with the Department of Nephrology, Aalborg University Hospital, Denmark in 2021. Patients diagnosed with CKD were divided into CKD without dialysis and CKD with dialysis. PGx prescription drugs were retrieved from the Patient Administration System. Actionable dosing guidelines (AG) for specific drug–gene pairs for CYP2D6, CYP2C9, CYP2C19 and SLCO1B1 were retrieved from the PharmGKB homepage. Results: Out of 1241 individuals, 25.5% were on dialysis. The median number of medications for each patient was 9 within the non‐dialysis group and 16 within the dialysis group. Thirty‐one distinct PGx drugs were prescribed. Altogether, 76.0% (943 individuals) were prescribed at least one PGx drug and the prevalence of prescriptions of PGx drugs was higher in the dialysis group compared to the non‐dialysis group. The most frequently prescribed drugs with AG were metoprolol, pantoprazole, atorvastatin, simvastatin and warfarin. Conclusion: This study demonstrated that a substantial proportion of patients with CKD are exposed to drugs or drug combinations for which there exists AG related to PGx of CYP2D6, CYP2C19, CYP2C9 and SLCO1B1. [ABSTRACT FROM AUTHOR]

Ex-vivo lung perfusion (EVLP) has extended the number of transplantable lungs by reconditioning marginal organs. However, EVLP is performed at 37°C without homeostatic regulation leading to metabolic wastes' accumulation in the perfusate and, as a corrective measure, the costly perfusate is repeatedly replaced during the standard of care procedure. As an interesting alternative, a hemodialyzer could be placed on the EVLP circuit, which was previously shown to rebalance the perfusate composition and to maintain lung function and viability without appearing to impact the global gene expression in the lung. Here, we assessed the biological effects of a hemodialyzer during EVLP by performing biochemical and refined functional genomic analyses over a 12h procedure in a pig model. We found that dialysis stabilized electrolytic and metabolic parameters of the perfusate but enhanced the gene expression and protein accumulation of several inflammatory cytokines and promoted a genomic profile predicting higher endothelial activation already at 6h and higher immune cytokine signaling at 12h. Therefore, epuration of EVLP with a dialyzer, while correcting features of the perfusate composition and maintaining the respiratory function, promotes inflammatory responses in the tissue. This finding suggests that modifying the metabolite composition of the perfusate by dialysis during EVLP can have detrimental effects on the tissue response and that this strategy should not be transferred as such to the clinic. [ABSTRACT FROM AUTHOR]

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Objectives were to (1) employ ensemble machine learning algorithms utilizing real-world clinical data to predict 90-day prognosis, including dialysis dependence and mortality, following the first hospitalized dialysis and (2) identify the significant factors associated with overall outcomes. Patients and Methods: We identified hospitalized patients with Acute kidney injury requiring dialysis (AKI-D) from a dataset of the Taipei Medical University Clinical Research Database (TMUCRD) from January 2008 to December 2020. The extracted data comprise demographics, comorbidities, medications, and laboratory parameters. Ensemble machine learning models were developed utilizing real-world clinical data through the Google Cloud Platform. Results: The Study Analyzed 1080 Patients in the Dialysis-Dependent Module, Out of Which 616 Received Regular Dialysis After 90 Days. Our Ensemble Model, Consisting of 25 Feedforward Neural Network Models, Demonstrated the Best Performance with an Auroc of 0.846. We Identified the Baseline Creatinine Value, Assessed at Least 90 Days Before the Initial Dialysis, as the Most Crucial Factor. We selected 2358 patients, 984 of whom were deceased after 90 days, for the survival module. The ensemble model, comprising 15 feedforward neural network models and 10 gradient-boosted decision tree models, achieved superior performance with an AUROC of 0.865. The pre-dialysis creatinine value, tested within 90 days prior to the initial dialysis, was identified as the most significant factor. Conclusion: Ensemble machine learning models outperform logistic regression models in predicting outcomes of AKI-D, compared to existing literature. Our study, which includes a large sample size from three different hospitals, supports the significance of the creatinine value tested before the first hospitalized dialysis in determining overall prognosis. Healthcare providers could benefit from utilizing our validated prediction model to improve clinical decision-making and enhance patient care for the high-risk population. [ABSTRACT FROM AUTHOR]

Aim: This study investigates the impact of magnetic field-assisted filtration on endotoxin reduction in dialysis water, focusing on the efficacy of ultrafiltration and nanofiltration membranes. Methods: The starting material was synthetic water with a known amount of endotoxin (0.48 EU/ml). The experiment was conducted in a small-lab-scale unit, likely to test and optimize the purification method before large-scale application. Limulus amebocyte lysate (LAL) assay is a standard test used to detect and quantify endotoxin levels in liquids. Results: The study found that all treatment strategies effectively reduced endotoxin levels, with the best treatment being a third hybrid treatment involving magnetic field, UF, and NF exposure. This kind of treatment reduced the endotoxin from 0.169 ± 0.09 EU/ml to 0.06 ± 0.06 EU/ml at an exposure time of 20 min for a magnetic field. Conclusion: The integration of magnetically treated water in dialysis treatment plants holds promise for enhancing the quality of dialysis fluid and aligning with international standards. By employing physical methods like magnetic treatment, facilities can address concerns surrounding water purity in dialysis, which is crucial for patient safety and treatment effectiveness. [ABSTRACT FROM AUTHOR]

Background: In the last two decades, sex and gender differences have been documented in chronic kidney disease (CKD) management, including access to renal replacement therapy and its outcomes. The objectives of this study were to 1) compare the pre-dialysis healthcare utilization in men and women, and 2) examine the sex-specific factors associated with emergency dialysis start. Methods: Adult patients with CKD who started dialysis in France in 2015 were extracted from the Renal Epidemiology and Information Network registry. Patients were matched to the French National Health Data System database to extract healthcare utilization data for the 2 years before dialysis start. Frequencies and monthly rates of consultations and hospitalizations were compared between men and women. Logistic regression analyses were performed separately in the two groups. Results: Among the 8856 patients included, 3161 (35.7%) were women. Median age (71 years) and estimated glomerular filtration rate (8.1 and 7.7 ml/min for men and women) were similar between groups at dialysis start. Monthly consultations rates with a general practitioner and nephrology-related care were similar between women and men. Some sex-specific differences were found: higher frequencies of consultations with a psychiatrist in women and more frequent hospitalizations for circulatory system diseases in men. Emergency dialysis start rate was 30% in both groups. Emergency dialysis start was associated with acute nephropathy, compared with slowly progressive nephropathy, in women but not in men (OR = 1.48, p<0.01 vs 1.15, p = 0.18). Conclusions: This study found similar quantitative pre-dialysis healthcare utilization in men and women. To better understand sex/gender differences in CKD care trajectories, future research should focus on patients with CKD who are unknown to nephrology services, on patients receiving conservative care and on the sex/gender-specific mechanisms underlying care decision-making. [ABSTRACT FROM AUTHOR]

Aim: Vascular and peritoneal access are essential elements for sustainability of chronic dialysis programs. Data on availability, patterns of use, funding models, and workforce for vascular and peritoneal accesses for dialysis at a global scale is limited. Methods: An electronic survey of national leaders of nephrology societies, consumer representative organizations, and policymakers was conducted from July to September 2018. Questions focused on types of accesses used to initiate dialysis, funding for services, and availability of providers for access creation. Results: Data from 167 countries were available. In 31 countries (25% of surveyed countries), >75% of patients initiated haemodialysis (HD) with a temporary catheter. Seven countries (5% of surveyed countries) had >75% of patients initiating HD with arteriovenous fistulas or grafts. Seven countries (5% of surveyed countries) had >75% of their patients starting HD with tunnelled dialysis catheters. 57% of low‐income countries (LICs) had >75% of their patients initiating HD with a temporary catheter compared to 5% of high‐income countries (HICs). Shortages of surgeons to create vascular access were reported in 91% of LIC compared to 46% in HIC. Approximately 95% of participating countries in the LIC category reported shortages of surgeons for peritoneal dialysis (PD) access compared to 26% in HIC. Public funding was available for central venous catheters, fistula/graft creation, and PD catheter surgery in 57%, 54% and 54% of countries, respectively. Conclusion: There is a substantial variation in the availability, funding, workforce, and utilization of vascular and peritoneal access for dialysis across countries regions, with major gaps in low‐income countries. [ABSTRACT FROM AUTHOR]

Background There is growing interest in home haemodialysis (HHD) performed with low-flow dialysate devices and variable treatment schedules. The target standard Kt/V (stdKt/V) should be 2.3 volumes/week, according to KDOQI guidelines (2015). The current formula for stdKt/V does not help prescribe the dialysis dose (eKt/V) and treatment frequency (TF). The aim of this study was to obtain a formula for stdKt/V that is able to define the minimum required values of eKt/V and TF to achieve the targeted stdKtV. Methods Thirty-eight prevalent patients on HHD were enrolled. A total of 231 clinical datasets were available for urea modelling using the Solute-Solver software (SS), recommended by KDOQI guidelines. A new formula (stdKt/V = a + b × Kru + c × eKt/V) was obtained from multivariable regression analysis of stdKt/V vs eKt/V and residual kidney urea clearance (Kru). The values of coefficients a, b and c depend on the treatment schedules and the day of the week of blood sampling for the kinetic study (labdayofwk) and then vary for each of their foreseen 62 combinations. For practical purposes, we used only seven combinations, assuming Monday as a labdayofwk for each of the most common schedules of the 7 days of the week. Results The stdKt/V values obtained with SS were compared with the paired ones obtained with the formula. The mean ± standard deviation stdKt/V values obtained with SS and the formula were 3.043 ± 0.530 and 2.990 ± 0.553, respectively, with 95% confidence interval +0.15 to –0.26. A 'prescription graph' was built using the formula to draw lines expressing the relationship between Kru and required eKt/V for each TF. Using this graph, TF could have been reduced from the delivered 5.8 ± 0.8 to 4.8 ± 0.8 weekly sessions. Conclusions The new formula for stdKtV is reliable and can support clinicians to prescribe the dialysis dose and TF in patients undergoing HHD. [ABSTRACT FROM AUTHOR]

Advances in the treatment of kidney failure with chronic dialysis have stagnated over the past three decades, with over 50% of patients still managed by conventional in-hospital haemodialysis. In parallel, the demands of chronic dialysis medical care have changed and evolved due to a growing population that has higher frailty and multimorbidity. Thus, the gap between the needs of kidney failure patients and the healthcare capability to provide effective overall management has widened. To address this problem, healthcare policy has increasingly aligned towards a human-centred approach. The paradigm shift of human-centred approach places patients at the forefront of decision-making processes, ensuring that specific needs are understood and prioritised. Integration of human-centred approaches with patient care has been shown to improve satisfaction and quality of life. The aim of this narrative is to evaluate the current clinical challenges for managing kidney failure for dialysis providers; summarise current experiences and unmet needs of chronic dialysis patients; and finally emphasise how human-centred care has advanced chronic dialysis care. Specific incremental advances include implementation of renal supportive care; home-assisted dialysis; hybrid dialysis; refinements to dialysis methods; whereas emerging advances include portable and wearable dialysis devices and the potential for the integration of artificial intelligence in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Rural areas face significant disparities in dialysis care compared to urban areas due to limited access to dialysis facilities, longer travel distances, and a shortage of healthcare professionals. The objective of this study was to conduct a national examination of rural-urban differences in quality of dialysis care offered across counties in the USA. Methods: Data were gathered from Medicare-certified dialysis facilities in 2020 from the Centers for Medicare and Medicaid Services website. To identify high-need counties, county-level estimated crude prevalence of diabetes in adults was obtained from the 2022 CDC PLACES data portal. Our analysis reviewed 3,141 counties in the USA. The primary outcome measured was whether the county had a dialysis facility. Among those counties that had a dialysis facility, additional outcomes were the average star rating, whether peritoneal dialysis was offered, and whether home dialysis was offered. Results: The type of services offered by dialysis facilities varied significantly, with peritoneal dialysis being the most commonly offered service (50.8%), followed by home hemodialysis (28.5%) and late-shift services (16.0%). These service availabilities are more prevalent in urban facilities than in rural facilities. The Centers for Medicare and Medicaid Services Five Star Quality ratings were quite different between urban and rural facilities, with 40.4% of rural facilities having a ranking of five, compared to 27.1% in urban. Conclusion: The majority of rural counties lack a single dialysis facility. Counties with high rates of chronic kidney disease, diabetes, and blood pressure, deemed high need, were less likely to have a highly rated dialysis facility. The findings can be used to further inform targeted efforts to increase diabetes educational programming and design appropriate interventions to those residing in rural communities and high-need counties who may need it the most. [ABSTRACT FROM AUTHOR]

Dietetic practice aims to help people modify their diet to slow disease progression and manage disease‐related complications while also meeting their nutritional and personal dietary needs. This can be challenging in people with kidney failure undergoing dialysis, particularly in our current food environment and culture. Fortunately, advancements in nutritional‐behavioral science and technology are providing new avenues and resources to help meet the challenge. However, progress is slow, and much of dietetic practice in the dialysis population still relies on the interpretation, translation, and application of low‐quality, indirect evidence. This Special Issue of Seminars in Dialysis provides readers with an update on and critical insights into some of the major issues and controversies impacting the field of kidney nutrition today. [ABSTRACT FROM AUTHOR]

Objective To analyze the frailty of patients with long-term maintenance dialysis (MD) and its influencing factors, and to explore the correlation of different dialysis modalities with the re-infection of novel coronavirus infection (COVID-19) and frailty syndrome. Methods Patients with regular dialysis in Nephrology Department of the Second Affiliated Hospital of Kunming Medical University from February to June 2023 were selected. A cross-sectional survey was conducted to collect clinical data of the patients, including dialysis modality (i. e. maintenance hemodialysis, abbreviated as hemodialysis, and continuous ambulatory peritoneal dialysis, abbreviated as peritoneal dialysis), and whether with re-infection of COVID-19. Patients were divided into 3 groups using Fried' s frailty phenotype (FP) : non-frailty group, pre-or-intermediate frailty group, and frailty syndrome group. The clinical characteristics of the FP were compared among the three groups. The correlation of frailty with clinical data, dialysis modality, re-infection of COVID-19 in each group was compared. Multifactorial logistic regression was used to analyze the factors influencing the development of frailty syndrome in patients. Results A total of 246 dialysis patients were included in this study, with 77 (31.3%) in the non-frailty group, 83 (33.7%) in the pre-frailty group and 86 (35.0%) in the frailty syndrome group. The frailty syndrome group showed characteristics of advanced age, high pre-dialysis creatinine level, low serum albumin level and combined pleural effusion ( all P < 0.05 ) .There was no statistically significant difference in the comparison of frailty between the hemodialysis and peritoneal dialysis group (P = 0.960).COVID-19 re-positive patients had higher frailty score than non-re-positive patients. Multifactor logistic regression showed that age, COVID-19 re-infection of COVID-19, serum albumin, pre-dialysis creatinine, and pleural effusion were factors influencing the development of frailty syndrome in dialysis patients (P < 0.05). Conclusion There is high incidence of frailty syndrome in dialysis patients, and there is no correlation of frailty with dialysis modality. High serum albumin level is a protective factor for the development of frailty syndrome in patients, whereas re-infection of COVID-19, advanced age, high pre-dialysis blood creatinine level and pleural effusion are risk factors for the development of frailty syndrome. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis reactions (HDRs) are similar to complement activation-related pseudo allergy (CARPA), a hypersensitivity reaction that occurs when administering certain (nano)drugs intravenously. The pathomechanism of CARPA was described based on animal experiments. Typical CARPA-like dialysis reactions, which occur at the start of hemodialysis, have been reported using polysulfone dialyzers. However, to our knowledge, this is the first dialysis reaction that occurred towards the end of hemodialysis treatment. Case presentation: This report describes a 52-year-old Caucasian male patient who had been receiving chronic hemodialysis for 3 years and exhibited a CARPA reaction during his third hour of treatment. Upon activation of the microbubble alarm, the extracorporeal system recirculated for five minutes. Following reconnection, the patient exhibited a drop in systemic blood pressure, chest pain, and dyspnea after five minutes. Symptoms disappeared spontaneously after reducing the speed of the blood pump, placing the patient in a Trendelenburg position, and administering a bolus infusion from the dialysis machine. The remaining dialysis treatment was uneventful. Conclusion: Numerous case reports about reactions occurring with modern high-efficiency polysulfone dialyzers have been published. However, due to changes in the material structure by the manufacturers, we have not encountered such cases lately. The recently reported increase in thromboxane-B2 and pulmonary arterial pressure and complement activation upon re-infusion of extracorporeal blood following dialysis may explain the reaction observed here. [ABSTRACT FROM AUTHOR]

Background/Aims: Intradialytic hypotension (IDH) is a serious and frequent complication of hemodialysis (HD). Thus far, data are scarcely available to assess the impact of first versus subsequent HD sessions of the week in IDH. Therefore, the purpose of this work was to evaluate IDH risk in patients on thrice-weekly HD. Methods: We conducted an analysis of all blood pressure (BP) measurements obtained during 492 HD treatments given to 41 prevalent adult patients over a one month period. A logistic regression model for repeated binary observations was used to determine the association between hypotension and patient and dialysis factors. Results: The incidence of IDH was 32.5%. First dialysis session of the week was associated with a 9% higher risk of hypotension relatively to the second one. The risk was even higher from the first to the third session of the week (60%) and from the second to the third (50%). A higher hypotension odds ratio was also associated with age (1.03, 90%CI: 1.01-1.06), higher predialysis BP (1.04, 90%CI: 1.03-1.05) and higher phosphorus level (1.38, 90%CI: 1.07-1.76). The risk decreased 24.4% for each additional antihypertensive drug taken by the patient. Conclusions: The odds of hypotension occurrence decrease throughout dialysis sessions of the week. Minimizing modifiable risk factors may decrease IDH episodes. [ABSTRACT FROM AUTHOR]

This article discusses the development and validation of a clinical screening algorithm for the diagnosis of primary hyperoxaluria type 1 (PH1) in adult patients undergoing dialysis. PH1 is a rare genetic disorder characterized by excessive production of oxalate, leading to kidney stones and nephrocalcinosis. The algorithm uses five clinical features, including active nephrolithiasis, presence of nephrocalcinosis, previous graft loss, early initiation of dialysis, and family history of chronic kidney disease, to estimate the probability of PH1. The algorithm showed good performance in terms of discrimination and calibration, and it could be easily implemented in dialysis facilities to identify high-risk patients for further investigation. [Extracted from the article]