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Children requiring long-term kidney replacement therapy are a "rare disease" cohort. While the basic technical requirements for hemodialysis (HD) are similar in children and adults, key aspects of the child's cardiovascular anatomy and hemodynamic specifications must be considered. In this article, we describe the technical requirements for long-term HD therapy for children and the devices that are currently available around the world. We highlight the characteristics and major technical shortcomings of permanent central venous catheters, dialyzers, dialysis machines, and software available to clinicians who care for children. We show that currently available HD machines are not equipped with appropriately small circuits and sensitive control mechanisms to perform safe and effective HD in the youngest patients. Manufacturers limit their liability, and health regulatory agencies permit the use of devices, only in children according to the manufacturers' pre-specified weight limitations. Although registries show that 6–23% of children starting long-term HD weigh less than 15 kg, currently, there is only one long-term HD device that is cleared for use in children weighing 10 to 15 kg and none is available and labelled for use in children weighing less than 10 kg anywhere in the world. Thus, many children are being treated "off-label" and are subject to interventions delivered by medical devices that lack pediatric safety and efficacy data. Moreover, recent improvements in dialysis technology offered to adult patients are denied to most children. We, in turn, advocate for concerted action by pediatric nephrologists, industry, and health regulatory agencies to increase the development of dedicated HD machines and equipment for children. [ABSTRACT FROM AUTHOR]

Despite significant medical and technical improvements in the field of dialysis, the morbidity and mortality among patients with chronic kidney disease (CKD) stage 5 on dialysis remains extremely high. Hemodiafiltration (HDF), a dialysis method that combines the two main principles of hemodialysis (HD) and hemofiltration—diffusion and convection—has had a positive impact on survival when delivered with a high convective dose. Improved outcomes with HDF have been attributed to the following factors: HDF removes middle molecular weight uremic toxins including inflammatory cytokines, increases hemodynamic stability, and reduces inflammation and oxidative stress compared to conventional HD. Two randomized trials in adults have shown improved survival with HDF compared to high-flux HD. A large prospective cohort study in children has shown that HDF attenuated the progression of cardiovascular disease, improved bone turnover and growth, reduced inflammation, and improved blood pressure control compared to conventional HD. Importantly, children on HDF reported fewer headaches, dizziness, and cramps; had increased physical activity; and improved school attendance compared to those on HD. In this educational review, we discuss the technical aspects of HDF and results from pediatric studies, comparing outcomes on HDF vs. conventional HD. Convective volume, the cornerstone of treatment with HDF and a key determinant of outcomes in adult randomized trials, is discussed in detail, including the practical aspects of achieving an optimal convective volume. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: OSAKA regimen is a novel bladder preservation therapy involving balloon-occluded selective arterial infusion of radio-sensitizing chemotherapeutic agent with concurrent hemodialysis (HD), followed by radiation therapy. Objectives are to study the feasibility of this novel regimen in patients with advanced cancer bladder (Ca Bladder). Methods: Two patients having advanced Ca Bladder with cisplatin ineligibility and poor performance status were managed with OSAKA regimen. Patients undergo super selective catheterisation of the anterior division of the internal iliac artery, followed by concurrent instillation of cisplatin (100 mg) via microcatheters and hemodialysis. Within 72 h, definitive radiation therapy is given. Image-guided radiation therapy (IGRT) with Helical Tomo using an Accuracy Radixact Tomography machine was used. 60 Gray/30 fractions is given to the bladder and nodes (50 Gray to bladder and nodes plus margin, with a boost of 10 Gray to bladder plus margin). Response is monitored by 3 monthly fluorodeoxyglucose positron emission tomography (FDG PET) imaging. Results: Our first patient tolerated the procedure well and showed a complete response at 3 months of FDG PET imaging, but unfortunately, 1 year of FDG PET showed bony metastases, and the patient was managed accordingly. Our second patient also tolerated the regimen well, showed a complete response at 3 and 12 months of FDG PET imaging, and is under follow-up. Conclusions: The OSAKA regimen, as a bladder preservation strategy, is feasible and safe in selective advanced Ca Bladder patients. [ABSTRACT FROM AUTHOR]

Introduction: Health‐related quality of life (HRQoL) studies demonstrate the impact of end‐stage renal disease (ESRD) on the physical and psychosocial development of children. While several instruments are used to measure HRQoL, few have standardized domains specific to pediatric ESRD. This review examines current evidence on self and proxy‐reported HRQoL among pediatric patients with ESRD, based on the Pediatric Quality of Life Inventory (PedsQL) questionnaires. Methods: Following PRISMA guidelines, we conducted a systematic review and meta‐analysis on HRQoL using the PedsQL 4.0 Generic Core Scale (GCS) and the PedsQL 3.0 ESRD Module among 5‐ to 18‐year‐old patients. We queried PubMed, Embase, Web of Science, CINAHL, and Cochrane databases. Retrospective, case‐controlled, and cross‐sectional studies using PedsQL were included. Findings: Of 435 identified studies, 14 met inclusion criteria administered in several countries. Meta‐analysis demonstrated a significantly higher total HRQoL for healthy patients over those with ESRD (SMD:1.44 [95% CI: 0.78–2.09]) across all dimensional scores. In addition, kidney transplant patients reported a significantly higher HRQoL than those on dialysis (PedsQL GCS, SMD: 0.33 [95% CI: 0.14–0.53]) and (PedsQL ESRD, SMD: 0.65 [95% CI: 0.39–0.90]) concordant with parent‐proxy reports. Discussion: Patients with ESRD reported lower HRQoL in physical and psychosocial domains compared with healthy controls, while transplant and peritoneal dialysis patients reported better HRQoL than those on hemodialysis. This analysis demonstrates the need to identify dimensions of impaired functioning and produce congruent clinical interventions. Further research on the impact of individual comorbidities in HRQoL is necessary for developing comprehensive, integrated, and holistic treatment programs. [ABSTRACT FROM AUTHOR]

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Aims: To investigate the immunological characteristics of hemodialysis (HD) patients with end-stage renal disease (ESRD) of various ages, and the impact of age-related immune alterations on these patients, with a focus on peripheral T cells. Methods: From September 2016 to September 2019, HD patients were enrolled and followed prospectively for 3 years. Patients were divided into three groups based on their ages: < 45, 45 to 64, and ≥ 65. The distribution of T cell subsets in different age groups was investigated and compared. The effects of altered T cell subsets on overall survival were also investigated. Results: A total of 371 HD patients were enrolled. The reduced number of naive CD8+ T cells (P < 0.001) and increased number of EMRA CD8+ T cells (P = 0.024) were independently associated with the advanced age among all T cell subsets studied. Patient survival may be affected by numerical changes in naive CD8+ T cells. However, when HD patients were < 45 or ≥ 65 years, the reduction had no significant impact on survival. Only in HD patients aged 45 to 64 years, the number of naïve CD8+ T cells found to be insufficient but not deficient, identified as an independent predictor of poor survival. Conclusions: The most significant age-related immune change in HD patients was a decrease in peripheral naive CD8+ T cells, which was an independent predictor of 3-year overall survival in HD patients aged 45 ~ 64 years. [ABSTRACT FROM AUTHOR]

Chronic kidney patients may have difficulties in blood filtration to eliminate the waste from the blood and to maintain the level of the minerals in the blood. Hemodialysis (HD) is an artificial way to remove the waste from the blood of a kidney patient and to maintain the proper mineral level in the blood. Reverse osmosis (RO) water having less total dissolved solids (TDS) < 50 ppm is used to prepare dialysis fluid/dialysate in dialysis with two chemicals (electrolytes and salts such as sodium bicarbonate). To check the purity of RO water from various RO machines used to prepare dialysate, which is vital for the safety of the patient, the laser-induced breakdown spectroscopy (LIBS) technique has been used. Also, the amount of replacement of electrolytes/minerals between the blood of the patient and dialysate after dialysis has been checked/determined for two different machines: hemodialysis machine (HDM) and on-line hemo-dia filtration machine (on-line HDF machine). It is observed that the proper amount of electrolytes (Na, Ca, and Mg) are maintained/normalized (depending upon patient's need), excess K is removed, and excess urea and creatinine is removed continuously from the blood of a patient during dialysis treatment which is essential for the better health of a kidney patient. Our results show that the RO water used in on-line HDF machine is purer (i.e., ultrapure); therefore, the quality of life of a kidney patient may be better if dialysis is performed with the on-line HDF machine. The experimental results also show that the filtration capacity of the dialyzer decreases after reusing it many times for dialysis treatment. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to develop Chronic Kidney Disease Patient Information Leaflets (CKD-PILs) to test their understandability and assess their usefulness. Materials and Methods: Prospective observational research was carried out in a dialysis unit at renowned medical care for 9 months and 140 CKD patients enrolled in the study to evaluate prepared CKD-PILs. Patient Information Leaflets (PILs) is prepared by referring to various medical database and it’s evaluated using computer-aided readability tools using the website “http://r eadabilityscore.com”. Afterward, PIL was translated into a regional language and verified by a subject expert. The design and layout were analyzed using BADL criteria and user option tests. Results: Prepared CKD-PILs found to be good design and layout as per BALD and user opinion (BALD Assamese: 27, BALD English: 28; User opinion: 82.7% for Assamese PILs and 89.2% for English PILs). The mean scores on the knowledge evaluated using user testing methods and Disease management and lifestyle-related knowledge increased from 49.08±4.16 to 80.40±5.71 (p<0.001) and is statistically significant. Conclusion: The results showed significant improvement of their lifestyle and disease-related knowledge after the implementation of PILs. The Prepared CKD-based patient information leaflets have been found to be a good and effective educational tool for CKD patients. [ABSTRACT FROM AUTHOR]

RATIONALE & OBJECTIVE: Patients receiving twice-weekly or less-frequent hemodialysis (HD) may need to undergo higher ultrafiltration rates (UFRs) to maintain acceptable fluid balance. We hypothesized that higher UFRs are associated with faster decline in residual kidney function (RKF) and a higher rate of mortality. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 1,524 patients with kidney failure who initiated maintenance HD at a frequency of twice or less per week for at least 6 consecutive weeks at some time between 2007 and 2011 and for whom baseline data for UFR and renal urea clearance were available. PREDICTOR: Average UFR during the first patient-quarter during less-frequent HD (

Background: Chronic kidney disease (CKD) patients need efficient vascular access once they progress to end-stage renal disease (ESRD) and require hemodialysis (HD). The most common forms of vascular access used in clinical practice are arterio-venous fistula (AVF), arterio-venous graft (AVG), and central venous catheters (CVC). AV Fistula is preferred over AVG and CVC because it provides better patient and Access survival owing to fewer access-related complications.Vascular access is the lifeline of the hemodialysis patient., vascular access malfunctions remain one of the extreme challenges in caring for hemodialysis patients, early fistula creation is very important because avoidance of early cannulation and complications of temporary catheter insertion, vascular access care is an essential especially physical examination and care by a nephrologist, nursing staff and by the patients. The review aims to highlight the importance of hemodialysis vascular access, prevention of its complications, to decrease the morbidity and mortality related to hemodialysis vascular access complications.

Abstract Background Peritoneal dialysis (PD) is the recommended renal replacement therapy for patients with end-stage kidney disease. Complementary hemodialysis (HD) once per week for PD patients can aid in achieving adequate dialysis and extend the duration of PD treatment. In Japan, this therapy is termed “combined therapy with PD and hemodialysis (combPDHD).” CombPDHD represents a treatment option for PD patients for whom adequate dialysis cannot be maintained. CombPDHD has been widely applied in Japanese PD patients; however, it is much less common outside of Japan. Clinical evidence, particularly regarding long-term prognosis and appropriate duration of treatment, remains insufficient. Summary CombPDHD will be required as an alternative for increasing the dose of PD under various conditions, such as a loss of residual kidney function (RKF) and peritoneal functional failure. The Japanese regimen for combPDHD involves 5 or 6 days of PD, combined with one weekly session of hemodialysis. According to some reports, the potential benefits of combPDHD are peritoneal rest with improved peritoneal function and delay in membrane deterioration. CombPDHD prevents peritoneal dysfunction and reduces cardiovascular complications by adjusting the fluid volume and improving renal anemia. Increased D/PCr indicates a deterioration in peritoneal function and is an independent risk factor for encapsulating peritoneal sclerosis (EPS). It is previously reported that no significant differences in combPDHD duration were observed between EPS and non-EPS groups. Laparoscopic findings involving patients with combPDHD revealed that there was a difference in abdominal wall degeneration depending on the intra-abdominal cavity of each case. Recently, prospective studies on long-term peritoneal function, survival, and hospitalization in combPDHD have been reported. However, reviews evaluating combPDHD long-term outcomes in multicenter and prospective studies are lacking. Conclusion It is difficult to continue PD alone with a declining RKF or when self-management is poor. Hence, combPDHD should be started to adjust the fluid volume, with adequate dialysis dose and peritoneal rest. This therapy is useful from a lifestyle viewpoint during the transition period from PD to HD and should not be continued indefinitely.

OBJECTIVE: This study evaluated olfactory function in patients undergoing hemodialysis. The evaluation utilized the Sniffin' Sticks test. PATIENTS AND METHODS: The study enrolled 56 individuals undergoing hemodialysis for chronic renal failure alongside 54 healthy controls. The Sniffin' Sticks battery was used to assess olfactory function in all subjects. The battery included 12 separately identifiable odors. A score below 6 was considered anosmia, whilst scores ranging from 7 to 10 were classed as hyposmia. A score of at least 11 indicated normal olfaction. RESULTS: There was a statistically significant difference in scores between the two groups. The hemodialysis patients scored 9.12±2.77 compared to 10.72±1.94 in the controls. In the hemodialysis patients, scores for males and females did not differ significantly. Furthermore, there was no correlation between score and age, sex or length of renal failure. Some 12.5% of hemodialysis patients were anosmic, whilst 50% were hyposmic. The corresponding rates in the control group were 7.4% and 20.4%. CONCLUSIONS: Undergoing hemodialysis is associated with a decreased total score on the Sniffin' Sticks battery, with anosmia in 12.5% of patients and hyposmia in 50.0%. Thus, olfactory impairment is present in 62.5% of hemodialysis patients. According to previous research, renal transplantation results in an improved ability to smell, depending on how plastic the neurons involved in olfaction are. [ABSTRACT FROM AUTHOR]

Several studies investigated the role of fibroblast growth factor 23 (FGF23) in the regulation of renal phosphate excretion in chronic kidney disease (CKD). However, patients with residual urine output (UO) seem to control their serum phosphorus levels better. Our aim was to determine whether FGF23 levels are influenced by dialysis modality and UO. We performed a cross-sectional study in hemodialysis (HD) and peritoneal dialysis (PD) patients. The C-terminal FGF23 (cFGF23) levels were determined in plasma with a two-site enzyme-linked immunosorbent assay. The UO collection referred to an mL/day measurement. All p values were two-sided, and the statistical significance was set at p < 0.05. We enrolled 133 patients (58 HD, 75 PD, UO 70%). The median cFGF23 was significantly higher in HD vs. PD patients (p = 0.0017) and not significantly higher in patients without UO (p = 0.12). We found a negative correlation between cFGF23 and the UO volume (p = 0.0250), but the correlation was not significant when considering the type of dialysis treatment. Phosphorus (ß = 0.21677; p = 0.0007), type of dialysis (ß = −0.68392; p = 0.0003), and creatinine (ß = 0.08130; p = 0.0133) were significant and independent predictors of cFGF23 levels. In conclusion, cFGF23 was significantly higher in HD than in PD patients. We found a significant negative correlation between cFGF23 and the residual UO volume, but the correlation was not significant considering the type of dialysis. Our study reveals that dialysis modality is an independent predictor of FGF23 levels. In particular, PD is associated with lower FGF23 levels than HD. [ABSTRACT FROM AUTHOR]

BackgroundPoorly controlled pain remains a problem for many patients with end-stage kidney disease requiring hemodialysis (ESKD/HD) and customary approaches to pain management (e.g., opioids, non-steroidals) confer substantial risk. Accordingly, non-pharmacologic therapies are needed for use in this population. Non-invasive transcranial Direct Current Simulation (tDCS) constitutes a promising nonpharmacologic method for pain management in affected individuals.AimsThis study seeks to: 1) determine the effects of an 8-week course of at-home tDCS vs. sham tDCS on pain intensity, pain interference, medication usage, quality of life, and mood; 2) determine if tDCS effects vary by race/ethnicity; and 3) ascertain patient satisfaction with device use.MethodsThis double-blind, randomized, sham-controlled clinical trial will enroll 100 ESKD/HD patients with moderate-to-severe (≥4 on 0–10 scale) chronic pain. The active study intervention consists of 20 min of tDCS delivered over the primary motor cortex 5 days/week for 8 weeks. The comparator is a sham procedure that provides no effective stimulation. The primary outcome analysis will evaluate efficacy of tDCS for pain reduction after two months of stimulation. We will also assess the effects of treatment on analgesic consumption, pain interference, depressed mood, and quality of life. The statistical plan will include fixed classification factors for treatment (vs. sham), clinic sites, and assessment time, and the interaction of these factors adjusting for covariates (e.g., race/ethnicity, pain level).ConclusionAt-home tDCS constitutes a promising nonpharmacologic treatment for pain mitigation in persons with ESKD/HD. This unique RCT could transform the way pain is managed in this vulnerable population.Trial RegistrationNCT05311956.

Despite advances in clinical management and dialysis care, the outcome of unplanned pregnancy in women on maintenance hemodialysis (MHD) remains a difficult journey for the patient, fetus, and healthcare staff, particularly in low-resource countries. We report the successful outcome of a pregnancy in an anuric woman on twice-weekly maintenance hemodialysis for chronic glomerulonephritis since November 2012 in Cameroon. She was discovered pregnant at 18 weeks of gestation. The pregnancy was maintained until 36 weeks when a healthy 2,270 g female baby was delivered by elective cesarean section for tight nuchal cords and intrauterine growth retardation. The mother’s post-partum period was uneventful. Except for hypoglycemia shortly after birth, the baby was fine. The patient is still on hemodialysis after 4 years, and the child is healthy and attending school.

IntroductionMagnesium (Mg) disturbances are related to cardiac, bone, and renal patient mortality. In this study, we compared biochemical markers in hemodialysis (HD) and peritoneal dialysis (PD) patients and explored the influencing factors of serum Mg in stage 5 chronic kidney disease (CKD5) patients.Material and methodsAll 598 patients with CKD5 from three medical centers in South China were recruited into this prospective cohort study from March 1, 2018, to January 31, 2021. Our study recorded the clinical characteristics and laboratory data of the patients.ResultsHemodialysis patients (0.99 ± 0.19 mmol/L) had a higher mean serum Mg level than PD patients (0.86 ± 0.20 mmol/L; p < 0.01). Regression analysis showed that only corrected calcium (Ca), phosphate (P), Ca/Mg, Ca × P, albumin (Alb), total protein and creatine (Cr) predicted Mg levels in CKD5 patients (p < 0.01). Ca/Mg predicts hypomagnesemia with 78% sensitivity and 85% specificity in CKD5 patients. The AUC value corresponding to Ca/Mg was 0.88.ConclusionsThis multicenter study in southern China showed that for all CKD5 patients, corrected Ca and Alb had a significant positive effect on serum Mg, while Ca/Mg had a significant negative effect on serum Mg. In 123 HD patients, Ca × P was positively associated with Mg while Ca/Mg and P were negatively associated with Mg. In 398 PD patients, Ca × P, Alb, and total protein were positively associated with Mg while Ca/Mg and P were negatively associated with Mg. In 77 non-dialysis patients, corrected Ca, Cr, and total protein were positively associated with Mg while Ca/Mg was negatively associated with Mg. Furthermore, Ca/Mg might be another useful technique to monitor blood Mg levels in CKD5 patients.Clinical trial registrationChiCTR1800014557.

Background: The aim of this study was to analyze clinical features and short-term mortality in hemodialysis (HD) patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) omicron BA.2.2.1 variant. Methods: In a retrospective single-center case series, 102 consecutive hospitalized HD patients infected with the coronavirus omicron variant were assessed at Pudong Hospital in Shanghai, China, from April 6 to April 18, 2022; the final date of follow-up was May 16, 2022. Clinical, laboratory, chest CT, and treatment data were collected and analyzed. The association between these factors and all-cause mortality was studied using univariate and multivariate analyses. The relationship between lymphocyte count and short-term mortality was based on receiver operating characteristic (ROC) curve analysis. Kaplan–Meier analysis was used to assess overall survival. Results: In total, 102 patients were included in this study. The patients were divided into two groups: HD patients with pneumonia (N = 46) and without pneumonia (N = 56). Of the 102 patients, 12 (11.8%) died. Multivariate regression analysis revealed that all-cause mortality was correlated with lymphocyte counts and type B natriuretic peptide (BNP), C-reactive protein (CRP), and D-dimer levels (P

Cardiac dysfunction is an important prognostic predictor of cardiovascular mortality in patients on hemodialysis (HD). Erythropoietin (EPO) has been reported to improve cardiac function by binding to the EPO receptor (EPOR) on cardiomyocytes. This study investigated whether anti-EPOR antibodies were associated with left ventricular cardiac function in patients undergoing HD. This multicenter, cross-sectional observational study included 377 patients (median age, 70 years; 267 (70.8%) males) with chronic kidney disease (CKD) undergoing stable maintenance HD. Serum levels of anti-EPOR antibodies were measured, and echocardiography was used to assess the left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). Anti-EPOR antibodies were found in 17 patients (4.5%). LVMI was greater (median of 135 g/m2 vs. 115 g/m2, p = 0.042), and the prevalence of LVEF < 50% was higher (35.3% vs. 15.6%, p = 0.032) in patients with anti-EPOR antibodies than in those without. Multivariable linear regression and logistic regression analysis (after adjusting for known risk factors of heart failure) revealed that anti-EPOR antibodies were independently associated with LVMI (coefficient 16.2%; 95% confidence interval (CI) 1.0–35.0%, p = 0.043) and LVEF <50% (odds ratio 3.20; 95% CI 1.05–9.73, p = 0.041). Thus, anti-EPOR antibody positivity was associated with left ventricular dysfunction in patients undergoing HD. [ABSTRACT FROM AUTHOR]

Although symptomatic peripheral arterial disease (PAD) is common in patients with hemodialysis (HD), few studies have evaluated the long-term clinical outcomes of revascularization in this population. The aim of the current study was to investigate the 10-year clinical outcomes of HD patients with PAD undergoing endovascular therapy (EVT). We retrospectively analyzed 750 limbs from 578 HD patients with symptomatic PAD due to infrainguinal lesions, treated with EVT, between May 2004 and November 2011. The primary outcome was 10-year mortality and the secondary outcome was 10-year freedom from major adverse limb events (MALEs). Predictors for each outcome were evaluated by Cox proportional-hazards model. The 10-year rate of survival and freedom from MALEs was 23.6 ± 3.1% and 76.4 ± 2.9%, respectively. In the multivariate analysis, patients with over 80 years [hazard ratio (HR) 2.10; 95% confidence interval (CI) 1.58–2.80; p < 0.001], non-ambulatory status (HR 1.55; 95% CI 1.19–2.03; p = 0.001), absence of hypertension (HR 1.59; 95% CI 1.19–2.08; p = 0.001), heart failure (HR 1.36; 95% CI 1.02–1.80; p = 0.03), and tissue loss (HR 1.65; 95% CI 1.28–2.12; p < 0.001) were at an increased risk of 10-year mortality. Cerebrovascular diseases (HR 1.60; 95% CI 1.03–2.49; p = 0.038), no cilostazol use (HR 1.69; 95% CI 1.09–2.70; p = 0.021), tissue loss (HR 3.87; 95% CI 2.37–6.34; p < 0.001), and poor below-the-knee (BTK) run-off (HR 1.68; 95% CI 1.04–2.71; p = 0.035) were significantly associated with MALEs. After risk stratification analysis based on risk score assignment according to number of predictors, 10-year survival and freedom from MALE were lower in the higher score groups (10-year survival rates according to number of risk factors: 0, 35.1%; 1, 20.3%; 2–5, 10.8%; respectively, p < 0.001, 10-year freedom from MALE rates in patients with greater number of risk factors: 0–1, 90.2%; 2–3, 65.5%; 4–5, 61.6%; respectively, p < 0.001). The 10-year clinical outcomes after EVT for HD patients with PAD due to infrainguinal disease were clinically suboptimal. Risk stratification based on these predictors before EVT would be useful in estimating future adverse outcome. [ABSTRACT FROM AUTHOR]

Background: Metabolic acidosis is a common complication in chronic hemodialysis (HD) patients and can cause loss of lean body mass. Interleukin 10 (IL-10) also is increased in chronic HD patients and has a prognostic value. Objectives: The aim of this study was to evaluate the effect of correction of metabolic acidosis on serum IL-10 levels in chronic hemodialysis patients. Patients and Methods: Forty chronic hemodialysis patients with predialysis bicarbonate levels <22 mEq/l were treated by increasing dialysate bicarbonate concentration till achieving serum bicarbonate ≥ 22 mEq/l. Serum IL-10 levels were measured at baseline and one month after correction of metabolic acidosis. Results: Bicarbonate levels significantly increased at end of study (22.83±0.71 vs 18.85±1.12 mEq/l, p<0.001). Serum IL-10 levels significantly decreased after correction of metabolic acidosis (19.91±6.68 vs 25.89±10.64 pg/ml, p<0.001) and the change of IL-10 was significantly correlated with the change in bicarbonate (r = - 0.436, p = 0.005). Conclusions: Correction of metabolic acidosis in chronic hemodialysis patients was associated with decrease in serum IL-10. [ABSTRACT FROM AUTHOR]

Background: Anemia in children on maintenance hemodialysis (HD) leads to poor quality of life. Our study aimed to assess and monitor anemia and iron status management in children on maintenance HD over 18 months using key performance indicators., Methods: Key performance indicators, formulated as the percentage of patients achieving the KDIGO (2012) guideline-recommended targets for hemoglobin (Hb) (11-12 g/dl), transferrin saturation (TSAT) (20-40%) and serum ferritin (200-500 ng/ml), were reported quarterly over the 18-month-period of this study., Results: This study was carried out over an 18 month-period, from April 1st, 2020, till October 31st, 2021. A total of 78 patients (45 males and 33 females) were included; mean age 12.16 ± 3.3 years and HD duration range 3.0-140.88 months, median 16.51 months. The three most common primary causes of CKD were Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) (29.5%), unknown cause (24.4%), and chronic glomerular diseases (20.5%). The quarterly reported percentages of patients achieving the recommended targets for Hb, TSAT, and serum ferritin ranges were 18.2-35.7%, 38.8-57.1%, and 11.9-26.6%, respectively., Conclusion: Although the mean Hb trend was nearing the KDIGO (2012) target, the key performance indicators showed that only a small percentage of our HD patients were achieving the targets for Hb, TSAT, & serum ferritin, thus alerting us to the need to revise our protocol for the management of anemia and iron status., (© 2024. The Author(s).)

Whether valacyclovir-associated neurotoxicity (VAN) occurs more frequently in patients with end-stage renal disease (ESRD) on dialysis is unknown. This is the first population-based study to examine the risk of VAN associated with ESRD patients on dialysis. Among 2,284,800 patients diagnosed as having herpes zoster from 2002 to 2016, patients with ESRD on dialysis and individuals with normal renal function were enrolled in this study. Following propensity score matching, we compared the risk of altered mental status between valacyclovir users and non-users in the ESRD and normal renal function cohorts over a 30-day follow-up period. In the ESRD cohort, the incidence of altered mental status was 1.68 and 0.52 per 1,000 person-day in valacyclovir users and non-users, respectively, with an adjusted hazard ratio (HR) of 3.22 (95% confidence interval [CI]: 2.04–4.99, P < 0.001). The incidence of altered mental status of valacyclovir users on hemodialysis (HD) and peritoneal dialysis (PD) was higher than that of non-users. The adjusted HR was 3.20 (95% CI: 1.98–5.15, P < 0.001) for those on HD and 3.44 (95% CI: 1.13–10.49, P = 0.030) for those with PD. However, altered mental status was not observed in patients on HD receiving ≤500 mg of valacyclovir three times per week or in those on PD receiving ≤500 mg of valacyclovir per day. The findings demonstrate that adjusting the valacyclovir dosage and monitoring VAN in patients with HD and PD who have herpes zoster is crucial.

BackgroundWe investigated factors associated with the selection of a dialysis modality for elderly patients compared to younger patients.MethodsThis study included 2,514 incident dialysis patients from a Korean multicenter prospective cohort. Multivariate logistic regression analyses were performed with demographic, socioeconomic, and clinical data to analyze factors associated with the chosen dialysis modality. Differences in these factors were compared between the elderly (≥65 years) and younger (

Left ventricular hypertrophy (LVH) is a risk factor of cardiovascular morbidity in dialysis patients. The association between LV mass and carotid intimal medial thickness (CIMT) could be due to increased hemodynamic load in dialysis patients. The relationship between CIMT and LVM indices in hemodialysis (HD) patients was investigated. This is a cross‐sectional study including 65 HD patients, divided into two groups: Group 1 with CIMT ≤ 1 mm (N = 29), Group 2 with CIMT > 1 mm (N = 36). Echocardiographic evaluation of the LVM, CIMT measurement using B‐mode ultrasonography, patients' basic clinical and biochemical data were recorded. Patients with CIMT > 1 mm (Group 2) showed significantly higher LVM, LVM/BSA (body surface area), and LVM/Ht2.7 (height). Regarding linear regression, CIMT was found to be an independent predictor for LVM, LVM/BSA, and LVM/Ht2.7. LVM, LVMI, and LVM/Ht2.7 are significantly elevated in HD patients with CIMT > 1 mm group. CIMT was found to be the independent predictor for LVH in maintenance HD patients. [ABSTRACT FROM AUTHOR]

Abstract Background Although most patients are suitable for both hemodialysis (HD) and peritoneal dialysis (PD), there seem to be differences in the outlook of patients who choose one modality over the other. There is currently limited literature about the impact of patients’ personal attitudes on the decision for PD or HD. In this study, we tried to find out whether there were differences between patients who were on HD and PD in their desire for control and responsibility for their treatment. Methods The data were drawn from a nationwide postal survey of 630 HD and PD patients. Patients’ desire for control was measured by scores on the internal locus of control (ILOC) scale. Patients were also asked how important taking responsibility for their dialysis had been for their treatment decision (ITR). Two multivariate logistic regression models, both adjusted for age, were applied to investigate whether there were differences between HD and PD patients in ILOC and ITR. Having one generic measure (ILOC) and one tailored to the dialysis context (ITR) gave the opportunity to investigate if it is a generic personality trait or rather a specific attitude that affects choice of dialysis modality. Results PD patients were younger and showed higher ILOC and ITR values. Multivariate logistic regression models adjusted for age confirmed the significant influence of ILOC and ITR on the uptake of PD. The odds ratios for being in the PD group were 1.53 for ILOC (p = 0.030; 95% CI 1.04–2.25), 1.49 for ITR (p = 0.019; 95% CI 1.07–2.07), and 0.95 (p = 0.000; 95% CI 0.94–0.97) for age in both models. Conclusions Our analysis shows the impact of personal attitudes on the uptake of PD. Participants who generally want to keep control of their lives and take responsibility for their dialysis treatment tended to choose PD. As PD is a home dialysis treatment that requires patients to participate and contribute, it is beneficial if patients’ personalities support the treatment procedure. Having two completely different treatment options that suit to different personalities gives us the opportunity to consider the relationship between personal attitudes and choice of dialysis modality. Trial registration The MAU-PD study is registered at the German Clinical Trials Register. DRKS-ID: DRKS00012555 . Date of Registration in DRKS: 2018/01/04.

Background: Anemia is one of the common problems in children on maintenance hemodialysis (HD). It leads to poor quality of life and when severe, it is associated with cardiovascular dysfunction, cardiomyopathy, and death. Proper treatment of anemia in these patients results in better physical and mental performance. So, our study aimed to assess the trend of anemia among HD children by following the monthly percentage of patients capable of achieving Hb level between 11-12g/dl. Methods: For optimum treatment of anemia, the Kidney Disease Improving Global Outcomes (KDIGO) guidelines (2012) recommended to measure Hb every month in HD children targeting monthly Hb concentration of 11-12 g/dl. So, we conducted this 12-months prospective study to assess the trend of anemia among HD children at Pediatric Dialysis Unit of Ain Shams University by following the monthly percentage of patients capable of achieving Hb level between 11-12g/dl. Results: This study was done over 12 month-period from April 1st, 2020, till March 31st, 2021. A total of 78 patients were included with a mean age at the time of enrollment in the study of 12.16 ± 3.3 years. They were 45 (57.7%) males and 33 (42.3%) females. All patients were receiving 3 hours every other day HD session for 3 sessions a week with a HD duration range of 3.0 - 140.88 months and a median of 16.51 months. All patients were receiving proper doses of recombinant human erythropoietin (rHuEPO) and intravenous iron therapy. Our study showed that the monthly reported percentages of patients achieved Hb level between 11-12g/dl ranged from 14.7% to 40.8% and that of patients with Hb level <11g/dl ranged between 51.4 - 73.5%. It also revealed statistical evidence of significant association between the presence of anemia in our patients at the time of enrollment in the study and HD durations < 6 months (p < 0.05). Conclusion: Despite proper HD treatment and proper doses of recombinant human erythropoietin (rHuEPO) and intravenous iron therapy, anemia is still a prevalent problem among our HD children. [ABSTRACT FROM AUTHOR]

BackgroundPatients with end-stage renal disease are known to be particularly frail, and the cause is still widely seen as being directly related to specific factors in renal replacement therapy. However, a closer examination of the transitional phase from predialysis to long-term hemodialysis leads to controversial explanations, considering that the frailty process is already well-described in the early stages of renal insufficiency. This study aims to describe longitudinally and multifactorially changes in the period extending from the decision to start the replacement therapy through to the end of 2 years of hemodialysis. We hypothesized that frailty is pre-existent in the predialysis phase and does not worsen with the beginning of the replacement therapy. Between 2015 and 2018 we recruited 25 patients (72.3 ± 5.7 years old) in a predialysis program, with the expectation that replacement therapy would begin within the coming few months.MethodsThe patients underwent a baseline visit before starting hemodialysis, with 4 follow-up visits in the first 2 years of treatment. Health status, physical performance, cognitive functioning, hematology parameters, and adverse events were monitored during the study period.ResultsAt baseline, our sample had a high variability with patients ranging from extremely frail to very fit. In the 14 participants that did not drop out of the study, out of 32 clinical and functional measures, a statistically significant worsening was only observed in the Short Physical Performance Battery (SPPB) score (p < 0.01, F = 8.50) and the number of comorbidities (p = 0.01, F = 3.94). A careful analysis, however, reveals a quite stable situation in the first year of replacement therapy, for both frail and fit participants and a deterioration in the second year that in frail participants could lead to death.ConclusionOur results should stimulate a reassessment about the role of a predialysis program in reducing complications during the transitional phase, but also about frailty prevention programs once hemodialysis has begun, for both frail and fit patients, to maintain satisfactory health status.

BackgroundA significant proportion of anti-neutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis eventually progresses to end-stage renal disease (ESRD) thus requiring long-term dialysis. There is no consensus about which dialysis modality is more recommended for those patients with associated vasculitis (AAV-ESRD). The primary objective of this study was to compare patient survival in patients with AAV-ESRD treated with hemodialysis (HD) or peritoneal dialysis (PD).MethodsThis double-center retrospective cohort study included dialysis-dependent patients who were treated with HD or PD. Clinical data were collected under standard format. The Birmingham vasculitis activity score (BVAS) was used to evaluate disease activity at diagnosis and organ damage was assessed using the vasculitis damage index (VDI) at dialysis initiation.ResultsIn total, 85 patients were included: 64 with hemodialysis and 21 with peritoneal dialysis. The patients with AAV-PD were much younger than the AAV-HD patients (48 vs. 62, P < 0.01) and more were female (76.2 vs. 51.6%, P = 0.05). The laboratory data were almost similar. The comorbidities, VDI score, and immuno-suppressive therapy at dialysis initiation were almost no statistical difference. Patient survival rates between HD and PD at 1 year were 65.3 vs. 90% (P = 0.062), 3 year were 59.6 vs. 90% (P < 0.001), and 5 years were 59.6 vs. 67.5% (P = 0.569). The overall survival was no significant difference between the two groups (P = 0.086) and the dialysis modality (HD or PD) was not shown to be an independent predictor for all-cause death (hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.31–1.7; P = 0.473). Cardio-cerebrovascular events were the main cause of death among AAV-HD patients while infection in patients with AAV-PD.ConclusionThese results provide real-world data that the use of either hemodialysis or peritoneal dialysis modality does not affect patient survival for patients with AAV-ESRD who need long-term dialysis.

Referral time for end-stage renal disease (ESRD) patients to nephrologists and initial vascular access method are considered significant factors that impact health outcomes at the time of hemodialysis (HD) initiation. Native arteriovenous fistula (AVF) is strongly recommended as initial access. However, little is known about the referral rate among ESRD receiving HD in Palestine and its correlation with AVF creation. In Ramallah Hemodialysis Center, we investigated the pre-dialysis nephrology care and AVF usage in 156 patients. Type of access at HD initiation was temporary central venous catheter (CVC) in 114 (73%), tunneled hemodialysis catheter (TDC) in 21 (13%) and AVF in 21 (13%). Out of all participants, 120 (77%) were seen by nephrologist prior to dialysis. Of the participants who initiated dialysis with a CVC, 36 (31%) had not received prior nephrology care. All participants who initiated dialysis with functional AVF had received prior nephrology care. Patients who were not seen by a nephrologist prior to HD initiation had no chance at starting HD with AVF, whereas 17% of those who had nephrology care >12 months started with AVF. In conclusion, a relatively large percentage of Palestinian HD patients who were maintained on HD did not have any predialysis nephrology care. In addition, patients who received predialysis nephrology care were significantly more likely to start their HD through AVF whereas all those without predialysis nephrology care started through CVC. More in-depth national studies focusing on improving nephrology referral in ESRD patients are needed to increase AVF utilization.

The objective of this study was to evaluate the effect of empowerment education on depression level and laboratory indicators of patients treated with hemodialysis.

Several studies investigated the role of fibroblast growth factor 23 (FGF23) in the regulation of renal phosphate excretion in chronic kidney disease (CKD). However, patients with residual urine output (UO) seem to control their serum phosphorus levels better. Our aim was to determine whether FGF23 levels are influenced by dialysis modality and UO. We performed a cross-sectional study in hemodialysis (HD) and peritoneal dialysis (PD) patients. The C-terminal FGF23 (cFGF23) levels were determined in plasma with a two-site enzyme-linked immunosorbent assay. The UO collection referred to an mL/day measurement. All p values were two-sided, and the statistical significance was set at p < 0.05. We enrolled 133 patients (58 HD, 75 PD, UO 70%). The median cFGF23 was significantly higher in HD vs. PD patients (p = 0.0017) and not significantly higher in patients without UO (p = 0.12). We found a negative correlation between cFGF23 and the UO volume (p = 0.0250), but the correlation was not significant when considering the type of dialysis treatment. Phosphorus (ß = 0.21677; p = 0.0007), type of dialysis (ß = −0.68392; p = 0.0003), and creatinine (ß = 0.08130; p = 0.0133) were significant and independent predictors of cFGF23 levels. In conclusion, cFGF23 was significantly higher in HD than in PD patients. We found a significant negative correlation between cFGF23 and the residual UO volume, but the correlation was not significant considering the type of dialysis. Our study reveals that dialysis modality is an independent predictor of FGF23 levels. In particular, PD is associated with lower FGF23 levels than HD.

Background: Patients on hemodialysis (HD) are prone to various cardiovascular complications. Two-dimensional speckle tracking echocardiography (2D STE) is an innovative technique for early myocardial dysfunction detection, even with normal ejection fraction (EF)., Objective: We aim to detect left ventricle (LV) dysfunction in regular hemodialysis patients using 2D STE compared to traditional echocardiography., Methods: The study comprised 30 patients with end-stage renal disease (ESRD), subdivided according to left ventricular mass index (LVMI) into group 1 with left ventricular hypertrophy (LVH) (n=19) and group 2 without LVH (n=11). Another 30 healthy control subjects were recruited as group 3. The EF, average systolic velocity (Sa), and 2D LV strain were taken as measures of LV systolic function. The indicators for diastolic function included the E/A ratio and E velocity/peak early diastolic velocity., Results: Regarding the parameters of LV systolic and diastolic functions assessed by traditional echocardiography, we found no significant difference between groups 1 and 2. However, using 2D STE, we observed significant differences in the average Sa velocity (p=0.025), average LV strain (p=0.03), 2D global longitudinal strain (GLS) (p=0.03), E/Ea (p=0.003), and LV myocardial performance index (MPI) (p=0.006). Also, a significant positive correlation was found between LVMI and left ventricular end-diastolic diameter (LVEDD) (p<0.01, r=0.63), EF measured by 2D (p=0.034, r=0.39), mitral E/A ratio (p=0.03, r=0.49), and mitral E/Ea (p<0.01, r=0.72). There was a significantly strong negative correlation between LVMI and 2D average LV strain (p=0.034, r=-0.39)., Conclusion: We concluded that 2D STE is more sensitive than a conventional echo in detecting early LV systolic and diastolic dysfunction even in patients with normal EF., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Research Ethics Committee of Al-Azhar University Institutional Review Board (IRB) issued approval RHDIRB/2018122001. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Habib et al.)

Background: Restless legs syndrome (RLS) is frequent in patients with hemodialysis (HD) and occurs predominantly in its most severe forms. The study was conducted to evaluate the efficacy and safety of acupuncture for RLS in patients with end-stage renal disease (ESRD) at hospital-based HD center. Methods: This single-blind, randomized controlled trial was performed on patients with HD and RLS who were randomly assigned to the experimental group and control group. Data were collected using the International Restless Legs Syndrome Rating Scale (IRLSRS), Insomnia Severity Index (ISI), and heart rate variability (HRV) records at baseline, after the therapeutic course (12 times/4 weeks), and 1-week follow-up. Result: A total of 47 patients were evaluated with IRLSRS score from 11 to 30 in this study. There were 41 patients enrolled in the study based on inclusion/exclusion criteria and allocated randomly into two groups. A total of 35 participants completed the trial, including 18 subjects in the experimental group and 17 subjects in the control group. The comparison of IRLSRS and ISI showed a significant reduction between two groups after acupuncture treatment ( p = 0.002, p = 0.003). The ISI after 1-week follow-up also revealed significant decrease ( p = 0.003). This HRV results showed that high frequency (HF%) increased significantly ( p = 0.021) and low frequency (LF%) decreased significantly in the acupuncture group ( p = 0.021). The generalized estimating equation showed that the IRLSRS improved by 2.902 points ( p < 0.001) in the acupuncture group compared with the control group and by 1.340 points ( p = 0.003) after 1-week follow-up. There were no adverse effects observed during HD in this study. Discussion: The authors conclude that acupuncture could effectively improve the symptoms of RLS significantly. The results from this study provide clinical evidence on the efficacy and safety of acupuncture to treat the patients with RLS at the HD center.

Background: Tuberculosis (TB) is still the main cause of mortality due to a single transfectant, Mycobacterium tuberculosis (MTB). Latent tuberculosis infection (LTBI) is a condition characterized by the presence of tuberculosis (TB) that is not clinically apparent but nonetheless shows a sustained response to MTB. Presently, tuberculin skin test (TST) and interferon gamma (IFN-γ) release assays (IGRAs) are mainly used to detect LTBI via cell-mediated immunity of T-cells. For people with end-stage renal disease (ESRD), the diagnosis of patients infected with MTB is difficult because of T-cell dysfunction. To get more accurate diagnosis results of LTBI, it must compensate for the deficiency of IGRA tests., Methods: Sixty-seven hemodialysis (HD) patients and 96 non-HD patients were enrolled in this study and the study population is continuously included. IFN-γ levels were measured by the QuantiFERON-TB Gold In-Tube (QFT-GIT) test. Kidney function indicators, blood urea nitrogen (BUN), serum creatinine (Cr), and estimated glomerular filtration rate (eGFR) were used to compensate for the declined IFN-γ levels in the IGRA test., Results: In individuals who were previously undetected, the results of compensation with serum Cr increased by 10.81%, allowing for about 28% more detection, and compensation with eGFR increased by 5.41%, allowing for approximately 14% more detectable potential among them and employing both of them could enhance the prior shortcomings of IGRA tests. when both are used, the maximum compensation results show a sensitivity increase rate of 8.81%, and approximately 23% of patients who were previously undetectable may be found., Conclusion: Therefore, the renal function markers which are routine tests for HD patients to compensate for the deficiency of IGRA tests could increase the accuracy of LTBI diagnosis.

Background: Due to frequent hospitalizations, complex dialysis procedures and immune compromising effects of end stage renal disease (ESRD), patients on dialysis are more prone to healthcare associated infections (HCAIs). Objective: To study the impact of HCAIs on survival and treatment outcomes among ESRD patients on renal replacement therapy (RRT). Methodology: A multicenter, retrospective study was conducted from June to December 2019 at two public hospitals of Malaysia. ESRD patients with minimum of 6 months on RRT were included, while pregnant patients and patients <18 years were excluded. Multinomial logistic regression was performed to identify risk factors associated with unsuccessful treatment outcomes. Kaplan Meier analysis was performed to study the survival. Results: A total of 670 records were examined, of which 400 patients were included as per the inclusion criteria. The mean survival time of patients without HCAIs [22.7 (95%CI:22.1–23.2)] was higher than the patients with HCAIs [19.9 (95%CI:18.8–20.9)]. Poor survival was seen in patients with >2 comorbidities, >60 years of age, low hemoglobin concentration and high C-reactive protein levels. The most frequent treatment outcome was cured [113 (64.9%)], followed by death [37 (21.3%)] and treatment failure [17 (9.8%)]. Advancing age, and low hemoglobin concentration were independent risk factors associated with death, while recurrent HCAIs, use of central venous catheters, and low serum sodium levels were risk factors for treatment failure. Conclusion: The high burden of HCAIs is a profound challenge faced by patients on RRT, which not only effects the treatment outcomes but also contributes substantially to the poor survival among these patients. [ABSTRACT FROM AUTHOR]

Background: Hypertension is prevalent in children on dialysis and associated with cardiovascular disease. We studied the blood pressure (BP) trends and the evolution of BP over 1 year in children on conventional hemodialysis (HD) vs. hemodiafiltration (HDF). Methods: This is a post hoc analysis of the "3H – HDF-Hearts-Height" dataset, a multicenter, parallel-arm observational study. Seventy-eight children on HD and 55 on HDF who had three 24-h ambulatory BP monitoring (ABPM) measures over 1 year were included. Mean arterial pressure (MAP) was calculated and hypertension defined as 24-h MAP standard deviation score (SDS) ≥95th percentile. Results: Poor agreement between pre-dialysis systolic BP-SDS and 24-h MAP was found (mean difference − 0.6; 95% limits of agreement −4.9–3.8). At baseline, 82% on HD and 44% on HDF were hypertensive, with uncontrolled hypertension in 88% vs. 25% respectively; p < 0.001. At 12 months, children on HDF had consistently lower MAP-SDS compared to those on HD (p < 0.001). Over 1-year follow-up, the HD group had mean MAP-SDS increase of +0.98 (95%CI 0.77–1.20; p < 0.0001), whereas the HDF group had a non-significant increase of +0.15 (95%CI −0.10–0.40; p = 0.23). Significant predictors of MAP-SDS were dialysis modality (β = +0.83 [95%CI +0.51 − +1.15] HD vs. HDF, p < 0.0001) and higher inter-dialytic-weight-gain (IDWG)% (β = 0.13 [95%CI 0.06–0.19]; p = 0.0003). Conclusions: Children on HD had a significant and sustained increase in BP over 1 year compared to a stable BP in those on HDF, despite an equivalent dialysis dose. Higher IDWG% was associated with higher 24-h MAP-SDS in both groups. [ABSTRACT FROM AUTHOR]

Diseases of kidney are among the most important causes of death in many countries. The major causes of chronic kidney disease include diabetes mellitus and chronic hypertension. This study was designed to evaluate some hematological and inflammation aspects in 95 patients, divided into (35) hemodialysis patients with diabetes, (35) hemodialysis patients without diabetes and (25) diabetes patients, and who attended at Ramadi General Hospital, in addition to (25) samples as control subject. Chemerin, Interleukin-18 (IL-18) and high sensitive C-reactive protein (hs-CRP) were established by ELISA. The results showed serum chemerin, interleukin-18 and hs-CRP were significantly higher in HD patients with diabetes (230.13±78.26 ng/ml at P=0.034, 677.23±99.14 pg/mL at P=0.026, and 15.77±2mg/L at P=0.048), respectively compared with control (110±20.42ng/ml, 143.68±35.78pg/mL, and 4.64±1.27mg/L), respectively. The results showed the significant and positive correlations between chemerin and hs-CRP or chemerin and IL-18 (r=0.149 at P=0.004 or r=0.123 at P=0.0325 in control), (r=0.165 at P=0.007 or r =0.190 at P=0.024 in diabetic patients), (r=0. 237 at P=0.0036 or r =0.263 at P= 0.038 in HD patients with diabetic) and (r=0. 0.235 at P = 0.0081or r=0.248 at P = 0.041in HD patients without diabetic) respectively. The mean of hemoglobin (Hb), Packed Cells Volume (PCV), Red Blood cells (RBC), White Blood Cells (WBC) and Lymphocytes were significantly decreased in HD patients without diabetes (8.55±0.63g/L (at p=0.0423), 27.63±1.31%(at p=0.028), 3.12±0.56 ˟1012\ L (at p=0.035), 6.7±0.53 ˟109/L (at p=0.021) and 30.23±5.84%(at p= 0.046), respectively compared with control. The mean of Monocytes% (17.23±7.28% at p=0.031) and Granulocyte% (59.31±9.45 % at p=0.042) were significantly higher in HD patients with diabetes, while mean of Mononocytes% was significant lower in diabetic patients. This study suggests a significant role of chemerin, hs-CRP and IL-18 in the pathogenesis and progression of diabetic complications, and we can use these parameters for predicting the progression of diabetic nephropathy in the early stages of CKD. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence supports a cardiovascular protective role of Cooled Dialysis (CD) in incident Hemodialysis (HD) patients. Whether this benefit can be extended to maintenance HD patients remains to be established. Objective: The aim of the present study was to assess the impact of CD by lowering Dialysate temperature (dt) 0.5°C below Core Body Temperature (CBT), on minimizing myocardial ischemia in maintenance HD patients (>1 year on HD). Patients and Methods: from March 2019 to January 2021, we randomized one hundred maintenance HD patients to receive either Cooled Dialysis (dt - 0.5°C below CBT, intervention) or Standard Dialysis (dt= CBT, control) for 12 months. Over the study period, serial measurements of ECG, echocardiography, and myocardial enzymes (CK-MB and Troponin-T) were performed for the whole study population as surrogates for myocardial ischemic injury. Results: By the end of 12-months, compared to Standard Dialysis (ST) patients, Cooled Dialysis (CD) patients had overall less incidence of new myocardial ischemia (composite surrogate outcomes: ECG, Echo and CK-MB) (p=0.032). In logistic regression analysis, CD was found to be independently protective against myocardial ischemia (OR 0.54, p-value 0.033, CI: 0.3-0.95). Conclusion: In maintenance HD patients, Cooled Dialysis might help decrease myocardial ischemia with a reasonable safety profile. Further studies are warranted to explore these findings. [ABSTRACT FROM AUTHOR]

Background: Due to frequent hospitalizations, complex dialysis procedures and immune compromising effects of end stage renal disease (ESRD), patients on dialysis are more prone to healthcare associated infections (HCAIs). Objective: To study the impact of HCAIs on survival and treatment outcomes among ESRD patients on renal replacement therapy (RRT). Methodology: A multicenter, retrospective study was conducted from June to December 2019 at two public hospitals of Malaysia. ESRD patients with minimum of 6 months on RRT were included, while pregnant patients and patients 2 comorbidities, >60 years of age, low hemoglobin concentration and high C-reactive protein levels. The most frequent treatment outcome was cured [113 (64.9%)], followed by death [37 (21.3%)] and treatment failure [17 (9.8%)]. Advancing age, and low hemoglobin concentration were independent risk factors associated with death, while recurrent HCAIs, use of central venous catheters, and low serum sodium levels were risk factors for treatment failure. Conclusion: The high burden of HCAIs is a profound challenge faced by patients on RRT, which not only effects the treatment outcomes but also contributes substantially to the poor survival among these patients.

Cardiac dysfunction is an important prognostic predictor of cardiovascular mortality in patients on hemodialysis (HD). Erythropoietin (EPO) has been reported to improve cardiac function by binding to the EPO receptor (EPOR) on cardiomyocytes. This study investigated whether anti-EPOR antibodies were associated with left ventricular cardiac function in patients undergoing HD. This multicenter, cross-sectional observational study included 377 patients (median age, 70 years; 267 (70.8%) males) with chronic kidney disease (CKD) undergoing stable maintenance HD. Serum levels of anti-EPOR antibodies were measured, and echocardiography was used to assess the left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). Anti-EPOR antibodies were found in 17 patients (4.5%). LVMI was greater (median of 135 g/m2 vs. 115 g/m2, p = 0.042), and the prevalence of LVEF < 50% was higher (35.3% vs. 15.6%, p = 0.032) in patients with anti-EPOR antibodies than in those without. Multivariable linear regression and logistic regression analysis (after adjusting for known risk factors of heart failure) revealed that anti-EPOR antibodies were independently associated with LVMI (coefficient 16.2%; 95% confidence interval (CI) 1.0–35.0%, p = 0.043) and LVEF p = 0.041). Thus, anti-EPOR antibody positivity was associated with left ventricular dysfunction in patients undergoing HD.

Introduction: This study was aimed to assess the Quality of Life (QOL) of Iraqi Hemodialysis (HD) patients and the influence of their clinical and demographic characteristics on their QOL. Methods: We used an Arabic version of the Kidney Disease Quality of Life Instrument Short Form (KDQOLSF) for QOL assessment. Mean individual domain scores and three composite scores, Physical Component Score (PCS), Kidney-Disease Component Score (KDCS), and Mental Component Score (MCS), were compared. Results: Sixty chronic HD patients from Baghdad Teaching Hospital, Baghdad and Imam Alsadiq Hospital, Babil, were recruited. The overall mean score was 49.9. Scores of >80 were obtained for two items, "social support" and "dialysis staff encouragement". Mean MCS, PCS, and KDCS were 36.3, 39.1, and 59.7, respectively. The male, unmarried, high educational level, high income groups exhibited higher average MCS, KDCS, and PCS scores; however, differences with the average scores of respective opposite groups were statistically not significant. KDCS scores showed significant correlation with MCS (r = 0.653, P = 0.001) and PCS scores (r = 0.611, P = 0.001). Conclusion: Our findings showed that the socio-demographic factors played a key role in determining the QoL of hemodialysis patients. However, none of the factors were significantly associated with the KDQOL scores. Compared to other countries, Iraqi patients exhibited lower QoL scores, which indicated that better infrastructure and income status considerably affect the patients' QoL. [ABSTRACT FROM AUTHOR]

Objective To determine the effect of duration of HD on the prevalence and severity of different cutaneous manifestations of ESRD. Methods 100 patients of ESRD at Fatima Memorial Hospital, Shadman were randomly enrolled and analyzed for multiple cutaneous manifestations over a period of eight months. The severity of these manifestations as mild, moderate, severe or very severe and their prevalence along with other particulars and time duration of HD was recorded in addition to any co-morbidities these patients had. Data was organized into tables and graphs. Results Out of 100 patients, 82% had xerosis, 69% had pruritus, 66% had pigmentary changes, 34% had nail changes, 15% had perforating dermatosis, 10% had bullous lesions, 30% had generalized hair loss and 7% had eczematization at the site of fistula. Out of 100 patients, 46% had severe xerosis, 19% had severe pruritus, 17% had severe pigmentary changes, 31% had severe nail changes, 14% had severe perforating dermatosis, no patients with bullous lesions fell in the category of severe disorder, 12% had severe hair loss and 4% had severe eczematization. The rest had mild and moderate forms of the disease. Conclusion Cutaneous manifestations among HD patients are common and most of them increase with an increase in the duration of HD. Coordination between a patient's dermatologist and nephrologist can optimize their health experience. [ABSTRACT FROM AUTHOR]