Introduction Remote patient monitoring facilitates the management of chronic conditions like chronic kidney disease (CKD) and home-based peritoneal dialysis (PD). This study assessed the acceptance of a remote monitoring application in CKD and PD patients. Methods It was a single-center study at Singapore General Hospital from December 2021 to February 2023, recruiting CKD and PD patients. Patients were followed up for up to six months. The Viva Konnect patient app allowed users to record vitals with a Bluetooth-enabled device, log medication schedule, track symptoms, log diet and monitor PD therapy. Results A total of 35 participants (13 CKD, 22 PD) enrolled; 8 (5 CKD, 3 PD) dropped out, leaving 27 (8 CKD, 19 PD) who completed the study. Among those who completed the study, 56% met the app acceptance criteria-defined as CKD patients logging data at least twice per week and PD patients at least once daily. Acceptance rates were 47.4% for PD and 75.0% for CKD. PD patients used the app a median of 6.7 (IQR 1.8-16.5) times per week, spending 6.9 (IQR 2.2-12.1) minutes per session. CKD patients used it a median of 6.2 (IQR 2.6-6.7) times per week, with a median session time of 4.7 (IQR 1.7-7.7) minutes. The median percentage of vitals recorded via smart companion devices was 52.9% (IQR 26.7-82.2) for PD patients and 83.4% (IQR 78.8-94.4) for CKD patients. Interviews identified three key themes that affected the usage: communication, convenience and clarity. Conclusion This pilot study demonstrated the feasibility of implementing a smartphone-based remote monitoring application in CKD and PD patients. These findings provided preliminary data on patient acceptance and usability, which will inform future refinement of the application and the design of larger multicenter studies.

Focal segmental glomerulosclerosis (FSGS) involves glomerular scarring and podocyte injury. FSGS treatment typically involves the use of corticosteroids and immunosuppressants. In patients with steroid-resistant FSGS, however, no ideal treatment exists. Extracorporeal therapies such as plasma exchange and low-density lipoprotein apheresis (LDL-A) may be promising options for managing lipid-mediated nephrotoxicity found in patients with steroid-resistant FSGS. Unfortunately, these extracorporeal techniques are inaccessible in many low- and middle-income countries (LMICs) due to high costs and infrastructure challenges. The use of extracorporeal therapies for FSGS management was evaluated at a single center. Additionally, a literature search was conducted across multiple databases to identify studies that explored FSGS treatment modalities in LMICs. Eligibility was assessed based on discussion of viability, efficacy, and application of therapies. At a single center, we found that double filtration plasmapheresis (DFPP) with the Evaflux filter was the most frequently used and most effective method of extracorporeal therapy for FSGS in terms of remission. The development of improvements in extracorporeal therapy, such as modified double filtration plasmapheresis (DFPP), may offer cost improvements due to reduced fluid replacement, which may lead to increased use in LMICs. Twinning programs and governmental intervention may be used to address the gaps in FSGS care in LMICs. Future efforts involve expanding access to plasmapheresis in the management of FSGS, especially in resource-limited settings.

In this retrospective cohort study, data from the Medical Information Mart for Intensive Care IV (MIMIC-IV 2.2) database were categorized into four quartiles based on SCr levels at CRRT initiation, with in-hospital mortality as the primary outcome. We applied Kaplan-Meier curves for outcome comparison across groups. Multivariate Cox proportional-hazards models and restricted cubic splines (RCS) were conducted to examine the association between initial SCr and mortality. Additional interaction and subgroup analyses were conducted to reinforce our findings. In a cohort of 989 AKI patients undergoing CRRT, the mean age was 62.5 years, with 60% being male and an in-hospital mortality rate of 47.5%. Kaplan-Meier curve analysis revealed that higher SCr levels were linked to a lower risk of in-hospital mortality. Cox proportional hazards regression confirmed a significant increase in mortality risk among patients in the lowest SCr quartile. Furthermore, RCS analysis demonstrated an L-shaped relationship between SCr and in-hospital mortality, with an inflection point at 5.75 mg/dL. No interactions were found between SCr and in-hospital mortality. In critically ill AKI patients requiring CRRT, a paradoxical L-shaped relationship between SCr levels and in-hospital mortality risk was observed, with an inflection point at 5.75 mg/dL. Further large, diverse studies are needed to confirm these results.

Expanded hemodialysis (HDx), using medium cut-off (MCO) membranes, offers enhanced clearance of middle-molecule uremic toxins. While HDx has shown promising clinical results in center-based settings, its application in frequent home hemodialysis (HHD) remains understudied. This study aims to assess the safety, efficacy, and quality of life of patients treated with HDx at home (HHDx) in routine clinical practice. This is a pragmatic, multicenter, observational study (retrospective and prospective) including patients on HHDx in Spain. Adult patients (≥18 years) either incident or prevalent (<24 months on HHDx) are followed for up to 24 months. The primary outcome is safety, measured by serum albumin trends. Secondary outcomes include laboratory markers, dialysis efficacy (Kt/V, solute clearance), adverse events, nutritional status (bioimpedance), residual renal function, and quality of life (KDQOL-SF). A total of 33 patients undergoing home hemodialysis (HHD) with medium cut-off dialyzers were enrolled. Baseline data collection includes demographics, comorbidities, dialysis prescription, laboratory values, clinical symptoms, and patient-reported outcomes. Statistical analysis will include intention-to-treat (ITT) and per-protocol sets (PPS), with generalized linear mixed models for repeated measures and Kaplan-Meier survival analysis for technique discontinuation. This real-world study will provide crucial data on the feasibility, tolerability, and potential benefits of HDx in a home setting, contributing evidence toward optimizing renal replacement strategies.

Continuous kidney replacement therapy (CKRT) serves as the preferred extracorporeal kidney support therapy for critically ill patients with hemodynamic instability. Although Kidney Disease: Improving Global Outcomes (KDIGO) recommends a delivered CKRT dose of 20-25 mL/kg/h, its effect on mortality remains unclear. This study aims to evaluate the association between CKRT intensity and mortality. We conducted a retrospective analysis on 2,265 patients from the Medical Information Mart for Intensive Care IV version 3.1 database. The delivered CKRT dose (mL/kg/h) was classified into low (<20), moderate (20-25), and high (>25). The outcome was 90-day mortality after CKRT initiation. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined by Cox regression models, supported by multinomial propensity score weighting. The dose-response relationship was assessed using restricted cubic spline models and an additional dose categorization. Low, moderate, and high intensities were administered to 275 (12.1%), 478 (21.1%), and 1,512 (66.8%) patients, respectively. Low-intensity (HR = 0.62, 95% CI: 0.51-0.76, p <0.001) and moderate-intensity CKRT (HR = 0.79, 95% CI: 0.68-0.91, p = 0.001) were associated with reduced mortality compared with high-intensity. Sensitivity analyses showed a nonlinear dose-response relationship at doses <35, with the lowest mortality observed at 15-19.9. Low and moderate intensities were associated with reduced mortality, with the greatest survival benefit observed at doses slightly below the KDIGO-recommended range. These findings suggest that this range should be further examined in randomized clinical trials.

Second-generation anticoagulant rodenticides often cause severe bleeding that can be life-threatening, and have limited effective treatment options. This study aimed to evaluate the therapeutic efficacy of hemoperfusion in patients with rodenticide poisoning. We retrospectively analyzed data of 148 patients diagnosed with rodenticide poisoning at the Fifth Medical Center of the Chinese PLA General Hospital (China) between 2014 and 2021. The patients were divided into hemoperfusion and non-hemoperfusion groups based on whether or not they had received blood purification treatment. We compared clinical characteristics, serum drug concentrations, durations of hospital stay, and durations of vitamin K1 (VK1) therapy between the two groups using univariate and multivariate analyses. Subgroup analyses were also conducted to assess the effect of hemoperfusion in patients poisoned with brodifacoum and bromadiolone. Of 148 screened patients, 115 patients were included (hemoperfusion [n=24] and non-hemoperfusion [n=91]). The rate of blood toxin clearance per unit time may have been faster in the hemoperfusion group. Subgroup analyses revealed that hemoperfusion significantly reduced the duration of VK1 therapy in patients poisoned with brodifacoum (P=0.044). Hemoperfusion effectively reduced serum rodenticide concentrations in patients with poisoning. Moreover, hemoperfusion can reduce the duration of VK1 therapy in patients poisoned by brodifacoum.

This single center randomized controlled trial (NCT03562754) compared pre-diluted IHDF (PIHDF) without systemic anticoagulation and the Prometheus system with regional citrate anticoagulation (IHD-RCA) in high-bleeding-risk patients. IHD-RCA with the Prometheus® device and PIHDF with a 5008H® dialysis monitor using priming and pre-dilution HDF online (25 ml/min) were compared in a 4-hour IHD session for 60 high-bleeding-risk patients between 2019 and 2020. Bleeding risk was defined by the nephrologist. Successful hemodialysis was defined as no premature interruption of the 4-hour session. We also analyzed adequacy (KT/V), dialyzer membrane status, cost and organization from the nurse's viewpoint. 82% of patients were on chronic IHD and 41% had a fistula. Three patients in the IHD-RCA arm were excluded for early vascular access failure or persistent oral anticoagulation. No statistically significant difference was observed for the primary outcome between the two techniques (96% vs. 83%, p=0.11). With PIHDF, 2 in 5 sessions failed after 3 hours. No statistically significant difference in KT/V was observed between groups (1.69 vs. 1.61, p=0.27) but a significantly higher mean blood flow for PIHDF was reached (294 vs. 263 ml/min., p<0.001). The visual coagulation score was significantly worse for PIHDF (p<0.01). No difference in clinical tolerance was found between groups. Hospital costs were higher with IHD-RCA than PIHD, mainly due to the nurse's workload. Conclusions Statistically, the primary outcome was not significantly different between techniques. The Prometheus device is efficient and clinically well-tolerated but PIHD is a cheaper, simpler procedure with little risk of coagulation if the session only lasts 3 hours.

Background Single plasma exchanges (SPE) and double filtration plasmapheresis (DFPP) are commonly used in clinical practice. However, there haven't been clear recommendations on the selection of SPE or DFPP in treating lupus nephritis (LN) in existing Therapeutic plasma exchange（TPE） related guidelines. Therefore, we aimed to evaluate the efficacy and safety of DFPP and SPE in patients with LN, and analyze the risk factors of ineffective DFPP and SPE in the treatment of LN. Methods: In this single-center, real-world retrospective study, we assessed safety and efficacy of therapy with SPE or DFPP in 67 patients with LN. Changes of laboratory test indicators and statistical indicators before and after treatment were compared, and the occurrence of adverse events (AEs) was observed in these patients. Results： 24 patients were treated with DFPP and 43 patients with SPE. DFPP and SPE showed a comparatively significant treatment response. The effective rate of DFPP was higher than that of SPE (P< 0.05), but the difference was not statistically significant. In both groups, platelet, potassium, chloride, APTT, Fib were significantly lower at baseline, and sodium was significantly higher at baseline (P<0.05), and the difference was statistically significant. The incidence of AEs in DFPP group was lower than in SPE group. The amount of plasma used in DFPP group was significantly less than that in SPE group during hospitalization. Economic cost of hospitalization and remission rate were no significant difference between the two groups. Length of hospital stay and serum creatinine both were the risk factors of ineffective short-term plasma exchange（PE）in the treatment of LN. Conclusions: In summary, both DFPP and SPE were effective and safe procedures for treating LN. However, DFPP did not depend on plasma, and could reduce the incidence of adverse reactions, it should be promoted.

Background Accurate volume assessment during immediate post-kidney transplantation period reduces morbidity and mortality. Lung ultrasound (LUS), VExUS score, and bioimpedance (BIA) are emerging methods for volume evaluation. We hypothesize LUS+VExUS may provide accurate means of congestion assessment in renal transplant patients, allowing more precise care. Method Exploratory, prospective, single-centre pilot study. A prospective cohort (Group 1, n = 31) underwent volume assessment using a combined VExUS + LUS protocol on days +1 and +7 post-transplantation, alongside physical examination (PhE) and bioimpedance analysis (BIA). Findings were compared with a historical reference cohort (Group 2, n = 40) managed with standard clinical assessment alone. Results Groups differed significantly in delayed graft function (45.2% vs. 15.0%, p = 0.008) and cold ischaemia time (p = 0.027). Acute pulmonary oedema occurred in 2/31 patients (6.5%) in Group 1 and 6/40 (15.0%) in Group 2, though this difference was not statistically significant (Fisher exact p = 0.452). VExUS showed no correlation with BIA (Spearman ρ = 0.127, p = 0.545), BNP (ρ = 0.187, p = 0.349), or CA-125 (ρ = 0.241, p = 0.226). VExUS detected venous congestion (grade ≥ 1) in 2/14 patients (14.3%) with normal PhE on Day +1. Physical examination showed poor agreement with VExUS (κ = 0.043) and moderate agreement with LUS (κ = 0.469). Combined ultrasound identified subclinical congestion in 28.6% of patients with normal PhE. Ultrasound findings prompted therapeutic modifications in 74.2% of cases on Day +1 (primarily IV fluid reduction) and 16.1% on Day +7. Conclusion In this exploratory pilot study, VExUS and LUS provided additional diagnostic information beyond physical examination and influenced clinical decision-making in the majority of cases. These hypothesis-generating findings warrant confirmation in larger, multicentre, prospective studies with standardised protocols.

Continuous renal replacement therapy (CRRT) is one of the adjunctive therapies for sepsis. This study compared 30-day mortality between conventional hemofilter and the polyethyleneimine-coated polyacrylonitrile membrane (AN69ST) in intensive care unit. Using the Diagnosis Procedure Combination (DPC) database provided by Medical Data Vision Co., Ltd. (MDV), our analysis focused on patients who underwent CRRT in ICU. The primary outcome was defined as the 30-day mortality rate. Patients were categorized into the AN69ST group and the non-AN69ST group. A subgroup analysis was performed. Furthermore, analysis was conducted considering changes in hemofilters to align with actual clinical practice. A total of 9,147 patients underwent CRRT, including 1,419 in the AN69ST group. The analysis demonstrated a statistically significant reduction in 30-day mortality in the AN69ST group (hazard ratio (HR) 0.825, 95% confidence interval (CI) 0.742-0.916).