ABSTRACTBackgroundVitamin D deficiency is highly prevalent among children on regular dialysis, affecting approximately 90% of patients. This deficiency (serum 25‐hydroxyvitamin D < 50 nmol/L or 20 ng/mL) is associated with various complications, including skeletal problems, increased infection risk, arterial stiffness, vascular calcification, and higher cardiovascular mortality. Severe deficiency (< 30 nmol/L) particularly increases mortality risks.MethodIn this cross‐sectional retrospective study, we examined 53 pediatric patients (28 boys, 25 girls) undergoing regular dialysis (hemodialysis and peritoneal dialysis) at a children's medical center from 2018 to 2020. The mean age was 8.21 years, with 71.7% aged 2–12 years, 20.8% adolescents, and 7.5% under 2 years. The mean vitamin D level was 23.51 ng/mL.ResultsResults showed that 26.41% of patients died, with mortality analysis revealing a hazard ratio of 3.2 for patients with vitamin D levels below 15 ng/mL. The mortality rate was 64.7% in severe deficiency (< 15 ng/mL), 18.8% in moderate deficiency (15–30 ng/mL), while patients with sufficient levels (> 30 ng/mL) recorded no deaths. Additionally, 11.32% developed skeletal disorders, including two cases of spinal fracture. Vitamin D levels showed significant positive correlations with calcium (r = 0.6) and years under dialysis (r = 0.52) (p > 0.05). Associations were found between vitamin D levels and phosphorus, PTH, and mortality rates. However, no significant relationships were observed with dialysis frequency, age, weight, gender, underlying disease, dialysis type, or hypertension.ConclusionIn conclusion, children with end‐stage renal disease undergoing dialysis face increased risks of vitamin D deficiency due to impaired kidney function. This deficiency significantly impacts survival rates and contributes to poor outcomes. Regular monitoring and management of vitamin D levels are crucial for improving survival in pediatric dialysis patients.

Simultaneous Heart-Kidney Transplantation (SHKT) following donation after circulatory determination of death (DCD) is increasing. Whether kidney allograft outcomes differ from donation after brain death (DBD) SHKT recipients has not been well studied. We identified adults in the UNOS database who were listed for SHKT and transplanted after 2018. Baseline characteristics of DBD and DCD recipients and donors were compared. Outcomes of interest included primary nonreceipt of a kidney allograft, acute post-transplant dialysis, and chronic dialysis or renal transplantation. Survival to 1-year and renal allograft function at follow up were also assessed. Univariate and multivariable logistic regression were used to identify risk factors for the individual outcomes with Cox proportional hazard modeling leveraged to identify risk factors for 1-year mortality. One-year survival was compared between both groups using Kaplan-Meier and Cox-Hazards ratio. From October 18, 2018 to December 31, 2023, there were 1956 SHKT recipients, with 1828 receiving allografts from DBD donors and 128 from DCD donors. DCD recipients were significantly older, listed at lower transplant status, and less likely to be on inotropic or intra-aortic balloon pump support before transplant. DCD donors were younger and had higher baseline eGFR. After a median follow-up of 847 days, there was no significant difference in renal allograft outcomes between groups. There was no difference in 1-year survival between DCD and DBD SHKT recipients, and DCD status was not associated with 1-year survival after adjustment for key donor and recipient characteristics. Kidney allograft outcomes are similar in DBD and DCD SHKT recipients, which supports DCD in expanding the donor pool for SHKT candidates.

Children receiving kidney replacement therapy frequently face complications resulting in recurrent hospitalizations. This nationwide retrospective observational study, conducted using data from the Italian Registry of Pediatric Chronic Dialysis (IRPCD), aimed to compare hospitalization rates and causes between children treated with chronic peritoneal dialysis (PD) and hemodialysis (HD). The study included children (< 18years) on chronic PD or HD recorded between January 2000 and December 2019. Hospitalizations were defined as admissions involving at least one overnight stay, excluding those for dialysis initiation or kidney transplantation. Hospitalization causes were categorized as infectious and non-infectious dialysis-related complications, other infections, non-infectious conditions, diagnostic procedures, and complications related to kidney failure. A total of 847 dialysis patients (493 on PD, 354 on HD) were included. Among 813 patients, 420 (51.7%) were hospitalized, with PD accounting for 72.9% at the first hospitalization. Dialysis-related infections were the most common cause (24.3%), particularly in PD patients, followed by non-infectious medical conditions (17.3%) and kidney failure-related complications (14.9%). Cox modeling indicated a lower risk of hospitalization for HD compared to PD (aHR 0.75 [95%CI 0.65-0.87]), with HD showing a protective effect over time. HD patients also had a lower likelihood of treatment changes after one year compared to PD (aHR 0.29 [95%CI 0.10-0.81]). This study highlights the significant burden of hospitalization among children on chronic dialysis, with PD patients experiencing higher risks over time compared to HD. These findings underscore the need for targeted strategies to mitigate hospitalization risks in pediatric dialysis populations.

As the global population ages, an increasing number of older adults progress to end-stage kidney disease (ESKD). In this population, frailty, multimorbidity, and functional decline often limit the survival benefit of dialysis, challenging the conventional approach to renal replacement therapy. To summarize current evidence comparing dialysis with conservative kidney management (CKM) in older adults with advanced chronic kidney disease (CKD), focusing on survival, quality of life, hospitalization, and prognostic tools. A narrative synthesis was conducted based on observational, cohort, and systematic review studies including adults aged ≥ 70years with stage 4-5 CKD. The literature search was performed exclusively in the PubMed database, which represents a methodological limitation of this review. Search terms included: end-stage renal disease, chronic kidney disease, kidney failure, dialysis, conservative management, frailty, geriatric patients, and elderly patients. Outcomes were grouped into four domains: survival, quality of life, healthcare utilization, and prognostic models. Across studies, dialysis prolonged survival mainly in younger and less comorbid patients, but this advantage diminished with increasing frailty and multimorbidity. CKM provided comparable or superior health-related quality of life (HRQoL) and was associated with fewer hospitalizations. Patients managed conservatively were more likely to die at home, reflecting closer alignment with end-of-life preferences. Prognosis was primarily determined by patient-level factors-age, frailty, and eGFR decline-rather than by treatment modality. CKM-specific prognostic models remain limited. In older adults with advanced CKD, survival gains from dialysis are modest and frequently offset by higher treatment burden. CKM offers a patient-centered alternative focused on quality of life, comfort, and goal-concordant care. The development of validated CKM-specific prognostic tools is essential to support individualized, evidence-informed decision-making.

For 25 years, the Brazilian Society of Nephrology has systematically monitored chronic dialysis care through the Brazilian Dialysis Survey (BDS), offering a unique perspective on the evolution of dialysis practices and access to treatment in a large and diverse middle-income country. Analysis of data from 1999 to 2024 reveals that hemodialysis has remained the dominant modality, representing on average 92% of treatments, while peritoneal dialysis accounted for only 8% and showed a steady decline. Regional differences have been marked: the Northeast consistently reported the lowest rates of peritoneal dialysis, while the South maintained above-average use. Funding sources also reflect broader structural dynamics in the health system. The Unified Health System (SUS) has been the backbone of dialysis provision, covering 83% of patients over the period. Yet, the role of private health insurance has expanded, with coverage increasing from 12% in 2006-2009 to 20% in 2019-2024. Interestingly, regional comparisons show contrasting patterns, with private insurance supporting a disproportionately high share of dialysis in the North compared with the general population, while in the Southeast the opposite scenario was observed. Taken together, these findings illustrate a landscape shaped by declining use of peritoneal dialysis, heavy reliance on public financing, and persistent regional inequities. Beyond documenting numbers, the BDS highlights the need for policies that promote equity, strengthen the role of peritoneal dialysis, and ensure sustainable access to kidney replacement therapies for all Brazilians.

BackgroundMeropenem-vaborbactam (MEV) is a novel β-lactam β-lactamase inhibitor combination approved in the United States for the treatment of complicated urinary tract infections caused by resistant organisms. Its spectrum includes carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa. Limited data exist on the use of MEV in patients with reduced renal function. This study compared clinical characteristics and outcomes between patients with moderate to severe renal impairment and those with mild or no impairment.Table 1.Baseline, infection, and treatment characteristics.Table 2.Clinical outcomes.MethodsThis was a real-world, multicenter, retrospective cohort study conducted between 2017 and 2025 in adult patients who received MEV for ≥72 hours. Patients with KDOQI CKD stages 3-5 or GFR < 60 mL/min/1.73m2 or on chronic dialysis were assigned to the renal impairment (RI) group. All other patients were assigned to the non-impaired (NI) group. The primary outcome was clinical success, defined as resolution or improvement in signs of infection without recurrence. Secondary outcomes included 30-day all-cause mortality, 30-day microbiologic recurrence, 30-day hospital readmission, and occurrence of treatment-emergent adverse events.ResultsSeventy-two patients were included in the RI group and 151 patients were included in the NI group. The median baseline eGFR was 52.3 vs. 91.3 mL/min/1.73m2 in the RI and NI groups, respectively. Nearly half (47%) of patients in the RI group were receiving chronic dialysis. Clinical success was achieved in 76% of patients in the RI group compared to 79% in the NI group (p=0.60). Thirty-day all-cause mortality was 20.8% in the RI group vs. 23.8% the in the NI group (p=0.62). Thirty-day microbiological recurrence and hospital readmission rates were similar between the two groups. Adverse events were rare in both groups and similar in incidence (2.8% vs. 2.6% in the RI and NI groups, respectively [p=0.96]).ConclusionThis study demonstrated the clinical outcomes of MEV when used in patients with moderate to severe renal impairment. Prospective randomized trials in this patient population are needed to validate these findings.DisclosuresKevin W. Garey, PharmD, MS, FIDSA, FASHP, Acurx: Grant/Research Support|Merck & Co.: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support Wesley D. Kufel, Pharm.D., BCPS, BCIDP, Merck & Co.: Grant/Research Support|Shionogi, Inc: Grant/Research Support|Shionogi, Inc: Honoraria Tamara Krekel, PharmD, BCPS, BCIDP, AbbVie: Advisor/Consultant|AbbVie: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria Taylor Morrisette, PharmD, MPH, AbbVie Inc: Advisor/Consultant|AbbVie Inc.: Grant/Research Support|Copeland, Stair Valz & Lovell: Expert Testimony|Infectious Diseases Special Edition: Honoraria|Stellus Rx: Grant/Research Support Travis J. Carlson, PharmD, BCIDP, Aimmune Therapeutics, Inc.: Speaker bureau Venugopalan Veena, PharmD, Merck: Grant/Research Support Vasilios Athans, PharmD, BCIDP, Astellas Pharma: Advisor/Consultant Kimberly C. Claeys, PharmD, PhD, bioMérieux: Advisor/Consultant|bioMérieux: Honoraria Michael J. Rybak, PharmD, PhD, MPH, Abbvie: Grant/Research Support|Innoviva: Grant/Research Support|Melina: Grant/Research Support|Merck: Grant/Research Support|Shionogi: Grant/Research Support

Provide an overview of the rationale for implementing time-limited dialysis trials (TLT-Ds) in critically ill older adults with acute kidney injury treated with dialysis, the communication strategies required for proper implementation, and future research directions. AKI-D is linked to high mortality, reduced renal recovery, and a substantial chance of discharge to nursing homes in older adults. Many older people value independence and quality of life over longevity. Yet acute dialysis often remains the reflexive treatment option, while patients and families face prognostic uncertainty in the face of mortality. A TLT-D is an ethically sound, person-centered approach that aligns with many patients' preferences. Its benefits include providing a structured opportunity for clinicians, families, and patients to assess the biomedical efficacy of dialysis while allowing time for deliberation, prognostic clarity, and emotional processing. This can inform whether to continue acute dialysis or transition to comfort care or chronic dialysis within prespecified or evolving goals. Acute dialysis decision-making for critically ill older adults needs improvement. Reflexive initiation followed by automatic transition to chronic dialysis may not align with many patients' goals. TLT-Ds can promote goal-concordant care. Further research is needed to guide their implementation and evaluate person-centered outcomes.

Penile calciphylaxis is a rare yet devastating vascular complication of end-stage renal disease (ESRD) on chronic dialysis, marked by arterial calcification, ischemic necrosis, and a mortality rate exceeding 60%. We report a male in his early forties with ESRD on hemodialysis who presented with dry gangrene of the glans penis. Imaging revealed extensive vascular calcification from the iliac to penile arteries, with markedly elevated calcium–phosphate product, hypoalbuminemia, and secondary hyperparathyroidism. Partial penectomy was performed, but the patient succumbed to systemic complications within 3 weeks. This case underscores the grave prognosis associated with penile calciphylaxis, particularly when accompanied by hypoalbuminemia, elevated calcium–phosphate product, and diffuse vascular involvement. Prompt recognition of such predictors, aggressive metabolic correction, and patient education are crucial to improving survival in this otherwise fatal condition.

Surgical wound complications after major lower limb amputations for chronic limb-threatening ischemia.

Education and decision support improve outcomes in urgent dialysis: A randomised trial.

Patient: Male, 68-year-oldFinal Diagnosis: Small leukocytic lymphoma/chronic leukocytic leukemiaSymptoms: Dizziness • dyspepsia • lymphadenopathy • nausea • oedema • pruritus • weaknessClinical Procedure: Blood test • bone marrow biopsy • CT abdomen and pelvis • peritoneal dialysis • ultrasonographySpecialty: Hematology • NephrologyObjective: Unknown etiologyBackgroundPruritus is common in chronic dialysis patients, usually due to metabolic imbalance, xerosis, or other cutaneous complications of chronic kidney disease (CKD), leading to a diagnosis of CKD-associated pruritus (CKD4P). When symptoms persist despite optimized dialysis, stable laboratory indices, and no dermatologic cause, alternative etiologies must be considered.Case ReportA 66-year-old man with end-stage renal disease (ESRD) of unknown origin, treated with peritoneal dialysis, developed progressive, treatment-resistant pruritus. Initially localized to the extremities without primary lesions, it was unresponsive to standard therapies. As the itch became generalized, systemic symptoms emerged, including fatigue, lower-extremity edema, and pancytopenia. Differential diagnoses were excluded. Pre-transplant abdominal CT revealed generalized lymphadenopathy and splenomegaly. A bone marrow biopsy confirmed chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) by immunophenotyping. Due to ESRD and active malignancy, the patient was ineligible for chemotherapy or kidney transplantation; pruritus management remained conservative.ConclusionsPersistent pruritus in dialysis patients warrants reevaluation beyond CKD-aP, especially in those with unknown CKD etiology and hematologic abnormalities. Recognizing paraneoplastic itch as a potential early sign of malignancy can enable earlier diagnosis in high-risk populations.

Membranoproliferative glomerulonephritides (MPGNs) are defined by a typical glomerular histopathological pattern including C3 glomerulopathy (C3G) and immune complex-mediated MPGN (IC-MPGN). The overall prognosis is poor and the treatment options remain limited. Outcome predictors and reliable surrogate endpoints are critically needed for interventional trials. Herein, we described the natural history and analyzed clinical, histological and biochemical data from a large cohort of patients with primary C3G/IC-MPGN. This is a retrospective analysis of patients with biopsy-proven primary C3G or IC-MPGN from the Italian Registry of MPGN. Demographic, clinical and histopathological data, molecular complement profiles, treatment patterns, and outcomes were collected. We performed univariable and multivariable Cox regressions and Kaplan-Meier survival analyses to assess risk associations with kidney disease progression. The composite endpoint included end-stage kidney disease (ESKD, defined by either eGFR <15 ml/min/1.73m2, initiation of chronic dialysis or kidney transplantation), doubling of serum creatinine at the last available follow-up, or death by kidney-related causes. Of the 349 patients identified, 208 had C3G and 141 IC-MPGN. Females were 41%, and over half were younger than 18 years old at time of biopsy. C3G and IC-MPGN patients shared most baseline and longitudinal features, with IC-MPGN patients presenting with higher baseline proteinuria (median 4.0 vs. 2.3 grams/24hours, p<0.001). Median estimated Glomerular Filtration Rate (eGFR) at presentation was 83 ml/minute/1.73m2. Twenty-six % of patients progressed to ESKD over a median follow-up of 5 years from diagnosis. Higher proteinuria levels at one year from biopsy, particularly ≥1gram/24hours, were significantly associated with a higher risk of adverse kidney outcomes. Pediatric onset was associated with better kidney survival, whereas kidney survival at 10 years did not statistically differ across histological subtypes. Complement dysregulation and rare functional variants in complement genes did were not associated with outcomes. Our findings from a large and well-characterized cohort of individuals with primary C3G/IC-MPGN identify age at onset and proteinuria levels as associations with kidney survival, a finding that should inform future interventional trials.

Background: Patients with chronic kidney disease (CKD), especially those on dialysis, have an increased risk of viral hepatitis B (HBV) and C (HCV) infection. The South African Renal Society recommends regular screening to ensure early detection, appropriate treatment and vaccination update for hepatitis B. Chronic kidney disease patients tend to have a poor immune response post-vaccination. Objectives: The study investigated the prevalence of HBV and HCV, screening practices and immune response to HBV vaccination among patients on state-funded dialysis in the Free State province. Method: Records of patients on chronic dialysis in 2021 were included in the study. Data were extracted from paper-archived and electronic medical and laboratory records. Results: In total, 223 records were included. Over 90% of patients were screened for hepatitis B and C at baseline at all dialysis units, which decreased to 30% at some satellite units at follow-up screening. The seroprevalence for both HBV and HCV was 1.8%. Viral hepatitis B immunity was found in 78.4% of patients. Patients with a mean age of 45 years were more likely to have increased antibody titres. Human immunodeficiency virus seropositive patients were more likely to have lower antibody titres when repeated at 6 months. The vaccination rate was 74.5%. The vaccination non-response rate was 9.8% with no variable demonstrating a significant effect on vaccine response. Conclusion: Both HVB and HCV prevalence were lower than described in similar settings with equal distribution between dialysis modalities. Screening was adequate at baseline but decreased at follow-up, resulting in non-identification of patients possibly needing re-vaccination. Contribution: Missed opportunities are concerning and call for action to strengthen the outreach service to satellite dialysis units located in regional hospitals.

ObjectivesChronic kidney disease requiring dialysis significantly increases the risks of coronary artery disease. However, there is limited data on this high-risk patient population requiring coronary artery bypass grafting. Using a UK national registry, we investigated the impact of preoperative dialysis on in-hospital mortality and early morbidity in patients undergoing coronary artery bypass graft (CABG).MethodsA retrospective analysis of National Adult Cardiac Surgery Audit data between January 1996, 2, and March 31, 2019, identified patients who underwent first-time isolated CABG. Propensity matching was performed to balance the baseline characteristics between dialysis and non-dialysis patients, yielding 633 matched pairs. We evaluated trends in CABG among dialysis patients and EuroSCORE 2 performance in predicting in-hospital mortality (calibration, discrimination, and clinical utility).ResultsThere was a steep increase in CABG operations in dialysis patients after 2011. EuroSCORE 2 showed poor calibration, discrimination, and minimal clinical benefit in predicting mortality in dialysis cases. Dialysis patients exhibited a significantly higher in-hospital mortality rate (7.9% vs 2.1%, P < .001) than non-dialysis patients. The dialysis patients had longer median hospital stays (12 vs 9 days, P < .001) and a higher rate of return to the theatre for bleeding (5.5% vs 2.7%, P = .034). We found no difference in postoperative neurological deficit rates between the 2 cohorts. The odds ratio of in-hospital mortality for the dialysis vs non-dialysis patients was 4.62, P < .001, 95% (CI: 2.54-8.4). Significant predictors of mortality in the dialysis CABG cohort included advanced age (OR: 2.48), New York Heart Association class IV (OR: 3.06), and pulmonary hypertension (OR: 11.91).ConclusionsThere has been an overall increase in coronary artery bypass operations performed in renal dialysis-dependent patients in the UK. Preoperative chronic dialysis is associated with considerable in-hospital mortality, return to theatre for bleeding and prolonged hospital stay. EuroSCORE 2 has poor predictive performance in this patient cohort.

To map and synthesise existing interventions aimed at improving environmental sustainability in kidney care and to identify challenges and opportunities for implementation across treatment modalities. Scoping review following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology. The study merged two existing frameworks to form appropriate review questions. Embase, MEDLINE, Scopus, and CINAHL alongside relevant grey literature, searched in September 2024. The review included studies from 1 January 2005 to 30 September 2024 that reported on environmental sustainability interventions in kidney care, including chronic kidney disease, haemodialysis, peritoneal dialysis, kidney transplantation, and conservative management and that provided measurable or descriptive information about the intervention. Conference abstracts and opinion pieces without intervention data were excluded. Out of 2,512 records screened, 95 studies were included. Environmental interventions were most commonly implemented in haemodialysis (n = 58), followed by chronic kidney disease (n = 19), transplantation (n = 6), peritoneal dialysis (n = 5), and conservative management (n = 1). Some studies addressed multiple modalities; therefore, categories are not mutually exclusive. The most frequent sustainability categories were water use, waste management, procurement optimisation, energy efficiency, and travel reduction. Interventions ranged from dialysate flow reduction and RO water reuse to telemedicine and supply chain redesign. While many demonstrated environmental and economic benefits, reporting was heterogeneous, and studies were concentrated in high-resource settings. There is growing interest in sustainability within kidney care, particularly in haemodialysis. However, adoption across other modalities remains limited. Future work should prioritise underrepresented areas, standardise metrics, and ensure inclusion of low-resource contexts. Co-design of interventions with patients and staff, combined with consistent reporting using frameworks such as SQUIRE 2.0, is essential. Integration of sustainability into clinical practice and policy is urgently needed to align kidney care with global climate and health goals.

Introduction: Maintaining fluid balance is one of the major challenges of the dialysis therapy. It includes, in particular, the management of “dry body mass.” We postulated that simple measurement of subscapular skinfold thickness before and after hemodialysis could help monitor hydration status in chronic dialysis patients. The aim of the study was to compare the conventional methods of monitoring hydration status during hemodialysis with an assessment of skinfold thickness. Methods: A total of 50 participants (21 F, 29 M; age 60 ± 15 years) were enrolled. Directly before the hemodialysis session, the following parameters were measured: body composition with bioimpedance spectroscopy, skinfold thickness in subscapular area with standardized caliper and blood tests – blood count, urea, n-terminal pro-B-type natriuretic peptide (nt-proBNP), and pro-adrenomedullin. The procedures were repeated at the end of three consecutive hemodialysis sessions. Results: The mean change of skinfold thickness in subscapular area before and after hemodialysis session was −2.2 ± 1.6 mm. A significant correlation was found between the change of extracellular water volume and skinfold thickness before and after hemodialysis (r = 0.33; p = 0.02) and between the change of total water volume and body mass before and after hemodialysis (r = 0.49; p < 0.01). There was also a positive correlation between the change of skinfold thickness and systolic blood pressure before and after a hemodialysis session (R = 0.36; p = 0.01). Dialysis vintage correlated significantly with the changes of plasma nt-proBNP level during hemodialysis (r = 0.40; p = 0.02). Multivariate analysis revealed that baseline body mass, BMI, changes of systolic blood pressure determined the variability of skinfold thickness during hemodialysis. Receiver operating curve analysis revealed that BIA spectrometry was more sensitive and specific than the skinfold thickness assessment for the assessment of hydration condition. Conclusion: The simple measurements of skinfold in subscapular area may approximate changes of hydration status but are inferior to BIA spectroscopy. Further research is needed to confirm the utility of this method in monitoring blood pressure control in dialysis patients.

Introduction: Renal Failure Represents Approximately 1% Of Emergency Admissions. In Our Setting, The Vast Majority of Chronic Renal Failure Patients Are Under-Dialyzed, And Access to Emergency Extracorporeal Renal Replacement Therapy Is Not Always Available. Objective: To Report the Clinical, Therapeutic, And Evolutionary Characteristics of Renal Failure in the Emergency Department of A Tertiary Hospital in Africa. Patients And Methods: This was a Cross-Sectional Prospective Study from January to December 2024, Including All Patients Presenting with Renal Failure Either at Admission or During Management of Another Condition in The Emergency Department. Results: During The Study Period, 160 Patients Were Diagnosed with Renal Failure, Giving A Prevalence Of 3.55%. The Mean Age Was 50 Years [16,7]. There Was A Male Predominance Of 54.4%. The Main Reasons for Consultation Were: Respiratory Distress 24.38%; Altered Consciousness 23.75%; Infectious Syndrome 12.50%; Arteriovenous Fistula Rupture 5%; Deep Vein Thrombosis 3.13%. A Total Of 33.1% Of Patients Were Known Chronic Renal Failure Patients, and 23% Were on Chronic Dialysis. In Addition, 29.4% Of Patients Were Diabetic, And 59.4% Hypertensive. A History of Nephrotoxic Drug Intake Within the Three Months Prior To Admission Was Found In 30.6% Of Patients. At Admission, 40% Had A GCS &lt; 15; Mean Spo₂ Was 89% [8.4]; Mean MAP Was 102 Mmhg. Mean Hemoglobin Level Was 8 G/Dl [2.5]; Creatinine 627 µmol/L [526]; Sodium 127 Mmol/L [10.46]. Life-Threatening Hyperkaliemia Was Present In 8.8% Of Patients. Oxygen Therapy Was Initiated In 55% Of Patients. Ten Percent Were Transfused. Emergency Renal Replacement Therapy Was Performed In 70% Of Cases. Major Complications Included: Infectious Pneumonia 25.6%; Uremic Coma 8.1%; Hemorrhagic Syndrome 5%; Status Epilepticus 2.6%. Mortality Was 31.3%. Mean Length of Stay Was 6 Days [3.5]. Conclusion: Under-Dialysis Is Responsible for Decompensations and High Mortality.

Introduction: Arteriosclerosis is common in candidates for kidney transplantation (KT) due to cardiovascular comorbidities and chronic dialysis. Previous studies have demonstrated the prognostic relevance of pelvic calcification on the surgical outcome after KT. The aim of this study was to evaluate the potential of the computed tomography (CT)-based pelvic calcification score (PCS) as a predictive marker of outcome and survival in KT in a comprehensive analysis. Methods: A prospectively maintained medical database of patients who received KT was used for the present analysis. Calcification in the common and external iliac arteries was analyzed in the CT scan, resulting in a PCS ranking from 0 to 44 points. Receiver operator characteristic curves were generated to determine the optimal diagnostic criterion threshold for predicting postoperative outcomes and survival. Predictive value and association of the PCS with clinicopathological parameters of the donors, recipients, and transplant procedure were analyzed retrospectively. Results: A total of 87 KTs (31 female, 35.6%) were included in the study with an average PCS of 19.8 ± 13.2 (range: 0–40), whereby 18.4% showed no calcification of the pelvic arteries. Recipient age and BMI showed a significant correlation with PCS (recipient age: r = 0.622; p < 0.001; recipient BMI: r = 0.276; p = 0.010). Using a PCS cut-off value of 14, there was an association of PCS with delayed graft function (DGF), graft survival and patient survival in univariate analysis; however, PCS failed to be an independent predictor of DGF, graft survival and patient survival after adjusting for other relevant donor, recipient, and transplant characteristics (DGF: OR 1.95, CI: 0.29–12.24, p = 0.493; graft survival: HR: 1.75, CI: 0.70–14.40; p = 0.133; patient survival: HR: 5.72, CI: 0.73–45.18, p = 0.098). Conclusion: Pelvic calcifications are frequent in patients with KT and found in 81.6% of cases. The PCS is associated with age and BMI and was associated with decreased graft and patient survival. However, PCS fails to be an independent predictor in the multivariable analysis. Larger studies are needed to confirm our preliminary results of the prognostic role of PCS.

Background/Objectives: Acute kidney injury (AKI) is a common complication in hospitalized patients and carries a substantial risk of chronic kidney disease (CKD), dialysis dependence, and mortality. Although novel biomarkers such as NGAL, KIM-1, and cystatin C have shown promise, their high cost and limited availability restrict their use in routine practice, particularly in developing countries where CKD incidence is rising. The trajectory of serum creatinine decline after its peak may provide a simple, low-cost, and universally available prognostic marker for renal recovery. Methods: This retrospective cohort study included 817 adult patients diagnosed with AKI between January 2015 and December 2024. The creatinine decline rate was calculated as the difference between peak and discharge creatinine divided by hospital stay (mg/dL/day). Patients were stratified into rapid or slow decline groups according to the median value (0.19 mg/dL/day). Post-discharge outcomes, including CKD development, readmission, dialysis requirement, and mortality, were evaluated at 3, 6, and 12 months. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff for predicting renal recovery. Results: Patients in the rapid decline group (n = 409) were younger and had fewer comorbidities and shorter hospital stays than those in the slow decline group (n = 408). The ROC analysis yielded an AUC of 0.78 (95% CI 0.73-0.82, p < 0.001) with an optimal cutoff of 0.18 mg/dL/day (sensitivity 76%, specificity 71%). At 12 months, CKD (18.6% vs. 34.3%), dialysis requirement (3.4% vs. 8.8%), readmission (29.8% vs. 41.2%), and mortality (9.3% vs. 14.2%) were all significantly higher in the slow decline group (all p < 0.05). In multivariable analysis, faster creatinine decline independently predicted renal recovery (OR = 1.36 per 0.1 mg/dL/day, 95% CI 1.22-1.53, p < 0.001), along with younger age, higher serum albumin, and shorter hospital stay. In the longitudinal GEE model, both time (p = 0.004) and group effects (p < 0.001) remained significant, with an interaction effect (p = 0.018) indicating greater eGFR improvement over time among patients with rapid creatinine decline. Conclusions: The rate of creatinine decline is an independent predictor of long-term renal recovery following AKI. This simple and inexpensive parameter may complement novel biomarkers and serve as a practical risk-stratification tool in diverse clinical settings, especially where resources are limited. Prospective multicenter studies integrating albuminuria and emerging biomarkers are warranted to validate and expand these findings.

Background/Objectives: Cytokine release during organ transplantation contributes to primary graft dysfunction and requires careful immunomodulation. CytoSorb, a hemoadsorption device developed to reduce circulating cytokine levels, is increasingly used in critically ill patients. However, its impact on concurrent immunosuppressive therapy remains unclear. Methods: In this ex vivo study, we investigated the adsorption of five immunosuppressants—cyclosporine A, tacrolimus, methylprednisolone, mycophenolic acid, and 6-mercaptopurine—using a scaled-down CytoSorb hemoadsorption circuit and compared results to chronic and acute dialysis. Additionally, a whole blood model was used to assess the functional impact of CytoSorb treatment on leukocyte activation, using LPS and anti-CD3 stimulation and subsequent cytokine measurement (TNF-α, IL-1β, IL-6, IL-8). Results: CytoSorb significantly reduced serum levels of methylprednisolone (92 ± 3%), mycophenolate (80 ± 2%), 6-mercaptopurine (65 ± 32%), and cyclosporine A (61 ± 16%), but had no significant effect on tacrolimus. Dialysis effectively removed methylprednisolone and 6-mercaptopurine, while strongly protein-bound drugs such as cyclosporine A and tacrolimus remained largely unaffected. In the whole blood model, CytoSorb treatment did not significantly alter cytokine release after immunostimulation, suggesting preserved immunosuppressive efficacy. Conclusions: CytoSorb treatment reduces the plasma concentration of selected immunosuppressants. However, short-term treatment appears to have minimal impact on immunosuppressive function. These findings support the cautious use of CytoSorb in transplant settings but highlight the need for in vivo confirmation.