Risk factors for incident or persistent SARC-F-defined sarcopenia in patients with end-stage kidney disease: a cohort study.

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.

Hypervolemia (HV) and arterial stiffness present an important problem for chronic hemodialysis (HD) patients. The most promising methods for evaluating excess fluid are bioelectrical impedance analysis (BIA) and lung ultrasonography with B-line assessment (LUS). The latter is traditionally performed in 28 anatomical locations on the front side of the chest. The study aimed to investigate whether a shorter LUS procedure in 8 locations correlates with other markers of HV and arterial stiffness. We performed a single dialysis center observational study in adult chronic HD patients. Patients had to be without active malignancy, infection, chronic atrial fibrillation, carotid stenosis, severe aortic stenosis, or peripheral artery disease. We performed predialysis blood pressure measurements, LUS on 8 predefined locations, BIA, carotid-femoral pulse wave velocity (cfPWV) assessment, and laboratory values of the N-terminal prohormone of brain natriuretic peptide. 19 patients were included, 7 male (36.8%). The median age of the patients was 71years (IQR (60-74)), the median dialysis vintage was 51 months (IQR (27-87)). We found a statistically significant positive correlation between LUS and overhydration measured by BIA (rs=0.697; p<0.001), LUS and intracellular water measured by BIA (rs=0.478; p=0.038), and between LUS and extracellular water measured by BIA (rs=0.462; p=0.046). Furthermore, we also found a statistically significant negative correlation between LUS and cfPWV (rs=-0.539; p=0.026). LUS in 8locations is associated with markers of HV in HD patients, correlating positively with BIA measurements. Its correlation with cfPWV should be further investigated.

Catheter-related bloodstream infections (CBSI) are serious complications in pediatric hemodialysis (HD) patients. We aimed to compare the CBSI rates associated with cuffed and uncuffed central venous catheters (CVC) in small children. All HD patients weighing <15kg and dialyzed via cuffed CVCs for at least 3 months between March 2016 and March 2022 were included. The CBSI rate was compared to that of a well-matched historical series of our patients before implementing cuffed CVCs. Three boys and 1 girl (median weight: 14.0kg) matched the inclusion criteria and received HD using the same type of cuffed CVC. Eleven CBSIs occurred during 4,870 days with cuffed CVCs, yielding a CBSI rate of 2.3/1,000 catheter days, compared to 7.7/1,000 catheter days in our historical series with uncuffed CVCs (p=0.002). A 70% reduction in the CBSI rate was achieved with cuffed CVCs (p=0.002). The median catheter survival times for cuffed and uncuffed CVCs were 189 and 53 days, respectively (p=0.002). Our results show that cuffed CVCs are associated with reduced CBSI rates and improved catheter longevity compared to uncuffed ones in small children.

Hypocalcemia is a common and clinically significant side effect of etelcalcetide therapy. The aim of this study was to evaluate the utility of ionized calcium (iCa) measurements with a point-of-care ionometer compared to albumin-corrected total calcium and to assess the incidence of hypocalcemia in patients receiving etelcalcetide therapy using pre-dialysis iCa values. This was a phase IV, non-interventional, prospective, single-arm, observational study. A total of 20 chronic hemodialysis patients were included in the study. The iCa concentration was determined before dialysis using a point-of-care ionometer (GEM Premier 3000) at the patient's bedside. Hypocalcemia was defined by a pre-dialysis iCa concentration of less than 0.90 mmol/L. Pre-dialysis corrected total calcium and iCa decreased over time during treatment with etelcalcetide. A statistically significant linear association was observed between point-of-care iCa and albumin-corrected calcium (r=0.532, p=0.019; R2=0.283). Visual comparisons generally showed parallel behavior, but only a moderate correlation. Of 240 iCa values measured, 3 cases (1.25%) were <0.90 mmol/L and 20 cases (8.3%) were between 0.90 and 0.96 mmol/L. Our results highlight the value of direct iCa monitoring as a practical and sensitive tool for detecting hypocalcemia and guiding etelcalcetide therapy. Bedside measurement enabled timely dialysate calcium adjustments, preventing clinically significant hypocalcemia and treatment discontinuation. Point-of-care iCa monitoring offers a safer, more responsive strategy for optimizing calcium management in hemodialysis patients.

To date, it remains unclear to what extent dialyzer performance is affected by clotting, and which hemocompatibility parameters can reliably predict this phenomenon. This study investigated the relationship between dialyzer clotting, performance, and hemocompatibility in four commercially available dialyzers under conditions of intentionally reduced anticoagulation. This crossover study included 10 chronic hemodialysis patients, who were randomized over four dialyzers: FX CorAL800, FX CorDiax800, xevonta Hi20 (all polysulfone-based), and Solacea-19H (cellulose-based). Patients received a single bolus of one-quarter of their standard Low-Molecular-Weight Heparin (LMWH) dose. Dialysis efficiency was assessed from toxin clearance of urea, β2-microglobulin, and myoglobin. Fiber patency was evaluated through visual scoring and μCT imaging. Hemocompatibility markers, including platelet counts, leukocyte counts, anti-Xa activity, thrombin-antithrombin complex (TAT), beta-thromboglobulin (β-TG), and neutrophil-activating peptide (NAP-2), were also analyzed. μCT analysis showed that Solacea dialyzer demonstrated superior fiber patency compared to the other dialyzers. However, fiber blockage did not compromise dialysis performance, as all dialyzers maintained effective toxin removal. Platelet and leukocyte counts remained stable with FX CorAL and Solacea, while declines were found in FX CorDiax and xevonta. No significant correlations were found between clotting parameters and fiber blockage. Hence, under reduced anticoagulation, the cellulose-based Solacea dialyzer exhibited superior fiber patency, but this did not result in higher middle molecule clearance. Since no correlation was found between fiber patency, dialysis performance, or clotting parameters, the underlying cause of the observed differences in dialyzer blockage remains unclear.

BackgroundOur study aims to compare Alpha-MSH (α-MSH) levels and their relationship with sleep state in cases with and without chronic kidney disease (CKD).Material and MethodsWe included CKD-diagnosed patients and a control group in this study. We assessed α-MSH, serum creatinine, and albumin levels in CKD-diagnosed patients and performed the Epworth sleepiness scale (ESS).ResultsA total of 155 people (56 controls, 84 CKD who did not need renal replacement therapy (CKD-without HD), and 15 under chronic hemodialysis (HD) therapy) were included in the study. ESS resulted in “sleepy” in 46.7% of HD, 33.3% in non-RRT CKD, and 19.6% in the control group. Sleepiness was statistically higher in the whole CKD (non-RRT and HD) group compared with the healthy group (p = 0.004). Pathologic ESS results had a positive correlation with the CKD stage and body mass index (BMI) in patients among the non-RRT CKD group. The most influential factors were BMI and eGFR. Considering all the patients, α -MSH results were highest in the control group and higher in the non-RRT group than in the HD group. Multivariate analysis revealed that the most significant factors were BMI and eGFR for pathologic ESS results.Conclusionsα-MSH levels in patients who diagnosed with CKD were lower than in the healthy group. The anti-inflammatory and sleep functions of α-MSH must be researched extensively. CKD patients with low eGFR and high BMI are at risk for sleepiness. In this group, special evaluation should be made in terms of sleep disorders.Trial registrationThe research had done with following permissions in Türkiye.

Patients treated with hemodialysis (HD) are at increased risk for all-cause and cardiovascular (CV) mortality even after adjustments for traditional CV risk factors. The authors identified lower plasma magnesium (pMg) as a risk factor for arrhythmias and sudden death in people treated with HD. The aim of this study was to determine the connection between dialysate Mg concentrations (dMg) and the clinical characteristics of patients on chronic HD. An observational study including 103 chronic HD patients. Patients were divided into two groups based on dMg: group 1 (dMg=0.5mmol/L) and group 2 (dMg=1mmol/L). Variables were collected from patients' medical documentation. There was no statistically significant difference between the groups regarding mean age (58.7±14.6 vs. 58.9±14.3 years, p=0.972), HD duration (4±0.3 vs. 4±0.5h, p=0.849), mean Qb (283.3±22.8 vs. 285.7±21.9mL/min, p=0.597), mean Kt/V (1.53±0.38 vs. 1.62±0.35, p=0.262) and mean dCa (1.61±0.19 vs. 1.61±0.16 mmol/L, p=0.793). We found pMg concentration to be statistically significantly lower and intact parathyroid hormone (iPTH), to be statistically significantly higher in the low dMg group: 0.97±0.73 vs. 1.31±0.25 mmol/L, p=0.007 and 242 (127-487) vs. 108 (47-290.75), p < 0.001, respectively. Mean QT interval did not differ significantly between the groups (380.7±46.3 vs. 387.7±50.3 ms, p=0.488). Higher dMg significantly increased pMg concentrations without significantly impacting the QT interval. This way we could safely increase pMg concentrations while potentially providing benefits regarding the control of secondary hyperparathyroidism.

BackgroundA person-centred approach is a key component of comprehensive high-quality nephrology care. However, the unpredictable nature of an acute or unplanned initiation of chronic haemodialysis treatment poses a challenge for meeting this patient group in a person-centred manner. Yet, little is known about the person-centred practices of clinical encounters prior to and along these suboptimal dialysis initiation (SDI) pathways. This study aimed to explore the patient and clinician perspectives on how these encounters unfold among older adults aged ≥ 65 years, receiving SDI.MethodsThe study builds on an ethnographic approach encompassing participant observation of clinical encounters during eight workdays and narrative interviews with 14 SDI patients aged ≥ 65 in combination with two focus group discussions with seven renal nurses and five nephrologists. This study was conducted at a specialized nephrology department at a tertiary hospital in the Capital Region of Denmark.ResultsThe results shed light on the existence and impact of ‘predefined’ encounters, encompassing various aspects such as the agenda of conversations during encounters, and the logical sequencing of nephrology care pathways. In the two key themes ‘Predefined’ agendas: lost in translation, and The optimal CKD pathway: what happens when?, we illustrate how the acute and unpredictable nature of SDIs challenge the ‘predefined’ encounter format. Thereby, the clinical encounters become misaligned with the needs and preferences of each patient, no longer responding in a person-centred manner.ConclusionClinicians pressed for time face challenges in responding to diverse patient needs in clinical SDI encounters. Existing ‘predefined’ agendas and logical sequencing have evolved to support clinicians in reaching clinical endpoints but fall short when SDI patients’ particular and dynamic perspectives does not fit the standard. To truly facilitate person-centred care, the flexibility of encounters and the overall nephrology care pathways should be improved to ensure that encounters are responsive to and reflect individual patient preferences, contexts, and needs.Clinical trial register number declarationNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12882-025-04560-y.

Hemodialysis (HD) is a method of kidney replacement therapy designed to remove uremic toxins from the body. Beta-2 microglobulin (beta-2 MG) is a middle molecule not yet effectively removed by conventional low-flux dialysis membranes and may contribute to long-term complications in chronic HD patients. While well-studied in adults, data in pediatric populations are limited. This study evaluated beta-2 MG levels before and after HD in children and assessed associations with dialysis prescription parameters and cardiovascular comorbidities. A cross-sectional study was conducted from June to July 2024 at the Kiara Children's Dialysis Unit, Rumah Sakit Umum Pusat Nasional (RSUPN) Cipto Mangunkusumo, Indonesia. Pre- and post-HD beta-2 MG levels were measured. Dialysis prescriptions, laboratory values, and cardiovascular parameters were recorded and analyzed for correlations with beta-2 MG levels and reduction ratios. The study involved 38 subjects, of whom 22 (57.9%) were male, with an average age of 13.2 ± 2.9years. Most patients received HD twice weekly. Pre-HD beta-2 MG levels were elevated in all patients. Synthetic-based high-flux dialyzers were significantly associated with greater beta-2 MG reduction ratios compared to cellulose-based low-flux membranes (r = 0.716; p = 0.000). No significant correlations were found between beta-2 MG levels and other HD parameters, laboratory markers, or cardiovascular outcomes. Synthetic-based high-flux dialyzers were associated with improved beta-2 MG clearance in pediatric HD patients, though pre-HD levels were comparable across membrane types. Further longitudinal studies are warranted to determine the clinical significance of beta-2 MG reduction and guide dialysis optimization in children.

Hip fractures in elderly dialysis patients are associated with increased postoperative complications and mortality, but large-scale analyses remain limited. This retrospective cohort study utilized Japan's nationwide Diagnosis Procedure Combination database (2016-2022). After applying 1:1 propensity score matching, 9,601 chronic hemodialysis patients were compared with 9,601 non-dialysis patients for postoperative outcomes, including venous thromboembolism (VTE), cognitive dysfunction, and in-hospital mortality. The study cohort included only patients receiving chronic maintenance hemodialysis; peritoneal dialysis patients were not included. Statistical significance was defined as a p < 0.001. The in-hospital mortality rate was 5.2% in dialysis patients versus 1.7% in non-dialysis patients. Thirty-day postoperative survival was 99.2% in non-dialysis patients and 97.5% in dialysis patients. Dialysis patients had higher odds of postoperative cognitive dysfunction (OR: 1.944; 95% CI: 1.515-2.495, p < 0.0001) and in-hospital mortality (OR: 3.288; 95% CI: 2.743-3.941, p < 0.0001). The incidence of VTE was lower among dialysis patients. Male sex, older age, and lower BMI were also independent risk factors for mortality. Dialysis is associated with markedly worse outcomes following hip fracture surgery. Comprehensive perioperative management and preventive strategies are essential to improve prognosis in this high-risk population.

Objetive. To test the effectiveness of nursing intervention to control fluid volume on improving laboratory test results and dialysis adequacy in patients with Excess fluid volume. Methods. This is a randomized, double-blind, parallel-group controlled trial involving 34 patients with chronic kidney disease and a nursing diagnosis of Excess Fluid Volume undergoing chronic hemodialysis equally randomized into two groups (control n=17 and intervention n=17). Data were collected on sociodemographic and clinical factors, the presence of Excess Fluid Volume, and water balance. Laboratory parameters, including serum electrolytes, urea, creatinine, and dialysis adequacy markers, were assessed before and after the intervention. The intervention consisted of 13 nursing activities, including educational, follow-up, and reminder components, such as fluid balance monitoring, daily weight control, edema assessment, laboratory follow-up, and health education on diet and self-care. The control group received only the usual care provided at the dialysis clinic. Results. There were significant improvements in laboratory test results and dialysis adequacy. The statistical difference between the groups was significant in the mean values of calcium (p<0.001), post-hemodialysis urea (p=0.002), and creatinine (p=0.006), demonstrating the direct effect of the intervention. In addition, there were improvements in overall dialysis quality and adequacy measures. Conclusion. The nursing intervention significantly improved laboratory test results and dialysis adequacy in patients with chronic renal failure and Excess Fluid Volume, highlighting its potential for enhancing patient management and nursing care.

Introduction: The prevalence of anemia in chronic kidney disease and among chronic hemodialysis patients is very high and is associated with significant morbidity and mortality. The aim of this study was to determine the prevalence of anemia in chronic hemodialysis patients in the Souss-Massa region and to evaluate its management. Materials and Methods: This was a retrospective, analytical, and descriptive study conducted between July 2023 and July 2024, including chronic hemodialysis patients from the Souss-Massa region. Anemia was defined according to the 2024 Kidney Disease Improving Global Outcomes (KDIGO) guidelines as hemoglobin levels &lt;13 g/dL in men and &lt;12 g/dL in women. Results: A total of 1,346 patients out of 1,800 participants were included, corresponding to an anemia prevalence of 74.7%. The mean age of the patients was 57.52 ± 15.54 years, with a male-to-female ratio of 1.12. Half of the patients had been on hemodialysis for less than 5 years. The leading causes of kidney disease were diabetic nephropathy and hypertensive nephropathy in 38.8% and 16.9% of cases, respectively. The mean hemoglobin, ferritin, and transferrin saturation (TSAT) levels were 10.02 ± 1.5 g/dL, 386.42 ng/mL, and 32.61% ± 15.4, respectively. Anemia management included erythropoietin (EPO) therapy, injectable iron, and blood transfusions in 85%, 13.4%, and 20% of patients, respectively. Multivariate analysis revealed significant correlations between anemia and history of hypertension (p=0.008), hepatitis C virus infection (p&lt;0.001), secondary hyperparathyroidism (p=0.04), prior catheter-related infectious complications (p=0.003), and chronic inflammatory syndrome (p=0.02). Discussion and Conclusion: Our study confirms a high prevalence of anemia in hemodialysis patients. Despite therapeutic advances, blood transfusion reliance remains high, increasing the risk of immunologic complications and limiting access to kidney transplantation.

Background: The optimal anticoagulation for chronic hemodialysis (HD) remains debated. Unfractionated heparin (UFH) is the historical standard but carries risks of metabolic complications and requires intensive monitoring. Low-Molecular-Weight Heparin (LMWH) offers pharmacological advantages, but concerns over bleeding risk in end-stage renal disease (ESRD) have limited its use. This study aimed to provide a holistic comparison by synthesizing recent evidence on the efficacy, safety, and, uniquely, the key metabolic consequences of LMWH versus UFH. Methods: This systematic review followed PRISMA 2020 guidelines. We searched PubMed, EMBASE, and CENTRAL from January 2014 to March 2025 for clinical studies comparing LMWH and UFH in chronic HD patients. We included 6 studies (3 prospective trials, 3 retrospective cohorts) totaling 7,890 patients. The primary efficacy outcome was circuit thrombosis; the primary safety outcome was major bleeding. Secondary outcomes focused on key metabolic markers (pre-dialysis potassium, lipid profile). Data from prospective trials and observational studies were analyzed separately using subgroup analysis and tested for interaction. Metabolic data were pooled using a random-effects model. Results: The analysis of key metabolic outcomes, derived from homogenous prospective trials (I2=0%), was the most robust finding. LMWH use was associated with a clinically significant reduction in pre-dialysis serum potassium (Mean Difference [MD]: -0.30 mEq/L; 95% CI: -0.50 to -0.10) and a superior atherogenic profile, including lower triglycerides (MD: -20.10 mg/dL) and higher HDL (MD: +4.50 mg/dL). For safety, no difference in major bleeding was found, a finding that was consistent across prospective trials (OR: 0.78; 95% CI: 0.33-1.85) and large retrospective cohorts (OR: 0.87; 95% CI: 0.69-1.09), with no subgroup interaction (p=0.75). Efficacy for preventing circuit thrombosis was also similar. Conclusion: This meta-analysis provides strong, high-quality evidence that LMWH confers significant and clinically relevant metabolic advantages over UFH, particularly in mitigating hyperkalemia and atherogenic dyslipidemia. Furthermore, our stratified analysis provides high confidence from real-world data that LMWH, when dosed appropriately, is as safe and effective as UFH.

Hyperphosphatemia in Patients on Hemodialysis May be Driven by the Consumption of Ultraprocessed Foods.

ABSTRACT Pregnancy in patients with ESRD is rare due to impaired fertility caused by HPO axis disruption. Nevertheless, with advancements in dialysis and maternal care, successful pregnancies have increasingly been reported. Such pregnancies, however, are considered high-risk and are often associated with complications such as preterm labor, intrauterine growth restriction, and low birth weight, particularly in patients with comorbidities like chronic hypertension and other risk factors such as AMA. A 41-year-old gravida 3 para 2 woman with ESRD secondary to chronic hypertension, undergoing routine hemodialysis twice weekly with each session lasting five hours for the past five years, presented with spontaneous preterm labor during a scheduled dialysis session. The patient began experiencing uterine contractions accompanied by a bloody show during the second hour of hemodialysis. The session was discontinued prematurely due to these symptoms. Subsequent examination revealed cervical dilation of 3 cm, confirming the onset of labor. Due to a history of menstrual irregularities, the pregnancy had been recognized relatively late, at 20 weeks of gestation. At 31 weeks, the patient delivered a live preterm infant. The neonate was born with low birth weight but responded well to immediate neonatal management and stabilization. Although pregnancy in ESRD patients presents significant risks, favorable maternal and neonatal outcomes can still be achieved. This case illustrates the importance of early detection, coordinated multidisciplinary care, and vigilant monitoring in improving perinatal outcomes in women undergoing chronic hemodialysis. Keywords: End-Stage Renal Disease, Hemodialysis, Preterm Labor, High Risk Pregnancy.

Background: Vascular access is a very important element for patients on chronic hemodialysis treatment, but it is also a major source of complications, often compromising patients’ quality of life. Arteriovenous fistulas (AVFs) are preferred for their durability, but complications such as edema, bruising, cannulation pain, and hygiene concerns can affect patient satisfaction. Aim: We aimed to evaluate patient satisfaction with vascular access and to identify the clinical and sociodemographic factors influencing this satisfaction. Methods: We conducted a multicenter cross-sectional study on 235 hemodialysis patients in Italy. Satisfaction was assessed using the Short Form Vascular Access Questionnaire (SF-VAQ). Clinical and sociodemographic data were collected and analyzed with descriptive statistics, correlations, and multivariate regression models. Results: Satisfaction was significantly influenced by local complications, perceived hygiene, and access duration. Lower satisfaction was reported by patients with swelling, bruising, or negative hygiene perceptions. Longer use of the access was also associated with declining satisfaction. Conclusions: Patient satisfaction involves both clinical outcomes and patient perceptions. The integration of patient-reported outcomes (PROs) into vascular access management can help clinicians identify early dissatisfaction and implement interventions that can improve treatment adherence and quality of life.

ABSTRACTBackgroundIntradialytic hypotension (IDH) is a serious complication of chronic hemodialysis (HD). BestShape is a novel artificial intelligence-driven system developed recently for real-time prediction of IDH. This study aimed to report the clinical results and health-economic benefits following the implementation of BestShape.MethodsMedical records from two institutions in Taiwan that incorporated BestShape into all HD practices were retrospectively reviewed. Data from HD sessions from January 2020 to December 2023, following BestShape implementation, constituted the “BestShape group.” Data from January 2016 through the end of 2019 served as the historical control group. The primary outcome was IDH frequency, and secondary outcomes were rates of cardiopulmonary resuscitation (CPR), falls, mortality, medical personnel satisfaction, and estimated cost reduction.ResultsIn total, 213 071 HD sessions of 18 141 patients were included (BestShape 152 792 sessions; control 60 279 sessions). The mean monthly IDH rate significantly reduced from 27% in 2019 to 21% in 2023 (P < .001). The need for CPR during dialysis decreased from eight to three times per month, and post-dialysis falls decreased from 21 to seven times. The estimated annual cost savings by implementing BestShape were USD 115 658. The mortality rate during HD was not significantly different before and after BestShape implementation (8% vs 9.3%, P = .260). Medical personnel expressed satisfaction with BestShape, with a mean satisfaction score of 86.ConclusionPreliminary clinical data show BestShape is associated with reductions in IDH, CPR, and falls in patients undergoing HD, and a reduction in healthcare costs and high medical personnel satisfaction.

ABSTRACTBudd–Chiari syndrome (BCS) is a rare condition characterized by hepatic venous outflow obstruction and is often associated with thrombosis or fibrous membranes (webs). To our knowledge, this is the first reported case of BCS occurring secondary to chronic kidney disease (CKD). This case emphasizes the complex reno‐vascular‐hepatic interplay and expands current literature. A 48‐year‐old female with stage V CKD on hemodialysis presented with signs of portal hypertension. Imaging revealed an IVC web causing BCS. Procoagulant workup showed elevated fibrinogen, PAI‐1, and homocysteine, suggesting CKD‐induced thrombosis as a possible trigger. She was managed with anticoagulation (enoxaparin, warfarin), diuretics, and beta‐blockers. Her symptoms stabilized, explaining BCS as a hypercoagulability‐driven complication rather than a coincidence. CKD creates a prothrombotic state through impaired fibrinolysis, endothelial and platelet dysfunction, and elevated procoagulants, potentially contributing to BCS. Though inherited or acquired thrombophilias are common causes of BCS, CKD‐related hypercoagulability may also play a significant role. Diagnosis relies on Doppler ultrasound and confirmatory CT or magnetic resonance imaging (MRI). Management ranges from anticoagulation to endovascular or surgical interventions. This case illustrates a rare overlap, where CKD may have triggered IVC web formation causing venous obstruction, emphasizing the need to consider thrombosis risk in CKD patients with unexplained signs of liver dysfunction to prevent cirrhosis. BCS should be suspected in patients on chronic hemodialysis presenting with unexplained ascites, hepatosplenomegaly, and abdominal pain. Timely imaging, hypercoagulability assessment, and individualized therapy are essential for optimal outcomes in this rare but critical complication of CKD.

BackgroundUrgent-start hemodialysis often involves severe biochemical abnormalities but is associated with a high risk of complications. Currently, no tool has been validated to predict post-hemodialysis urea and electrolytes in acute settings from prescription data alone.MethodsIn this ambispective, two-phase study, we developed and validated a model to predict post-hemodialysis blood urea nitrogen and electrolytes using only prescription parameters in patients with urgent hemodialysis indications and those at risk for dialysis disequilibrium syndrome, severe hyponatremia, or hyperkalemia. The model was validated through statistical assessment of correlation and agreement. The model was integrated into a free, user-friendly web application (Adequator app®).ResultsThe development cohort included 303 treatments in 42 chronic hemodialysis patients. Dialyzer clearance, which was calculated via formal urea kinetic modeling, demonstrated excellent correlation and agreement with the proposed model (r = 0.99; 95% CI: 0.99 to 0.99) and a bias of 0.23 ± 1.2 ml/min (95% CI: −2.17 to 2.63). The validation cohort included 44 urgent hemodialysis sessions in 30 patients with chronic kidney disease or acute kidney injury and severe electrolyte abnormalities or at risk of dialysis disequilibrium syndrome. The predicted post-hemodialysis, blood urea nitrogen, sodium, and potassium levels strongly correlated with the measured values: r = 0.96 (95% CI: 0.93 to 0.98), r = 0.96 (95% CI: 0.94 to 0.98), and r = 0.84 (95% CI: 0.73 to 0.91), respectively. Agreement was also high, with biases of 0.4 ± 9.4 mg/dL (95% CI: −19.0 to 18.1) for blood urea nitrogen, −0.6 ± 1.6 mEq/L (95% CI: −3.8 to 2.5) for sodium, and 0.17 ± 0.4 mEq/L (95% CI: 0.6 to 0.9) for potassium. Among patients at risk of dialysis disequilibrium syndrome, 92% achieved the target blood urea nitrogen reduction ( < 40%) without severe neurological events. The sodium correction remained below 6 mEq/L, and potassium normalized in all the cases.ConclusionsA prescription-based model can reliably predict post-Hemodialysis urea and electrolyte values in urgent dialysis settings. The Adequator App HD-Predictor (https://adequatorapp.com/hd-predictor) offers a non-invasive, accessible tool to guide individualized prescriptions, enhancing safety and precision in high-risk clinical scenarios.