Complication Of End-stage Renal Disease Research Articles

Description of Pre-Hemodialysis Serum Phosphate in Late-Stage Kidney Disease Patients of Productive Age (15-64 Years) at the Indonesian Christian University General Hospital

In Indonesia, end-stage kidney disease is still a health problem that needs attention. End-stage kidney disease or abbreviated as PGTA reflects the fifth stage of chronic kidney disease, at this stage, there is a buildup of toxins, fluids, electrolytes, and the remains of the body's metabolism. In stage 5 chronic kidney disease, the glomerular filtration rate decreases < 15 ml/minute / 1.73 m2 and has occurred for 3 months or more. One of the clinical complications of end-stage renal disease is an increase in phosphate levels in the patient's blood serum (hyperphosphatemia), this occurs due to disruption of the kidney's phosphate excretion function. Hyperphosphatemia in PGTA patients can result in hyperparathyroidism, soft tissue, and cardiovascular calcification, and affect bone mineral disorders. In kidney disease patients with a glomerular filtration rate < 30 ml/minute / 1.73m2, the prevalence of hyperphosphatemia complications increased to 23%. This study aims to determine the description of pre-hemodialysis inorganic phosphate levels in the serum of PGTA patients of productive age (15-64 years) undergoing hemodialysis at the Indonesian Christian University General Hospital for the period January 2022. The research conducted was a descriptive study, to determine the description of phosphate levels serum of PGTA patients. The data used in this study is primary data by directly taking the blood of 20 pre-hemodialysis patients with end-stage kidney disease and then examining it in the laboratory. In this study, the results showed that 10 PGTA patients (50%) experienced an increase in serum inorganic phosphate levels above normal (>5 mg/dl). Meanwhile, 9 people (45%) had normal serum phosphate levels (2.5 - 5 mg/dl), and 1 other person had below normal serum phosphate levels (<2.5 mg/dl). Keywords: Inorganic Phosphate, Hemodialysis, Hyperphosphatemia, End Stage Renal Disease

Vitamin D Receptor (VDR) Gene Polymorphisms and High-Turnover Renal Osteodystrophy or Secondary Hyperparathyroidism in End-Stage Renal Disease: A Systematic Review.

Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are often complicated by high-turnover renal osteodystrophy (HTRO) and secondary hyperparathyroidism (SHPT), characterized by disturbances in mineral metabolism and skeletal abnormalities. Genetic variations within the vitamin D receptor (VDR) gene, known as VDR gene polymorphisms, have been implicated in modulating the susceptibility to HTRO and SHPT. This systematic review aims to evaluate the existing literature on the association between VDR gene polymorphisms and the development of these complications in ESRD and hemodialysis patients. A comprehensive literature search across multiple databases was conducted, and studies investigating VDR gene polymorphisms and HTRO or SHPT in ESRD or hemodialysis patients were included. The included studies examined various VDR gene polymorphisms, such as BsmI, ApaI, TaqI, and FokI, and their associations with clinical outcomes like parathyroid hormone (PTH) levels, bone mineral density, and the development of SHPT or HTRO. The findings suggest that certain VDR gene polymorphisms, notably the ApaI "aa"genotype, BsmI "bb"genotype, TaqI "tt"genotype, and FokI variant, may contribute to the pathogenesis of SHPT and HTRO by affecting PTH levels, bone turnover markers, and vitamin D sensitivity. However, the studies had relatively small sample sizes and were conducted in different populations, limiting generalizability. Further larger-scale studies, functional investigations, and exploration of gene-environment interactions are warranted to elucidate the underlying mechanisms and facilitate personalized treatment approaches for CKD and ESRD patients with mineral and bone disorders.

Knowledge, attitudes, and practices toward cardiovascular complications among end-stage renal disease patients undergoing maintenance hemodialysis

BackgroundThis study aimed to investigate the knowledge, attitudes, and practices (KAP) toward cardiovascular complications among end-stage renal disease patients undergoing maintenance hemodialysis.MethodsThis web-based cross-sectional study was conducted at Guangdong Provincial People’s Hospital between December 2022, and May 2023.ResultsA total of 545 valid questionnaires were collected, with an average age of 57.72 ± 13.47 years. The mean knowledge, attitudes and practices scores were 8.17 ± 2.9 (possible range: 0–24), 37.63 ± 3.80 (possible range: 10–50), 33.07 ± 6.10 (possible range: 10–50) respectively. Multivariate logistic regression analysis showed that patients from non-urban area had lower knowledge compared to those from urban area (odds ratio (OR) = 0.411, 95% CI: 0.262–0.644, P < 0.001). Furthermore, higher levels of education were associated with better knowledge, as indicated by OR for college and above (OR = 4.858, 95% CI: 2.483–9.504), high school/vocational school (OR = 3.457, 95% CI: 1.930–6.192), junior high school (OR = 3.300, 95% CI: 1.945–5.598), with primary school and below as reference group (all P < 0.001). Besides, better knowledge (OR = 1.220, 95% CI: 1.132–1.316, P < 0.001) and higher educational levels were independently associated with positive attitudes. Specifically, individuals with a college degree and above (OR = 2.986, 95% CI: 1.411–6.321, P = 0.004) and those with high school/vocational school education (OR = 2.418, 95% CI: 1.314–4.451, P = 0.005) have more positive attitude, with primary school and below as reference group. Next, better attitude (OR = 1.174, 95% CI: 1.107–1.246, P < 0.001) and higher education were independently associated with proactive practices. Those with college and above (OR = 2.870, 95% CI: 1.359–6.059, P = 0.006), and those with high school/vocational school education (OR = 1.886, 95% CI: 1.032–3.447, P = 0.039) had more proactive practices, with primary school and below as reference group.ConclusionsEnd-stage renal disease patients undergoing maintenance hemodialysis demonstrated insufficient knowledge, positive attitudes, and moderate practices regarding cardiovascular complications. Targeted interventions should prioritize improving knowledge and attitudes, particularly among patients with lower educational levels and income, to enhance the management of cardiovascular complications in end-stage renal disease.

Correction of hyperphosphatemia in a patient with end-stage chronic kidney disease and a complex case of anemia. A clinical case

Iron supplements and/or blood transfusions in combination with recombinant human erythropoietin injections are routinely used to correct renal anemia, which is a common complication of end-stage renal disease. However, massive blood transfusions and inadequate intravenous iron supplementation can lead to iron overload syndrome, and anemia is not always nephrogenic. A rare clinical case of a patient with end-stage chronic kidney disease with complex genesis of anemia, who is on hemodialysis, is presented. The case is interesting because the prescription of first-line drugs was life-threatening in nature, and sevelamer was the drug chosen for the correction of mineral-bone disorders.

Iron Management and Anemia in Patients on the Active Kidney Transplant List

IntroductionIron metabolism disorders and anemia are one of the main complications of end-stage renal disease that may affect the evaluation process for kidney transplantation. The study aimed to assess the iron metabolism in hemodialysis patients in relation to waiting list status. Study MethodThe study included 5068 hemodialysis patients, including those on the active waiting list (N = 449) and those who were not eligible for the waitlist (N = 4619). Demographic and biochemical data, Charlson's comorbidity index, duration of hemodialysis therapy and, respectively, hemoglobin, ferritin, and transferrin saturation levels were compared in both groups of patients. ResultsPatients on the active waiting list were significantly younger −53.2 vs 67.2 years (P < .001), with a lower Charlson comorbidity index score: 3.33 vs 4.42 (P < .001). The duration of hemodialysis therapy was similar: 66.0 vs 63.2 months (P = .416), the incidence of anemia according to World Health Organization (90.6%, vs 91.2%) and KDIGO (72.4% vs 70.4%). The degree of anemia correction in terms of hemoglobin concentration and transferrin saturation was comparable in both groups and amounted to an average of 10.9 g/dL (P = .349) for hemoglobin concentration and 32.7% vs 33.4% (P = .513) for transferrin saturation. However, there was a statistically significant difference in ferritin concentration: 554 ug/L vs 733 ug/L (P = .001). ConclusionsPatients on the active list have significantly lower ferritin levels despite similar duration of hemodialysis treatment and comparable hemoglobin values. This may be due to lower inflammation, and less frequent blood transfusions, and lead to a lower risk of immunization and an increased chance of potential kidney transplantation.

Uremic pericarditis: a case report of favorable outcomes with early detection and management

Uremic pericarditis is a rare, potentially life-threatening complication of end-stage renal disease (ESRD) caused by the accumulation of uremic toxins. This case report describes a 32-year-old man with diabetes and ESRD on hemodialysis who developed uremic pericarditis. The patient presented with fever, chest pain, dyspnea, cough, and foot pain. Diagnostic investigations led to treatment with broad-spectrum antibiotics and surgical debridement of a necrotizing soft tissue infection of the right foot. The lack of clinical improvement in hemodynamic status prompted rapid investigation with electrocardiography and echocardiography, confirming the diagnosis of uremic pericarditis. Prompt initiation of renal replacement therapy with close monitoring led to a successful management outcome. This case report highlights the importance of early recognition, appropriate interventions, and a multidisciplinary approach in treating uremic pericarditis. Keywords: End-stage renal disease, uremic pericarditis, dialysis-associated pericarditis, pericardial friction rub

The covariant structural and functional neuro-correlates of cognitive impairments in patients with end-stage renal diseases.

Cognitive impairment (CI) is a common complication of end-stage renal disease (ESRD) that is associated with structural and functional changes in the brain. However, whether a joint structural and functional alteration pattern exists that is related to CI in ESRD is unclear. In this study, instead of looking at brain structure and function separately, we aim to investigate the covariant characteristics of both functional and structural aspects. Specifically, we took the fusion analysis approach, namely, multimodal canonical correlation analysis and joint independent component analysis (mCCA+jICA), to jointly study the discriminative features in gray matter volume (GMV) measured by T1-weighted (T1w) MRI, fractional anisotropy (FA) in white matter measured by diffusion MRI, and the amplitude of low-frequency fluctuation (ALFF) measured by blood oxygenation-level-dependent (BOLD) MRI in 78 ESRD patients versus 64 healthy controls (HCs), followed by a mediation effect analysis to explore the relationship between neuroimaging findings, cognitive impairments and uremic toxins. Two joint group-discriminative independent components (ICs) were found to show covariant abnormalities across FA, GMV, and ALFF (all p < 0.05). The most dominant joint IC revealed associative patterns of alterations of GMV (in the precentral gyrus, occipital lobe, temporal lobe, parahippocampal gyrus, and hippocampus), alterations of ALFF (in the precuneus, superior parietal gyrus, and superior occipital gyrus), and of white matter FA (in the corticospinal tract and inferior frontal occipital fasciculus). Another significant IC revealed associative alterations of GMV (in the dorsolateral prefrontal and orbitofrontal cortex) and FA (in the forceps minor). Moreover, the brain changes identified by FA and GMV in the above-mentioned brain regions were found to mediate the negative correlation between serum phosphate and mini-mental state examination (MMSE) scores (all p < 0.05). The mCCA+jICA method was demonstrated to be capable of revealing covariant abnormalities across neuronal features of different types in ESRD patients as contrasted to HCs, and joint brain changes may play an important role in mediating the relationship between serum toxins and CIs in ESRD. Our results show the mCCA+jICA fusion analysis approach may provide new insights into similar neurobiological studies.

A narrative review on the application of artificial intelligence in renal ultrasound.

Kidney disease is a serious public health problem and various kidney diseases could progress to end-stage renal disease. The many complications of end-stage renal disease. have a significant impact on the physical and mental health of patients. Ultrasound can be the test of choice for evaluating the kidney and perirenal tissue as it is real-time, available and non-radioactive. To overcome substantial interobserver variability in renal ultrasound interpretation, artificial intelligence (AI) has the potential to be a new method to help radiologists make clinical decisions. This review introduces the applications of AI in renal ultrasound, including automatic segmentation of the kidney, measurement of the renal volume, prediction of the kidney function, diagnosis of the kidney diseases. The advantages and disadvantages of the applications will also be presented clinicians to conduct research. Additionally, the challenges and future perspectives of AI are discussed.

The effects of omega-3 fatty acids supplementation on hemoglobin, hematocrit, and platelet levels of patients with ESRD condition undergoing dialysis

BackgroundConcomitant inflammation may boost the cardiovascular complications in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Omega-3 fatty acids may have certain health benefits in HD patients. The aim of this study was to investigate the effects of omega-3 fatty acids supplementation on hematocrit (HCT), hemoglobin (HB) level and platelet (PLT) counts of HD patients. MethodsA randomized controlled trial was conducted on HD patients at a private dialysis center in Rasht, Iran. Three omega-3 fatty acid supplement capsules (3 g/d) were administered daily for two months to patients in the intervention group (n = 55). The control group (n = 60) were given three placebo capsules containing medium chain triglyceride (MCT) oil, similar to the supplemental dose of the intervention group at the same period. Three parameters of HCT, HB and PLT were measured at baseline and after the intervention. ResultsThe PLT count decreased in the intervention group compared to the control group (173.38 ± 74.76 vs. 227.68 ± 86.58 103/mm3, F = 4.83, P = 0.03). No significant change was found on the levels of HCT and HB parameters between the two groups after the intervention. ConclusionOmega-3 supplementation in HD patients may decrease the risk of forming blood clots in the blood vessels. Further studies are warranted.

LncRNA FAS-AS1 served as a diagnostic biomarker of end-stage renal disease and mediated vascular calcification via regulating oxidative stress and inflammation

PurposeVascular calcification is a frequently occurring complication of end-stage renal disease (ESRD). This study focused on the significance of long non-coding RNA Fas cell surface death receptor-antisense 1(lncRNA FAS-AS1) in ESRD-related vascular calcification aiming to explore a potential biomarker for the detection. MethodsThe study enrolled 65 healthy individuals, 79 ESRD patients (48 patients with vascular calcification), and 93 early-stage (I-IV) chronic kidney disease (CKD) patients. The expression of FAS-AS1 in serum was evaluated by real-time quantitative polymerase chain reaction (PCR). The diagnostic potential of FAS-AS1 was assessed in discriminating ESRD patients, vascular calcification, and the severity of vascular calcification. In vitro, the vascular smooth muscle cells (VSMCs) were treated with a hyperphosphatemia medium to evaluate the effect of FAS-AS1 on VSMCs calcification. ResultsElevated serum FAS-AS1 was observed in ESRD patients, which could discriminate from healthy individuals and early-stage CKD patients. FAS-AS1 was associated with the development of ESRD and the occurrence of vascular calcification. FAS-AS1 was also upregulated in vascular calcification patients, especially the patients with severe calcification, which showed diagnostic significance in evaluating vascular calcification degrees. Calcified VSMCs showed significantly increased levels of Ca2+, reactive oxygen species (ROS), tumor necrosis factor-α (TNF-α), and interleukin 6 (IL-6), which was attenuated by silencing FAS-AS1. ConclusionsFAS-AS1 discriminated ERSD patients and was associated with the occurrence of vascular calcification. The knockdown of FAS-AS1 suppressed hyperphosphatemia-induced vascular calcification via alleviating oxidative stress and inflammation.

Assessment of amino-terminal C-type natriuretic peptide serum level and its correlation with high-density lipoprotein structure and function in patients with end stage renal disease before and after kidney transplantation

We aimed to investigate serum amino-terminal C-type natriuretic peptide (NT-proCNP) and its relationship with quantitative and qualitative HDL-parameters in patients with end-stage renal disease (ESRD) before, then 1 and 6 months after kidney transplantation (TX). Seventy patients (47 males, 23 females, mean age 51.7 ± 12.4 years) were enrolled in a prospective follow-up study. We examined serum creatinine, C-reactive protein, procalcitonin, fasting glucose and lipid parameters before, then 1 and 6 months after TX. High-density lipoprotein- (HDL)-associated paraoxonase-1 (PON1) paraoxonase and arylesterase activities were measured spectrophotometrically. Lipoprotein subfractions were determined by Lipoprint. NT-proCNP and oxidized low-density lipoprotein (oxLDL) levels were measured by ELISA. Mean NT-proCNP was 45.8 ± 21.9 pmol/L before renal transplantation and decreased markedly 1 month and 6 months after transplantation (5.3 ± 2.5 and 7.7 ± 4.9 pmol/L, respectively, P = 1 × 10−4). During the 6 months’ follow-up, PON1 arylesterase, paraoxonase and salt-stimulated paraoxonase activities improved. NT-proCNP positively correlated with procalcitonin and creatinine and negatively with GFR, LDL-cholesterol (LDL-C) and HDL-cholesterol (HDL-C). There was a negative correlation between serum NT-proCNP and PON1 arylesterase activity. According to the multiple regression analysis, the best predicting variables of NT-proCNP were serum procalcitonin, creatinine and PON1 arylesterase activity. NT-proCNP might be a novel link between HDL dysfunction and impaired vascular function in ESRD, but not after kidney transplantation. Further studies in larger populations are needed to clarify the exact role of NT-proCNP in the risk prediction for cardiovascular comorbidities and complications in ESRD.

Sofosbuvir and Velpatasvir Regimen Outcome for Chronic Hepatitis C Patients With End-Stage Renal Disease Undergoing Hemodialysis.

Background Patients on hemodialysis (HD) are most likely to contract hepatitis C (HCV) infection, which is associated with significant morbidity and disease progression. Direct-acting antivirals (DAAs) are safe and tolerable in chronic kidney disease (CKD) with a 90-100% cure rate, and limited data exist regarding their efficacy in end-stage renal disease (ESRD), particularly for HDpatients in South Asia. The study aimed to assess the outcome of a 12-week sofosbuvir (SOF) and velpatasvir (VEL) treatment regimen on ESRD patients with chronic HCV infection undergoing HDin the Pakistani Asian population. Methodology This prospective cohort study was conducted between January 2022 and January2023 at the outpatient nephrology and gastroenterology clinic of Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, Pakistan. This study included a total of 220 ESRD patients fulfilling the inclusion criteria, aged 20-55 years, who had been undergoing weekly HD sessions for at least two years, with acquired HCV infection. Data on demographic and clinical characteristics were collected through patient interviews. Laboratory and dialysis profiling was executed to assess ESRD and discover the underlying cause by ultrasound abdomen, blood pressure measurement by sphygmomanometer, random blood sugarfor diabetes, and taking note of the duration and frequency of dialysis. HCV RNA PCR was done at selected intervals to evaluate the virological response to treatment. Sustained virological response (SVR), liver cirrhosis status, and number of weekly HD sessions were compared at one year of SOF/VEL regimen. Results The mean age of patients with ESRD was 41.8 with a standard deviation (SD) of 9.3 years, and HCV diagnosis was 1.3 years with SD of 0.4 years; 52.7% (n=116) were males, 47.3% (n=104) were females, 75% (n=165) were urban dwellers, and 93.6% (n=206) were married.CKD that requires dialysis was caused mainly by hypertension (78, 35%), diabetes mellitus type 2 (52, 24%), bilateral small kidney disease (40, 18%), and others (34, 16%). One hundred and six (48.2%) received dialysis thrice weekly, 83 (37.7%) twice, and 31 (14.1%) once weekly. The study monitored the rapid virological response (RVR) at four weeks of SOF/VEL regimen in 89.5% of ESRD patients, observed end-of-treatment response (ETR) at 12 weeks in 93.2%, and noted 91.4% SVR response at one year. Only four (1.8%) relapses were observed in the study, which was statistically insignificant. The status of liver cirrhosis showed a 50% improvement, decreasing from 40% to 20%. The frequency of weekly HD sessions decreased from thrice to twice-thrice a week. Conclusion The prevalence of contracting HCV is high among CKD and dialysis ESRD patients. All-oral DAA therapy has revolutionized HCV treatment with co-morbidities. Renal functions improved after the SOF/VEL regimen for chronic HCV infection in ESRD patients undergoing HD, with the number of weekly dialysis sessions reduced and SVR reaching 91.4%. Thus, a single-tablet, pan-genotypic DAA regimen of SOF/VEL for 12 weeks is safe, effective, and tolerable regardless of the underlying etiology of ESRD, complications of cirrhosis, HCV genotype, or previous treatment exposure. The successful treatment of HCV and achieving SVR lowers the risk of ESRD complications, improves extra-hepatic manifestations, and greatly enhances survival. Further studies are warranted after the availability of other DAAs to confirm findings with no limitations.

Effect of cardiopulmonary bypass on plasma and erythrocytes oxylipins

BackgroundOxylipins, the oxidative metabolites of polyunsaturated fatty acids (PUFAs), serve as key mediators of oxidative stress, inflammatory responses, and vasoactive reactions in vivo. Our previous work has established that hemodialysis affects both long chain fatty acids (LCFAs) and oxylipins in plasma and erythrocytes to varying degrees, which may be responsible for excess cardiovascular complications in end-stage renal disease. In this study, we aimed to determine changes in blood oxylipins during cardiopulmonary bypass (CPB) in patients undergoing cardiac surgery to identify novel biomarkers and potential metabolites of CPB-related complications. We tested the hypothesis that CPB would differentially affect plasma oxylipins and erythrocytes oxylipins.MethodsWe conducted a prospective observational study of 12 patients undergoing elective cardiac surgery with expected CPB procedure. We collected venous and arterial blood samples before CPB, 15 and 45 min after the start of CPB, and 60 min after the end of CPB, respectively. Oxylipins profiling in plasma and erythrocytes was achieved using targeted HPLC‐MS mass spectrometry.ResultsOur results revealed that most venous plasma diols and hydroxy- oxylipins decreased after CPB initiation, with a continuous decline until the termination of CPB. Nevertheless, no statistically significant alterations were detected in erythrocytes oxylipins at all time points.ConclusionsCPB decreases numerous diols and hydroxy oxylipins in blood plasma, whereas no changes in erythrocytes oxylipins are observed during this procedure in patients undergoing cardiac surgery. As lipid mediators primarily responsive to CPB, plasma diols and hydroxy oxylipins may serve as potential key biomarkers for CPB-related complications.

#6246 PIVKA II IS A BIOMARKER FOR PREDICTING CORONARY CALCIFICATION IN HEMODIALYSIS PATIENTS WITH DIABETES

Abstract Background and Aims Vascular calcification (VC) is a commonly occurring and serious complication in end-stage renal disease (ESRD) patients that increases mortality. Vitamin K deficiency is well known to cause the occurrence of VC through the inactivation of Vitamin K dependent proteins (VKDP). Therefore, a marker that can easily predict the risk of VC due to vitamin K deficiency is needed in clinical practice. In this study, we aim to investigate whether the easily measurable vitamin K absence II (PIVKA-II) can serve as a surrogate marker for predicting coronary artery calcification (CAC) in ESRD patients receiving hemodialysis and what factors influence the prediction of CAC. Method This study is an observational study conducted on end-stage renal disease patients receiving hemodialysis treatment. Patients with liver cirrhosis, HCC, or a history of coronary artery disease with stent placement were excluded, as well as patients with active infectious diseases. CAC score was measured by Non-enhanced computed tomography, and before starting hemodialysis, blood samples were collected to measure PIVKA-II, osteocalcin (OC), and bone-specific alkaline phosphatase (BAP) among other bone markers. PIVKA-II was measured two times with 3 months interval, and the average value was calculated. Additionally, ankle-brachial index (ABI) and DEXA bone densitometry were also performed. Results In this study, 69 dialysis patients participated. Among them, 34 patients had diabetes mellitus (DM). The study compared two groups based on the presence of DM. The results showed that patients with DM had higher Body Mass Index (BMI) (p = 0.01) and a higher frequency of vascular diseases such as coronary artery disease or cerebrovascular disease (p = 0.004). The DM group also had higher LDL cholesterol levels (p = 0.03), but there was no significant difference between the two groups in terms of PIVKA-II, BAP, and Osteocalcin levels (Table 1). When analyzing the factors that had a correlation with the CAC score in all 69 patients, LDL cholesterol (r = -0.37, p = 0.002) and CRP (r = 0.28, p = 0.03) were found to have a significant correlation, but PIVKA-II (p = 0.065, Figure 1A), BAP (p = 0.57), and OC (p = 0.45) did not. In the DM group, there was a statistically significant correlation between CAC score and PIVKA-II (r = 0.283, p = 0.001), but there was no correlation between CAC score (Figure 1B) and CaxP, LDL cholesterol, CRP, BAP, and OC (p = 0.7, p = 0.4, p = 0.3, p = 0.7 and p = 0.4 respectively). Conclusion The results suggest that in patients with diabetes who undergo dialysis, PIVKA-II can be clinically useful as a surrogate marker for predicting CAC associated with vitamin K deficiency. This is because diabetic patients may have more pronounced VKDP inactivation and VC due to vitamin K deficiency, but additional research is needed to fully understand this relationship.

Investigation of the correlation between brain functional connectivity and ESRD based on low-order and high-order feature analysis of rs-fMRI.

The lack of analysis of brain networks in individuals with end-stage renal disease (ESRD) is an obstacle to detecting and preventing neurological complications of ESRD. This study aims to explore the correlation between brain activity and ESRD based on a quantitative analysis of the dynamic functional connectivity (dFC) of brain networks. It provides insights into differences in brain functional connectivity between healthy individuals and ESRD patients and aims to identify the brain activities and regions most relevant to ESRD. Differences in brain functional connectivity between healthy individuals and ESRD patients were analyzed and quantitatively evaluated in this study. Blood oxygen level-dependent (BOLD) signals obtained through resting-state functional magnetic resonance imaging (rs-fMRI) were used as information carriers. First, a connectivity matrix of dFC was constructed for each subject using Pearson correlation. Then a high-order connectivity matrix was built by applying the "correlation's correlation" method. Second, sparsification of the high-order connectivity matrix was performed using the graphical least absolute shrinkage and selection operator (gLASSO) model. The discriminative features of the sparse connectivity matrix were extracted and sifted using central moments and t-tests, respectively. Finally, feature classification was conducted using a support vector machine (SVM). The experiment showed that functional connectivity was reduced to some degree in certain brain regions of ESRD patients. The sensorimotor, visual, and cerebellum subnetworks had the highest numbers of abnormal functional connectivities. It is inferred that these three subnetworks most likely have a direct relationship to ESRD. The low-order and high-order dFC features can identify the positions where brain damage occurs in ESRD patients. In contrast to healthy individuals, the damaged brain regions and the disruption of functional connectivity in ESRD patients were not limited to specific regions. This indicates that ESRD has a severe impact on brain function. Abnormal functional connectivity was mainly associated with the three functional brain regions responsible for visual processing, emotional, and motor control. The findings presented here have the potential for use in the detection, prevention, and prognostic evaluation of ESRD.

PENILE CALCIPHYLAXIS: AN EXPERIENCE OF TWO CASES MANAGED AT A TERTIARY CARE CENTRE

Penile calciphylaxis is a rare complication of end-stage renal disease, &amp; occurs as a manifestation of calcic uremic arteriolopathy, leading to necrosis and gangrenous changes in the penis. Also, penile calciphylaxis is a late manifestation in the course of end-stage renal disease, and potentially a forerunner of more sinister events to follow, such as mortality. Despite the rich vascular supply of the penis, this uncommon affectation of the penis by uremic arteriolopathy is an intriguing entity for urologists &amp; nephrologists alike, and no formal management protocol or guidelines exist for successful management of such cases. We present 2 such cases of penile calciphylaxis which were managed at our institution

COMMD5 is involved in the mechanisms of hypotension after parathyroidectomy in patients receiving hemodialysis

BackgroundSecondary hyperparathyroidism (SHPT) is a common complication of end-stage renal disease. Parathyroidectomy (PTx) is often employed for treatment of severe SHPT. However, PTx may cause hypotension via unknown mechanisms. COMM domain-containing protein 5 (COMMD5) in the parathyroid glands has been linked to blood pressure regulation of spontaneously hypertensive rats. ObjectiveTo explore the relationship between COMMD5 levels and reduced BP after PTx in patients receiving hemodialysis (HD). Methods and results(1) The study cohort included 31 patients receiving HD who underwent PTx. Serum COMMD5 levels were higher post-PTx vs. pre-PTx. (2) Sprague-Dawley rats (n = 22) were assigned to a 5/6 nephrectomy group or sham surgery group, vascular rings of the thoracic aorta from rats with CKD were incubated with COMMD5, and changes in vascular tension were compared. COMMD5 inhibited vasoconstriction of vascular rings with intact endothelium, but had no effect on vascular rings without the endothelium. (3) Human umbilical vein endothelial cells were stimulated with COMMD5 or small interfering RNA (siRNA). The expression levels of atrial natriuretic peptide (ANP) and endothelial nitric oxide synthase (eNOS) were up-regulated and down-regulated, respectively. ConclusionsSerum COMMD5 levels were increased after PTx in SHPT patients. COMMD5 promoted high expression of ANP and eNOS in endothelial cells, leading to vasodilation and resulting in hypotension.

Rapid Initiation of Peritoneal Dialysis by Automated Peritoneal Dialysis or Hemodialysis: A Randomized Clinical Trial

Introduction: It is still controversial whether automated peritoneal dialysis (APD) or hemodialysis (HD) is a more favorable choice for the rapid initiation of peritoneal dialysis (PD). Methods: A pilot randomized prospective controlled trial was carried out in Shanghai Ruijin Hospital. Sixty-seven patients who chose long-term PD treatment and needed unplanned dialysis were enrolled and randomized into HD-CAPD group (33 cases) or APD-CAPD group (34 cases) based on the dialysis modality during the transition period (within 14 days from the day PD catheter was implanted). Continuous ambulatory PD started after the transition period. The primary outcome was the decline rates of residual glomerular filtration rate (GFR). Secondary outcomes included the rates of mechanical complications, the rates of infectious complications, and complications of end-stage renal disease. Results: We found residual GFR decline was faster in HD-CAPD group than in APD-CAPD group (0.06 mL/min/w vs. 0.03 mL/min/w, p < 0.01). The incidences of mechanical complications were similar in APD-CAPD group comparing with HD-CAPD group, including hernia (2.9% vs. 3.0%, p = 1.00), catheter malposition (0.02 episodes/patient-months vs. 0.02 episodes/patient-months, p = 0.70), leakage (5.9% vs. 6.1%, p = 1.00), and omental wrap (0 episode vs. 3 episodes, p = 0.368). Though the 1-year overall infection rates were similar (0.03 episodes/patient-months vs. 0.05 episodes/patient-months, p = 0.10), APD-CAPD group had lower rate of bacteremia compared to HD-CAPD group (0 episodes/patient-months vs. 0.02 episodes/patient-months, p < 0.01). Conclusions: Both APD and HD could be used for patients who need to start dialysis in an unplanned manner. APD may have the advantage in protecting residual renal functions among these patients.

Response of salivary flow rate to transcutaneous electrical nerve stimulation in haemodialysis patients

IntroductionHyposalivation is one of the common oral complications in end-stage renal disease. This study aimed to assess the immediate and 3-week effects of transcutaneous electrical nerve stimulation (TENS) on hyposalivation in end-stage renal disease patients on maintenance haemodialysis.MethodsOverall, 80 haemodialysis patients with hyposalivation complaints (40 diabetics and 40 nondiabetics with a mean age of 59.35 ± 9.59 and 59.45 ± 9.66 years, respectively) were treated with 20-minute extraoral TENS (50 Hz and 250 µs pulse duration) applied bilaterally to parotid glands for 3 successive weeks (3 sessions per week). Besides the baseline measurement, the whole resting saliva was collected immediately after the first and last TENS sessions in a graduated test tube via the 5-minute low forced spitting method. The whole resting salivary flow rate (WRSFR) (ml/min) was calculated by dividing the collected salivary volume by the 5-minute collection period.ResultsWhen the baseline WRSFR mean was compared with its value after the first or last TENS session, WRSFR showed a highly significant increase in diabetic and nondiabetic haemodialysis patients.ConclusionsExtraoral electrostimulation via TENS is an effective therapeutic modality for hyposalivation in end-stage renal disease patients on maintenance haemodialysis.

The efficacy and safety of Sacubitril/Valsartan on pulmonary hypertension in hemodialysis patients.

Pulmonary hypertension (PH) is a common complication of end-stage renal disease which is associated with adverse outcomes including all-cause mortality and cardiovascular events. Recent studies have demonstrated that Sacubitril/Valsartan (Sac/Val) as an enkephalinase inhibitor and angiotensin II receptor blocker could reduce pulmonary artery systolic pressure (PASP) and improve the prognosis of patients with heart failure. However, whether Sac/Val is effective in hemodialysis (HD) patients with PH is essentially unknown. In this retrospective study, we aimed to evaluate the efficacy and safety of Sac/Val in the treatment of PH in HD patients. A total of 122 HD patients with PH were divided into Sac/Val group (n = 71) and ARBs group (n = 51) based on the treatment regimen. The PASP, other cardiac parameters measured by echocardiography, and cardiac biomarkers including N-terminal fragment of BNP (NT-proBNP) and cardiac troponin I (cTnI) were observed at baseline and 3 months after treatment. There were no significant differences in the baseline characteristics between the two groups. PASP decreased significantly from 45(38, 54) to 28(21, 40) mmHg in Sac/Val group (p < 0.001). PASP reduced from 41(37, 51) to 34(27, 44) mmHg in ARBs group (p < 0.001), and the decrease was more pronounced in the Sac/Val group (p < 0.001). In addition, improvements in the right atrial diameter (RAD), left ventricular diameter (LVD), left ventricular posterior wall thickness (LVPWT), left atrial diameter (LAD), pulmonary artery diameter (PAD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and fractional shortening (FS) were found in Sac/Val group (ps < 0.05). After 3 months, LVD, LAD, LVEDV, LVESV, LVEF, SV, and PASP were significantly improved in Sac/Val group compared with ARBs group (ps <0.05). Significant reduction in NT-proBNP [35,000 (15,000, 70,000) pg/ml vs. 7,042 (3,126, 29,060) pg/ml, p < 0.001] and cTnI [0.056(0.031, 0.085) ng/ml vs. 0.036 (0.012, 0.056) ng/ml, p < 0.001) were observed in Sac/Val group. No significant differences were observed in adverse events between the two groups (ps > 0.05). Sac/Val seems to be an efficacious regimen in PH with favorable safety and has huge prospects for treating PH in HD patients.