Impact of hemodialysis Catheter Related Infection on Catheter Longevity and Dialysis Adequacy

The relationship between gut microbiota dysbiosis and bone mineral density (BMD) in hemodialysis patients, mediated through immune-metabolic pathways, remains to be fully elucidated. In this single-center prospective cross-sectional study, 165 maintenance hemodialysis patients were included to evaluate the independent association between gut microbiota composition and BMD, quantify the mediating roles of immune markers and gut-derived metabolites, and assess the effect modification by nursing-modifiable factors. Fecal samples underwent 16S rRNA sequencing and functional prediction. Inflammatory cytokines (IL-6, TNF-α), gut-derived metabolites (indoxyl sulfate, butyrate), and BMD via dual-energy X-ray absorptiometry (DXA) were measured. Gut microbiota community structure significantly differed across BMD tertiles (R2 = 0.033, P = 0.003). After full adjustment, principal coordinate 1 (PCoA-PC1, beta-diversity) was negatively associated with femoral neck BMD, while the Shannon diversity index showed a positive association (both P < 0.05). We identified 15 differentially abundant genera between high and low BMD groups. Functional prediction revealed short-chain fatty acid pathways were positively associated with BMD, while indole/p-cresol pathways showed negative associations. Mediation analysis demonstrated that immune markers and gut-derived metabolites collectively explained 45.71% of the microbiota-BMD relationship. Nursing factors significantly modified this association, with the negative relationship strengthened by low fiber intake, severe constipation, proton pump inhibitor use, and inadequate dialysis (Kt/V < 1.4). In conclusion, gut microbiota dysbiosis is independently associated with lower BMD in hemodialysis patients, partially mediated through immune-inflammatory pathways and gut-derived metabolites. Dietary fiber optimization, constipation management, prudent proton pump inhibitor prescribing, and dialysis adequacy represent actionable nursing targets to mitigate gut-mediated bone loss in this vulnerable population.

Clinical outcomes in patients on maintenance dialysis are still unsatisfactory. Despite delivery of adequate dialysis, residual symptoms and signs of uremic intoxication are often present, such as pruritus and xeroderma, restless leg syndrome, sleep disorders, cognitive impairment, anxiety and depression, cramps, fatigue, and muscular weakness, mineral and bone disorders, cardiovascular complications, chronic inflammation, and accelerated atherosclerosis. These have been correlated with retention of inflammatory chemical mediators, protein-bound uremic toxins, and middle to large molecular weight toxins that are insufficiently cleared by current dialysis techniques. A new extracorporeal technique combining hemoadsorption with hemodialysis (HAHD) has been utilized with promising results but enormous variability of procedures, resulting in limited evidence. Previous experience in incorporating innovative approaches has demonstrated that, after several years of pioneering work, a common pathway is necessary to generate sufficient evidence, spanning from case reports, expert debates, retrospective and observational studies, registries, and underpowered trials to multicenter international randomized clinical trials and meta-analyses. Thus, the widespread adoption of HAHD requires the application of implementation science techniques supported by healthcare policies. The scope of this conference is to conduct an objective appraisal of current knowledge and to propose a standardized application modality, enabling the design of comparable clinical trials and the acquisition of homogeneous datasets suitable for evaluation and discussion.

The annual Brazilian Dialysis Survey (BDS) plays an important role in informing and shaping national health policies. To present the 2024 epidemiological findings from the BDS conducted by the Brazilian Society of Nephrology (BSN) and compare them with previous years. A survey was conducted among Brazilian chronic dialysis centers through voluntary participation, utilizing an online questionnaire to assess clinical and epidemiological characteristics of dialysis patients, as well as dialysis center attributes. For specific estimates of prevalence, incidence, and funding source, a nationally representative random sample of dialysis centers stratified by geographic region was selected (n = 258). A total of 386 dialysis centers (42.7%) voluntarily responded to the online questionnaire, and 162 centers from the randomly selected centers provided data. On July 1st, 2024, the estimated number of dialysis patients was 172,585, with 52,944 new patients starting dialysis in 2024. The estimated prevalence and incidence rates per million population (pmp) were 812 and 249, respectively. Among prevalent patients, 87.3% were undergoing hemodialysis, 7.1% hemodiafiltration, and 5.6% peritoneal dialysis. Compared to the previous year, there was an increase in catheter use for hemodialysis vascular access, along with higher prevalence rates of anemia, hyperphosphatemia, hyper-kalemia, and low Kt/V. The estimated crude annual mortality rate was 16.5%. Data from a random sample of dialysis centers indicate a continued rise in the number and prevalence of chronic dialysis patients in Brazil. Worsening trends in permanent vascular access, dialysis adequacy, and metabolic control underscore the need for targeted improvements in patient care.

End-stage kidney failure (ESKF) represents a major and expanding public health challenge globally and in Thailand, where patients receiving maintenance haemodialysis continue to experience high morbidity and mortality. The Thailand Renal Replacement Therapy (TRT) Registry offers a comprehensive national database to evaluate dialysis practices, patient characteristics and long-term outcomes. We conducted a nationwide retrospective cohort study using TRT Registry data from January 2018 to December 2023. A total of 60 053 adult patients undergoing maintenance haemodialysis at 1106 dialysis centres were included. Survival outcomes were assessed using Kaplan-Meier methods, and factors associated with all-cause mortality were identified using multivariable Cox proportional hazards models. Mortality data were ascertained through linkage with national death records. Diabetic nephropathy and hypertensive nephropathy accounted for more than 80% of ESKF etiologies. The estimated 1-, 3- and 5-year survival rates were 95.0%, 84.6% and 76.6%, respectively. Five-year survival varied significantly by primary cause of ESKF, being lowest in diabetic nephropathy (71.6%, 95% CI 70.7-72.4) and highest in glomerulonephritis (85.4%, 95% CI 82.8-87.7). Patients receiving twice-weekly haemodialysis had lower 5-year survival than those receiving thrice-weekly treatment (74.4% vs. 77.7%). Cardiovascular disease (34.1%), infection (20.8%) and cerebrovascular disease (8.0%) were the leading causes of death. Independent predictors of mortality included advanced age, male sex, diabetes-related kidney failure, use of permanent catheters, twice-weekly dialysis, haemoglobin < 10 g/dL, serum sodium < 135 mEq/L, potassium < 3.5 mEq/L, bicarbonate < 22 mEq/L, phosphate > 4.5 mg/dL, albumin < 3.5 g/dL, intact parathyroid hormone (PTH) < 130 pg/mL, transferrin saturation < 30% or > 40%, URR < 65% and nPCR < 1.2 g/kg/day. Although early survival among Thai haemodialysis patients is relatively favourable, long-term mortality remains substantial. Targeting modifiable clinical risk factors, optimising dialysis adequacy and vascular access and addressing socioeconomic disparities are critical to improving national outcomes.

Patients undergoing hemodialysis commonly experience complications such as poor sleep quality and inadequate dialysis efficiency. Therefore, effective nursing interventions are essential to mitigate these issues. This study was conducted with the aim of determining the effect of home-based Otago exercise on sleep quality and dialysis adequacy among patients undergoing hemodialysis in selected hospitals affiliated with Iran University of Medical Sciences in Tehran. In this randomized controlled clinical trial, 46 hemodialysis patients were recruited from two dialysis centers in Tehran and randomly allocated into intervention and control groups using block randomization. The intervention group performed home-based Otago exercises three sessions per week for eight weeks, following initial training and regular follow-up. The outcome measures included the Pittsburgh Sleep Quality Index (PSQI) questionnaire and dialysis adequacy indices (Kt/V and URR), which were assessed both before and after the intervention in both groups. Data were analyzed using descriptive and inferential statistical tests through SPSS software version 16. Out of 45 participants, 44 completed the study. The two groups were demographically homogeneous. After the intervention, the intervention group showed significant improvements in sleep quality (P < 0.001), KT/V (P = 0.002), and URR (P = 0.006). Between-group comparisons also showed significant differences in sleep quality (P = 0.006) and KT/V (P = 0.023), but not in URR (P = 0.693). Home-based Otago exercise can be used as a safe, low-cost, and effective intervention to improve both sleep quality and dialysis adequacy in patients undergoing hemodialysis. It is recommended that implementation of this home exercise program be taught to patients and followed up regularly. This trial was registered at the Iranian Registry of Clinical Trials: IRCT20210911052440N1)Date of registration: 2022-02-25) https://irct.behdasht.gov.ir/trial/58681.

Due to the accumulation of uremic toxins, hemodialysis patients exhibit a variety of symptoms and increased mortality. With their unique pore size and distribution, medium cut-off (MCO) membranes can provide clearance of middle-sized uremic toxins without causing albumin loss. Such a property may decrease overall mortality in hemodialysis patients. This study aims to analyze the effects of MCO membranes on the clearance of β2-microglobulin, tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6) to assess the safety of using these membranes and to compare two different MCO membranes. This was a prospective observational study. Sixty hemodialysis patients who had been dialyzed thrice weekly via high flux dialyzers were switched to one of two MCO dialyzers (Elisio Hx or Theranova) for 1 month. The mean age was 58.7 ± 13.4 years, and the mean dialysis vintage was 65.8 ± 58.6 months. Serum levels of β2-microglobulin, TNF-α, and IL-6 were compared by paired-samples t test between the end and the beginning of the study period. Dialysis adequacy, electrolytes, heparin doses, low-density lipoprotein (LDL), hemoglobin, and albumin levels were also compared. In addition, the performance of the two MCO dialyzers was compared using an independent-samples t test. There was a significant decrease in β2-microglobulin (p = 0.02), LDL (p < 0.01), and albumin levels (p < 0.001) at the end of the study. Dialysis adequacy, hemoglobin, phosphorus, C-reactive protein, IL-6, and TNF-α levels did not change significantly. Among patients receiving standard heparin for anticoagulation, heparin doses had to be increased during MCO membrane use. The performance of the two different dialyzers was not statistically different. MCO membranes provide clearance of middle-sized uremic toxins. This effect is most prominent for β2-microglobulin and does not differ between the two MCO dialyzers studied. MCO membranes may cause some albumin loss, and heparin requirements may increase during their use.

Background/Objectives: Background: Dyslipidaemia and oxidative stress (OS) are frequent in peritoneal dialysis (PD). The Lipoprotein Combine Index (LCI) integrates lipid parameters, but its relationship with peritoneal transport and OS is unclear. Methods: This cross-sectional study included 100 clinically stable adults on continuous ambulatory PD with preserved ultrafiltration and adequate dialysis. LCI was calculated as (total cholesterol × triglycerides × LDL-C)/HDL-C and analyzed by tertiles. Lipid peroxidation and antioxidant markers were measured in serum, erythrocytes, urine, and spent dialysate. Multivariable regression models examined associations between LCI, peritoneal solute transport, and dialysate OS markers. Results: Higher LCI was independently associated with lower peritoneal solute transport. LCI correlated inversely with the 4 h dialysate-to-plasma creatinine ratio (ρ = -0.32, p = 0.001) and remained significant after adjustment (adjusted R2 = 0.224, p < 0.001). Increasing LCI was associated with higher malondialdehyde levels in serum, urine, and dialysate (all p ≤ 0.008) and impaired antioxidant defenses, including lower total peroxidase activity in erythrocytes and dialysate (both p = 0.001), reduced serum sulfhydryl groups (p = 0.011), decreased oxidative resistance of erythrocytes, and increased peroxide-induced hemolysis (both p = 0.001). In adjusted models, logLCI was independently associated with higher dialysate malondialdehyde (p < 0.001) and lower dialysate peroxidase activity (p = 0.005). Conclusions: In clinically stable PD patients, higher lipid burden assessed by LCI is independently associated with lower peritoneal solute transport and a marked increase in systemic and local OS. Our findings suggest that dyslipidaemia may contribute to early metabolic and oxidative changes even before overt peritoneal membrane dysfunction develops.

ObjectivesThe increasing prevalence of end-stage renal disease (ESRD), especially in aging populations, presents significant challenges for healthcare systems. Dialysis centers must navigate growing demands for cost efficiency while maintaining high-quality care. This study aimed to evaluate the relationship between operational efficiency and clinical quality in dialysis centers, using a systems-based performance assessment framework.MethodsWe analyzed 578 dialysis centers in Taiwan using Data Envelopment Analysis (DEA) to estimate operational efficiency. Clinical quality was assessed using outcome indicators including mortality rate, dialysis adequacy (urea reduction ratio [URR], Kt/V), serum albumin and hemoglobin levels, calcium-phosphate (Ca × P) product, and cardiothoracic ratio. Multiple regression analyses were conducted to examine associations between efficiency scores, clinical outcomes, and organizational characteristics, including chain affiliation and ownership type.ResultsHigher efficiency scores were significantly associated with lower URR, Kt/V, and Ca × P values, suggesting potential trade-offs between operational efficiency and clinical quality. Centers affiliated with chains generally reported better clinical outcomes. For-profit centers exhibited higher URR, Kt/V, and albumin levels, as well as lower Ca × P values, compared to their non-profit counterparts.ConclusionsOperational efficiency in dialysis centers may come at the cost of certain clinical outcomes. However, organizational characteristics such as chain affiliation and for-profit ownership are linked to better quality indicators. These findings highlight the value of DEA as a tool for system-level performance evaluation and inform strategies to optimize dialysis care delivery.

The increasing prevalence of end-stage renal disease (ESRD), especially in aging populations, presents significant challenges for healthcare systems. Dialysis centers must navigate growing demands for cost efficiency while maintaining high-quality care. This study aimed to evaluate the relationship between operational efficiency and clinical quality in dialysis centers, using a systems-based performance assessment framework. We analyzed 578 dialysis centers in Taiwan using Data Envelopment Analysis (DEA) to estimate operational efficiency. Clinical quality was assessed using outcome indicators including mortality rate, dialysis adequacy (urea reduction ratio [URR], Kt/V), serum albumin and hemoglobin levels, calcium-phosphate (Ca × P) product, and cardiothoracic ratio. Multiple regression analyses were conducted to examine associations between efficiency scores, clinical outcomes, and organizational characteristics, including chain affiliation and ownership type. Higher efficiency scores were significantly associated with lower URR, Kt/V, and Ca × P values, suggesting potential trade-offs between operational efficiency and clinical quality. Centers affiliated with chains generally reported better clinical outcomes. For-profit centers exhibited higher URR, Kt/V, and albumin levels, as well as lower Ca × P values, compared to their non-profit counterparts. Operational efficiency in dialysis centers may come at the cost of certain clinical outcomes. However, organizational characteristics such as chain affiliation and for-profit ownership are linked to better quality indicators. These findings highlight the value of DEA as a tool for system-level performance evaluation and inform strategies to optimize dialysis care delivery.

Background: Dialysis adequacy (Kt/V) remains an essential marker of hemodialysis quality; however, it does not fully capture patients' overall well-being. Growing evidence underscores the need for a more holistic, patient-centered approach that integrates clinical efficiency with factors affecting daily functioning and quality of life (QoL). Objectives: This study aimed to identify the key determinants of health-related quality of life (HRQoL) among Polish patients undergoing hemodialysis. Methods: Seventy hemodialysis patients from a single center completed the KDQOL-36 questionnaire and provided demographic and clinical data. Statistical analyses included Pearson's and Spearman's correlations, as well as multiple linear regression, to determine predictors of HRQoL. Results: The mean (SD) KDQOL summary score was 60.9 (17.3). Pain (B = -15.9, p < 0.001) and the need for additional dialysis sessions (B = -10.2, p = 0.008) were the strongest independent predictors of poorer HRQoL, collectively accounting for 28.6% of variance. Longer dialysis-related transportation time (r = -0.238, p = 0.03) and longer hemodialysis vintage (r = -0.254, p = 0.03) were also significantly associated with lower HRQoL, while dialysis adequacy showed no significant effect. Conclusions: Pain, additional dialysis sessions, and longer dialysis-related transportation time are key, modifiable contributors to reduced HRQoL in Polish hemodialysis patients. These findings underscore the importance of a patient-centered approach that supplements clinical measures with interventions targeting comfort, education, and accessibility. Incorporating structured pain management and improved transport into routine nephrology practice can meaningfully improve patient QoL.

Background/Objectives: Chronic kidney disease (CKD) progresses with the gradual and irreversible loss of renal function. In Romania, given the increasing number of patients undergoing hemodialysis (HD), the prevalence of psychiatric symptoms and disorders in this population has become particularly significant. Although important advances have been made in the management of psychiatric conditions in HD patients, their mental health remains relatively poor. The aim of this study was to observe the severity temporal trends of depression, anxiety and stress symptoms and correlations among HD patients. Methods: A total of 173 patients, underwent a detailed anamnesis, with emphasis dialysis duration, comorbidities and a complex psychiatric evaluation, followed by the application of the Socio-economic Scale (SES-3); Mini Mental State Examination (MMSE); and the Depression, Anxiety and Stress Scale 21R (DASS-21R). The dialysis performance (spKt/V) and Charlson Comorbidity (CCI) indices were provided by DIAVERUM Nephrology and Dialysis Center in Craiova. Results: The severity of depression and anxiety symptoms significantly increased over six months, 0.248 ± 1.432 vs. 0.453 ± 1.488 (p < 0.0001; rrb = 0.296) for depression, and -0.090 ± 1.004 vs. 0.089 ± 1.047 (p < 0.0001; rrb = 0.252) for anxiety; while stress-like symptoms remained stable 0.080 ± 1.318 vs. 0.164 ± 1.357 (p = 0.0661; rrb = 0.123), despite improvements in dialysis adequacy (spKt/V). Depression scores were moderately correlated with anxiety and weakly correlated with stress and spKt/V. Anxiety results were moderately correlated with stress, while both anxiety and stress showed negligible correlations with spKt/V. Clinical variables assessed showed moderate predictive value for psychological outcomes in this cohort. Conclusions: Our study confirms the temporal trend of severity of mental symptoms and their persistence among HD patients, highlighting the urge to integrate mental health screening and intervention programs and a multidisciplinary team adapted for each case.

Central venous catheters (CVC) are often the only option for hemodialysis, particularly when arteriovenous fistulas cannot be created or in urgent situations. However, the exhaustion of traditional access sites necessitates alternative approaches. This study aims to describe our center's experience with transhepatic venous access for hemodialysis, focusing on infection rates, catheter patency, and dialysis adequacy, to evaluate the feasibility of this option in patients with limited vascular access options. We conducted a retrospective study at Pro-Rim Foundation (January 2017 - February 2024) on patients with transhepatic CVC. Clinical records were reviewed for demographics, comorbidities, CVC details, dialysis adequacy, and outcomes. A total of 24 longterm transhepatic CVCs were placed in 12 patients (58.3% male, mean age 55.9 years). The technical success rate was 100%, with no complications within 24 hours. Over 3615 catheter-days, thrombosis occurred at a rate of 0.30 per 100 catheterdays, and infection occurred at 0.08 per 100 catheter-days. The mean dialysis dose (eKt/V) was 1.29. Seven patients died during follow-up, with only one death related to vascular access complications. The mean primary and secondary catheter patency times were 162.9 and 204.0 days, respectively. Our study supports transhepatic hemodialysis catheters as a viable option for patients with no other access options, showing good long-term functionality, low infection rates, and reasonable dialysis adequacy. Thrombosis remains a significant challenge, necessitating better maintenance, monitoring, and further research to improve outcomes.

Uremic toxins accumulate in the body due to kidney dysfunction and are classified by molecular weight into small, middle, and large solutes. Middle-sized molecules, such as myoglobin and interleukin-1 (IL-1), are implicated in chronic inflammation, cardiovascular complications, and dialysis-related issues. Conventional hemodialysis (HD) effectively removes small solutes but is less efficient at clearing middle molecules. To assess the removal efficiency of myoglobin and IL-1 using two different high-flux dialyzers (FX80 and Platinum H4, surface area 1.8 m²) in both high-flux hemodialysis (HF-HD) and hemodiafiltration (HDF) modalities. A crossover study was conducted on 30 prevalent ESRD patients undergoing thrice-weekly HD at Ain Shams Uni-versity Specialized Hospital. Patients received both HD and HDF treatments using FX80 and Platinum H4 dialyzers, with a two-week washout period between modalities. Each session was conducted with blood flow ≥300 mL/min and bicarbonate dialysate. Serum IL-1 and myoglobin were measured before and after sessions, and reduction ratios were calculated. The mean age of patients was 51.8 ± 12.9 years, and 80% were male. Baseline pre-dialysis IL-1 and myoglobin levels showed no significant differences across groups. Post-dialysis, the highest reduction ratios were observed with HDF-Platinum H4 for both IL-1 (81.6 ± 12.6%) and myoglobin (83.8 ± 10.6%), followed by HDF-FX80, HD-Platinum H4, and HD-FX80 (p < 0.001). Urea reduction ratio was also significantly higher with HDF compared to HD (75.2 ± 5.6% vs. 67.1 ± 8.3%, p < 0.001). No significant correlations were observed between transmembrane pressure and reduction ratios. IL-1 and myoglobin are reliable markers for dialysis adequacy. HDF demonstrates superior removal of these middle molecules compared to HF-HD. Among dialyzers, Platinum H4 outperformed FX80, showing greater clearance efficiency in both modalities.

Anticoagulation is essential in hemodialysis (HD) to maintain circuit patency and reduce thromboembolic risk. Common options include unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), regional citrate anticoagulation (RCA), and direct oral anticoagulants (DOACs). This review synthesizes current evidence on these agents in HD, emphasizing efficacy, safety, cost, administration, and remaining knowledge gaps. We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance and predefined inclusion and exclusion criteria. Interventions included DOACs, LMWH, UFH, RCA, nafamostat, and heparin-free strategies. Typical comparators were VKAs, saline flush protocols, or other anticoagulant classes. Eligible studies reported at least one outcome of interest: circuit patency, bleeding events, cost effectiveness, or identified gaps in the literature. DOACs particularly apixaban and rivaroxaban demonstrated efficacy comparable to VKAs for thromboembolic prevention. UFH and LMWH showed similar effectiveness in maintaining circuit patency, and RCA and nafamostat provided alternatives for patients at high bleeding risk. Safety profiles generally favored DOACs and RCA, with lower rates of major bleeding than warfarin and UFH/LMWH. Practical considerations indicated that UFH was often the most cost-effective option, whereas DOACs offered the convenience of oral administration at higher drug costs. Important evidence gaps persist, including limited long term comparative studies and few placebo-controlled trials. Anticoagulant selection in HD should balance efficacy, safety, cost, administration, and monitoring, tailored to patient risk profiles and institutional resources. Future research should prioritize head-to-head comparisons, long term outcomes, cost effectiveness, and the effects of anticoagulation strategies on dialysis adequacy to support more precise clinical decision making.

IntroductionThis study identified key factors influencing hemoglobin (Hb) target achievement (≥110 g/L) in maintenance hemodialysis (MHD) patients in Wuhan to guide improvement strategies.MethodsA multicenter retrospective study (January 2019–December 2023) included 4,906 MHD patients from 70 dialysis centers in Wuhan. Data on demographics, dialysis-related parameters, pre-dialysis laboratory indices, and medication use were collected. Patients were categorized into target (Hb ≥ 110 g/L) and non-target group (Hb < 110 g/L). Group differences were analyzed, and binary multivariate logistic regression identified independent factors.ResultsA total of 4,906 MHD patients from 70 dialysis centers were included in this study. Multivariate logistic regression analysis identified female sex (OR = 1.18, p = 0.011), TCC use (OR = 1.23, p = 0.006), dialysis frequency <3 times/week (OR = 1.20, p = 0.006), pre-dialysis hypertension (OR = 1.28, p < 0.001), lack of LC use (OR = 1.16, p = 0.043), higher serum phosphorus (pre 0.1 mmol/L OR = 1.02, p < 0.001) and CRP (pre 1 mg/dL OR = 1.01, p < 0.001) as independent risk factors for not achievement. Independent protective factors included LMWH use (OR = 0.59, p = 0.002), coverage under employee medical insurance (OR = 0.74, p = 0.033), higher serum albumin (pre 1 g/L OR = 0.90, p < 0.001), calcium (per 0.1 mmol/L OR = 0.95, p < 0.001), and TSAT (pre 1% OR = 0.99, p < 0.001).ConclusionHb target achievement in Wuhan MHD patients is influenced by a complex interplay of demographic (sex), clinical (vascular access type, dialysis adequacy and frequency, blood pressure management, inflammatory status, mineral/nutrition/iron status), therapeutic (LMWH and LC management), and socioeconomic factors (insurance). Targeting modifiable factors is crucial for optimizing anemia management.

Background and Objectives: Chronic kidney disease (CKD) and maintenance hemodialysis (HD) are frequently associated with psychological distress and impaired health-related quality of life (HRQoL). However, the relationships between depressive, anxiety, and stress symptoms, clinical factors, and HRQoL remain insufficiently understood in routine care. This study aimed to assess the prevalence of psychological distress and to explore cross-sectional correlates of kidney disease-specific and generic HRQoL in Romanian patients receiving long-term HD, providing one of the first detailed characterizations of these relationships in an Eastern European maintenance HD cohort. Materials and Methods: This single-center cross-sectional study included 125 adult patients undergoing maintenance HD for at least one year. Baseline assessment comprised socioeconomic, demographic and clinical and paraclinical data, including Charlson Comorbidity Index (CCI), dialysis adequacy (spKt/V), cognitive function, psychological distress assessed with the Depression, Anxiety and Stress Scale (DASS-21R), and HRQoL evaluated using the Kidney Disease Quality of Life Short Form (KDQOL-SF™ 1.3). HRQoL domains and physical and mental component summary scores (PCS, MCS) were analyzed using descriptive statistics, correlation analyses, and multivariable linear regression. Follow-up assessments at approximately one year were summarized descriptively. Results: Disease-specific HRQoL revealed marked impairment in perceived disease burden and work status, while physical HRQoL was substantially reduced (PCS 36.5 ± 9.6). Mental HRQoL was relatively preserved (MCS 48.8 ± 8.8). At baseline, 48.0% of patients reported at least mild depressive symptoms, 34.4% anxiety symptoms, and 44.0% stress symptoms. spKt/V showed a modest association with PCS. Psychological distress demonstrated weak associations with HRQoL; stress was independently associated with lower MCS, with limited explained variance (R2 ≤ 0.15). Conclusions: Psychological distress is common among Romanian HD patients and is cross-sectionally associated with markedly impaired physical HRQoL. While the present design does not allow causal inferences, these findings support the implementation of routine psychological screening and the consideration of targeted psychosocial interventions in HD care.

IntroductionThe major neutrophilic peptide alpha-defensin plays a pivotal role in atherogenesis. Atherosclerosis is more frequent in dialysis patients, increasingly ascribed to chronic low-grade inflammation. We investigated the potential association between dialysis treatment and circulating alpha-defensin levels.MethodsIn a cohort of hemodialysis (HD) patients, plasma alpha-defensin concentrations were determined immediately before and after a dialysis session. Blood samples were also tested for CBC, CRP, lipid profile, and troponin levels. Body weight change, Urea Reduction Ratio and Kt/V were used to assess dialysis adequacy. Patients were divided into two groups based on alpha-defensin increase post dialysis. Groups were compared for dialysis adequacy, CBC, CRP, LDL levels, and the incidence of new documented coronary artery narrowing post HD initiation. The study was approved by the local IRB and all patients were consented.ResultsA total of 37 HD patients (55% males, median age 66.5 (60.3–78 years)) were recruited. There was a marked surge in median alpha-defensin levels after HD [11,571 vs. 16,661 ng/ml, p=0.009]. Overall, alpha-defensin levels increased in 65% of cases, whereas CRP levels showed no significant rise following dialysis. Similarly, platelet and neutrophil counts exhibited no significant change. Kt/V values were found favorable in HD patients with alpha-defensin decrease (1.48 vs. 1.37, P = 0.24), corresponding to a higher body weight decrease post dialysis (2.4% vs. 1.75%). Moreover, the HD group with alpha-defensin increase was more prone to sustain new cardiovascular events (12.5% vs. 0% at a median time of 5 (3.75-6.57) years), despite demonstrating a better blood lipid profile (LDL 63 vs. 87 mg/dl).ConclusionHD is an alpha-defensin generating procedure. Patients are potentially predisposed to atherosclerosis because of their enhanced alpha defensin secretion. alpha-defensin might evolve as a potential therapeutic target for atherosclerosis mitigation in this high-risk population. However, this remains to be validated in future research.

Patients with ESRD who receive dialysis experience a wide range of unpleasant symptoms that have a negative effect on patient prognosis. The aim of this study was to evaluate the relationship between dialysis symptoms, adherence to interdialytic weight gain, fluid control, and associated factors in hemodialysis patients. This study was conducted in a descriptive and cross-sectional design. Demographic and clinical characteristics form, mean of interdialytic weight gain last 12 hemodialysis sessions, Fluid Control in Hemodialysis Patients Scale, and Dialysis Symptom Index (DSI) were used to collect data. Patients with chronic illnesses and unemployment patients experienced higher DSI scores. The literate participants had a significantly higher DSI and lower adequacy of fluid intake. The regression analysis results showed that employment, chronic diseases, dialysis adequacy, and compliance with fluid intake explained 20.3% of the variance and that the model was a significant predictor of the DSI. Dialysis symptoms were seen prevalently among the patients, and factors such as employment status, chronic disease, dialysis adequacy, and fluid intake compliance affected the DSI. It is important to monitor the fluid volume status and hemodialysis symptoms of hemodialysis patients regularly.

Dialysis adequacy is an important parameter with regards to morbidity and mortality in chronic haemodialysis (HD) patients. Measuring the adequacy of HD is not an easy task. There is no objective, reliable and universally accepted criteria for measuring the adequacy. Clinically, several parameters must be considered to provide adequate dialysis, such as control of fluid overload and electrolytes disturbance, correction of metabolic acidosis and dialysis dose. This cross-sectional study explores the assessment of the adequacy of haemodialysis by urea kinetic modeling (UKM), a vital method for determining the optimal dialysis dose. This study was conducted at the haemodialysis unit of the National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh between the periods of 1st January 2012 and 30th June 2013. Purposive sampling of 120 end stage renal disease (ESRD) patients on maintenance haemodialysis (MHD) getting dialysis for at least one month through arterio-venous fistula (AVF) and at least 2 dialysis sessions per week. Out of 120 patients, 72 (60%) were male and the ratio was 1.5:1. The mean age of haemodialysis patients in this study was 51 years (range: 18-75 years). Approximately 62 (52%) patients were on an 8-hour per week haemodialysis session. Our study showed mean total clearance of urea normalized or corrected for distribution volume (Kt/V), urea reduction ratio (URR), time average concentration of urea (TACurea) and normalized protein catabolic rate (nPCR) of all study population was 1.21±0.40, 62±12, 83±26, and 1.29±0.46, respectively. In 12 hours per week haemodialysis group achieved target Kt/V &gt;1.2 was only 26 (45%), on the other hand, in 8 hours per week haemodialysis group achieved target Kt/V &gt;2 was only 3 (5%). Among the study population only 52 (43%) patients achieved URR &gt;65%, 13 (11%) patients TACurea was less than 52 mg/dl and 107 (89%) patients achieved nPCR &gt;1g/kg/day. The mean values of the URR was significantly higher for dialysis patients who achieved a Kt/V of &gt;1.2 than for those who did not achieve a Kt/V &gt; 1.2. To achieve haemodialysis adequacy of KDOQI 2006 recommendation needs to increase the frequency of HD that is 3 sessions per week (12 hours/week) and needs to give more attention to other factors that increase urea clearance. To improve patient management with end-stage kidney disease, needs of continuous research to enhance our understanding of haemodialysis adequacy and its dose calculation. Jalalabad Med J 2025; 22 (1): 17-22.