Dialysis Patients Research Articles

Due to the poor prognosis of dialysis patients, accurately predicting life expectancy after aortic stenosis surgery remains challenging, leading to potential misselection of treatment options. This study aimed to develop a prognostic model specific to dialysis patients to facilitate individualized treatment selection. A total of 171 dialysis patients with aortic stenosis who underwent initial isolated surgical aortic valve replacement at seven cardiovascular centers in Japan between 2011 and 2021 were enrolled. The cohort was randomly divided into the training and validation cohorts in a 2:1 ratio. Risk factors contributing to mortality were identified from preoperative variables, and a prognostic model was developed using the Cox proportional hazards model. Among the 171 patients, 88 deaths occurred during the total observation period of 488.9 person-years. The cumulative overall survival rates at 1, 3, and 5 years, estimated using the Kaplan-Meier method, were 74.7%, 59.4%, and 38.7%, respectively. An optimal risk model was developed, incorporating six factors: age, serum albumin, peripheral artery disease, sex, insulin-dependent diabetes mellitus, and atrial fibrillation. The model demonstrated strong predictive accuracy, with a 5-year C-statistic of 0.723 (95% confidence interval: 0.658-0.788) and 0.656 (95% confidence interval: 0.543-0.770) in the training and validation cohorts, respectively. Calibration plots confirmed that actual survival up to 5 years was well predicted (intraclass correlation coefficient = 0.918, 95% confidence interval: 0.703-0.981). The proposed model is a reliable prognostic tool for dialysis patients who underwent surgical aortic valve replacement.

Background: Dialysis patients with both acute coronary syndrome (ACS) and atrial fibrillation (AF) face high thrombotic and bleeding risks. The optimal antithrombotic strategy and long-term outcomes remain unclear. Methods: We analyzed data from the CRUISE-R, a nationwide, multicenter, retrospective cohort in China. Patients were grouped by AF status. The primary endpoint was a composite of all-cause mortality, non-fatal myocardial infarction, and stroke. Baseline features, antithrombotic strategies, and outcomes were compared. betwee groups. Results: Among 1,147 patients, 102 (8.9%) had AF. Compared to those without AF, AF patients were older (65.1 vs. 61.4 years, p < 0.001), had higher proBNP (30,826 vs. 21,153 pg/ml, p = 0.015), and larger left atrial diameter (43.6 vs. 40.9 mm, p = 0.001). Triple therapy (OAC + aspirin + clopidogrel) was more common in AF patients (9.8% vs. 0.96%, p < 0.001) (Figure 1). Over 22.9 months of follow-up, 511 patients (44.6%) reached the primary endpoint—450 (43.1%) without AF vs. 61 (59.8%) with AF. AF patients had higher composite event and cardiac mortality rates (p < 0.05), but stroke and bleeding rates were not significantly different (p = 0.18 and 0.056, respectively) (Figure 2). Cox regression analysis identified AF as an independent predictor of the primary endpoint (HR 1.46, 95% CI: 1.07–1.98, p = 0.016) and cardiac death (HR 1.52, 95% CI: 1.02–2.27, p = 0.038). Triple antithrombotic therapy was independently associated with an increased risk of bleeding (HR 5.88, 95% CI: 1.41–24.52, p = 0.015). Among the 106 patients with both ACS and AF, mean CHA2DS2-VASc and HAS-BLED scores were 3.8 and 3.4 (Figure 3A). However,both scores demonstrated limited predictive value for non-fatal stroke and bleeding events in this population, with area under the curve (AUC) values below 0.65 (Figure 3B). Conclusion: In dialysis patients with ACS, the presence of atrial fibrillation is associated with a significantly worse prognosis, including higher primary composite endpoint and cardiac mortality, although the incidence of stroke is not significantly increased. Triple antithrombotic therapy markedly raises the risk of bleeding and should be used with caution. Standard risk scores such as CHA2DS2-VASc and HAS-BLED have limited predictive power in this population. Further research is needed to develop more effective risk stratification tools for identifying high-risk subgroups prone to thrombotic and bleeding events.

Background: Patients with end-stage renal disease (ESRD) undergoing dialysis and with concomitant heart failure (HF) experience substantial cardiovascular risks. Although mineralocorticoid receptor antagonists (MRAs) are guideline-recommended for HF management, their utilization in dialysis-dependent populations is constrained by safety concerns and a paucity of outcome data. Objective: This study aimed to evaluate the association of spironolactone use with the risks of major adverse cardiovascular events (MACE) and all-cause mortality among dialysis patients with HF. Methods: This retrospective cohort study utilized data from the TriNetX US collaborative network, encompassing over 122 million patients. We identified adult patients with ESRD undergoing dialysis and diagnosed with HF between 2015 and 2024. Spironolactone users (n=6,951) were propensity score-matched (1:1) to non-users. The primary endpoints were the 5-year incidence of MACE and all-cause mortality. Cox proportional hazards regression and Kaplan-Meier survival analysis were employed. Subgroup and sensitivity analyses were performed to assess the robustness of the findings. Results: Compared to non-users, spironolactone users exhibited significantly reduced risks of MACE (HR: 0.892, 95% CI: 0.850–0.937) and all-cause mortality (HR: 0.738, 95% CI: 0.694–0.786). Subgroup analyses revealed consistent reductions in mortality across various patient characteristics, including sex, age, and comorbidities such as diabetes, ischemic heart disease, and atrial fibrillation (Figure 1). Kaplan-Meier survival curves illustrated a sustained benefit throughout the follow-up period . Conversely, spironolactone use was associated with increased risks of ischemic stroke (HR: 1.157), hypotension (HR: 1.197), and hyperkalemia (HR: 1.086). Baseline left ventricular ejection fraction (LVEF) did not differ significantly between the groups (p=0.802). Conclusion: In this cohort of dialysis patients with HF, spironolactone administration was associated with lower MACE and all-cause mortality, albeit with an increased incidence of hyperkalemia and ischemic stroke. These findings advocate for the judicious use of spironolactone in this high-risk cohort, while emphasizing the imperative for randomized controlled trials (RCTs) to confirm its efficacy and safety profile.

Background: The arteriovenous fistula (AVF) is a requirement for hemodialysis therapy in end-stage kidney disease (ESKD) patients. A consequence of AVF creation is compensatory cardiovascular hemodynamics, which are subsequently associated with cardiac remodeling. Relatedly, cardiovascular mortality and morbidity are elevated in ESKD patients, which worsens in dialysis patients. Currently, no suitable uremic large animal models exist to investigate the underlying mechanisms of AVF-induced cardiac remodeling. Research Question: This study aims to characterize cardiovascular changes secondary to AVF creation, supported by percutaneous transluminal angioplasty (PTA), in a uremic pig model. Methods: Chronic kidney disease (CKD) was induced via renal embolization, followed by AVF creation 28 days later. The AVF was created by anastomosis of the left common carotid artery to the left external jugular vein. AVF stenosis was alleviated 28 days thereafter via PTA, and cardiac MRI was performed at 14-, 28-, and 42-days post-PTA. Results: Increased end-diastolic volumes were observed in the left and right ventricles at day 42 vs 14 (200.8ml to 249.5ml, p=0.0457, and 204.6ml to 260.0ml, p=0.0268 respectively), while systolic function was preserved. Left ventricle (LV) stroke volume and blood flow through the aorta, pulmonary artery, and vena cava were also increased. In perivascular areas of the free wall of the LV at day 42 vs control, senescence markers showed increased p16 expression (fold change 10.21, p=0.0086) and decreased p21 expression (fold change 0.07, p=0.0357). The LV showed perivascular fibrosis (0.2% to 0.59%, p=0.021), via picrosirius red, reduced collagen-type IV expression (fold change 0.81, p=0.0089), and increased MMP2 levels (fold change 14.33, p=0.0213). Cardiomyocyte cross-sectional area was increased (from 800.9 µm 2 to 1250.0 µm 2 , p=0.0296), without CD4+ or CD68+ cell LV infiltration. Conclusion: In conclusion, AVF creation leads to modified left and right ventricular function and increased peripheral flow, potentially mediated by cellular senescence and fibrosis, resulting in progressive cardiac remodeling. This model of uremic kidney disease can now be used to evaluate mechanisms of AVF induced cardiac disease and test the efficacy of therapeutics like senolytics and anti-fibrotic agents.

Background: Recent studies have demonstrated that sodium-glucose cotransporter 2 inhibitors (SGLT2i) may reduce procedure-related acute kidney injury (AKI), heart failure readmission and late mortality in patients undergoing transcatheter aortic valve replacement (TAVR). Hypothesis: We sought to investigate the frequency of use and clinical impact on in-hospital and late TAVR outcomes of SGLT2i in a real-world setting in a high volume TAVR center. Methods: From a total cohort of 3,333 TAVR procedures performed since 2015, we compared in-hospital, 1-year and 5-year clinical outcomes in 241 patients treated with SGLT2i versus 3,092 without SGLT2i use. Patients received SGLT2i (empagliflozin n=181, dapagliflozin propanediol n=54, or canagliflozin n=6) prior to and following TAVR for treatment of heart failure with diabetes, renal insufficiency and/or left ventricular systolic dysfunction. Dialysis patients and valve-in-valve TAVR procedures were excluded. Propensity-matching was used to adjust for co-variates. AKI was defined by VARC-2 criteria. Results: Propensity-matched SGLT2i (n=225) and No SGLT2i (n=1,949) cohorts did not differ with respect to baseline characteristics including age (80.0±6.6 vs. 80.9±8.5 years, p=0.061), sex, creatinine, hemoglobin, NYHA class, pre-TAVR echo and cardiac catheterization findings, and STS score (8.9±7.2% vs. 8.0±6.5%, p=0.063). Both groups had similar use of general/conscious sedation anesthesia, femoral/carotid access, balloon-expandable/self-expanding valve type, fluoroscopy time and contrast load (80.0±42.2 vs 84.0±40.3 ml, p=0.248). SGLT2i versus No SGLT2i patients had similar in-hospital mortality (0.0 vs 0.4%, p=0.0338), ischemic strokes (0.9 vs 1.3%, p=0.575), major vascular complications (2.2 vs 2.5%, p=0.790), and composite bleeding (2.2 vs 2.9%, p=0.576), although SGLT2i patients had a lower incidence of AKI (2.2 vs 6.0%, p=0.020). At 1-year, the SGLT2i group had lower all-cause mortality (3.2 vs 6.6%, p=0.046) but similar hospital readmission rates (19.1 vs 21.7%, p=0.379) and quality of life KCCQ12 scores (81.7±19.0 vs 81.7±19.1, p=0.071). At a mean follow-up of 65.9 (64.2-67.5) months, Kaplan-Meier survival analysis demonstrated lower all-cause mortality in the SGLT2i cohort (p=0.009) (figure). Conclusion: In this single center study, SGLT2i use was infrequent in patients undergoing TAVR, and was associated with decreased procedural AKI as well as decreased all-cause mortality at 1 and 5-year follow-up.

Background: In a recent clinical trial, Semaglutide, a GLP-1 agonist, reduced the risk of clinical outcomes and death from cardiovascular causes in patients with chronic kidney disease (CKD) and type 2 diabetes (Perkovic 2024 NEJM ). Given the substantial benefit to patients with CKD, the question remains whether, and to what extent, these drugs benefit patients with end-stage kidney disease (ESKD). In this analysis, we sought to evaluate the impact of GLP-1 agonist use in incident ESKD patients on mortality. Methods: Patients included in this analysis were adult ESKD patients who initiated 3x weekly in-center hemodialysis (ICHD) at a kidney care organization between Jan 1, 2018 and Apr 15, 2024. Using internal EHR data, eligible patients who initiated dialysis on a GLP-1a (with a GLP-1a prescription in the first 30 days after dialysis initiation; n=2,492) were matched 1:1 to those not on a prescription. Matching factors included weight, index date, evidence of predialysis nephrology care, a diabetes diagnosis, and use of diabetes medications during the first 30 days of dialysis. Patients were followed from index date until death or the end of the study (Jul 31, 2024). Incident rate ratios were estimated using a negative binomial distribution with a random intercept to account for the matched nature of the data. Results: Patients filling GLP-1a prescriptions in the first month of dialysis were on average 63 years old and predominately male (59%). Compared to other eligible dialysis patients, nearly all patients on a GLP-1a have a known diagnosis of diabetes (98% vs. 73%), a majority have evidence of predialysis nephrology care (76% vs. 67%), are White (46% vs. 39%), and have a mean BMI of 33 (vs. 30). Results indicate that after matching and adjustment for age, race, and dual eligibility, GLP-1s are independently associated with a reduction in mortality [IRR: 0.83 (0.73, 0.95)]. Conclusions: Results indicate that in the context of known diabetic, incident ICHD patients, continued GLP-1a use is independently associated with a 17% reduction in mortality.

Hemodialysis patients have an increased risk of bleeding related to platelet dysfunction and uremia leading to acquired defects in primary hemostasis. Frequently, these patients have multiple medical comorbidities requiring treatment with antiplatelet agents and anticoagulants, further increasing their bleeding risk. This presents added challenges when they present to the emergency department (ED) with arteriovenous fistula or arteriovenous graft (AVF/AVG) bleeding. This retrospective cohort study aims to characterize patient characteristics, mortality outcomes, hemorrhage outcomes, infectious outcomes, repeat ED visits, non-invasive procedures, and invasive procedures associated with ED encounters for AVF/AVG bleeding. This is a retrospective cohort study evaluating ED encounters for patients on hemodialysis with a chief complaint of a bleeding AVF/AVG. Descriptive statistics as well as logistic regression were used to find correlations between patient and encounter factors and the risk of requiring an advanced procedure to prevent further AVF/AVG bleeding. The primary outcome was the need for a formal intervention to revascularize or perform angioplasty on the patient's AVF or AVG. This occurred in 173 (50.7%) encounters. A history of any bleeding event was associated with the primary outcome while a higher initial platelet count or the use of antiplatelets were inversely associated with the primary outcome. This multi-center retrospective cohort study evaluated patient and clinical characteristics in encounters involving AVF/AVG bleeding. Correlating factors between ED encounters involving AVF/AVG bleeding and the need for advanced AVF/AVG interventions are described. Further research with a larger, more diverse patient base is needed to confirm these findings before these characteristics can be considered indications for more rapid interventional radiology or vascular surgery follow up in cases of AVF/AVG bleeding.

Accurate methods of assessing fluid status in patients with kidney failure in need of dialysis are pivotal to preventing volume overload. Unidentified volume overload can lead to cardiac complications such as left ventricular hypertrophy, hypertension, and, ultimately, heart failure. Currently, there is no gold standard for determining the hydration status of this patient group. This systematic review aims to synthesise studies that have assessed the diagnostic accuracy of lung ultrasound in evaluating fluid status and the use of lung ultrasound to improve long-term endpoints in chronic dialysis patients. The protocol was registered in the PROSPERO registry (CRD 42022334147), and was conducted in accordance with PRISMA guidelines. The search was conducted in the PubMed, Embase, Medline and Web of Science databases to identify studies related to lung ultrasound and dialysis. The search yielded 2543 studies, and after screening, five diagnostic accuracy studies and seven randomised controlled trials (RCTs) were included in the final analysis. The diagnostic accuracy studies reported sensitivity between 33 and 94.5% and specificity from 39 to 80%, highlighting considerable heterogeneity among the studies. The RCTs indicated that using ultrasound in volume management was not associated with improving long-term endpoints such as all-cause mortality and cardiovascular events. The quality assessment of the included studies showed an overall risk of bias in both types of studies (RCT and diagnostic accuracy studies). Lung ultrasound is an accurate, low-cost, and easily implementable method that could complement but not replace the standard of care. The available literature concerning the use of lung ultrasound in volume assessment of patients with kidney failure was characterised by heterogeneity and risk of bias. Future rigorous, high-quality research must involve randomised controlled trials to consolidate the efficiency and efficacy of lung ultrasound for kidney failure patients.

To analyze the effects of aerobic combined resistance exercise in dialysis on restless legs syndrome (RLS), sleep quality, anxiety, depression, and quality of life of maintenance dialysis patients. 59 patients who underwent maintenance hemodialysis combined with RLS in the blood purification center of Taihe County People's Hospital of Anhui Province from September to December 2024 were selected as the study subjects. The study subjects were divided into 30 cases of the control group and 29 cases of the intervention group using a randomized numerical table. The control group received routine dialysis and health education. In contrast, the intervention group received aerobic combined resistance exercise in dialysis, similar to the control group, with the time controlled at about 40 min, three times a week for 12 weeks. We observed the severity of RLS (IRLS), Pittsburgh Sleep Quality Index (PSQI), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and quality of life (the Kidney Disease Questionnaire, KDQ) in the two groups before and after 12 weeks of intervention. There was no statistical difference in IRLS, PSQI, SAS, SDS, and KDQ scores between the two groups before the intervention (p > 0.05). After 12 weeks of intervention, IRLS, SAS, and SDS scores of the intervention group were lower than those of the control group (p < 0.05). Notably, the intervention group showed significantly improved PSQI scores (p < 0.05). The KDQ scores were higher than those of the control group, and the differences were all statistically significant (p < 0.05). Aerobic combined resistance exercise in dialysis can improve the symptoms of RLS in maintenance hemodialysis patients, enhance sleep quality, reduce negative emotions such as anxiety and depression, and improve quality of life.

Efficacy and safety of Shen-Qi Paste, a Traditional Chinese Medicine, in dialysis patients with sarcopenia: A randomized, double-blind, placebo-controlled trial.

Comment on “COVID-19 Hospitalization and Mortality Trends Among US Dialysis Patients by Race/Ethnicity and Vaccination Status” by Shieu et al

Obstructive sleep apnea in adult dialysis patients: A review.

To examine the disruption of kidney care services in Sudan following the 2023 conflict, highlighting the compounded risks faced by dialysis and transplant patients during crises, and offering evidence-based strategies for future emergency preparedness. The conflict in Sudan exposed deep systemic weaknesses in an already under-resourced nephrology infrastructure. Hemodialysis centers were damaged or shut down, supply chains collapsed, and patient displacement became widespread. Over 70% of patients experienced treatment interruption and many died due to missed dialysis sessions or transplant rejection. Emergency responses were delayed and uncoordinated. In contrast, experience from Ukraine and Gaza disasters illustrate how registry-based evacuation and cross-border planning can save lives. Egypt's subsequent collaboration with WHO and KSrelief (King Salman Humanitarian Aid and Relief Center) offered a late but instructive model for regional support. Sudan's crisis demonstrates how kidney patients suffer disproportionately from adverse effects of disasters when health systems collapse. Displacement may become a survival tactic in the absence of formal evacuation or support plans. Embedding kidney care into disaster response-through registries, mental health support, cross-border agreements, and sustainable NCD programming-is urgently needed. Global momentum, such as WHA78's kidney resolution, must now translate into national preparedness for fragile settings.

Since 2021, Japan has been classified as a country with a low prevalence of tuberculosis (TB). Although dialysis patients have significantly higher incidences of TB and mortality, no recent nationwide surveys have assessed the TB status among dialysis patients in Japan. We conducted a nationwide cross-sectional survey of all 4167 dialysis facilities registered with the Japanese Society for Dialysis Therapy and collected facility-level data between April 2022 and March 2024. The survey assessed TB diagnoses (latent tuberculosis infection [LTBI] and active TB), diagnostic triggers, screening practices and treatment rates for LTBI, epidemiological data and clinical characteristics of active TB, incidence of TB close contacts, healthcare providers’ perceptions of TB in dialysis patients, and challenges associated with managing TB in dialysis patients. Survey responses were received from 2468 facilities with 194,720 dialysis patients. Among these patients, 331 were diagnosed with LTBI and 196 developed active TB during the 2-year study period. The LTBI rate was 85.0 cases per 100,000 person-years (95% confidence interval: 75.8–94.2), and the estimated annual rate of active TB was 50.3 cases per 100,000 person-years (95% confidence interval: 43.3–57.5). LTBI was most frequently diagnosed during screening before dialysis initiation (42.7%); however, only 4.5% of facilities conducted routine interferon-gamma release assay screening. The LTBI treatment rate was 75.2%. Among patients with active TB, diabetic nephropathy was the most prevalent underlying disease (44.2%); additionally, extrapulmonary TB was frequently observed. The incidence of active TB was highest among patients approximately 70 years of age (40.2%). Furthermore, 22.2% of patients developed TB within 3 months after dialysis initiation and 61.6% developed TB more than 1 year later. The mortality rate of these patients was 28.8%. Concerningly, 43.2% of dialysis healthcare staff appeared unaware of the TB risk, and 63.8% of facilities reported challenges regarding patient transfer and care coordination. TB is a significant burden among dialysis patients in Japan. Therefore, early awareness and treatment of TB, standardized LTBI screening protocols, robust treatment infrastructure with enhanced awareness among healthcare providers, as well as strengthened collaboration between medical institutions, government agencies, and TB-specialized healthcare facilities are necessary.

Introduction Malnutrition is common in dialysis patients and is associated with increased morbidity and mortality. Body Mass Index (BMI) may underestimate nutritional disturbances; therefore, multidimensional assessment is recommended. This study evaluated nutritional status, appetite and risk of weight loss in chronically dialyzed patients, and compared different methods, Subjective Global Assessment (SGA), Simplified Nutritional Appetite Questionnaire (SNAQ), anthropometry and biochemical markers. Methods A total of 105 chronically dialyzed patients were included (88.6% on hemodialysis, 11.4% on peritoneal dialysis). Nutritional status was assessed using SGA (seven-point scale), SNAQ, anthropometry (BMI, mid-arm circumference), and serum concentrations of albumin and C-reactive protein (CRP) as the markers of nutritional and inflammatory status. The Shapiro–Wilk test was used for normality; group comparisons employed Student’s t-test or Mann–Whitney U test and Kruskal–Wallis ANOVA for multiple groups. Correlations were analyzed using Spearman’s coefficient. Results Malnutrition, according to SGA (≤5 points), was present in 54.3% of patients, whereas BMI <20 kg/m2 was observed in only 9.8%. Among those with low BMI, 90% were malnourished by SGA, and 60% had appetite impairment. Appetite disorders (SNAQ ≤14 points) occurred in 42% of patients and were associated with lower albumin levels, smaller mid-arm circumference and lower body weight . BMI positively correlated with SGA, SNAQ and albumin. Conclusions Malnutrition is highly prevalent in Polish dialysis patients and is linked with appetite impairment, elevated CRP, reduced albumin and poorer clinical status. BMI alone is insufficient to detect nutritional disturbances. Regular use of multidimensional tools (SGA, SNAQ, albumin) should be employed to enhance the early detection and management of malnutrition in patients with end-stage kidney disease (ESKD).

Dialysis patients are at increased risk of fractures, particularly in the proximal femur where cortical bone predominates. Effective treatments targeting cortical bone are therefore essential. Romosozumab is a monoclonal antibody that simultaneously promotes bone formation and inhibits bone resorption. It is administered monthly in a clinical setting and continued for one year, offering a treatment regimen acceptable to patients. In dialysis patients, romosozumab has been shown to significantly increase bone mineral density not only in the lumbar spine but also in the proximal femur and femoral neck. However, since dialysis patients are at higher risk of cardiovascular events, the risks and benefits of romosozumab require careful consideration. Romosozumab effectively improves both trabecular and cortical bone mass in dialysis patients. Cardiovascular safety concerns necessitate cautious patient selection. Romosozumab offers medical and economic advantages over teriparatide.

Assessing the risk of colorectal cancer (CRC) after kidney transplantation (KT) in patients with endstage renal disease (ESRD) receiving dialysis is crucial to determine KT's risks and benefits. In Korea, the study results remain unclear. Therefore, using a nationwide health screening and claims database, this longitudinal study aimed to investigate CRC risk in KT recipients versus patients with ESRD receiving hemodialysis. This research recruited 65,154 participants (60,202 on dialysis vs. 4,955 with KT) from the database of the Korean National Health Insurance Service, which provides mandatory health insurance to all Korean citizens. These participants were followed up from the baseline to CRC development, loss of follow-up, or study completion. The landmark method was used to effectively control the immortal time bias. During the follow-up period, the incidence of CRC was 2.9 per 1,000 person-years in the dialysis group and 1.2 per 1,000 person-years in the KT group (p < 0.001). The mean time for CRC development in the dialysis and KT groups was 4.5 and 4.8 years, respectively. Compared with dialysis patients, the KT group obtained an adjusted hazard ratio of 0.54 for CRC (95% confidence interval, 0.42-0.71; p < 0.001). Landmark analysis showed that the 15-year cumulative CRC incidence was significantly higher in the dialysis group than in the KT group after landmark time points of 3 and 5 years (p < 0.0001). The risk of CRC after KT remained significantly lower than that of patients undergoing dialysis, even after landmark analysis.

BackgroundIn older adults, hospitalization often leads to increased frailty, which can result in higher rates of subsequent hospitalization and mortality. This study investigated whether a history of hospitalization before initiating dialysis affected mortality rates in dialysis patients.MethodsWe analyzed 2,765 patients who visited hemodialysis clinics at 17 teaching hospitals. The study examined the association between mortality and various factors, including demographics, comorbidities, laboratory findings, and medication use. Hazard ratios (HR) were calculated using survival analysis to determine whether prior hospitalization increased mortality risk in dialysis patients.ResultsOf the subjects, 8.0% (n = 222) had been hospitalized for 1 month or longer within the year before starting dialysis. There was no significant difference in gender between the two groups; however, the hospitalized group was older, and many patients in this group began dialysis using a catheter. This group also had a higher prevalence of conditions such as cerebrovascular accidents (CVA), hypertension, dementia, heart failure, and atrial fibrillation. Laboratory findings revealed higher platelet counts and blood urea nitrogen (BUN) levels, but lower levels of intact parathyroid hormone, creatinine, albumin, alkaline phosphatase, and cholesterol. Additionally, this group used fewer medications, including renin-angiotensin-aldosterone system blockers, calcium channel blockers, and antiplatelet agents. In multivariate analysis, controlling for factors such as age, sex, dialysis access, comorbidities (e.g., dementia, malignancy, ischemic heart disease, CVA, heart failure, atrial fibrillation, liver cirrhosis, fractures), ejection fraction, and laboratory markers (e.g., lymphocytes, platelets, BUN, creatinine, albumin, phosphorus, total cholesterol), the HR for mortality in the group with a history of hospitalization was 1.686 (95% CI, 1.162–2.447).ConclusionsPatients hospitalized for more than 1 month before starting dialysis had significantly higher overall mortality rates. These findings highlight the need for comprehensive care and targeted interventions for this high-risk population.Clinical trial numberNot applicable.

Calciphylaxis is a rare but a devastating condition predominantly affecting patients with end-stage kidney disease (ESKD), characterized by calcification of small to medium-sized cutaneous arteries, leading to ischemia, painful skin necrosis, and high mortality. Penile calciphylaxis is an exceptionally rare manifestation with a poor prognosis. (1) We report a case of a 53-year-old male with type 2 diabetes mellitus, hypertension, and ESKD on continuous ambulatory peritoneal dialysis (CAPD) who developed a painful penile ulcer while on treatment for a necrotic foot ulcer with cellulitis. Diagnosis was supported by penile Doppler ultrasonography revealing penile arteriolar calcifications with absent distal blood flow. Despite broad-spectrum antibiotics and wound management, the patient succumbed to severe sepsis shortly after diagnosis. This case highlights the importance of early recognition of penile calciphylaxis in dialysis patients presenting with painful penile ulcers. We review diagnostic challenges and emerging treatment options, highlighting the need for multidisciplinary approaches to improve outcomes.

Calciphylaxis is a rare, life-threatening complication in dialysis patients, characterized by necrotic skin lesions and often linked to mineral metabolism disorders and proinflammatory states. We report a 42-year-old female with lupus nephritis on long-term hemodialysis (HD) who developed calciphylaxis after kidney transplantation complicated by acute rejection, vascular thrombosis, and surgical infection. She presented with necrotic skin ulcers, elevated inflammatory markers (ESR 96 mm/h, CRP up to 10 mg/dL), and a heterozygous MTHFR C677T mutation. Eight double-filtration plasmapheresis (DFPP) sessions over 3 months using an EC-50W filter achieved CRP (−49%) and fibrinogen (−69%) reduction, with lesion improvement. Post-session leukocyte rebound (+205%) suggested microcirculatory recovery. At treatment completion, her condition stabilized without further flare-ups. DFPP may be a valuable option for refractory calciphylaxis with persistent inflammation.