Patients with chronic kidney disease who have progressed to dialysis treatment have increased fracture risk. However, the impact of osteoporosis treatment on fracture risk has not been evaluated in a large-scale study using Japanese real-world data. In this retrospective observational study (UMIN000054749), DeSC-IQVIA Integrated Claims Data were used to investigate the impact of osteoporosis treatment on fracture risk and other events in patients receiving maintenance hemo- or peritoneal dialysis. Data from April 2014 to August 2022 were extracted, and patients were divided into treated/untreated groups based on prescription records for osteoporosis medications during a 1-year exposure assessment period. The primary endpoint was the incidence of total and hip fractures from the index date (1year post-exposure assessment period) until the end of follow-up. Of 156,557 patients receiving maintenance dialysis for ≥ 1year, 38,246 were included: 1093 and 37,153 in the treated and untreated groups, respectively. Although there was a numerically higher fracture incidence in the treated group, no significant difference was observed between the groups overall. As aged, the difference in fracture risk between the groups decreased. Multivariable regression analysis revealed that age, sex, fracture history (primary risk factor), diabetes, and sleep disorder were statistically significant effect modifiers of fracture risk. The numerically higher incidence of fractures in the treated group may have been due to patient background differences. Fracture risk management is essential in dialysis patients, and osteoporosis treatment should be considered at an earlier age, taking into account the patient's background.

Abstract Background Sarcoidosis-associated hypercalcemia can cause acute kidney injury (AKI); however, reports of severe cases superimposed on advanced chronic kidney disease (CKD) stage G4 requiring hemodialysis (HD) are rare. We report a case that offers important clinical insights into diagnostic pitfalls in patients with CKD and the clinical approach to identify reversible “treatable AKI.” Case presentation A man in his seventies with baseline CKD stage G4 (serum creatinine [Cr] 2.3–2.6 mg/dL, estimated glomerular filtration rate [eGFR] 19.0–23.0 mL/min/1.73m 2 ) due to nephrosclerosis was emergently admitted for moderate hypercalcemia (corrected serum calcium 13.3 mg/dL) and AKI (Cr 5.15 mg/dL, eGFR 9.3 mL/min/1.73m 2 ). Endocrinological examination revealed suppressed intact parathyroid hormone (PTH) and elevated 1,25-dihydroxyvitamin D (1,25(OH) 2 D), leading to a diagnosis of PTH-independent, vitamin D-dependent hypercalcemia. Although serum angiotensin-converting enzyme (ACE) levels were within the normal range, this was considered to be masked by the chronic use of an ACE inhibitor (imidapril). A clinical diagnosis of sarcoidosis was made on the basis of markedly elevated soluble IL-2 receptor and lysozyme levels and mediastinal lymphadenopathy. Owing to his poor general condition, tissue biopsy could not be performed. Emergency HD was promptly initiated, followed by corticosteroid therapy with prednisolone (30 mg/day) once the clinical diagnosis was strongly suspected. Following treatment, hypercalcemia normalized rapidly, and kidney function gradually improved, allowing liberation from dialysis after five HD sessions. Conclusions When encountering unexplained AKI with hypercalcemia in patients with CKD, clinicians should consider sarcoidosis as a potential underlying cause. Additionally, clinicians will perform a multifaceted evaluation including 1,25(OH) 2 D measurement. Even in severe cases requiring dialysis, early diagnosis and appropriate treatment can render the condition a “treatable AKI.”

To increase the use of home dialysis and kidney transplant, the Centers for Medicare & Medicaid Services launched the End-Stage Renal Disease Treatment Choices (ETC) model, a mandatory, randomized pay-for-performance program applied to 30% of US hospital referral regions. Its impact after 4 years of implementation is uncertain. To assess the ETC model's impact on home dialysis, kidney transplant, and transplant waitlist, as well as measure the rate of financial penalties. This retrospective cross-sectional study used traditional Medicare claims and enrollment data for beneficiaries with kidney failure linked to concurrent transplant data from the United Network for Organ Sharing from January 1, 2017 (4 years before model implementation), to September 30, 2024 (3.75 years postimplementation). Receiving dialysis treatment in a region randomly assigned to the ETC model. Primary outcomes were rates of home dialysis, kidney transplant, and transplant waitlist, as well as facility-level financial penalization. Facility-level financial penalties were assessed using Centers for Medicare & Medicaid Services-published performance data. The study population included 795 232 persons with kidney failure (mean [SD] age, 61.8 [14.4] years; 41.5% female), reflecting 20 729 696 person-months from January 1, 2017, to September 30, 2024. The rate of home dialysis increased from 12.8% to 16.7% of attributed patient-months in ETC regions (change of 3.9 percentage points [pp]) and from 13.7% to 17.3% in control regions (change of 3.7 pp), yielding an adjusted differences-in-differences of -0.1 pp (95% CI, -0.6 to 0.5 pp). The number of kidney transplants per 1000 patient-months increased from 3.3 to 4.5 in ETC regions (change of 1.2) and from 3.4 to 4.4 in control regions (change of 1.0), resulting in a differences-in-differences of 0.2 pp (95% CI, -0.1 to 0.4 pp). The percentage of patients per month on the transplant waitlist decreased from 16.1% to 15.5% in ETC regions (change of -0.5 pp) and from 17.7% to 16.7% in control regions (change of -1.0 pp). The adjusted differences-in-differences for transplant waitlist was 0.6 pp (95% CI, -0.3 to 1.6 pp). The proportion of ETC facilities receiving financial penalties increased from 13.8% in 2021 to 25.1% in 2023. Subgroup analyses showed no meaningful differential effects of the model. This cross-sectional study shows that after nearly 4 years, the ETC model was not associated with meaningful increases in home dialysis, kidney transplant, or transplant waitlist, while the proportion of facilities receiving financial penalties increased. Future value-based payment models may need to move beyond narrowly targeted financial incentives to address the broader structural and patient-level barriers that influence access to complex specialty care.

Purpose Social participation and post-traumatic growth (PTG) both exert beneficial effects on well-being of patients receiving maintenance dialysis. However, the temporal directionality of their association has remained unexamined. This study aimed to examine the bidirectional, longitudinal relationship between PTG and social participation over 1-year period among patients receiving maintenance dialysis. Methods Research data were collected from patients receiving dialysis treatment for over 3 months at two tertiary hospitals in China. A total of 193 participants completed the baseline survey, and 147 completed the second-wave survey. Self-reported questionnaires were delivered to assess their PTG and social participation. Cross-lagged analysis was used to examine the possible relationship between PTG and social participation. Results After adjusting for confounding factors, a unidirectional linear relationship was observed: higher levels of PTG at baseline were associated with greater social participation over time (β = 0.290, 95% CI: 0.151–0.430, p < 0.001), whereas baseline social participation was not significantly associated with subsequent PTG. Conclusions This study revealed low levels of social participation among patients receiving maintenance dialysis. Based on the cross-lagged analysis, PTG appears to play a contributing role in improving social participation over time.

Knowledge, attitudes and practices (KAP) of kidney care providers regarding climate change, environmental impacts of kidney care and environmentally sustainable kidney care have been assessed in diverse regions worldwide, but little is known about the perspectives of people who receive dialysis therapies. We aimed to assess the KAP of people on dialysis about these subjects. An electronic KAP survey, based on a previous survey of Canadian kidney care providers, was administered to people receiving all available dialysis modalities in a single center in Canada, from December 2024 to May 2025. A total of 69 people responded to the survey, of whom 67% identified as men, and 70% were undergoing in-center hemodialysis (ICHD), 14% home hemodialysis (HHD) and 16% peritoneal dialysis (PD). Most (87%) of the respondents felt informed about climate change to at least an average degree. Nearly half were either extremely or very concerned about climate change (44%) and the waste generated by dialysis treatments (43%), and the levels of concern differed across dialysis modalities. Overall, 51% of respondents never felt guilt or anxiety related to the carbon footprint of dialysis treatment. However, there were significant differences (χ2 test; P < .001) in the occurrence of these feelings depending on the dialysis modality (more frequent in people receiving home modalities, and more in PD than HHD). Most respondents were either very (45%) or slightly (45%) interested in obtaining more information about the themes explored in the survey. This survey showed that most respondents receiving a dialysis therapy felt informed and at least moderately concerned about climate change. Higher levels of concern about climate change and the amount of waste generated by dialysis treatment, as well as more frequent occurrence of guilt/anxiety about the carbon footprint of dialysis were observed in people on home therapies (PD and HHD) compared with ICHD.

Left ventricular diastolic dysfunction (LVDD) is common in chronic kidney disease (CKD) and is suggested to be linked to worse renal prognosis. We investigated the associations between both the ratio of early mitral inflow velocity to early diastolic tissue velocity (E/e') and LVDD grades with the risk of end-stage kidney disease (ESKD). This prospective cohort study included individuals with non-dialysis-dependent CKD from the nephrology outpatient clinics at Rigshospitalet and Herlev-Gentofte hospital, Copenhagen. All participants underwent a thorough, protocolized echocardiographic examination. The outcome was time to ESKD (defined as dialysis treatment or kidney transplantation). A total of 731 participants were included. Mean age was 57 ± 13 years and 39% were female. During a median follow-up of 3.8 years (IQR: 3.3;4.5), 102 individuals reached ESKD. In multivariable Cox regression models, both increasing continuous E/e' (HR = 1.09 [95%CI:1.03;1.15], P = 0.004, per 1 unit increase) and E/e' > 14 (HR = 3.44 [95%CI:1.44;8.26], P = 0.005) (reference E/e' < 8) were associated with ESKD, while E/e' 8-14 was not. Compared with no or indeterminate LVDD, LVDD grades 2 or 3 were associated with ESKD (HR = 2.92 [95% CI:1.44;5.94], P = 0.003), while LVDD grade 1 was not. E/e' > 14 and LVDD grade 2 or 3 demonstrated similar predictive accuracy with excellent specificity and negative predictive values, but poor positive predictive values and sensitivity. Prominent LVDD assessed by E/e' and LVDD grades was independently associated with worse renal prognosis and had similar predictive accuracy in patients with non-dialysis dependent CKD.

Starting dialysis is challenging for both patients and their informal caregivers. Caregivers help patients adapt and adhere to treatment by providing practical and emotional support, but these responsibilities can take a considerable toll on them. Because little is known about how caregiver experiences evolve after dialysis initiation, we (1) assessed the trajectory of experiences and health-related quality of life (HRQoL) of caregivers of patients on dialysis during the first year of dialysis, (2) assessed whether differences in these trajectories exist between caregivers of home dialysis patients and those of in-center hemodialysis (ICHD) patients, and (3) explored in which domains caregivers desire support over time. Multicenter, longitudinal cohort study. 202 dyads of incident dialysis patients and their adult informal caregivers. Home dialysis and ICHD. Positive experiences, caregiver burden, depressive symptoms, and HRQoL. Descriptive analyses of desired support and linear mixed models to assess and compare trajectories. All but 2 of the caregiver outcomes deteriorated over the first year of dialysis. The change over time was significant for positive experiences (β, -1.44 [95% CI, -2.36 to -0.51]), depressive symptoms (β, 5.20 [95% CI, 3.15-7.25]), physical HRQoL (β, -5.73 [95% CI, -9.20 to -2.26]), general HRQoL (β, -0.13 [95% CI, -0.17 to -0.07]), and perceived health status (β, -9.40 [95% CI, -15.12 to -3.67]), but not for caregiver burden (β, 0.85 [95% CI, -0.02 to 1.72]) or mental HRQoL (β, -2.99, [95% CI, -6.93 to 0.94]). No differences in the trajectories were found between caregivers of patients receiving home dialysis and ICHD, but these groups did differ in desired support. Small sample size of subgroups. Informal caregivers experience significant challenges during the first year of dialysis, marked by a notable decline in positive experiences, physical and general HRQoL, and perceived health status, alongside an increase in depressive symptoms, regardless of dialysis location. These findings underscore the need for targeted support for informal caregivers in dialysis care. The initiation of maintenance dialysis treatments presents notable challenges not only to patients but also to their informal caregivers, such as spouses, other family members, or friends. However, there is limited understanding of how these caregivers are affected over time. Therefore, we studied caregivers' experiences and health-related quality of life (HRQoL) during the first year of dialysis treatments received by the individual for whom they provide care. We found that caregivers reported a decline in positive experiences, worse physical and general HRQoL, and more depressive symptoms over time, whether dialysis was implemented in the home or a dialysis center. However, the types of support needed by caregivers of home and in-center dialysis patients differed. These findings underscore the need for targeted support for informal caregivers in dialysis care.

Background/Objectives: Choosing a treatment modality for kidney failure represents one of the most complex decisions faced by patients with advanced chronic kidney disease. Decisional conflict may arise when patients feel uncertain, insufficiently informed, or unclear about their personal values, potentially affecting treatment satisfaction and long-term adaptation. This study examined decisional conflict among patients initiating dialysis and explored how patients described their experiences during the decision-making process. Methods: This exploratory mixed-methods study was conducted at a university-affiliated hospital in Portugal and included 32 adults initiating dialysis following structured pre-treatment education about kidney failure treatment options. Decisional conflict was assessed using the Decisional Conflict Scale, and sociodemographic data were collected. Participants' reflections expressed during questionnaire administration were documented verbatim and evaluated using thematic analysis. Quantitative data were analyzed using non-parametric statistics. Results: Overall decisional conflict levels were low, although the uncertainty subscale showed a moderate mean score. Twenty-five percent of participants reported moderate to high uncertainty regarding decision implementation. Age was positively associated with the "informed" subscale, suggesting that older participants reported greater difficulty feeling adequately informed during decision-making. Qualitative findings identified three themes: lack of engagement in decision-making, perceived absence of choice, and resignation and coping. These themes reflected the influence of clinician authority, the perception of dialysis as an inevitable life-preserving intervention, and patients' emotional adaptation to treatment. Conclusions: Decisional conflict during dialysis initiation appears to be shaped by the interplay between information exchange, values clarification, and perceived autonomy. These findings highlight the importance of patient-centered communication strategies that support deliberation and meaningful engagement in treatment decisions.

Background/Objective: Older patients with end-stage renal disease who receive dialysis often discontinue treatment before the end of their lives. However, the trajectory of family caregiving in this specific context remains under-researched. This study explored the experiences of family members caring for older patients with end-stage kidney disease (ESKD), from the introduction of dialysis to end-of-life care. Methods: This qualitative descriptive study included three family members caring for older patients with end-stage renal disease who were undergoing dialysis in Japan. Data were collected through semi-structured, one-on-one interviews and analyzed using inductive qualitative content analysis within a qualitative descriptive design. Results: The results identified seven categories regarding the family's experience from dialysis initiation to end-of-life care: Key findings, particularly regarding the terminal phase, included 'shock of dialysis treatment discontinuation', 'last moments shared with the patient', 'nostalgic memories of the patient over time, and 'reflections on end-of-life care for the patient.' Families described a process wherein the sudden need for proxy decision-making, often without prior discussion, was linked to feelings of regret. Conclusions: The findings describe the continuous experiences of family caregivers in the Japanese context. These exploratory insights suggest that the absence of early Advance Care Planning may contribute to caregiver distress during the withdrawal phase. The results highlight the need for culturally sensitive renal supportive care that fosters communication and understanding of patients' wishes to mitigate the ethical burdens on families.

Patients receiving dialysis treatments suffer from a high rate of systemic comorbid conditions, including cardiovascular disease, mineral and bone disorders, chronic inflammation, amyloidosis, and recurring infections, leading to increased morbidity and mortality rates despite the progress made in the field of renal replacement therapies. The aforementioned conditions result from the continued dysregulation and overproduction of molecular biomarkers, which cannot be adequately monitored by traditional, intermittent laboratory tests. This review critically assesses the newly developed biosensor technologies for the detection of major dialysis biomarkers, including potassium, phosphorus, parathyroid hormone (PTH), β2-microglobulin, creatinine, and cystatin C, with special emphasis on biosensors based on electrochemistry, optics, impedimetry, nanophotonics, and biological engineering techniques. These recent biosensors have been evaluated based on their analytical performance, the biofluids used in the studies, and their suitability for measuring relevant concentrations of these biomarkers. Special attention is given to biosensors capable of continuous operation or minimally invasive sampling, as well as to newly developed biofluid sampling techniques, including microneedle-, microtube-, and micropillar-based systems, for the long-term monitoring of the biomarkers in the serum of patients receiving dialysis treatments. The biosensing techniques for measuring infection biomarkers have also been discussed, given the high risk of bloodstream and access infections among patients receiving dialysis. The limitations of these biosensors include biofouling, calibration drift, and their integration into the dialysis treatment workflow. Finally, the future prospects of the recent biosensors offer the possibility of the proactive management of the high rate of comorbid conditions in this high-risk population of patients receiving dialysis treatments.

Fushen Granule (FSG), a Chinese medicine formular, was used clinically to improve the efficiency of dialysis in end-stage renal disease patients receiving peritoneal dialysis treatment. However, the mechanisms of its antifibrotic effect on peritoneal fibrosis (PF) have not yet been studied. In this study, we aimed to identify the potential mechanism of FSG in intervening in PF. Network pharmacology analysis and molecular docking were used to predict the related ingredients and potential targets of FSG in treating PF. TGF-β1 induced MeT5A cells were used for in vitro verification. Label-free proteomics analysis was performed to detect the differentially expressed proteins in TGF-β1 induced MeT5A cells upon treatment with FSG-containing serum. Western blot and immunofluorescence assays were used to evaluate the expression of proteins related to PF and PI3K/AKT signalling. PPI network analysis showed that TP53, EGFR, HSP90AA1, AKT1, CCND1, MYC, STAT3, SRC and ESR1 constitute the core network. KEGG analysis found that the PI3K/AKT signalling pathway was significantly enriched. Molecular docking analysis indicated that the main active ingredient from the component–target network can closely integrate with targets in the PI3K/AKT signalling pathway. Proteomics analysis on TGF-β1-treated MeT5A also indicated that the PI3K/AKT signalling pathway was closely correlated with the effect of FSG in intervening PF. Further in vitro experimental validation showed that FSG decreased the protein levels of FN, Col Ⅰ, α-SMA, ITGβ3, PDK1, p-mTOR and p-AKT and reversed the expression of E-cad in TGF-β1-treated MeT5A cells. FSG showed therapeutic effects against PF, mainly by inactivating PI3K/AKT signalling.

Arteriovenous fistulas provide reliable vascular access to process high volumes of blood during hemodialysis. Fistula dysfunction can interrupt dialysis treatment and warrants prompt assessment of patency. In this study, we evaluate the diagnostic accuracy of infrared thermography as an accessible point-of-care screening tool to assess mature arteriovenous fistula patency in new flow-related complications that hinder hemodialysis. Thirty adults undergoing hemodialysis were recruited who had been referred to interventional radiology due to new flow-related complications of their mature arteriovenous fistulas, hindering hemodialysis. Assessments of fistulas were first carried out by thermography, then compared with CT angiography for validation. Thermography demonstrated all instances of stenoses and occlusions in arteriovenous fistulas and their superficial drainage veins, with 100% sensitivity, 94% specificity, 100% negative predictive value, 92% positive predictive value, and 97% accuracy rate. In one case, while thermography suggested superficial stenosis, this could not be demonstrated on CT angiography. Thermography was also able to show superficial venous aneurysmal dilatations. In six cases, fistula dysfunction was secondary to central venous stenoses, and thermography demonstrated consequent superficial venous distensions and collateralizations in the arm. Thermography shows potential to offer an accessible, portable, inexpensive, non-invasive, and radiation-free point-of-care screening tool for the assessment of arteriovenous fistula patency with high accuracy.

The high rate of people with chronic kidney disease on dialysis is a public health problem, especially in developing countries. To evaluate demographic and socioeconomic changes related to dialysis treatment in Brazil from 2002 to 2019. This descriptive, analytical study reviewed retrospective documentary data. A comparative analysis was conducted on demographic, economic, and social trends, as well as changes in dialysis service provision in Brazil between 2002 and 2019. Correlation analysis between Municipal Human Development Index (HDI-M) and the number of dialysis units was performed. There was an increase in the percentage of the older population (5.3% vs. 9.25%) and in life expectancy at birth (70.8 vs. 75.9 years). The gross domestic product (GDP) increased by 453%; the percentage of investment in public health (below 4%) was stable and the ranking of global Human Development Index decreased (73 vs 84). The increase in the prevalence of patients on chronic maintenance dialysis was greater than the increase in the number of patients in new centers (117.3% vs. 43.9%), with fewer patients receiving treatment in the North and Northeast regions. There was a positive linear correlation between the HDI-M values and the number of dialysis units (R = 0.52; 95% CI: 0.75-0.18; p = 0.006). Despite Brazil's strong economic growth and the drastic demographic changes that occurred during the study period, this progress did not translate into a higher investment in health and equitable access to dialysis treatment across the country.

The 2023 CONVINCE trial demonstrated improved survival with high-dose hemodiafiltration (HDF), prompting discussions about widespread adoption. However, this clinical advancement occurs amid growing awareness of healthcare's environmental impact, particularly dialysis treatments that consume extensive water and energy resources. This review examines the environmental implications of HDF adoption, synthesizing recent evidence on resource consumption and emerging sustainability solutions in the context of the climate crisis facing nephrology. Life cycle assessments indicate HDF has a carbon footprint 30-40% higher than conventional hemodialysis, consuming an additional 10 300 L of water per patient annually. However, recent technological innovations show promise: expanded hemodialysis (HDx) using medium cut-off membranes reduces water usage by >20% and energy consumption by >30% compared to HDF while potentially achieving similar clinical outcomes. Water conservation technologies, including reverse osmosis, reject water reuse and reduced dialysate flow protocols, can decrease environmental impact by 30-50% without any difference in patient outcomes. The adoption of HDF represents a critical test case for sustainable healthcare innovation. While the potential benefits should not be ignored, technology is not static and, if confirmed, additional sustainability work and comprehensive policy frameworks integrating environmental impact assessments into technology evaluation are urgently needed. The nephrology community must balance clinical excellence with planetary stewardship through technological innovation, resource optimization, and evidence-based environmental guidelines that benefit, not compromise, patient care.

Summary: On October 7, 2023, Tel Aviv Medical Center - Ichilov faced the immediate aftermath of Israel’s largest terror attack, launching us into the Iron Sword War. Amid overwhelming casualties, we activated our unique underground hospital, swiftly evacuating wards while continuing daily operations. This facility enabled continuous care, including dialysis and long-term treatment, sheltering patients and staff under fire. Ichilov’s extensive real-world experience with modern warfare challenges positioned us to respond to hundreds of helicopter landings and treat more than a thousand casualties, mostly soldiers. Our efforts also extended to the unique operational challenges of caring for hostages who were released later during the conflict, requiring specialized attention and a coordinated approach across multiple medical and mental health disciplines. Through prompt intervention, triage, and expanded ICU capabilities, we saved countless lives. In parallel, we opened extensive rehabilitation services and immediate mental health support for both victims and staff, ensuring a holistic approach to recovery during war. Our experience highlights the critical importance of preparedness, both through infrastructure and training. Ichilov’s readiness stemmed from rigorous planning, continuous drills, and staff familiarization with protected hospital operations. This presentation will explore the operational challenges of maintaining hospital functionality during active conflict, including staff deployment, managing resources, and overcoming the complexities of modern warfare injuries. The presentation will share practical insights from the field, ranging from rapid evacuation to post-trauma care, reinforcing the need for protected, resilient healthcare systems in the face of security threats. Ichilov’s story demonstrates that through constant preparedness, innovation, and an integrated approach, hospitals can remain a lifeline during national crises.

Although erythropoiesis-stimulating agents (ESAs) are widely used to treat anemia in patients with kidney failure, concerns have been raised about their potential to promote tumor growth. However, the association between ESA use and incidence of cancer in patients undergoing long-term dialysis remains unclear. To examine the association between ESA use and cancer development among patients receiving long-term dialysis. This nested case-control study identified patients in the Korean National Health Insurance Service database with kidney failure who began long-term dialysis treatment and received ESAs between 2006 and 2017 in Korea. Each case with incident cancer was matched with 4 controls based on age, sex, follow-up time, year of dialysis initiation, and dialysis modality. Data were analyzed between August 2024 and August 2025. ESA exposure was categorized as high or low dose according to the median of the mean weekly dose of each ESA drug. The primary outcome was newly diagnosed cancer occurring 6 months after the initiation of long-term dialysis. Conditional logistic regression, adjusted for potential confounders, was used to assess the association between ESA use and cancer development. A total of 9776 patients (mean [SD] age, 62.2 [12.0] years; 6296 [64.4%] male) undergoing dialysis were included; 2320 patients with incident cancer were matched to 7456 controls. After multivariable adjustment, high-dose ESA use was found to be associated with increased odds of cancer development (adjusted odds ratio, 1.23; 95% CI, 1.11-1.35) compared with low-dose use. Stratified by age, the odds of cancer development were 0.90 (95% CI, 0.77-1.05) among patients aged younger than 60 years and 1.47 (95% CI, 1.30-1.67) among those aged 60 years or older. In this case-control study of patients undergoing dialysis, high-dose ESA use was associated with greater odds of new cancer development. These results suggest that caution should be exercised to avoid aiming for excessively high hemoglobin levels during ESA therapy.

Aims: There are studies showing that IV iron sucrose is vasoactive and causes changes in intradialytic blood pressure in hemodialysis patients. Intradialytic hypotension has been associated with vascular thrombosis, inadequate dialysis, and increased mortality. Intradialytic hypertension, has been shown in some studies to be associated with increased cardiovascular mortality and an increase in the frequency of hospitalization. In this study, we aimed to investigate the effect of iron sucrose on intradialytic blood pressure in hemodialysis patients.Methods: In this study, 59 patients undergoing hemodialysis three times a week had their blood pressure measured before hemodialysis and recorded at minute 0. 100 mg/5 ml iron sucrose was administered as an IV infusion during the first 30 minutes of dialysis treatment, and blood pressure was measured and recorded every 30 minutes. The same patient's blood pressure was measured every 30 minutes during the next hemodialysis session without iron sucrose treatment. Results: Intradialytic hypotension developed in two different patient; one patient in the session in which iron sucrose was given and one in the session in which iron sucrose was not given. There was no significant difference in intradialytic hypertension between the groups according to all three definitions of intradialytic hypertension (p=0.134; 0.523; and 1, respectively).Conclusion: We found that iron sucrose administration does not cause both intradialytic hypotension and intradialytic hypertension.

BackgroundEarly detection of the changes of left atrial (LA) structure and function in uremic patients after peritoneal dialysis (PD) treatment facilitates clinical evaluation and early intervention. This study aimed to construct a model using the four-dimensional automatic LA quantification technique (4D-LAQ) to evaluate the impact of PD on the left atrium of patients with chronic kidney disease stage 5 (CKD-5).MethodsThis study included 109 patients with CKD-5 and 38 age- and gender-matched healthy volunteers. The required clinical and ultrasound parameters were collected from all participants. Continuous variables were expressed as mean ± standard deviation or median (interquartile range), whereas categorical variables were presented as frequency (percentage). Independent risk factors associated with PD treatment were identified using binary logistic regression analysis, which was also employed to construct a predictive model. The performance of this model was assessed using receiver operating characteristic (ROC) curve analysis, with the area under the curve (AUC) and its confidence interval (CI) calculated to quantify predictive accuracy. A P value <0.05 was considered statistically significant.Results(I) Compared with group n, the LA volume of CKD-5 patients was higher. (II) Compared with the PD group, maximum left atrial volume (LAVmax), left atrial pre-atrial contraction volume (LAVpreA), left atrial maximum volume index (LAVImax), and left atrial ejection volume (LAEV) in the CK5 stage (N-PD) group increased (P<0.05). (III) 4D-LAQ can be used to construct a risk model for predicting adverse cardiovascular events, for which LAVImax is an independent risk factor. (IV) LAVImax, New York Heart Association (NYHA) heart function classification ≥ II, and E/e' ≥14 combined had the largest AUC.ConclusionsThe 4D-LAQ technique can be used to evaluate the effect of PD on the left atrium of CKD-5 patients, and can predict the probability of adverse cardiovascular events in CKD-5 patients after PD.

Background: Chronic kidney disease is a long-term progressive condition requiringongoing dialysis treatment, which significantly affects not only patients but also theircaregivers. Caregivers of patients undergoing dialysis often experience physical,psychological, social, and financial stress due to prolonged caregiving responsibilities,frequent hospital visits, and lifestyle disruptions.Aim and Objectives: The study aimed to assess the level of stress among caregiversof patients undergoing dialysis in selected hospitals of Ambala, Haryana, and todetermine the association between caregiver stress and selected socio-demographicvariables.

Objective: To investigate the clinicopathological features, immunophenotype, molecular characteristics and prognosis of acquired cystic disease-associated renal cell carcinoma (ACD-RCC). Methods: The clinicopathological data of four ACD-RCC cases diagnosed at the Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China and one case at the Ningbo Clinical Pathology Diagnostic Center, Ningbo, China between 2018 and 2025 were collected. The clinical, histological, and immunohistochemical characteristics were analyzed. FISH and high-throughput DNA targeted next generation sequencing (NGS) were carried out. Follow-up was conducted with review of relevant literature. Results: Among the five patients, four were male and one was female, aged 45-71 years. All patients had a history of chronic kidney disease (duration 9-30 years) and received dialysis treatment. Three cases occurred in the right kidney and two in the left kidney. All were single lesions with a maximum diameter of 2.0-15.0 cm. Grossly, the tumors showed a solid-cystic appearance. Histologically, various histological patterns were observed, including cystic (4 cases), tubular (4 cases), papillary (4 cases), solid (2 cases), cribriform (2 cases), and microcystic structures (1 case). Two cases were accompanied by tumor necrosis, and one case was accompanied by sarcomatoid differentiation. The tumor cells had abundant eosinophilic cytoplasm with intracytoplasmic vacuoles, conspicuous nucleoli, and high nuclear grades (World Health Organization/International Society of Urological Pathology nuclear grade 3 or 4). Two cases had focal, clear cytoplasm. Oxalate crystals were present in all tumors. In all cases, the surrounding renal parenchyma was atrophic with multiple cysts. The cysts in three cases were lined by single-or multiple-layered eosinophilic cells, which had abundant cytoplasm and visible nucleoli. Tumor cells in all five cases expressed PAX8, CD10 and P504s. Two cases partially expressed carbonic anhydrase Ⅸ(CAⅨ). Two cases focally expressed CK7, CD117, HMB45, Melan A, TFE3, TFEB, GATA3, 2SC and ALK were negative in all cases. FH, SDHB and SMARCB1 (INI1) proteins were not deficient. TFE3 gene rearrangement was not detected in two cases using FISH with break-apart probes. High-throughput DNA targeted NGS showed that one tumor had a KMT2C mutation, one had KMT2B, TSC1, SETD2 and TP53 mutations, one had an MTOR mutation, one had a TSC2 mutation, and one had an SETD2 mutation. The five cases were followed up for 6-70 months and had no recurrence or metastasis, except one case with local recurrence and retroperitoneal lymph node metastasis four years after the surgery. Conclusions: ACD-RCC is a rare renal cell carcinoma that occurs in patients with end-stage renal disease and has unique morphological features. It is often associated with favorable prognosis and alterations in genes related to the MTOR/TSC pathway or chromatin modification.