Dialysis Treatment Research Articles

Management and Outcomes for Peritoneal Dialysis Patients Diagnosed with Abdominal Hernias.

The success of peritoneal dialysis is highly dependent on the integrity of the abdominal wall. Therefore, routine examination and treatment of abdominal hernias can prevent peritoneal dialysis (PD) failure, discontinuation, and conversion to hemodialysis. In this present study, we present our examination protocol for patients proposed for PD and our attitude in treating parietal defects in patients on peritoneal dialysis. highlight whether PD is a risk factor for the occurrence of ventral hernias, the relationship between associated pathologies and the occurrence of hernias and the need for an HD switch in the postoperative period. Between January 2016 and December 2022, a group of 133 patients proposed for insertion of a PD catheter were evaluated according to the protocol established by our hospital. Routine examination for the diagnosis of abdominal hernias and repair before starting the DP is part of the procedure. We included patients with a 3 year minimum follow-up after insertion and evaluated the incidence of parietal defects that appeared during PD treatment. Nine patients were diagnosed and operated on for abdominal hernia before starting peritoneal dialysis and none of them had a recurrence of hernia during PD. Twelve patients were diagnosed with abdominal hernias during dialysis treatment (9% incidence) and the median length of time at which parietal defects occur during PD is 12.5 months [range 2-48]. Median BMI is 27.12 [range 22.3-31.24], with a female-male ratio of 2:1 Five patients were transferred to HD, three permanently and two patients temporarily. No patient abandoned PD treatment due to the presence of an abdominal parietal defect. Diagnosis of ventral hernias prior to the time of catheterization for PD leads to a decrease in the incidence of parietal defects during PD and is mandatory in patients who are candidates for PD. Open alloplastic surgical procedures are safe procedures with a low recurrence rate in PD patients. The postoperative continuation of PD is feasible but the decision is to be made by the multidisciplinary team and individualized for each patient.

Catalytic urea electrooxidation on nickel‐metal hydroxide foams for use in a simplified dialysis device

AbstractElectrocatalytic urea removal is a promising technology for artificial kidney dialysis and wastewater treatment. Urea electrooxidation was studied on nickel electrocatalysts modified with Cr, Mo, Mn, and Fe. Mass transfer limits were observed for urea oxidation at physiological concentrations (10 mmol L). Urea oxidation kinetics were explored at higher concentrations (200 mmol L), showing improved performance, but with lower currents per active site. A simplified dialysis model was developed to examine the relationship of mass transfer coefficients and extent of reaction on flowrate, composition, and pH of the reacting stream. For a nickel hydroxide catalyst operating at 1.45 V, 37 , and pH 7.1, the model shows a minimum geometric electrode area of 1314 cm2 is needed to remove 3.75 g urea h with a flow rate of 200 mL min for continuous operation.

Reliable Stenosis Detection Based on Thrill Waveform Analysis Using Non-Contact Arteriovenous Fistula Imaging.

Hemodialysis therapy is an extracorporeal circulation treatment that serves as a substitute for renal function. In Japan, patients receive this efficient four-hour treatment, three times per week, allowing them to maintain a social life nearly equivalent to that of healthy individuals. Before the treatment, two punctures are performed to establish extracorporeal circulation, and a high blood flow rate is essential to ensure efficient therapy. Specialized blood vessels created through arteriovenous fistula (AVF) surgery are utilized to achieve high blood flow rates. Although the AVF allows safe and efficient dialysis treatment, AVF stenosis leads to a serious problem in dialysis. To early detect this abnormal blood flow, auscultation and palpation methods are widely used in hospitals. However, these methods can only provide qualitative judgment of the AVF condition, so the results cannot be shared among other doctors and staff. Additionally, since the conventional methods require contact with the skin, some issues require consideration regarding infection and low reproducibility. In our previous study, we proposed an alternative method for auscultation using non-contact optical imaging technology. This study aims to construct a reliable AVF stenosis detection method using Thrill waveform analysis based on the developed non-contact device to solve the problem with the contact palpation method. This paper demonstrates the performance validation of the non-contact imaging in the normal AVF group (206 total data, 75 patients, mean age: 69.1 years) and in the treatable stenosis group (107 total data, 17 patients, mean age: 70.1 years). The experimental results of the Mann-Whitney U test showed a significant difference (p=0.0002) between the normal and abnormal groups, which indicated the effectiveness of the proposed method as a new possible alternative to palpation.

A novel hybrid prosthesis for open repair of acute DeBakey type I dissection with malperfusion: Early results from the PERSEVERE trial

BackgroundOutcomes after hemiarch repair for acute DeBakey type I aortic dissection (ADTI) remain unfavorable, with high rates of major adverse events and negative aortic remodeling. The PERSEVERE study evaluates the safety and effectiveness of the AMDS Hybrid prosthesis, a novel bare metal stent, in patients presenting with preoperative malperfusion. MethodsPERSEVERE is a prospective single-arm investigational study conducted at 26 sites in the United States. Ninety-three patients underwent ADTI aortic dissection repair with AMDS implantation. The 30-day primary endpoints are a composite rate of 4 major adverse events and the rate of distal anastomotic new entry tears. The secondary endpoints include aortic remodeling. ResultsClinical malperfusion was documented in 76 patients (82%); only radiographic malperfusion, in 17 (18%). The median follow-up in the 93 patients was 5.6 months. Within 30 days, 9 patients died (9.7%), 10 patients (10.8%) experienced new disabling stroke, and 18 patients (19.4%) had new-onset renal failure requiring ≥1 dialysis treatment. There were no cases of myocardial infarction. The composite rate of major adverse events (27%) was lower than that reported in the reference cohort (58%). There were no distal anastomotic new entry tears. Technical success was achieved in 99% of patients. Early remodeling indicated total aortic diameter stability, true lumen expansion, and false lumen reduction in the treated aortic segment. ConclusionsEarly results show significant reductions in major adverse events and distal anastomotic new entry tears, successfully meeting both primary endpoints. The technical success rate was high. AMDS can be used safely in patients with ADTI dissection with malperfusion.

The Effect of Intradialytic Exercise on Fatigue in Patients Undergoing Hemodialysis: A Literature Review

Introduction: Fatigue is a common and debilitating symptom experienced by patients undergoing hemodialysis. Intradialytic exercise, which involves physical activity performed during dialysis treatment, has been studied as a potential intervention to alleviate this fatigue. This literature review aims to determine the effects of intradialytic exercise on fatigue in patients undergoing hemodialysis. Methods: The literature review search was carried out using three databases, namely Google Scholar, PubMed, and Science Direct. The inclusion criteria for the literature review search were articles with publication years 2019-2024 in Indonesia and English. The articles could be open access. The keywords used in searching for the article were “intradialytic AND fatigue.” Results: The literature review identified fifteen studies for inclusion in the final analysis. Three articles used randomized control trials, seven articles used quasi-experiments, and five articles used pre-experiments. Many types of intradialytic exercises during hemodialysis were discovered. Conclusion: Intradialytic exercises have proven successful in reducing the level of weakness in patients undergoing hemodialysis. Fifteen research articles were found to support the provision of intradialytic exercises to patients undergoing hemodialysis. Intradialytic exercises can include active movement exercises, leg exercises, and relaxation movements.

Ethical and legal aspects of end of life in dialysispatients: an Italian point of view.

In the Western world, thanks to continuous progress in the medical field, and to changes in society,the concept of death seems to be increasingly replaced by that of "keeping alive at all costs". Thus also dialysis, a life-sustainingtreatment for patients suffering from kidney failure, in some cases can no longer be seen as a treatment aimed at prolonging life, but as a treatmentto temporarily avert death. In fact, the literature highlights that dialysis is not always associated with greater lifeexpectancy and better quality of life for fragile patients with kidney failure. This point-of-viewpaperdiscusses legal and ethical principles of respect for patient autonomy (beneficence, non-maleficence, justice and professional integrity) inherent in the choice to suspend or tonot start dialysis treatment, while following apathway ofconservative and/or palliative therapy.

Who decides on peritoneal dialysis treatment? A decision analysis for patients with kidney failure.

Peritoneal dialysis, a home-based treatment, enhances patient well-being but is less preferred in Taiwan. This study uses in-depth interviews and ranking surveys to examine the decision-making process of 25 patients (13 male, 12 female, aged 31-80) who initiated peritoneal dialysis. Findings reveal that physicians significantly influence dialysis choices, with their expertise and leadership being core factors. Patients' participation in decision-making is categorized as "active" or "passive" based on their knowledge and acceptance of treatments. Family members also play a crucial role in decisions for patients relying on familial care. Trust in physicians' recommendations is crucial, emphasizing the importance of a strong doctor-patient relationship and ongoing support to boost patient confidence in peritoneal dialysis.

Left Atrial Coupling Index Predicts Heart Failure in Patients with End Stage Renal Disease.

Background and Objectives: We aimed to ascertain the predictive power of the left atrial coupling index (LACI) in patients with end stage renal disease (ESRD) for heart failure with preserved ejection fraction (HFpEF). Materials and Methods: This is a retrospective study including 100 subjects between 18 and 65 years of age with ESRD and not on dialysis treatment. Patients were divided into groups with and without HFpEF. The LACI was defined as the ratio of the left atrial volume index (LAVI) to the a' wave in tissue Doppler imaging (TDI). Statistical analyses were performed, including univariate and multivariate regression analyses. Results: The mean age of the participants was 47 ± 13.3 years. Individuals with HFpEF exhibited a higher LACI. Univariate and multivariate regression analyses demonstrated that the predictive capacity of the LACI for HFpEF was considerably higher than that of the LAVI and other echocardiographic parameters. Conclusions: Higher LACI levels were consistently related to the presence of HFpEF in ESRD patients. The LACI can be easily obtained in daily practice using conventional Doppler echocardiographic measurements during left atrial functional assessments.

The efficacy of sacubitril/valsartan in patients receiving peritoneal dialysis with diabetes and heart failure with preserved ejection fraction.

To investigate the efficacy of sacubitril/valsartan in the treatment of peritoneal dialysis (PD) in patients with diabetes and heart failure with preserved ejection fraction (HFpEF). Patients with diabetes who underwent PD and had HFpEF (n = 64) were divided into two groups: the experimental group (n = 31), which was administered sacubitril/valsartan, and the control group (n = 33), administered valsartan alone. Data were collected before and after treatment to compare the inter-group changes in cardiac function indexes, residual renal function (RRF), and PD adequacy indexes. Compared with the control group, the N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were lower in the experimental group after treatment (Wilcoxon test, p < 0.05). The descent ranges of NT-proBNP, left ventricular end-systolic dimension, and left ventricular fraction shortening, as well as increases in the amplitude of left ventricular ejection fraction after treatment were better in the experimental group than in the control group (t-test, p < 0.05). The descent ranges of residual renal glomerular filtration rate, residual renal Kt/Vurea, and residual renal creatinine clearance, as well as increases in the amplitude of β2-microglobulin, were lower in the experimental group than in the control group (Wilcoxon test, p < 0.05). However, there were no significant differences between the two groups in the descent ranges of the PD adequacy indexes (Wilcoxon test, p > 0.05). Hyperkalemia occurred in 8 cases (25.81%) in the experimental group and 13 cases (39.39%) in the control group, while hypotension occurred in 2 cases (6.45%) and 1 case (3.03%), respectively. No other adverse effects were observed in either group. The findings suggest that sacubitril/valsartan can safely and effectively improve RRF and cardiac function in patients with diabetes combined with HFpEF receiving PD, but it has little effect on PD adequacy.

Development of a Resource for Health Professionals to Raise Advance Care Planning Topics During Kidney Care Consultations: A Multiple User-Centered Design

Rationale & ObjectivePlanning and delivering treatment pathways that integrate end-of-life care, frailty assessment and enhanced supportive care is a service priority. Despite this, people with kidney failure are less likely to have an advance care plan, and receive hospice and palliative care, compared to other chronic illness populations. This is linked to health professionals feeling unskilled initiating conversations around future treatment and care options. This article describes research underpinning the development of a guide for kidney health professionals discussing end-of-life and advance care planning options with people with kidney failure and family members. Study DesignThe study comprised two parts: an initial cross-sectional qualitative approach using in-depth interviews with older adults with kidney failure and (bereaved) carers, followed by resource development with input from multiple stakeholders. Setting & ParticipantsOlder adults with kidney failure, and (bereaved) carers, recruited from two renal units in the North of England, and via online advertisements with national UK based, kidney patient charities. Resource development included input from co-applicants, independent advisory committee, patient and public involvement team, multidisciplinary health professionals and academics in the UK and Denmark. Analytical ApproachThematic analysis was used to analyze the data. ResultsTwenty-seven people were interviewed: older adults with kidney failure (n=18), carers (n=5), bereaved carers (n=4). Five themes are described: the context within which end-of-life conversations take place, preferences for end-of-life treatment and care, family members’ role and needs in supporting people with kidney failure at the end-of-life, expectations and experience of dialysis treatment, beliefs and experiences of death and dying. LimitationsParticipants were mainly White, British, and receiving hemodialysis. ConclusionsPeople with (lived) experience of kidney failure informed a guide which aims to build upon health professionals existing skills and improve confidence having conversations about future treatment and care. Kidney teams have expressed interest implementing the guide in practice and within their broader communications training packages.

Emergencies in nephrology

Emergencies in nephrology are mainly acute life-threatening situations for patients. Furthermore, one needs to consider constellations that are so damaging to the kidneys that the need for permanent dialysis develops within ashort period of time. Acute kidney failure as an immediate consequence is categorized using the Acute Kidney Injury Network (AKIN) stages and is pathophysiologically subdivided into pre-, intra- and post-renal. This leads to changes in volume status, acid base and electrolytes, while the terms nephrotic and nephritic describe the amount of kidney damage and help to choose diagnostic steps wisely. Patients that are already undergoing dialysis treatment or have received akidney transplant are afurther specific group in the case of emergencies.

Profiles of Geriatric Syndromes and Resources in Older Patients with Atrial Fibrillation.

Objective: Older patients with nonvalvular atrial fibrillation (AF) are at high risk for frailty and geriatric syndromes (GSs), which modulate their individual prognosis and are therefore relevant for further management. Because few studies have evaluated the geriatric profile of older AF patients, this secondary analysis aims to further characterize the patterns of GSs and geriatric resources (GRs) in AF patients and their association with anticoagulation use. Methods: Data from 362 hospitalized patients aged 65 years and older with AF (n = 181, 77.8 ± 5.8 years, 38% female) and without AF (non-AF [NAF]; n = 181, 77.5 ± 5.9 years, 40% female) admitted to an internal medicine and nephrology ward of a large university hospital in Germany were included. All patients underwent usual care plus a comprehensive geriatric assessment (CGA) including calculation of the Multidimensional Prognostic Index (MPI) and collection of 17 GSs and 10 GRs. Patients were followed up by telephone 6 and 12 months after discharge to collect data on their health status. Results: The mean MPI score of 0.47 indicated an average risk of poor outcome, and patients with AF had a significantly higher MPI than those without AF (p = 0.040). After adjustment for chronological age, biological sex, Cumulative Illness Rating Scale (CIRS) for relevant chronic diagnoses and MPI as a proxy for biological age, AF patients had significantly more mnestic resources (63.5% vs. 33.1%, p < 0.001), a tendency for less age-appropriate living conditions (56.4% vs. 72.9%, p = 0.051) and more sensory impairment (78.5% vs. 52.5%, p < 0.001) than NAF patients. They also had a higher number of GSs (p = 0.046). AF patients on oral anticoagulants (OACs, n = 91) had less age-appropriate living conditions (48.4% vs. 64.4%, p < 0.05) and mnestic resources (36.3% vs. 54.4%, p < 0.01), but more emotional resources (80.2% vs. 65.6%, p < 0.05) and chronic pain (56% vs. 40%, p < 0.05) than patients without OACs (n = 90). Overall, mortality at 1 year was increased in patients with a higher MPI (p < 0.009, adjusted for age, sex and CIRS), with a diagnosis of AF (p = 0.007, adjusted for age, sex, CIRS and MPI), with of male sex (p = 0.008, adjusted for age, CIRS and MPI) and those with AF and treated with hemodialysis (p = 0.022, compared to AF patients without dialysis treatment). Conclusions: Patients with AF and patients with AF and OACs show differences in their multidimensional frailty degree as well as GR and GS profiles compared to patients without AF or with AF not treated with OACs. Mortality after 1 year is increased in AF patients with a higher MPI and dialysis, independently from OAC use and overall burden of chronic disease as assessed per CIRS. GRs and GSs, especially age-appropriate living conditions, emotional resources, sensory impairment and chronic pain, can be considered as factors that may modify the individual impact of frailty, underscoring the relevance of these parameters in the management of older patients.

The Effect of Dialysis Membranes on Coagulation Activation during Haemodialysis of Maintenance Haemodialysis Patients

Abstract Background Platelets, leukocytes, and the coagulation cascade are activated during hemodialysis. During hemodialysis, systemic anticoagulation is used to prevent clotting of the extracorporeal circuit which may lead either to complete clotting to the degree that prevent blood return to the patient or to a lesser extent can only affect the dialyzer membrane fibers which will decrease the effective surface area and that will decrease the session efficacy Aim of the Work The aim of the current study was to evaluate contact system activation and overall coagulation activation during in vivo hemodialysis in prevalent hemodialysis patients, using current generation dialyzer membranes. A crossover study design allowed assessment of differences among regular dialyzer membranes. Patients and Methods We performed a single-center sequential interventional clinical trial study. Twenty patients older than 18 years and treated with maintenance hemodialysis (&amp;gt;3 months) underwent 2 hemodialysis study sessions at Ain Shams University hospitals dialysis unit. Exclusion criteria were clopidogrel or anticoagulant therapy, active infection, presence of central venous catheter or arteriovenous graft and known vascular access dysfunction. Results The increase of TAT at 240 minutes after dialysis start in our study, irrespective of the dialyzer membrane used, suggests a late-onset threshold for thrombin generation, which is well before the treatment effect of the UFH is expected to have faded. The changes in TAT dynamics are in line with previously published results. Dialysis treatments were standardized except for dialyzer membrane. Hence, the differences between membranes are most likely due to differences in physicochemical characteristics. Whether these differences are clinically meaningful needs further study. Analysis costs and the exploratory set-up of the trial drove the small sample size and design of the study. A more comprehensive evaluation of the coagulation activation over a longer time period of hemodialysis treatment would be of interest. Conclusion Driven by the recent interest in the therapeutic options of specific contact system inhibitors, we aimed to evaluate contact system activation during in vivo he-modialysis. Chronic hemodialysis patients dialyzed through arteriovenous dialysis access show coagulation activation during hemodialysis, marked by increased TAT levels, despite using systemic anticoagulation to prevent macroscopic clotting of the extracorporeal circuit. The increase in thrombin generation markers was not associated with measurable contact system activation. Our results argue against effective contact system activation during hemodialysis and generate the hypothesis that novel specific contact system inhibitors alone might not suffice as anticoagulant treatment during hemodialysis.

Candida auris Response in a Tennessee Dialysis Facility, 2023

Background: Candida auris, a multi-drug resistant fungal pathogen, was introduced to Tennessee in 2021. There are limited studies on the spread of C. auris in highly specialized care settings including outpatient dialysis facilities. Facilities are concerned that C. auris transmission is difficult to prevent in this setting due to patient vulnerability, treatment frequency and length, and isolation challenges. As a result, these facilities may reject patients based on their positive colonization status. In 2023, the Tennessee Department of Health (TDH) conducted two containment-driven colonization screenings in response to a colonized patient receiving dialysis treatment for one month without their status being known to the facility. Methods: An initial point prevalence survey (PPS) was conducted to assess for ongoing transmission among dialysis patients. Patient screening was prioritized for the cohort of patients who received dialysis at the same time as the index patient (Cohort A). The screening was broadened to include patients dialyzed directly before Cohort A (Cohort B) by request of the Cohort B patients. A second PPS was conducted 7 weeks later, targeting the same cohorts. Specimens were collected through supervised patient self-collection of a skin swab from the axilla and groin. Flocked Eswabs were used for collection and transferred in Amies transport media to the Tennessee State Public Health Lab. The presence of C. auris was detected via Polymerase Chain Reaction (PCR). Results: Twenty-three patients (12 from Cohort A; 11 from Cohort B) were screened in the first PPS. One patient from Cohort A tested positive. This colonized patient was determined to be a known C. auris case first detected four months prior, but the patient’s status was never communicated to the dialysis facility from the discharging acute care facility. Eleven patients, excluding the previously identified positives, participated (9 from Cohort A; 2 from Cohort B) in the second PPS; no positives were identified. Discussion: The index patient and an additional patient identified by the PPS both received dialysis at this facility for up to 4 months without facility knowledge. These results suggest that the standard infection control practices at this dialysis facility were adequate to prevent the transmission of C. auris among dialysis patients on multiple shifts. Additionally, patient self-collection identified a known C. auris patient. Future TDH work includes further evaluating the risk of C. auris transmission and developing targeted infection prevention and control practices for the outpatient dialysis setting.

Seroprevalence and Risk Factors of Hepatitis B, C and D in Adults in Trabzon, Türkiye

Viral hepatitis are infections that can cause liver damage, become chronic, lead to cirrhosis, hepatocellular carcinoma and ultimately result in death due to their ability to spread in the community through blood and infected body fluids. The aim of this study was to determine the seroprevalence of hepatitis B (HBV), hepatitis C (HCV), and hepatitis D (HDV) transmitted through blood among individuals living in Trabzon province and to examine the factors potentially associated with seroprevalence. This cross-sectional study was conducted in Trabzon province, located in the northeast of Türkiye, including a total of 10 districts, including the central district. Since seroprevalence was calculated for HBV, HCV, and HDV in the study, the sample size was separately calculated for each, and the calculated maximum sample size of 1116 was accepted as the minimum sample size for the study. The study was completed with 1502 participants. Serological tests for HBV included HBsAg, anti-HBs, and anti-HBc IgG; for HCV, anti-HCV; and for HDV, anti-HDV were analysed. Data were evaluated for HBV risk factors using univariate analyses with Chi-square test and for multiple analyses using enter model logistic regression analysis. The mean age of the participants was 45.7 ± 16.6 years, with 767 (51.1%) being female. The prevalence of HBV seropositivity, indicating vaccination, was 23.0%, while the seroprevalence of HBV among unvaccinated adults was 27.4%. HBsAg positivity was 5.1%, and isolated anti-HBc IgG positivity was 4.2%. The proportion of individuals with HBsAg in the gray zone was 0.5%, while the positivity rates for anti-HBs and anti-HBc IgG (indicating past infection) were 17.6%. The prevalence of anti-HCV was six per thousand, while anti-HDV was not detected in the analyses. HBsAg positivity and co-infection with HCV were found in one person, and among the nine individuals positive for anti-HCV, isolated anti-HBc IgG positivity was detected in three. Increasing age, presence of a person with jaundice in the family, presence of diabetes mellitus, alcohol use and cupping therapy were identified as risk factors for HBV in the logistic regression analysis. Risk factors for HCV in univariate analyses were being over 40 years old, presence of hepatic steatosis and receiving dialysis treatment. The results of the study indicate that despite being included in our vaccination schedule and the administration of vaccines to high-risk adults, HBV still requires intensive attention as a public health problem. HCV, lacking a vaccine has been evaluated as an infectious agent that needs to be taken into consideration due to its potential risks and requires the complete implementation of individual and social precautions.

Pay-for-Performance Incentives for Home Dialysis Use and Kidney Transplant

The Centers for Medicare & Medicaid Services' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant. To assess the ETC's association with use of home dialysis and kidney transplant during the model's first 2 years and examine changes in these outcomes by race, ethnicity, and socioeconomic status. This retrospective cross-sectional study used claims and enrollment data for traditional Medicare beneficiaries with kidney failure from 2017 to 2022 linked to same-period transplant data from the United Network for Organ Sharing. The study data span 4 years (2017-2020) before the implementation of the ETC model on January 1, 2021, and 2 years (2021-2022) following the model's implementation. Receiving dialysis treatment in a region randomly assigned to the ETC model. Primary outcomes were use of home dialysis and kidney transplant. A difference-in-differences (DiD) approach was used to estimate changes in outcomes among patients treated in regions randomly selected for ETC participation compared with concurrent changes among patients treated in control regions. The study population included 724 406 persons with kidney failure (mean [IQR] age, 62.2 [53-72] years; 42.5% female). The proportion of patients receiving home dialysis increased from 12.1% to 14.3% in ETC regions and from 12.9% to 15.1% in control regions, yielding an adjusted DiD estimate of -0.2 percentage points (pp; 95% CI, -0.7 to 0.3 pp). Similar analysis for transplant yielded an adjusted DiD estimate of 0.02 pp (95% CI, -0.01 to 0.04 pp). When further stratified by sociodemographic measures, including age, sex, race and ethnicity, dual Medicare and Medicaid enrollment, and poverty quartile, there was not a statistically significant difference in home dialysis use across joint strata of characteristics and ETC participation. In this cross-sectional study, the first 2 years of the ETC model were not associated with increased use of home dialysis or kidney transplant, nor changes in racial, ethnic, and socioeconomic disparities in these outcomes.

Allo-Hemodialysis, a Novel Dialytic Treatment Option for Patients with Kidney Failure: Outcomes of Mathematical Modelling, Prototyping, and Ex Vivo Testing.

It has been estimated that in 2010, over two million patients with end-stage kidney disease may have faced premature death due to a lack of access to affordable renal replacement therapy, mostly dialysis. To address this shortfall in dialytic kidney replacement therapy, we propose a novel, cost-effective, and low-complexity hemodialysis method called allo-hemodialysis (alloHD). With alloHD, instead of conventional hemodialysis, the blood of a patient with kidney failure flows through the dialyzer's dialysate compartment counter-currently to the blood of a healthy subject (referred to as a "buddy") flowing through the blood compartment. Along the concentration and hydrostatic pressure gradients, uremic solutes and excess fluid are transferred from the patient to the buddy and subsequently excreted by the healthy kidneys of the buddy. We developed a mathematical model of alloHD to systematically explore dialysis adequacy in terms of weekly standard urea Kt/V. We showed that in the case of an anuric child (20 kg), four 4 h alloHD sessions are sufficient to attain a weekly standard Kt/V of >2.0. In the case of an anuric adult patient (70 kg), six 4 h alloHD sessions are necessary. As a next step, we designed and built an alloHD machine prototype that comprises off-the-shelf components. We then used this prototype to perform ex vivo experiments to investigate the transport of solutes, including urea, creatinine, and protein-bound uremic retention products, and to quantitate the accuracy and precision of the machine's ultrafiltration control. These experiments showed that alloHD performed as expected, encouraging future in vivo studies in animals with and without kidney failure.

Management of Chronic Heart Failure in Dialysis Patients: A Challenging but Rewarding Path.

Chronic heart failure (CHF) is a common complication and cause of death in dialysis patients. Although several clinical guidelines and expert consensus on heart failure (HF) in the general population have been issued in China and abroad, due to abnormal renal function or even no residual renal function (RRF) in dialysis patients, the high number of chronic complications, as well as the specificity, variability, and limitations of hemodialysis (HD) and peritoneal dialysis (PD) treatments, there are significant differences between dialysis patients and the general population in terms of the treatment and management of HF. The current studies are not relevant to all dialysis-combined HF populations, and there is an urgent need for high-quality studies on managing HF in dialysis patients to guide and standardize treatment. After reviewing the existing guidelines and literature, we focused on the staging and diagnosis of HF, management of risk factors, pharmacotherapy, and dialysis treatment in patients on dialysis. Based on evidence-based medicine and clinical trial data, this report reflects new perspectives and future trends in the diagnosis and treatment of HF in dialysis patients, which will further enhance the clinicians' understanding of HF in dialysis patients.

Assessment of the perceptions of health-related quality of life in Greek patients undergoing automated peritoneal dialysis with remote monitoring: A qualitative study.

This study aimed to explore in depth the lived experience and quality of life outcomes in patients receiving automated peritoneal dialysis (APD) treatment. The study adhered to the standards of the Consolidated Criteria for Reporting Qualitative Research. A total of 19 APD patients were recruited and assessed using in-depth semi-structured interviews on various aspects of life with respect to APD modality. The interviews were transcribed verbatim and analyzed using Interpretive Phenomenological Analysis. Study findings generated five superordinate themes: (a) treatment-free daily routine, (b) sleep disturbances, (c) remote care, (d) limitations of peritoneal dialysis, and (e) the dimension of chronic disease. Further analysis of the material revealed the relationship of these themes with individual patient characteristics. Overall, our findings suggest that APD characteristics contribute to the perceptions of quality of life in patients under dialysis considerably.

Analysis of the Effect of High-Dose Segmental Citrate Anticoagulation in High Flux Hemodialysis

Objective: To analyze the clinical effect of high-dose citrate in segmental extracorporeal anticoagulation for high-throughput hemodialysis. Methods: The subjects included in this study were admitted to the hospital for maintenance hemodialysis treatment from January 2021 to January 2023. All patients had a high risk of bleeding and received 4% trisodium citrate anticoagulant treatment, administered at a rate of 200 mL/h before and after the dialyzer. The anticoagulant effects achieved by the patients were observed and analyzed. Results: The total number of patients who received high-dose segmented citrate extracorporeal anticoagulation dialysis treatment was 50, with each patient undergoing 100 treatments. During the treatment, 2 patients had to end the treatment early due to transmembrane pressure exceeding 30 mmHg and an increase in venous pressure exceeding 250 mmHg; the treatment times for these patients were 20 minutes and 200 minutes, respectively. The remaining patients successfully completed the 4-hour treatment. Blood pH and calcium ion concentration in the venous pot were monitored. It was observed that before dialysis, after 2 hours of dialysis, and at the end of dialysis, the blood pH of the patients remained within a relatively normal range. Although some patient levels changed after dialysis, they remained within the normal range. No adverse reactions (such as numbness of the limbs or convulsions) were observed during the anticoagulant treatment. Conclusion: Administering 4% trisodium citrate at a rate of 200 mL/h before and after the dialyzer achieves a good anticoagulant effect, maintains the patient’s blood gas levels within the normal range at the end of dialysis, and causes no adverse reactions.