Hemodialysis For End-stage Renal Disease Research Articles

Study Protocol for a French Multicenter Randomized Controlled Trial Evaluating the Medico-Economic Impact of Surgical versus Endovascular Arteriovenous Access Creation for Hemodialysis in End-Stage Renal Disease (ENDO-FAV)

Study Protocol for a French Multicenter Randomized Controlled Trial Evaluating the Medico-Economic Impact of Surgical versus Endovascular Arteriovenous Access Creation for Hemodialysis in End-Stage Renal Disease (ENDO-FAV)

Incidence, Risk Factors, Organism Types, and Outcomes of Catheter-Related Bloodstream Infections in Hemodialysis Patients.

Background Patients undergoing hemodialysis for End-Stage Renal Disease (ESRD) are at risk for Hemodialysis Catheter-Related Bloodstream Infections (CRBSIs). This study evaluates the incidence, risk factors, organism types, and outcomes of CRBSI in adult patients on maintenance hemodialysis at King Faisal Hospital, Rwanda. Methods This was a prospective cohort study of adult patients with end-stage renal disease undergoing hemodialysis via central venous hemodialysis catheters at King Faisal Hospital, Rwanda. Upon receiving the IRB approval, 81 eligible patients, women, and men aged between 19 and 74, were enrolled. Restricted Mean Survival Time (RMST) analysis evaluated the risk factors for CRBSI. The statistical significance was determined using p-values, with a cut-off of 0.05. Results The incidence of CRBSI was found to be 0.78 episodes per 1,000 catheter-days. Acute hemodialysis catheter type and anemia were associated with increased risk for CRBSI, with a P-value less than 0.05. In addition, all CRBSI cases were due to bacteria, with 52.63% gram-negative and 47.37% gram-positive. Out of 19 CRBSI events,nine cases (47.37%) required hospitalization with a median duration of seven days. Approximately half of the CRBSIs required catheter removal. No metastatic infection or death was noted. Conclusion The present study demonstrated that our hemodialysis unit has an incidence of 0.78 episodes per 1,000 catheter-days. Catheter type and anemia were significantly associated with CRBSI.

Relationship Between Cerebrovascular Reactivity and Depression in Patients With End-Stage Renal Disease

Objective To investigate the relationship between cerebrovascular reactivity (CVR) and emotional disorders in the patients undergoing continuous hemodialysis for end-stage renal disease (ESRD).Methods The clinical data of the ESRD patients undergoing continuous hemodialysis were collected.Anxiety and depression of the patients were assessed by the Hamilton anxiety scale (HAMA) and Beck depression inventory,respectively.The cerebral hemodynamic changes during the breath holding test were monitored by transcranial Doppler sonography,and the breath-holding index (BHI) was calculated.The BHI≥0.69 and BHI<0.69 indicate normal CVR and abnormal CVR,respectively.Binary Logistic regression was employed to analyze the factors affecting the depressive state of ESRD patients.Results The group with abnormal CVR exhibited higher total cholesterol level (P=0.010),low density lipoprotein level (P=0.006),and incidence of depression (P=0.012) than the group with normal CVR.Compared with the non-depression group,the depression group displayed prolonged disease course (P=0.039),reduced body mass index (P=0.048),elevated HAMA score (P=0.001),increased incidence of anxiety (P<0.001),decreased BHI (P=0.015),and increased incidence of abnormal CVR (P=0.012).Binary Logistic regression analysis indicated anxiety as a contributing factor (OR=22.915,95%CI=2.653-197.956,P=0.004) and abnormal CVR as a risk factor (OR=0.074,95%CI=0.008-0.730,P=0.026) for depression.Conclusion Impaired CVR could pose a risk for depression in the patients with ESRD.

Association Between Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score and Arteriovenous Fistula Failure in Patients on Maintenance Hemodialysis.

Arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis in end-stage renal disease (ESRD) patients but has a significant failure rate. Atherosclerotic cardiovascular disease (ASCVD) is a major cause of mortality in ESRD patients. Atherosclerosis of the peripheral vessels may contribute to poor maturation of AVF leading to the exploration of the ASCVD score as a prognostic tool for AVF failure. Thisstudy included 110 hemodialysis patients with AVFsand aimed to examine the association between ASCVD score and AVF failure. Participants were categorized into the presence of vascular access failure (N=12) and absence of vascular access failure (N=98), and demographic and clinical data were collected. Results: The study comprised predominantly male patients (63.6%), with a notable prevalence of hypertension anddiabetes. Twelve patients experienced AVF failure, with pseudoaneurysms and thrombosis being the predominant causes. The ASCVD risk group at intermediate and high stages exhibited a statistically significant risk (relative risk (RR)=1.403; 95% CI, 1.041-1.904) of AVF failure in comparison to the low and borderline ASCVD risk groups.There was no association of age, gender (male and female), body mass index (BMI),serum calcium, serum phosphorus, intact parathyroid hormone (iPTH), and serum albumin with AVF failure. The ASCVD score emerges as a potential prognostic tool to identify dialysis patients at high risk of AVF failure, suggesting avenues for targeted interventions and improved patient care. However, limitations of the ASCVD risk estimator and study limitations, such as small sample size and absence of mortality data, warrant cautious interpretation and necessitate further exploration in larger patient populations.

#2697 Association between neutrophil-lymphocyte ratio and morbidity among patients on maintenance hemodialysis with ESRD from diabetic nephropathy

Abstract Background and Aims The prevalence of end-stage renal disease (ESRD) is on the rise in the Philippines, and the prognosis for ESRD worsens with the presence of diabetes mellitus. Although the neutrophil-to-lymphocyte ratio (NLR) is a dependable prognostic marker for mortality, its applicability as a prognostic biomarker in patients with diabetes and chronic kidney disease remains uncertain. This study seeks to establish the correlation between NLR and morbidity among Filipino patients with ESRD due to diabetic nephropathy undergoing maintenance hemodialysis. To determine the association between NLR and morbidity among Filipino patients on maintenance hemodialysis due to ESRD secondary to diabetic nephropathy. Method Among the 191 screened ESRD patients on maintenance hemodialysis, 71 were attributed to diabetic nephropathy, and only 63 met the inclusion criteria for the study. Clinicodemographic information, encompassing age, sex, height, weight, body mass index (BMI), medications, and comorbidities, was extracted from the medical records of these 63 eligible patients. Subsequently, the patients were categorized into two groups based on their baseline neutrophil-to-lymphocyte ratio (NLR) values, with a cutoff set at 3.5—forming the high NLR group (≥3.5) and the low NLR group (&amp;lt;3.5). This threshold was established considering data indicating that an NLR of ≥3.5 is associated with heightened inflammatory states, leading to increased morbidity. After a 6-month follow-up, data on the primary outcome measure, i.e., the occurrence of the disease, were collected. Results Out of the 63 patients assessed, the majority (n=39, 61.9%) had a baseline NLR value of &amp;lt;3.5, and only 2 individuals in this group developed a disease. The high NLR group comprised 24 (38.1%) patients, with 15 of them developing diseases. Among these cases, 4 (0.16%) had diabetic foot, 3 (0.125%) had pneumonia, 3 (0.125%) developed catheter-related bloodstream infections, and 2 (0.08%) had pulmonary edema. Additionally, 1 case each of coronary artery disease (0.04%), hypertensive emergency (0.04%), and calciphylaxis (0.04%) were observed. NLR demonstrated a significant association with clinical outcomes (p &amp;lt; 0.05). Conclusion In conclusion, there is a significant correlation between the neutrophil-to-lymphocyte ratio (NLR) and disease development in Filipino patients undergoing maintenance hemodialysis for ESRD attributed to diabetic nephropathy. Patients with a high baseline NLR exhibit an elevated inflammatory state and a greater susceptibility to developing disease conditions compared to those with an NLR&amp;lt;3.5. Therefore, a high baseline NLR can serve as a predictive indicator for prognosis within this specific population.

Hemodiafiltration vs. Hemodialysis in end-stage renal disease

Hemodiafiltration vs. Hemodialysis in end-stage renal disease

The relationship between heart functions and anemia in patients with end-stage renal disease receiving hemodialysis

Objective: We investigated the relationship between anemia and cardiac functions by conventional and speckle-tracking echocardiography (STE) in patients with end-stage renal disease (ESRD) receiving hemodialysis. Methods: One hundred six patients with ESRD receiving hemodialysis were included in this cross-sectional study. The conventional echocardiography and STE findings were compared between the patients with and without anemia. In addition, a comparison of the findings between the ESRD patients and healthy controls consisting of 68 participants was conducted. Results: Compared to healthy controls, ESRD patients had lower left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LVGLS), and left atrial reservoir strain (LASr) [53% (48-57) vs. 65% (62-68), -15.2 (-16.9˗ -13.6) vs. -19.7 (-16.9˗ -13.6), and -21.9 (-29.5˗ -15.3) vs. -29.9 (-35.3˗ -22.8), respectively, P-value &amp;lt;0.001 for all]. Of the ESRD patients, 70 (66%) had anemia. ESRD patients with anemia had higher interventricular septum (IVS), posterior wall (PW), and left atrial volume index (LAVi) values than patients without anemia. In addition, ESRD patients with anemia had lower LVEF, LVGLS, and LASr than patients without anemia [median (IQR), 13 (12-15) vs. 12 (11-14), P=0.004, 13 (12-15) vs. 12 (11-13.5), P&amp;lt;0.005, 43 (35-55) vs. 34.7 (28-50), P=0.013, 52 (48-55) vs. 56 (47.5-60), P=0.016, -14.6 (-16.4˗ -13.5) vs. -16 (-18.6˗ -14.7), P=0.003, and -21.6 (-30.5˗ -16.3) vs. -30.5 (-33.6˗ -23.3), P=0.006, respectively]. In multivariable logistic regression analysis, diabetes, PW, LASr, and LVGLS were independently associated with the presence of anemia in ESRD patients. Conclusion: Our study confirmed impaired cardiac mechanics in ESRD hemodialysis patients and showed that anemia was associated with further worsening cardiac mechanics in this population.

Cost-effectiveness of dialysis and kidney transplantation to treat end-stage renal disease in Ukraine.

Aim: To determine the economic feasibility of using kidney transplantation compared to hemodialysis in end-stage renal disease in the long term in countries with a low and medium level of economic development using the example of Ukraine. Materials and Methods: The cost effectiveness analysis method was used. Conducted Markov modeling and comparison of the consequences of kidney transplantation and hemodialysis in terms of treatment costs and the number of added years of life for a cohort of 1,675 patients were carried out. The incremental cost-effectiveness ratio is defined. Results: Based on the results of modeling, it was determined that among 1,675 patients with end-stage kidney disease in Ukraine, 1,248 (74.5%) will remain alive after 10 years of treatment when kidney transplantation technology is used. The highest costs will be in the first year ($25,864), and in subsequent years - about $5,769. With the use of hemodialysis technology, only 728 patients (43.5%) will be alive after 10 years, the cost of treating one patient per year is $11,351. The use of kidney transplantation adds 3191 years of quality life for 1675 patients compared with hemodialysis (1.9 years per patient). Conclusions: Kidney transplantation is an economically feasible technology for Ukraine, as the incremental cost-effectiveness ratio is $4694, which is 1.04 times higher than Ukraine's GDP per capita. The results of the study allow us to recommend that decision-makers in countries with a low and medium level of economic development give priority in financing to renal transplantation.

Study the effect of urokinase-type plasminogen activator (UPA) and some biochemical parameters in Iraqi hemodialysis patients with type 2 diabetes

Abstract The most common cause of end-stage renal disease (ESRD) and leading ultimately to hemodialysis (HD) is type 2 diabetes mellitus (T2DM). The current study aims to assess the role of serum urokinase plasminogen activator (UPA) levels among Iraqi hemodialysis patients with ESRD with type 2 diabetes. The study encompassed 50 patients aged 40–74 years (35 males and 15 females), admitted to the Iraqi dialysis center at Baghdad Teaching Hospital, Al-Hayat Center at Al-Karama Teaching Hospital, and Hamida Al-Misfah Dialysis Center in Imam Al-Kadhimin Medical City for the period from October 2022 to February 2023. Were diagnosed based on previous medical reports, and laboratory tests by a consultant nephrologist. UPA, Blood. Urea, Creatinine, fasting serum glucose (FSG), HbA1c, Insulin, HOMA-IR, and lipid profile levels were determined. The present study showed a significant increase in serum UPA levels in HD patients in ESRD with T2DM compared to control. In addition, there was an important negative correlation between UPA and Hb1AC, FSG, and a positive correlation with VLDL-C and TG in HD patients in ESRD with T2DM patients. This study demonstrates increased UPA serum levels in HD in ESRD with T2DM patients and associated with FSG, Hb1AC, TG, and VLDL this shows that it can be considered a good marker for the development of diabetes complications, the most important of which is diabetic kidney disease (DKD).

Eye movement desensitisation and reprocessing: part 3 – applications in physical health conditions

SUMMARYEye movement desensitisation and reprocessing (EMDR) is a psychological therapy that addresses trauma, stress and emotional distress. It has been successfully used in the management of various psychiatric disorders. This article shows that it may also be safely used to manage the psychological distress arising from a variety of physical health conditions and in so doing, reduce the illness burden from conditions such as various cancers, traumatic childbirth, tokophobia, pre-eclampsia, myocardial infarction, haemodialysis in end-stage renal disease, and acute postoperative pain. It can be a stand-alone treatment for hyperemesis gravidarum and tinnitus. The article examines the rationale and evidence for its use in these conditions and suggests areas where more research is needed. Adding EMDR therapy to the range of available interventions in general hospitals has the potential to improve the health and well-being of patients in these settings.

Abstract #1404669: Diazoxide in the Treatment of Asymptomatic Refractory Hypoglycemia in End Stage Renal Disease

Diabetic patients with end-stage renal disease (ESRD) treated with insulin or any other diabetic agent show high variations in their glucose metabolism, lower insulin clearance level, and uncertain accuracy of glycemic control measurements. Therefore, these patients are at a greater risk of developing hypoglycemia. Diazoxide use in the treatment of spontaneous and refractory hypoglycemia in this population has not been well documented. We report a case of a young diabetic male that has been successfully treated with diazoxide for his asymptomatic refractory hypoglycemic episodes. A young man with type 2 diabetes mellitus complicated by diabetic nephropathy, on hemodialysis for ESRD, presented with shortness of breath due to COVID pneumonia. After resolution of his infection, he was noted to have recurrent asymptomatic hypoglycemic episodes, although he has been off his diabetes medications for the past few years due to worsening of his kidney function. His oral intake was adequate and there was no concern for malnutrition, or any substance use. From the testing performed, we were able to exclude exogenous insulin or insulin secretagogues use and the presence of insulin antibodies. Insulin and noninsulin (insulin-like growth factor) mediated mechanisms were also ruled out. Since he was having recurrent and refractory asymptomatic hypoglycemic episodes and to minimize the need for supplemental dextrose containing fluids, he was started on diazoxide at 3 mg/kg/day. Knowing the risk of fluid retention with diazoxide, this patient on hemodialysis tolerated it well. Diazoxide helped reduce his episodes of hypoglycemia and he was then safely discharged on it. In ESRD, hypoglycemia can be explained by the impaired contribution of the kidneys to gluconeogenesis and glucose release, as well as the higher insulin levels caused by insulin resistance and decrease in insulin clearance. When his hypoglycemia persisted even after the resolution of his infection, further testing and work-up was done and other causes of hypoglycemia were ruled out. Generally, diazoxide is used as a treatment to manage the symptoms of hypoglycemia in congenital hyperinsulinism, insulinomas and post bariatric surgery cases of hyperinsulinemic hypoglycemia. However, it has not been the optimal treatment when it comes to treating hypoglycemia in ESRD patients because of its side effects; specifically, fluid retention, and electrolyte imbalances. In our case, the patient was treated with diazoxide as a last resort, despite its known side effects and the limited documentation of its use in ESRD patients. Actually, a few other case reports, have also shown promising results with the use of diazoxide for that purpose with no or minimal side effects. However, there are not enough studies that have shown the benefits or risks of long-term treatment of diazoxide in ESRD patients, an area of growing interest.

Non-alcoholic fatty liver disease in diabetes mellitus patients on chronic hemodialysis - A case series addressing cardiovascular and mortality risks.

Non-alcoholic fatty liver disease (NAFLD) has an important role in the pathogenesis of cardiovascular diseases in the population with diabetes and it is highly prevalent in end-stage renal disease (ESRD) patients. This case series describes NAFLD associated factors and survival in type 2 diabetes patients (T2DM) who have ESRD treated with hemodialysis. NAFLD prevalence in patients with T2DM and ESRD is 69.2%. A high number of patients (15 out of 18) have obesity evaluated by calculating body mass index (BMI) and bioimpedance measurements. Patients with NAFLD have higher cardiovascular mortality risk, 13 of 18 patients were already diagnosed with coronary heart disease, 6 of 18 had cerebrovascular disease, and 6 of 18 had peripheral artery disease. Fourteen patients were treated with insulin, two patients with sitagliptin (renal adjusted dose of 25mg/day) and two patients with medical nutrition therapy, with an HbA1c ranging from 4.4 to 9.0%. After one-year follow-up 7 of 18 patients died, the causes having roughly equal proportions: myocardial infarction, SARS-CoV2 infection, and pulmonary edema. In conclusion, our population of type 2 diabetic patients with ESRD in hemodialysis had a prevalence of ultrasound-diagnosed NAFLD of 69.2%. Also, this population had a high death rate at one-year follow-up, cardiovascular causes being among the most common.

Evaluation of plasma doravirine concentrations in patients with HIV-1 undergoing hemodialysis

The pharmacokinetics of doravirine (DOR) have not been clarified in patients undergoing hemodialysis (HD). In this study, we evaluated the pharmacokinetics of DOR in four HIV-1-infected patients undergoing HD who were administered DOR. The participants were patients undergoing HD for end-stage renal disease and were administered DOR. DOR was administered once daily (one tablet of 100 mg), every evening. On days of HD treatment, DOR was administered after the end of the procedure. After administration of DOR for at least 1 week, the plasma DOR concentration was measured. The median plasma trough DOR concentration was 766.9 ng/mL (range: 509–1085 ng/mL). The median DOR clearance by HD, DOR elimination rate, half-life (T1/2) of plasma DOR concentration during HD, and T1/2 during the non-HD period were 85.04 mL/min, 73.12%, 7.71 h, and 13.76 h, respectively. The T1/2 during the HD period was significantly shorter than the T1/2 during the non-HD period (p = 0.0030). In this study, elimination of DOR by HD was confirmed. Viral suppression was maintained in all patients undergoing HD, and none had adverse events or safety problems. As DOR is eliminated by HD, monitoring its plasma concentration is considered necessary for clinical use.

Multifactorial analysis of renal anemia-associated substandard hemoglobin levels and prevalence of anemia in patients on maintenance hemodialysis in Liaoning Province: a cross-sectional study

In hemodialysis (HD) patients, anemia is greatly improved due to regular weekly use of iron and erythropoietin (EPO), but a large number of patients still show persistent anemia. We do a survey to elucidate the influencing factors that contribute to the failure of hemoglobin (Hb) to meet the standard and provide epidemiological data reference for promoting the recognition of renal anemia and improving the treatment effect of renal anemia. The clinical data of End-Stage Renal Disease (ESRD) HD patients in 22 tertiary hospital HD centers in Liaoning Province from September 2021 to June 2022 were collected by convenient sampling. According to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) anemia diagnostic criteria. The standard of Hb compliance: Hb ≥110 g/L is considered as Hb compliant, and Hb <110 g/L as Hb non-compliant. The factors influencing Hb up-to-standard in ESRD HD patients and their correlations were analyzed by comparison between the two groups. The results of this study showed that among the 1,652 ESRD patients investigated in Liaoning Province, the prevalence rate of anemia was 89.29% (1,475/1,652), and the Hb compliance rate was 46.25% (764/1,652). The Hb compliance rate in maintenance hemodialysis (MHD) patients with different primary diseases was statistically significant (P<0.05). Compared with the Hb non-standard group, the gender, dialysis access, HD frequency, concurrent infection, primary disease of ESRD patients, red blood cell (RBC) count, hematocrit (HCT), mean RBC Hb concentration, mean RBC Hb content, platelet (PLT), albumin (ALB), total protein (TP), serum creatinine (Cr), serum calcium (Ca), serum potassium (K), ferritin (Fer), serum iron (SI), and transferrin (TRE) saturation were significantly different between both groups (P<0.05). Adrenaline was an independent risk factor affecting Hb failure in ESRD patients (OR =1.001, 95% CI: 1.000-1.002); dialysis frequency (OR =0.726, 95% CI: 0.601-0.878), ALB (OR =0.959, 95% CI: 0.929-0.990), TP (OR =0.982, 95% CI: 0.968-0.996), serum Cr (OR =0.959, 95% CI: 0.929-0.999), and SI (OR =0.961, 95% CI: 0.940-0.982) were protective factors affecting Hb failure in ESRD patients (P<0.05). Pearson correlation analysis showed that ALB, TP, serum Cr, serum Ca, serum K, SI, and TRE saturation were positively correlated with Hb (P<0.05). The anemia rate of ESRD patients treated with MHD in Liaoning Province is high. Based on the results, increasing the frequency of dialysis can improve anemia. Parathyroid hormone levels need to be controlled.

NT-proBNP and stem cell factor plasma concentrations are independently associated with cardiovascular outcomes in end-stage renal disease hemodialysis patients.

End-stage renal disease (ESRD) treated by chronic hemodialysis (HD) is associated with poor cardiovascular (CV) outcomes, with no available evidence-based therapeutics. A multiplexed proteomic approach may identify new pathophysiological pathways associated with CV outcomes, potentially actionable for precision medicine. The AURORA trial was an international, multicentre, randomized, double-blind trial involving 2776 patients undergoing maintenance HD. Rosuvastatin vs. placebo had no significant effect on the composite primary endpoint of death from CV causes, nonfatal myocardial infarction or nonfatal stroke. We first compared CV risk-matched cases and controls (n = 410) to identify novel biomarkers using a multiplex proximity extension immunoassay (276 proteomic biomarkers assessed with OlinkTM). We replicated our findings in 200 unmatched cases and 200 controls. External validation was conducted from a multicentre real-life Danish cohort [Aarhus-Aalborg (AA), n = 331 patients] in which 92 OlinkTM biomarkers were assessed. In AURORA, only N-terminal pro-brain natriuretic peptide (NT-proBNP, positive association) and stem cell factor (SCF) (negative association) were found consistently associated with the trial's primary outcome across exploration and replication phases, independently from the baseline characteristics. Stem cell factor displayed a lower added predictive ability compared with NT-ProBNP. In the AA cohort, in multivariable analyses, BNP was found significantly associated with major CV events, while higher SCF was associated with less frequent CV deaths. Our findings suggest that NT-proBNP and SCF may help identify ESRD patients with respectively high and low CV risk, beyond classical clinical predictors and also point at novel pathways for prevention and treatment.

The Performance of Risk Scores for Bleeding and Ischemia as Outcome Predictors in Acute Myocardial Infarction Patients with End-Stage Renal Disease.

In patients with end-stage renal disease (ESRD), acute myocardial infarction (AMI) increases the risks of cardiovascular events, death, and bleeding. Several scores have been developed for predicting ischemic and bleeding outcomes in AMI patients, but none have been validated specifically for ESRD patients. To compare and validate different risk scores as predictors of ischemic and bleeding outcomes in AMI patients with ESRD. This retrospective study enrolled 340 patients who had received percutaneous coronary intervention for AMI while undergoing maintenance hemodialysis for ESRD. Ischemic risk scores (TIMI-STEMI, TIMI-NSTEMI, GRACE, DAPT) and bleeding risk scores (PRECISE-DAPT, CRUSADE, ACUITY, ACTION, SWEDEHEART) were calculated. The ischemic outcome mainly focused on major adverse cardiovascular events (MACEs) within 14 days after hospitalization, and the bleeding outcome was 14-day major bleeding according to the CRUSADE criteria. The GRACE score was superior in discriminating ischemic outcomes, especially in 14-day MACEs [area under curve (AUC) 0.791, p < 0.001]. None of the scores could ideally discriminate 14-day CRUSADE major bleeding, while the PRECISE- DAPT score had the best discriminative power (AUC 0.636, p < 0.001). Either GRACE score > 222 or PRECISE-DAPT score > 48 was associated with higher net adverse cardiovascular events (a composite of 14-day MACEs and 14-day CRUSADE major bleeding). In AMI patients with ESRD, the GRACE score can effectively discriminate the risk of short-term ischemic events. None of the scores could ideally discriminate the bleeding risk, but a high PRECISE-DAPT score still represented a higher rate of bleeding events.

A Four-Year Report on Renal Outcomes Following the Elective Withdrawal of Long-Term Renin-Angiotensin-Aldosterone Blockade in a Cohort of Patients With Otherwise Inexplicable New-Onset and Progressive Acute Kidney Injury

Background Renin-angiotensin-aldosterone (RAAS) blockade is acclaimed, by consensus, to be renoprotective in both diabetic and non-diabetic chronic kidney disease (CKD). Contradictory reports exist regarding renal and cardiovascular outcomes after stopping RAAS blockade in advanced CKD. A few prospective, non-randomized, cohort studies have demonstrated improvement in kidney function after discontinuation of RAAS blockade. In this study, we investigated renal and mortality outcomes following the elective withdrawal of RAAS blockade after otherwise inexplicable acute kidney injury (AKI). Methodology We conducted a retrospective cohort analysis of patients enrolled between February 2018 and May 2021. Kidney function was monitored after elective withdrawal of long-term RAAS blockade in CKD patients presenting with new-onset otherwise inexplicable progressive AKI, defined by a >25% increase in baseline serum creatinine. Results In total, 71 patients, 69 Caucasians, one African American, and one Hispanic, were included in the study, with a male-to-female ratio of 42:29, and a mean age of 69.4 (37-95) years. Through February 2022, 12 patients had died, with eight remaining on hemodialysis for end-stage renal disease. Of the remaining 51 patients followed for 706 (40-1,478) days, baseline serum creatinine was 1.30 ± 0.42 (0.66-2.70) mg/dL, peak enrollment serum creatinine was 2.17 ± 1.06 (1.1-8.3) mg/dL (n = 51, p < 0.0001, t = 6.4872, df = 135), and serum creatinine after four years was 1.58 ± 0.54 (0.84-3.3) mg/dL (n = 50, p < 0.0001, t = 5.1805, df = 119). Death in 11 of 12 (91%) patients was from non-renal causes, and most deaths occurred despite improved kidney function. Conclusions Our results demonstrate clearly improved renal outcomes in most patients following the elective withdrawal of long-term RAAS blockade in CKD patients with new-onset progressive yet otherwise inexplicable AKI without increased cardiovascular mortality.

Brachial artery and cephalic vein diameter as maturation predictors of brachiocephalic arteriovenous fistula in end-stage renal diseases with type 2 diabetes mellitus

Introduction: Arteriovenous fistula (AVF) is the gold standard for vascular access for hemodialysis in end-stage renal disease (ESRD) patients. There is a high rate of AVF maturation failure, especially in DM patients, and it takes longer for maturation in diabetes mellitus (DM) patients. This study aimed to obtain the recommendations for the minimum diameter of the brachial artery and cephalic vein as a predictor of brachiocephalic AVF maturation in ESRD patients with type 2 diabetes mellitus after six weeks to eight weeks of AVF creation. Methods: This study is a retrospective cohort study using secondary data from patients with brachiocephalic arteriovenous fistula. The examined variables were brachial artery diameter, cephalic vein diameter, and brachiocephalic arteriovenous fistula maturation. Comparative analysis and ROC curve analysis were performed. Results: A total of 72 patients met the inclusion and exclusion criteria. Forty-four (61,11%) patients were mature at six weeks, while 47 (65,28%) were mature at eight weeks postoperatively. At week six, the mature group had a significantly larger cephalic vein diameter (3,20±0,94 vs. 2,65±1,02, p=0,002). At week eight there was a significantly larger brachial artery (4,22±0,70 vs 3,78±0,60, p=0,012), and cephalic vein diameter (3,28±0,98 vs 2,43±0,82, p=0,000) in the mature group. Conclusion: The best threshold value for preoperative brachial artery diameter predicting AVF maturation eighth week was 3.85 mm. The best threshold value for preoperative cephalic vein diameter predicting AVF maturation at the sixth week was 2.45 mm, and at the eighth week, it was 2.45 mm.

Mortality rate of COVID-19 infection in end stage kidney disease patients on maintenance hemodialysis: A systematic review and meta-analysis.

BACKGROUNDCoronavirus disease 2019 (COVID-19) has been the most talked-about disease of the past few years. Patients with significant comorbidities have been at particular risk of adverse outcomes. This study looked at the outcomes and risk factors for adverse outcomes among patients on chronic hemodialysis for end-stage renal disease, a group of patients known to be particularly susceptible to infectious complications.AIMTo assess outcomes and risk factors for adverse outcomes of COVID-19 infection among patients on chronic hemodialysis.METHODSWe searched PubMed/MEDLINE, EMBASE, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Web of Science databases for relevant terms and imported the results into the Covidence platform. From there, studies were assessed in two stages for relevance and quality, and data from studies that satisfied all the requirements were extracted into a spreadsheet. The data was then analyzed descriptively and statistically.RESULTSOf the 920 studies identified through the initial database search, only 17 were included in the final analysis. The studies included in the analysis were mostly carried out during the first wave. We found that COVID-19 incidence among patients on hemodialysis was significant, over 10% in some studies. Those who developed COVID-19 infection were most likely going to be hospitalized, and over 1 in 5 died from the infection. Intensive care unit admission rate was lower than the infection lethality rate. Biochemical abnormalities and dyspnea were generally reported to be associated with adverse outcomes.CONCLUSIONThis systematic review confirms that patients on chronic hemodialysis are very high-risk individuals for COVID-19 infections, and a significant proportion was infected during the first wave. Their prognosis is overall much worse than in the general population, and every effort needs to be made to decrease their exposure.

A Descriptive Investigation of the Prevalence of Neurological Disorders in People Treated Hemodialysis for End-Stage Renal Disease

Objectives: Patients with end-stage renal disease (ESRD) who were receiving hemodialysis were the subjects of a study to determine the neurological effects of the treatment. Methodology: ESRD patients at the Institute of kidney diseases hayatabad peshawar were the subjects of this descriptive research, which ran from jan to Dec 2021. Before participating in the trial, all Chronic Kidney Disease (CKD) patients had been on Hemodialysis (HD) for at least six months. HD patients were monitored for a total of six months in this study. Neurological events were observed and recorded at this period. All patients on HD, regardless of gender or age, were included in this research, which was conducted between the ages of 17 and 77. In this research, patients under the age of 15 years, those with acute renal failure, congestive cardiac failure, cirrhosis of the liver, malignancy, disseminated intravascular coagulation, sepsis, meningitis, or encephalitis, were all ruled out as candidates for inclusion. The data was analysed using SPSS version 2.2. Results: Intradialytic hypotension, Cerebrovascular accident, Encephalopathy, Dialysis dementia, Neuropathy, Dialysis disequilibrium, Reversible leukoencephalopathy, Central pontine myelinosis, Autonomic dysfunction, and Myopathy were the most common neurological consequences. Conclusions: Our patients on hemodialysis suffer from the most prevalent neurological complication: Intradialytic hypotension. While the long-term result and prognosis of this group may be affected by cerebrovascular illnesses and Dialysis dementias, it is important to examine them as soon as possible. Keywords: neurological problems, (ESRD),frequency, hemodialysis , end-stage renal disease.