ESRD Patients Research Articles

Residual Red Blood Cell Volume in Extracorporeal Blood Circuit After Hemodialysis: A Single-center Study.

The factors contributing to blood loss during HD procedures remain underexplored. This study aimed to quantify blood loss during HD and identify the potential factors associated with it. The study included 70 ESRD patients undergoing HD. After dialysis, the extracorporeal blood circuits were rinsed with 1,000 mL of 0.05% NH3 solution in distilled water, and hemoglobin (Hb) levels were measured. Univariate regression was used to assess the linear relationship between residual red blood cell (RBC) volume and various parameters, including HD mode, dialyzer surface area, ultrafiltration goal (UFG), hypotension during HD, blood flow rate, activated partial thromboplastin time (aPTT), and C-reactive protein (CRP). Multivariate regression was also conducted to explore the relationships among these parameters. The mean RBC volume remaining in the extracorporeal blood circuit after HD was 1.6 ± 0.9 ml (mode: 1.0, range: 0.3-6.5 ml). When converted to whole blood volume per patient, the mean blood volume was 5.3 ± 3.0 ml (median: 4.1 ml, mode: 4.0 ml, range: 1.0-19.0 ml). Multivariate analysis identified the dialyzer surface area as the only significant determinant of residual RBC volume. After HD, the remaining RBC volume in the extracorporeal blood circuit varies from 1.6 to 6.5 ml. When the RBC volume was converted to whole blood volume for each case, the blood loss ranged from 1.0 to 19.0 ml. Dialyzer surface area was the only significant determinant of residual RBC volume.

7630 Incidental Calvarial Brown Tumor in an ESRD patient with seizures

Abstract Disclosure: K.N. Pereira: None. V. mehta: None. S. Sekaran: None. M. Renzu: None. Brown Tumor [BT], also known as Osteitis fibrosa cystica [OFC], is a rare tertiary manifestation of hyperparathyroidism [HPTH]. BT commonly affects the maxilla/mandible, long bones and spine and presents as lytic bone lesions on imaging. Among the crania-facial bones, the maxilla, palate, temporal bone, nasal cavity, orbital bone and paranasal sinuses are affected. We describe a case of a 37 year old African-American female with extensive medical history including ESRD on hemodialysis who initially presented to the hospital with hypertensive emergency in the setting of 1 week of missed dialysis. During her presentation, she had an unexplained seizure which led to further workup with imaging. CT head revealed findings suspicious of renal osteodystrophy as well as a discrete lucency at the calvarial vertex suggestive of a brown tumor. Endocrinological studies were noted to have very high PTH levels with hypercalcemia, hyperphosphatemia and vitamin D deficiency indicative of tertiary hyperparathyroidism. Based on her clinical presentation, labs and imaging, her bone disease including BT and pathologic fractures, was deemed to be due to tertiary hyperparathyroidism in the setting of ESRD, which were not amenable to surgical intervention. Extensive literature review did not reveal any reported BTs in the calvarial vertex. This case emphasizes on the holistic approach to diagnosis of BTs and underlines that fact that BT can occur in any cortical bone including unusual presentation sites like the calvarial vertex. Presentation: 6/3/2024

Robotic kidney transplant has superior outcomes compared to open kidney transplant: results of a propensity match analysis.

Several studies have demonstrated the feasibility of robotic kidney transplant (RKT) as a safe alternative to open kidney transplant (OKT). However, significant selection bias in RKT patient selection limits meaningful comparison between the two techniques. This is a single-center retrospective review of a prospectively maintained kidney transplant database (2021-2024). Outcomes after the first 50 "non-selected" RKTs are compared with a contemporary cohort of 100 OKTs after propensity score matching for age, gender, BMI and type of donation (living vs deceased). Data pertinent to recipient demographics, intraoperative parameters, and short-term post-operative outcomes were collected and compared. Both groups were well-matched for recipient age, gender, BMI, and donation type. RKT group had significantly longer total operative time (RKT 258min vs. OKT 183min; p < 0.0001) and warm ischemia time (RKT 37min vs. OKT 31min; p < 0.0001) but significantly less blood loss (OKT 155ml vs. RKT 93ml). Average length of hospital stay for both groups was 5days, with OKT group demonstrating significantly higher rates of post-operative complications (OKT 31% vs. RKT 14%; p = 0.028), return to OR (OKT 15% vs. RKT 2%; p = 0.021), hematoma (OKT 13% vs. RKT 2%; p = 0.0355), and lymphocele (OKT 25% vs. RKT 6%; p = 0.0039). OKT group also had higher 30-day readmission rate (OKT 31% vs. RKT 14%) and post-operative opioid requirement (OKT 93 MME vs. RKT 65; p = 0.0254). There were no differences in rates of wound infection, urine leaks, delayed graft function, acute rejection, graft loss, and patient death between the two groups. RKT is a safe and viable alternative to OKT as a first-choice procedure for all patients with ESRD. RKT offers many advantages over OKT which can lead to its wider adoption in the coming years as the new standard of care for ESRD patients.

Kidney transplantation restores sex hormone profile and improves sexual function in ESRD patients with erectile dysfunction.

Erectile dysfunction (ED) and sex hormone profile disturbances are common in ESRD patients. To assess the effect of kidney transplant (KT) and Hemodialysis/peritoneal dialysis (HD/PD) on the serum sex hormone profile and sexual functions in ESRD patients with ED. A single-center, nonconcurrent cohort study included a hundred ESRD patients with ED, on regular HD/PD (group A, n = 50) and after KT (group B, n = 50) at Armed Forces Hospitals Southern Region, KSA. the mean age of patients was 47.3 ± 7.01 and 56.8 ± 9.6 years in groups A and B, respectively. The cohorts were comparable regarding patient demographics, apart from a higher incidence of comorbidities in group B. After KT the mean testosterone level was higher in Group B (13.64 ± 3.21 nmol/L vs 10.26 ± 3.26 nmol/L, p < 0.001). Similarly, LH and prolactin levels were lower in group B than in group A (p < 0.05). As regards sexual function, ED was reported in 92% of patients in group A compared to 42% in group B (p < 0.001). In groups A and B, mild ED was found in 48% and 14% of patients, while moderate ED was found in 16% and 8%, respectively. The mean total IIEF-15 score was 36.42 ± 9.33 and 43.87 ± 9.146 in groups A and B, respectively (p = 0.0001). Sexual desire and orgasm were significantly better in Group B. Our study showed that kidney transplantation could improve erectile function and restore normal sex hormone levels in ESRD male patients with ED, with better outcomes compared to HD/PD.

Platelet count has a nonlinear association with 30-day in-hospital mortality in ICU end-stage kidney disease patients: a multicenter retrospective cohort study

This study addresses the relationship between platelet count and 30-day in-hospital mortality in End-Stage Kidney Disease (ESRD) patients in the intensive care unit (ICU), a topic with limited existing evidence. Utilizing data from the US eICU-CRD v2.0 database (2014–2015), a retrospective cohort study was conducted involving 3700 ICU ESRD patients. We employed binary logistic regression, smooth curve fitting, and subgroup analyses to explore the association between platelet count and 30-day in-hospital mortality. The 30-day in-hospital mortality rate was 13.27% (491/3700), with a median platelet count of 188 × 109/L. After adjusting for covariates, we observed a relationship between platelet count and 30-day in-hospital mortality (OR = 0.98, 95% CI 0.97, 0.99). Subgroup analyses supported these findings. More importantly, a nonlinear association was detected, with an inflection point at 222 × 109/L. The effect sizes (OR) on the left and right sides of the inflection point were 0.94 (0.92, 0.96) and 1.03 (1.00, 1.05), respectively. The most significant finding of this study is the revelation of a nonlinear relationship between baseline platelet count and 30-day in-hospital mortality in ICU patients with ESRD. This discovery explicitly suggests that when ESRD patients are admitted to the ICU, a platelet level closer to 222 × 10⁹/L may predict a lower 30-day in-hospital mortality risk.

Outcomes of Patients with End-Stage Renal Disease Hospitalized with COVID-19 in Ahvaz Razi Hospital from February 2020 to May 2021

Background: End-stage renal disease patients on maintenance hemodialysis (ESRD-HD) are at very high risk for COVID-19 infections due to their older age and comorbidities such as diabetes and hypertension. Objectives: This study aimed to investigate the outcomes of COVID-19 in ESRD-HD patients. Methods: This was a retrospective study conducted on ESRD-HD patients aged 18 years and older who were referred to Razi Hospitals in Ahvaz from February 2020 to May 2021 for hemodialysis and diagnosed with COVID-19. Patient information was extracted retrospectively from their medical records. Results: A total of 180 patients were examined. The average age of the patients was 61.5 years, and 118 (65.6%) were men. The most common underlying condition was hypertension (81.1%). The most prevalent clinical symptom was shortness of breath (70.6%), followed by cough (47.8%). Seventy-five patients (41.66%) were admitted to the intensive care unit (ICU), with an average stay of 5 days. Hypertension and ischemic heart disease were significantly more common among patients admitted to the ICU (P = 0.008 and 0.015, respectively). In-hospital mortality was 32.8%. Advanced age, fever, shortness of breath, cough, and the need for a ventilator were significant predictors of mortality in hospitalized ESRD patients with COVID-19 (P = 0.016, 0.033, 0.001, 0.012, and 0.011, respectively). Conclusions: Our study demonstrated that ESRD-HD patients with COVID-19 are at high risk for ICU admission and mortality. Advanced age and clinical symptoms such as fever, shortness of breath, cough, and the need for a ventilator significantly predict in-hospital mortality in these patients.

Intradialytic oral nutrition effects on malnourished hemodialysis patients: a randomized trial

Oral nutritional supplementation (ONS) is recommended for malnourished hemodialysis patients when their nutritional intake remains inadequate to meet energy and protein requirements. Patients were randomized into two groups: the intradialytic ONS supplements (INTRA-ONS) group (N = 16) and the interdialytic ONS supplements (INTER-ONS) group (N = 16) for a duration of 12 weeks. Malnutrition inflammation score (MIS) and serum albumin levels were assessed. The total MIS decreased significantly in patients from both the INTRA-ONS group (− 6.13, 95% CI − 8.29 to − 3.96) and the INTER-ONS group (− 3.50, 95% CI − 5.56 to − 1.35). A significant difference in the change of MIS was observed between the two groups (− 3.06, 95% CI − 5.94 to − 0.17). No significant differences were observed between the groups concerning serum albumin levels, dietary intake, anthropometric measurements, or body weight. Intradialytic ONS demonstrates similar benefits on nutritional biomarkers but improves the MIS among malnourished ESRD patients compared to interdialytic ONS.Trial registration Thai Clinical Trials Registry (TCTR) identification number is TCTR20220322007: 16/09/2021.

347.10: Health related quality of life among ESRD patients on hemodialysis and kidney transplant recipients: A comparative study.

347.10: Health related quality of life among ESRD patients on hemodialysis and kidney transplant recipients: A comparative study.

BIVARIATE FUNCTIONAL PATTERNS OF LIFETIME MEDICARE COSTS AMONG ESRD PATIENTS.

In this work we study the lifetime Medicare spending patterns of patients with end-stage renal disease (ESRD). We extract the information of patients who started their ESRD services in 2007-2011 from the United States Renal Data System (USRDS). Patients are partitioned into three groups based on their kidney transplant status: 1-unwaitlisted and never transplanted, 2-waitlisted but never transplanted, and 3-waitlisted and then transplanted. To study their Medicare cost trajectories, we use a semiparametric regression model with both fixed and bivariate time-varying coefficients to compare groups 1 and 2, and a bivariate time-varying coefficient model with different starting times (time since the first ESRD service and time since the kidney transplant) to compare groups 2 and 3. In addition to demographics and other medical conditions, these regression models are conditional on the survival time, which ideally depict the lifetime Medicare spending patterns. For estimation, we extend the profile weighted least squares (PWLS) estimator to longitudinal data for the first comparison and propose a two-stage estimating method for the second comparison. We use sandwich variance estimators to construct confidence intervals and validate inference procedures through simulations. Our analysis of the Medicare claims data reveals that waitlisting is associated with a lower daily medical cost at the beginning of ESRD service among waitlisted patients which gradually increases over time. Averaging over lifespan, however, there is no difference between waitlisted and unwaitlisted groups. A kidney transplant, on the other hand, reduces the medical cost significantly after an initial spike.

CT-426 Outcomes of Bone Marrow Transplant in ESRD vs Non-ESRD Patients: A Nationwide Analysis

CT-426 Outcomes of Bone Marrow Transplant in ESRD vs Non-ESRD Patients: A Nationwide Analysis

Outcomes of Bone Marrow Transplant in ESRD vs Non-ESRD Patients: A Nationwide Analysis

Outcomes of Bone Marrow Transplant in ESRD vs Non-ESRD Patients: A Nationwide Analysis

Association of Social Deprivation Index with Home Dialysis Technique Failure: A Single Center Experience.

Despite offering several advantages to patients and healthcare systems, utilization of home dialysis modalities (HDM) remains low, particularly among racial and ethnic minorities, and those with increased sociodemographic stress. Providers' apprehension towards adverse outcomes and home dialysis failure remains a barrier to HDM referral. We investigated the relationship sociodemographic factors have on HDM use and technique failure. We performed a retrospective cohort study of adult incident ESRD patients over a six-year period at the University of Rochester to evaluate the association between demographic factors, social deprivation index (SDI), and co-morbidity burden on HDM utilization and technique failure. Person-time incidence rates were calculated to compare outcome variables, and rates were compared using a Poisson Rate Ratio Test. A univariate Cox regression was used to examine predictors impacting technique failure. Of the 873 patients, 102 started dialysis with HDM, 79 patients converted to HDM, and 692 remained on in-center hemodialysis (ICHD). Age, race, and SDI scores were significantly different between patients starting on ICHD, peritoneal dialysis (PD) and home hemodialysis (HHD) with no significant difference in comorbidity burden. Black patients represented 32% of the overall cohort, but only 16% of the initial home dialysis population. Compared to those that remained on ICHD, individuals converting from ICHD to HDM were younger and had significantly different SDI scores. SDI was not associated with HDM technique failure. Historically underrepresented racial populations are less represented in those starting home dialysis, however there was no racial difference in the group transitioning to HDM after initiating ICHD. Social deprivation scores were higher in those on ICHD compared to PD. Neither social deprivation nor race predicted success on home therapy. These findings demonstrate a disparity in initial modality, and a disconnect between sociodemographic factors associated with home dialysis use and those predicting HDM technique failure.

Comparing the Hemodynamic Effects of Intravenous and Volatile Anesthesia in Patients with End Stage Renal Disease Undergoing Laparoscopic Implantation of Peritoneal Dialysis Catheter in a Randomized Double-Blind Clinical Trial

Background: Due to the associated hypertension and cardiovascular disease in patients with ESRD hemodynamic changes during operations are detrimental and may be life-threatening. Therefore, hemodynamic stability is an important criterion in selecting the anesthetic approach. Methods: 72 ASA class III/IV, ESRD Patients were studied in randomized double blind clinical trial. They were divided into two groups by four-block randomization. A group of patients were induced and maintained by etomidate and second of patients were induced by Na thiopental and maintained by isoflurane. Systolic, diastolic and mean arterial blood pressure and heart rate were measured at interval of pre and post induction, postintubation, pre and post abdominal insufflation during and at the end of surgery and in recovery. The total BP modulators were recorded and postoperative nausea and vomiting was registered in the recovery. Data were analyzed by STATA version 12. Results: There was no significant difference in physical characteristics between two groups. There was no statistical difference between the groups in SBP and HR (P&gt;0.05), although DBP fluctuation&gt;20% at interval postinduction and prior to abdominal insufflation during surgery and at the end of surgery, was significantly higher in the isoflurane group of patients. (P=0.004, 0.001, 0.003 and 0.009, respectively). Also, the MAP fluctuation at interval of post induction, preinsufflation and at the end of surgery was significantly higher in isoflurane of patients. (P=0.04, 0.001, and 0.02, respectively). Conclusion: The group anesthetized with isoflurane had a higher hemodynamic fluctuation, compared to the group anesthetized with etomidate. As hemodynamic changes are critical in patients with ESRD, etomidate is a more appropriate anesthetic choice for implantation of peritoneal dialysis catheter by laparoscopic approach.

Anchor versus parachute suturing technique in arteriovenous fistula creation for hemodialysis.

Chronic kidney disease (CKD) affects 13% of the global population and requires renal replacement therapy due to ESRD. Hemodialysis (HD) is the most common dialysis modality for ESRD patients, but establishing vascular access is challenging due to high morbidity and mortality rates. Arteriovenous fistulas (AVFs) are the gold standard for vascular access, but many fail due to anastomotic hemodynamics, vein diameter, and anastomatic suture technique. A prospective study was conducted to evaluate the impact of two continuous suturing techniques, the anchor technique and the parachute technique, on AVFs' initial outcomes. This randomized, controlled study involved adult patients who presented for AVF creation at our center. We divided the patients into two groups: anchors and parachutes. Four skilled vascular access surgeons performed the procedures. The primary goal was functional maturation of the AVF, defined as an AVF fistula ready to be cannulated with a cannulating vein length of at least 10cm, a diameter of more than 6mm, a depth of less than 6mm, and a flow rate of 600mL/min. Secondary goals included patency and complications such as bleeding, infection, steal syndrome, and aneurysmal dilatation at the anastomosis site. AVFs were evaluated immediately after surgery and during follow-up visits at the outpatient clinic. A duplex scan was performed to measure flow at various intervals. All patients provided appropriate written consent. The study involved 186 patients, with 86 excluded. 100 were randomized, with 5 cases losing follow-up and 3 deaths within 12months. The follow-up continued until January 2024, with a mean of 8.6months. The Parachute technique shows higher technical success (p value = 0.046) and primary patency at 30days (p value = 0.014) compared to Anchor, but there is no statistical significance between both groups regarding functional maturation at 6 weeks (p value = 0.352). The parachute technique has a higher hematoma rate than the anchor technique (p value = 0.025), while other complications like intra-operative bleeding, postoperative bleeding, pseudoaneurysm formation, thrombosis, steal syndrome, and seroma formation show no significant differences. Nine patients, five of whom were diabetic and underwent conservative management, exhibited mild to moderate steal syndrome. This suggests an increased risk of steal syndrome among diabetic patients. The parachute technique for AVF creation offers better technical success and short-term primary patency outcomes, while both parachute and anchor techniques are equally effective for long-term functional maturation and overall complication rates.

Does The Serum Zinc Level Affect the Quality of Life in Dialysis Patients? A Report from Iran

Background: Zinc deficiency is a common finding among ESRD and dialysis patients and may affect their quality of life. Objectives: This study aimed to evaluate the serum level of zinc and its correlation with the quality-of-life score in dialysis patients. Methods: A cross-sectional study was conducted in 2018 on dialysis patients. Patients’ information and clinical data, their serum zinc levels, and quality of life assessed by the SF-36 questionnaire were collected. The Spearman correlation test was used to assess the correlation between serum zinc levels and the Physical (PCS) and Mental (MCS) Component Summary scores of the SF-36 questionnaire in general and in different subgroups. P-values less than 0.05 were considered significant. Results: In the HD group, PCS and MCS scores were significantly correlated (P = 0.0001), while this correlation was not observed in the PD group. Additionally, there was a positive correlation between zinc levels and PCS and MCS scores in the HD group but not in the PD group (P = 0.0001). In the PD group, only age negatively correlated with the PCS score (P = 0.03), without any other significant correlations with other study variables. Multivariate analysis revealed that zinc level was an independent predictor of PCS and MCS scores in the HD group (P &lt; 0.001). In the PD group, age (P = 0.02) and zinc level (P = 0.03) were independent predictors of PCS score but not MCS score. Conclusions: There is a positive correlation between serum zinc levels and both the physical and mental aspects of quality of life in dialysis patients.

Investigating the Link Between Left Ventricular Hypertrophy and Anemia in End-Stage Renal Disease

Background:ESRD significantly burdens healthcare systems worldwide. Its related complications, such as LVH and anemia, lead to increased morbidity and mortality. Left Ventricular Hypertrophy (LVH), which mirrors an increase in myocardial mass and wall thickness, is easily identified in patients with ESRD. Anemia, a state of low hemoglobin, increases cardiac work Aims and Objective: To explore anemia and its association with LVH in ESRD patients on maintenance hemodialysis by detailed echocardiographic assessment and comprehensive blood analysis. Methodology: This comparative study was carried out at a teaching hospital, namely Ghurki Teaching Hospital and a tertiary care hospital, Mayo Hospital, Lahore, Pakistan from March 2023 to April 2024. A purposive sample of 200 adults on maintenance hemodialysis with ESRD was obtained through stratified random sampling techniques and the participants were grouped based on anemia status: anemic; (hemoglobin &lt;13g/dL in males, &lt;12g/dL in females) or non-anemic. The data were analyzed using SPSS software (Version 26) by employing independent t-test to compare the means, chi-squared test for categorical variables, A p-value &lt; 0. 05 was considered significant. Results:In patients with anemia, the LVMI was significantly (P≤0.05) higher than in patients without anemia. Anemia was found to be a significant (P≤0.05) predictor of an increase in LVMI over time, indicating its role in the development of LVH. Conclusion:The findings of present research indicated that, as shown by echocardiography, there is a substantial correlation between LVH and anemia in patients on maintenance of hemodialysis.

SARS-CoV-2 Vaccination and Severe COVID-19 Infection and Reinfection Outcomes among ESRD Patients from A National Dialysis Provider

SARS-CoV-2 Vaccination and Severe COVID-19 Infection and Reinfection Outcomes among ESRD Patients from A National Dialysis Provider

Effect of Dialysis Modality and Membrane Permeability on FGF 23 Level and Cardiovascular Calcification in ESRD Patients

Abstract Introduction Cardiovascular disease is the most common cause of death in patients with chronic kidney disease (CKD) and vascular calcification is one of the strongest predictors of cardiovascular risk. The prevalence of vascular calcification increases as glomerular filtration rate (GFR) declines and calcification occurs years earlier in CKD patients than in the general population. (26). Aim of the Study To study the effect of hemodialysis modality in controlling FGF-23and to determine the impact of FGF23 on cardiovascular calcification Patients and Methods We selected 50 patients ESRD maintained on hemodialysis divided into 2 groups, Group 1: comprised of 25 patients maintained on hemodialysis with high flux dialyzer and Group 2: comprised of 25 maintained on weekly session of hemodiafiltration and comparison between both groups regarding FGF23 serum level in addition to cardiovascular screening for calcifications using ECHO, Carotid intima-media thickness, and carotid duplex. Results we found that Post dialysis FGF23 was significantly lower in “hemodiafiltration patients” than ‘hemodialysis patients” and Reduction ratio was significantly higher in “hemodiafiltration patients”(P &amp;lt; 0.001).ECHO score and carotid duplex score were insignificantly different between both groups, but carotid intima-media thickness was significantly higher in haemodialysis patients (P value 0.035). Post HDF FGF 23 had a significant positive correlation with IMT (r = 0.579, P = 0.008). Serum FGF23 post-HD and HDF had significant positive correlation with serum Calcium (r = 0.659, P = 0.002), (r = 0.474, P = 0.035), PTH (r = 0.485, P = 0.03), (r = 547, P = 0.013) and CRP (r = 0.646, P = 0.002), (r = 707, P &amp;lt; 0.001) and serum Phosphorus (r = 0.462, P = 0.04), (r = 478, P = 0.033) respectively. In HD group Carotid Duplex Score had significant positive correlation with serum Ca (r = 0.469, P = 0.037), while in HDF group Carotid Duplex Score had significant positive correlation with PTH (r = 0.59, P = 0.006). Conclusion Using online HDF technique showed a significant reduction of FGF23 and improvement of carotid intima-media thickness calcification score.

Comparative Study Evaluating the Effect of the Administration of Vitamin K1 versus Placebo on Vascular Calcification in Haemodialysis Patients

Abstract Background Cardiovascular calcification is a risk factor and contributor to morbidity and mortality in End stage kidney disease patients. Cardiovascular calcification is most likely due to an imbalance of promoters (e.g. Calcium and phosphate) and inhibitors (e.g. fetuin-A and matrix Gla protein). Aim of the Work We aimed to study the effect of oral vitamin k1 on serum carboxylated Matrix gla protein in patients on maintenance hemodialysis and to study its effect as an important marker of vascular calcification. Patients and Methods This Placebo Controlled clinical trial was conducted for 3 months on 80 adult ESRD patients on regular Hemodialysis randomly allocated into 2 groups of either vitamin K1 versus oral placebo tablet administration for 3 months. Patients in both groups were age and sex matched, study group included 18 (45%) males and 22 (55%) females with mean age ± SD 47.350 ± 14.420 years, while the placebo group included 16 (40%) males and 24 (60%) with mean age ± SD 49.500 ± 14.509 years, with no significant difference between both groups as regard demographic data, access of hemodialysis, and duration of Hemodialysis. Results There was no significant change in bone parameters (serum Ca, PO4 &amp; Ca/PO4 product) after 3 months of vit K1 administration compared to baseline in the study group. Serum phosphorus levels showed a minimal, yet statistically significant decrease after 3 months of placebo administration, this might be attributed to the different doses of PO4 binders in patients of both groups. Consequently, Ca/ PO4 product showed a statistically significant decrease after 3 months of placebo administration (P = 0.002), mostly attributed to the significant decrease in serum phosphorus in the same group over the same period. We observed that serum MGP levels significantly increased after administration of vitamin k1 in study group (P &amp;lt; 0.001) with 78.05% increase. However, a much lower increase, yet statistically significant increase in serum MGP level was noticed in the placebo group (P &amp;lt; 0.001) with 40.60 % increase. There was no statistically significant difference between the two groups according to their risk factors regarding smoking, HTN, HCV, DM, and ISHD. Conclusion We concluded that Oral vitamin K1 therapy significantly increased serum active form of Matrix GLA protein levels among hemodialysis patients with potential decrease in cardiovascular calcification and cardiovascular diseases.

Impact of Increased Hemodialysis Frequency on Kt/V Achievement in Hemodialysis Patients: A Center-Based Observational Study

ntroduction: Chronic kidney disease (CKD) remains a significant global health challenge, necessitating life-sustaining hemodialysis for many individuals. The evidence demonstrates that mortality among ESRD patients is lower when sufficient hemodialysis treatments are provided. The achievement of adequate dialysis dose, measured by Kt/V, plays a pivotal role in improving patient outcomes. Method and Material: This was a center-based descriptive cross-sectional study carried out in Hemodialysis unit of NIKDU, Dhaka, Bangladesh from January 1, 2012, to June 30, 2013, seeks to investigate whether increasing the frequency of hemodialysis sessions to three times per week, totaling 12 hours per week, significantly improves the attainment of target Kt/V in hemodialysis patients when compared to those receiving the conventional regimen of 8 hours per week. Purposive sampling of 120 ESRD patients on maintenance hemodialysis (MHD) getting dialysis for at least one month through Arterio-Venous Fistula (AVF) and at least 2 dialysis session per week. Discussion: Out of 120 patients 72 (60.0%) were male and ratio was 1.5:1. The mean age of hemodialysis patients in this study was 51 years (range: 18-75 years). Most of the patients 62 (52%) were on 8 hours per week hemodialysis session. Our study showed mean Kt/V, URR, TACurea and nPCR of all study population was 1.21 ± 0.40 62 ± 12, 83 ± 26 and 1.29 ± 0.46 respectively. In 8 hours per week hemodialysis group achieved target Kt/V &gt; 2 was only 3(5%) and on the other hand 12 hours per week hemodialysis group achieved target Kt/V &gt; 1.2 was only 26(45%). Among the study population only 52 (43%) achieved URR &gt; 65% , 13 (11%) patients TACurea was less than 52 mg/dl and 107 (89%) patients achieved nPCR &gt; 1 g/kg/day. Mean values of URR was significantly higher of Kt/V of &gt;1.2 and nPCR of &gt;1 g/kg/day group. Most of our hemodialysis patients inadequately dialyzed. In 12 hours per week dialysis group significantly higher BMI, hemoglobin, nPCR and low phosphorus and TACurea. To achieve hemodialysis adequacy of KDOQI 2006 recommendation needs to increase frequency of HD that is 3 sessions per week (12 hours /week) and needs to give more attention to others factors which increase urea clearance. Conclusions: Furthermore, it underscores the need for continuous research to enhance our understanding of hemodialysis adequacy and improve the management of patients with end-stage kidney disease.