Findings In Hemodialysis Patients Research Articles

Association of vascular endothelial growth factor-C, plasma angiotensinogen and left ventricular hypertrophy in patients with hemodialysis.

This study aims to examine the relationship between fluid overload, Vascular Endothelial Growth Factor C (VEGF-C), plasma Angiotensinogen (pAGT), and echocardiography findings in hemodialysis patients. This was a single-center, cross-sectional study. Patients were divided into two groups according to mid-week inter-dialytic weight gain (mIDWG): (1) mIDWG ≤3% and (2) mIDW >3%. A total of 55 patients were enrolled in this study. While the mean pAGT and left ventricular mass index were significantly higher in patients with mIDWG >3% compared to patients with mIDWG ≤3%, VEGF-C was similar between groups. pAGT ≥76.8 mcg/L, VEGF-C ≤175.5 pg/ML, and pAGT /VEGF-C ≥0.45 were significant cut-offs for the prediction of left ventricular hypertrophy(LVH). Univariate logistic regression analysis revealed that these cut-off values were significantly associated with LVH. Renin-angiotensin-aldosterone system activation may persist in hemodialysis patients with excessive IDWG. Additionally, pAGT and VEGF-C could be risk factors for the development of LVH.

Dental and Periodontal Findings in Hemodialysis Patients

Abstract Background: End-stage renal disease (ESRD) are more to infections due to their decrease in immune systems and general debilitated health, most of patients with renal failure showing oral symptoms. Objectives: The aim of this study is to assessment the kind and severity of oral symptoms in ESRD patients undergoing hemodialysis and compare these results with healthy, disease-free persons. Materials and Methods: The study involved 40 individuals, comprising 20 hemodialysis patients and 20 healthy control. The patient group was randomly chosen from ESRD patients, while the control group consisted of disease-free persons with normal glomerular filtration rates. The symptoms such as dry mouth, taste changes, halitosis, and mucosal pain, and were oral changes like tongue coating, pallor, ulceration, and enamel hypoplasia. Results: The ESRD patients established significantly more oral changes compared to the control group. These due to metabolic disorders caused by renal failure. Conclusion: there is significant impact of ESRD on the oral health of the patients, with correlation between oral health and ESRD.

Evaluation of bone marrow findings in hemodialysis patients with erythropoietin-resistant anemia.

Treatment with erythropoietin-stimulating agents (ESAs) is widely used in anemia of chronic kidney disease (CKD). Acquired ESA resistance is an important problem. The aim of this study is to examine the bone marrow findings in hemodialysis patients with ESA-resistant anemia. The data of 210 patients with acquired ESA resistance were reviewed retrospectively. The patients were divided into groups according to having diagnosis of dysplasia and hematological disease, and survival analysis was performed. A total of 26 patients were included in the study. While dysplasia was present in 10 (38.5%) patients, five of them were diagnosed hematologically. When survival analysis was performed between those with and without a hematological diagnosis, a difference in survival was observed against the group with the diagnosis (24.4 vs. 72 months, p = 0.045). Unresponsiveness to ESA treatment in CKD patients or a decrease in one of the other cell lines along with hemoglobin, it would be appropriate to perform early bone marrow examination.

Echocardiographic Findings in Hemodialysis Patients in a Tertiary Care Hospital

Objective: To find out the echo abnormalities in a south Asian cohort on maintenance hemodialysis in a tertiary care hospital. 
 Study Design: Descriptive cross-sectional study.
 Place and Duration of Study: Combined Military Hospital Abbottabad, from Feb 2022 to Apr 2022.
 Methodology: 57 adult patients on maintenance hemodialysis had a non-contrast transthoracic echocardiographic study recording parameters of left and right ventricular systolic and diastolic function.
 Results: We had 57 patients. 71.9% (n=41) were male, and females 28.1% (n=16), diabetics 47.4 % (n=27), hypertensives 84.2%(n=48), smoking 28.1% (n=16); 15.8%(n=9) had some form of ischemic heart disease. Left ventricular hypertrophy was noted in 78.9% (n=45) of the entire patient population. 84% (n=48) of hypertensive patients had LVH. Overall, 82% (n=47) of hypertensive patients had some degree of diastolic dysfunction compared to non-hypertensive patients (p<0.0001). Diastolic dysfunction of Grades I, II, III was seen in 35.1%(n=20), 29.8%(n=17), 17.5% (n=10). Mean E/e' ratio was 24.9±15, with 40.3%(n=23) having a value ≥15. The LV systolic dysfunction noted was: Mild 26.3%(n=15), Moderate 19.3%(n=11), Severe 1.8%(n=1). For the medial mitral annular systolic velocity(s’) 19.3%(n=11) had normal s’, while 80.7%(n=46) had reduced s’.The mean Pulmonary artery acceleration time (PA-AT) was was <100 ms in 68.4%(n=39). The mean tricuspid plane systolic excursion (TAPSE) was < 17 mm in 19.3%(n=11) of patients indicating RV systolic dysfunction. The Minimum PASP was 16, max 64, mean 41.5±14mm Hg.
 Conclusion: In our study of CKD patients on regular hemodialysis, we found high rates of LVH, DD, LV systolic dysfunction,RV systolic function, and pulmonary hypertension. This creates a case for a larger scale study of these patients in a south Asian cohort as well as institution of a screening program in CKD patients on hemodialysis.

Long COVID-19 laboratory findings in hemodialysis patients: Should they be considered post-COVID syndrome?

Long COVID-19 laboratory findings in hemodialysis patients: Should they be considered post-COVID syndrome?

Association of Angiotensin-Converting Enzyme Inhibitor Gen PolyMorphism with Electrocardiography and Echocardiography Findings in Hemodialysis Patients

Background: Gene polymorphism of angiotensin-converting enzyme (ACE) may be associated with adverse prognosis and increased cardiovascular complications in hemodialysis patients. Objectives: This study aimed to compare the frequency of ACE gene polymorphism in both hemodialysis patients and normal individuals considering echocardiographic findings. Methods: This cross-sectional study included 110 hemodialysis patients (case) and 113 healthy subjects (control). Gene polymorphism of ACE was evaluated in both groups. ECG and echocardiography tests were performed for all patients. Correlations between gene polymorphisms and other variables were analyzed in this study. Polymerase chain reaction (PCR) was used to identify the short deletion allele (D with 190bp), large insertion allele (I with 490bp), and ID genotype which has both alleles. Results: Case and control groups included 46 and 54 female and 64 and 59 male patients, respectively. There were no significant differences between the prevalence of DD, II, and DI alleles of the ACE gene with DI as the most common allele in both groups. No significant differences were found between systolic and diastolic blood pressure and heart rate in DD, DI, and II alleles of the case group. Echocardiographic findings of the patients showed no significant differences between DD, DI, and II genotypes of the case group and intraventricular septal end-diastole (IVSd), MVE vel, MVA vel, MVE/A ratio, MV DT, and MV Dec slope. The mean±SD left ventricular end-diastolic diameter (LVEDD) in II, ID, and DD patients were 4.3±0.72, 4.52±0.66, and 4.89±0.93 respectively (P=0.046). Conclusion: The findings of the present study showed that there were no differences in the prevalence of alleles of an ACE gene in hemodialysis patients and control groups. Moreover, no significant associations were observed between alleles of an ACE gene in the patients' group and echocardiographic findings except in left ventricular end-diastolic diameter.

Dyspepsia in Montenegrin chronic kidney disease patients undergoing hemodialysis: endoscopic and histopathological features.

The main purpose of this study was to analyze the characteristics of dyspepsia and contributing factors in Montenegrin maintenance hemodialysis patients. The study included 43 patients undergoing hemodialysis with symptoms of dyspepsia and 40 control dyspeptic subjects with preserved kidney function. All subjects underwent an interview about dyspeptic symptoms, physical and biochemical examination, and upper gastrointestinal endoscopy with pathohistological analysis of biopsy specimens. Early satiety, bloating and heartburn were the most common symptoms in hemodialysis patients but without significant difference in frequency in relation to controls. Chronic kidney disease patients had statistically lower concentration of total proteins and albumin (p < 0.001), as well lower BMI values (p = 0.002). Despite this, no significant correlation of laboratory parameters with dyspeptic symptoms was found. Pathohistological examination indicated that the most common finding in hemodialysis patients was chronic active gastritis (58%), while chronic atrophic gastritis was significantly more common in dialytic patients (p = 0.032). Patients on hemodialysis had more frequently atrophy of corpus mucosa, which was positively related to dialysis duration (p = 0.001) and negatively related to pH values (p = 0.004) and bicarbonate concentration (p = 0.049). Helicobacter pylori was considerably more common in patients who underwent shorter time on hemodialysis (p < 0.001) and had higher values of bicarbonate (p = 0.037). Maintenance hemodialysis patients are at risk for chronic gastric diseases that correlated with both dialysis vintage and duration.

Evaluation of COVID-19 Thorax Computed Tomography Findings in Hemodialysis Patients

Aim: Coronavirus disease 2019 (COVID-19) is an unprecedented cause of pandemics affecting all segments of society. It is not known whether hemodialysis patients form a different patient group in terms of susceptibility to COVID-19 infection or severe disease. In this study, thorax computed tomography (CT) findings were evaluated in hemodialysis patients diagnosed with COVID-19 infection during the pandemic period.&#x0D; Material and Methods: CT findings of 32 hemodialysis patients diagnosed with COVID-19 with real-time polymerase chain reaction or thorax CT examination were evaluated retrospectively. Radiological findings were classified as ground glass, consolidation, mixed type involvement (ground glass and consolidation), crazy paving appearance, interlobular septal thickening, nodule, halo-reverse halo finding, air bronchogram finding, subpleural curvilinear opacities and tree-in-bud views.&#x0D; Results: A total of 32 patients were included in the study. Twenty-one (65.6%) of the patients were male and 11 (34.4%) were female. The mean age was 67.5±8.5 years. All patients had chronic kidney failure. Thorax CT examination revealed ground-glass opacities in 14 (43.8%) patients, consolidation in 3 (9.4%) patients, and mixed type involvement (ground-glass opacities and consolidation) in 15 (46.9%) patients. The accompanying CT findings were pleural effusion in 23 (71.9%) patients, subpleural curvilinear opacities in 13 (40.6%) patients, bronchial wall thickening in 11 (34.4%) patients, lymphadenopathy in 7 (21.9%) patients, bronchiectasis in 4 (12.5%) patients and pleural thickening in 4 (12.5%) patients.&#x0D; Conclusion: When hemodialysis patients are infected with COVID-19 infection, they differ significantly from other COVID-19 patients in terms of symptoms, clinical course, and prognosis, as well as imaging findings.

Exercise in patients on chronic hemodialysis: current evidence, knowledge gaps and future perspectives.

Physical inactivity is common in hemodialysis patients, and is associated with disability and poor outcomes. We summarize the effects of aerobic, resistance or mixed exercise training on aerobic capacity, muscle mass and strength, dialysis efficiency, quality of life and cardiovascular adaptation according to clinical studies on this population, also focusing on knowledge gaps as topics for future research. Finally, we put evidence into clinical context deriving practical indications for exercise implementation in these patients. In hemodialysis patients, aerobic or mixed exercise training increases predominantly aerobic capacity, whereas resistance training seems more effective in increasing muscle strength. Data concerning dialysis efficiency are equivocal, although phosphate and potassium clearances seem to be improved. There is also inconclusive evidence concerning changes in cardiovascular risk factors. All types of exercise improve patients' quality of life. However, there is a need for protocol standardization and selection of easily measurable endpoints. In clinical practice, it is advised that exercise implementation be performed gradually, and goals be tailored to individual pretraining fitness levels to maximize patient adherence and clinical benefits. The overall evidence suggests that exercise training is beneficial and well tolerated in hemodialysis patients, although heterogeneity across studies hinders generalization of results. In any case, a gradual and individualized approach should be used to implement exercise in these patients.

Endoscopic findings in hemodialysis patients upon workup for kidney transplantation.

Upper gastrointestinal (GI) abnormality is believed to be higher in patients with end-stage renal disease (ESRD) which can make a big trouble for whom undergo kidney transplant. We conducted this study to assess upper GI findings of patients with ESRD. In the present retrospective study we recorded upper GI endoscopy results in hemodialysis patients who were candidate for renal transplantation during a 10-year period. We reviewed files of 1256 patients with a mean age of 37.6 ± 13.4 years. Half of patients (50.6%) had an abnormal endoscopy. Two most common abnormalities were mild gastritis (35.6%) and gastro-esophageal reflux disease (16.7%). GI ulcers were observed in 11% of patients. Duodenal ulcer was the most common ulcer which was seen in 6.8% of patients. Helicobacter pylori was positive in 32.9% of patients and correlated with GI lesions (P = 0.000, r = 0.371). Longer dialysis duration and older patients revealed more upper GI abnormality (P = 0 .032, <0.001). As long as more than half of our patients have at least one upper GI involvement, we recommended that endoscopy must be done as a pretransplantation evaluation for patients without symptoms who have risk factors for ulcers.

Characteristics of abnormal post-stent optical coherence tomography findings in hemodialysis patients.

Clinical outcomes after percutaneous coronary intervention (PCI) in hemodialysis (HD) patients are significantly worse than those in non-HD patients. Optical coherence tomography (OCT) is a high resolution imaging modality and provides a detailed assessment of post-interventional abnormal findings that influence worse clinical outcomes. However, little is known about the abnormal post-stent OCT findings in HD patients. Therefore, in this study, we compared the abnormal post-stent OCT findings between HD and non-HD patients. One hundred thirty-nine consecutive OCT guided PCI (21 lesions in HD patients and 118 lesions in non-HD patients) were enrolled. We compared the post-stent OCT findings, including the edge dissections, under expansion index (minimum stent area/mean reference area), and stent eccentricity index (minimum stent diameter/maximum stent diameter) between HD and non-HD patients. We also compared the device-oriented clinical events (DoCEs) at 8 months of follow up. There was a significantly higher prevalence of distal edge dissections (16.7% vs. 2.8%, P = 0.011) in HD patients. HD patients had a significantly lower under expansion index (0.76 ± 0.21 vs. 0.85 ± 0.14, P = 0.029) and stent eccentricity index (0.82 ± 0.09 vs. 0.88 ± 0.18, P = 0.018). The cumulative rate of DoCEs was significantly higher in the HD patients (23.8% vs. 5.2%, P = 0.013). A higher prevalence of distal edge dissections, under expansion and stent eccentricity were detected by the detailed OCT findings in HD patients.

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

Background: Malnutrition is a frequently observed disorder in patients with chronic kidney disease (CKD) receiving hemodialysis (HD). While variously defined, malnutrition is a frequently observed condition among patients on HD. Prevalence estimates of malnutrition among Israeli HD patients have not been reported. Objectives: To survey nutrition intake in Israeli HD patients; estimate malnutrition risk prevalence; identify risk factors, and characterize malnutrition risk in HD patients. Methods: A representative sample of 378 Israeli HD patients treated in hospital HD centers throughout the country were surveyed. Using the 24-h recall method, dietary intake was estimated and the chronologically corresponding biochemistry, anthropometric, and hemodynamic measures were recorded. Four categories of malnutrition risk were defined: “minimal”: body mass index (BMI) > 23 kg/m² and serum albumin > 3.8 g/dL; “mild”: BMI < 23 kg/m² and albumin > 3.8 g/dL; “moderate”: BMI > 23 kg/m² and albumin < 3.8 g/dL; “severe”: BMI < 23 k/m² and serum albumin < 3.8 g/dL. Results: Elevated malnutrition risk was identified in 175 (46.3%) study participants, who were more likely to require feeding assistance, have major comorbidities, reduced hemoglobin, and elevated C-reactive protein. Oral nutrition supplementation was prescribed to only 14.3% of patients with elevated malnutrition risk. Intradialytic parenteral nutrition was recorded for 6 patients, all of whom had moderate or severe malnutrition risk. Less than one-third of patients met the guidelines for dietary intake of energy or protein, and this did not differ across malnutrition risk groups. Discussion: Elevated malnutrition risk is a frequent finding in HD patients treated in hospital settings in Israel. Dietary intake does not meet guidelines but does not differ across malnutrition risk categories. Nutrition supplements are underused in HD patients with high malnutrition risk. There is a need to expand the survey to community HD centers.

Tympanogram Findings in Hemodialysis Patients.

The aim of this study is to investigate whether changes in cerebrospinal fluid (CSF) pressure during the hemodialysis (HD) treatment are reflected on tympanometric measurements. The study was performed on 24 HD patients. The static compliance and absorbance values of the patients before and after HD were measured using a wideband tympanometry. The tympanogram tests were performed immediately before and at the end of the HD session. The static compliance values of the patients after HD were significantly lower than those before HD. This decrease significantly correlated with the adequacy of dialysis determined by urea reduction rate and Kt/V. The absorbance values showed a decrease in the band 343 and 727 Hz, but no significant difference was found in other frequencies. The static admittance and absorbance values were influenced by the HD process. This influence might be due to the increase in CSF pressure as a result of the removal of urea from blood during HD session.

Depression Symptoms in Haemodialysis Patients Predict All-Cause Mortality but Not Kidney Transplantation: A Cause-Specific Outcome Analysis.

Depression is common in haemodialysis (HD) patients and associated with poor outcomes. To evaluate whether depression symptoms predict survival and transplantation in a large sample of haemodialysis patients using cause-specific survival models. Survival data was collected between April 2013 and November 2015, as part of the screening phase of a multicentre randomised placebo-controlled trial of sertraline in HD patients. Depression was measured using the Beck Depression Inventory-II (BDI-II) and the Patient Health Questionnaire-9 (PHQ-9). Demographic and clinical data were collected via a self-report questionnaire and medical records. Competing risk survival analysis involved cause-specific and subdistribution hazard survival models. All models were adjusted for appropriate covariates including co-morbidity and C-reactive protein (CRP) in a subanalysis. Of 707 cases available for analysis, there were 148 deaths. The mean survival time was 787.5 days. Cumulative survival at 12 months was 88.5%. During the study follow-up period, there were 92 transplants. The cumulative transplant event rate at 12 months was 7.8%. In separate adjusted models, depression symptoms predicted mortality (BDI-II HR = 1.03 95% CI 1.01, 1.04; PHQ-9 HR = 1.04 95% CI 1.01, 1.06). With respect to screening cut-off scores, a PHQ-9 ≥ 10 was associated with mortality (HR = 1.51 95% CI 1.01, 2.19) but not a BDI-II ≥ 16. Depression symptoms were not associated with time to transplantation in either cause-specific or subdistribution model. Consistent with past findings in HD patients, depression symptoms predicted survival but were not associated with kidney transplantation. Suitable treatments for depression need further evaluation, and their impact upon quality of life and clinical outcomes determined. (ISRCTN06146268).

Oral findings in chronic kidney disease. A cross-sectional study in Shiraz, Iran

Background: In hemodialysis patients, there are some oral hard and soft tissue changes. Objectives: The aim of this single-center, cross-sectional study was to evaluate oral findings in hemodialysis patients. Patients and Methods: A total of 144 patients participated. Of them, 28 patients (19%) had diabetes mellitus (DM), 17 patients (12%) had systemic lupus erythematosus (SLE), and 15 patients (10%) had severe hypertension. The oral cavity was inspected by an oral medicine specialist using proper light, mirror and explorer. The lips, cheek, tongue, palatal mucosa, floor of the mouth, gingiva, pharyngeal fauces, dentures, teeth and occlusion were checked. The significance level was P<0.05. Results: Around 78% of the studied population had oral manifestations. The most diagnosed finding in hemodialysis patients was dryness of the mouth followed by tooth loss due to mobility and poor oral hygiene. Diabetic cases showed numerous oral symptoms than nondiabetic subjects. Conclusions: Oral lesions in hemodialysis patients is a prominent finding and untreated lesions may cause severe side effects.

Echocardiographic findings in haemodialysis patients according to their state of hydration

BackgroundChronic fluid overload is frequent in hemodialysis patients (P) and it associates with hypertension, left ventricular hypertrophy (LVH) and higher mortality. Moreover, echocardiographic data assessing fluid overload is limited. Our aim was to evaluate the relationship between fluid overload measured by bioimpedance spectroscopy (BIS) and different echocardiographic parameters. MethodsCross-sectional observational study including 76 stable patients. Dry weight was clinically assessed. BIS and echocardiography were performed. Weekly time-averaged fluid overload (TAFO) and relative fluid overload (FO/ECW) were calculated using BIS measurements. ResultsBased on TAFO three groups were defined: A- dehydrated, TAFO <-0.25 L 32 P (42%); B- normohydrated, TAFO between -0.25 and 1.5 l: 26 (34%); C- overhydrated, TAFO>1.5 l: 18 (24%). We found significant correlation between TAFO and left atrial volume index (LAVI) (r: 0.29; p=0.013) but not with FO/ECW (r 0.06; p=0.61). TAFO, but not FO/ECW kept a significant relationship with LAVI (p=0.03) using One-Way ANOVA test and linear regression methods. LVH was present in 73.7% (concentric 63.2%, eccentric in 10.5%). No differences between groups in the presence of LVH or left ventricular mass index were found. ConclusionsWe found that left atrial volume index determined by echocardiographic Area-length method, but not left ventricle hypertrophy or dimensions of cavities, are related on hydration status based on bioimpedance measured time-averaged fluid overload (TAFO), and not with FO/ECW.

Usefulness of the conicity index together with the conjoint use of adipocytokines and nutritional-inflammatory markers in hemodialysis patients.

Abdominal fat has been recognized as the most hormonally active tissue secreting a variety of adipocytokines and, therefore, potentially contributing to inflammation. The conicity index (Cindex) has been considered a valuable indicator of central obesity. This study aims to relate plasma concentrations of leptin, adiponectin, interleukin-6 (IL-6), and serum C-reactive protein (CRP) with Cindex values in hemodialysis (HD) patients. Cross-sectional study in 45 HD patients (55.6% men; DM 20%; mean age, 68.1year). Cindex and nutritional-inflammatory markers were used for the abdominal fat depot assessment. Patients were classified as having a low or high median Cindex (MCindex): low group (men, <1.39; women, <1.33) and high group (men, ≥1.39; women, ≥1.33). A combination of plasma leptin, IL-6, adiponectin, and CRP was used to design an inflammatory index (Iindex) while a protein-energy wasting index (PEWindex) was calculated from the Iindex plus the malnutrition-inflammation score (MIS). Waist circumference (WC) and Cindex but not BMI were significantly higher in men than in women (p<0.01). The MCindex was significantly associated with the adipocytokine profile (CRP, leptin, and adiponectin). Patients with a high MCindex had a higher Iindex and PEWindex (p<0.01). ROC curve analyses measured by area under the curve (AUC) were 0.69 and 0.68 (p<0.05), for the Cindex and MCindex, respectively, demonstrating the usefulness of the Cindex as an abdominal fat mass biomarker able for wasting-inflamed HD patients. These findings in HD patients underscore the importance of incorporating the evaluation of one abdominal fat indicator, such as the Cindex and an inflammatory biomarker such as the IL-6 and CRP, in substitution of the BMI, in current clinical practice.

Echocardiographic findings in haemodialysis patients according to their state of hydration

BackgroundChronic fluid overload is frequent in hemodialysis patients (P) and it associates with hypertension, left ventricular hypertrophy (LVH) and higher mortality. Moreover, echocardiographic data assessing fluid overload is limited. Our aim was to evaluate the relationship between fluid overload measured by bioimpedance spectroscopy (BIS) and different echocardiographic parameters. MethodsCross-sectional observational study including 76 stable patients. Dry weight was clinically assessed. BIS and echocardiography were performed. Weekly time-averaged fluid overload (TAFO) and relative fluid overload (FO/ECW) were calculated using BIS measurements. ResultsBased on TAFO three groups were defined: A- dehydrated, TAFO <-0.25 L 32 P (42%); B- normohydrated, TAFO between -0.25 and 1.5 l: 26 (34%); C- overhydrated, TAFO>1.5 l: 18 (24%). We found significant correlation between TAFO and left atrial volume index (LAVI) (r: 0.29; p=0.013) but not with FO/ECW (r 0.06; p=0.61). TAFO, but not FO/ECW kept a significant relationship with LAVI (p=0.03) using One-Way ANOVA test and linear regression methods. LVH was present in 73.7% (concentric 63.2%, eccentric in 10.5%). No differences between groups in the presence of LVH or left ventricular mass index were found. ConclusionsWe found that left atrial volume index determined by echocardiographic Area-length method, but not left ventricle hypertrophy or dimensions of cavities, are related on hydration status based on bioimpedance measured time-averaged fluid overload (TAFO), and not with FO/ECW.

Intradialytic Oral Protein Supplementation and Nutritional andInflammation Outcomes in Hemodialysis: A RandomizedControlled Trial.

Malnutrition is a common finding in hemodialysis patients and can increase oxidative stress and inflammation levels. A randomized, controlled, nonblinded, parallel trial. 92 hemodialysis patients from a single center with malnutrition according to subjectiveglobal assessment (SGA) score (SGA score > 7). 3 treatment groups (23 patients each) received 220mL of fermented vitamin E-fortified whey beverage (15g of whey protein concentrate+ 600IU of vitamin E) or 220mL of fermented whey beverage (15g of whey protein concentrate) or vitamin E (600IU) 3 times a week for 8 weeks. The control group (23 patients) received no intervention. Primary outcomes were change in SGA score and malnutrition-inflammation score (MIS) from baseline to the end of the trial. At the end of the study, 83 patients were analyzed (2, 3, 1, and 3 patients left the study in the vitamin E-fortified whey beverage, whey beverage, vitamin E, and control groups, respectively). Changes in SGA scores were-3.48 (95% CI,-4.90 to-2.00),-3.22 (95% CI,-4.13 to-2.30),-1.70 (95% CI,-3.20 to-0.24), and 1.56 (95% CI, 0.60 to 2.50) for the vitamin E-fortified whey beverage, whey beverage, vitamin E, and control groups, respectively (overall P<0.001; P≤0.001 for each treatment group vs control). Changes in MISs were-3.17 (95% CI,-4.40 to-1.90),-1.83 (95% CI,-2.50 to-1.10),-2.30 (95% CI,-3.50 to-1.10), and 1.48 (95% CI, 0.65 to 2.30) for the vitamin E-fortified whey beverage, whey beverage, vitamin E, and control groups, respectively (overall P<0.001; P<0.001 for each treatment group vs control). Few adverse effects were reported in any group. Lack of blinding, small sample size, and short duration. Whey protein in the form of a new fermented whey beverage and vitamin E supplementation may improve SGA score and MIS in the short term.

Letter to the editor: spontaneous renal haemorrhage in end-stage renal disease.

Letter to the editor: spontaneous renal haemorrhage in end-stage renal disease.