Hemodialysis Patients Research Articles

Knowledge about peritoneal dialysis among patients with end-stage kidney disease on hemodialysis: a cross-sectional study

Introduction Peritoneal dialysis (PD) is an alternative modality to hemodialysis (HD) for end-stage Kidney disease (ESKD) treatment. However, PD is underutilized, and patients’ knowledge about PD is crucial in making an informed decision about the dialysis modality. This study aims to evaluate the knowledge about PD among HD patients and explore the reasons for its underutilization. Materials and methods A cross-sectional study of 108 HD patients was conducted from August to November 2023, at Al-Jaber Dialysis Center in Al-Ahsa. They interviewed to assess the knowledge about PD and explore the reasons for its underutilization. Results The patients’ ages ranged from 20 to 80 years, with a mean age of 44.2 years. Regarding knowledge about PD, 81.5% of the ESKD patients had heard about other renal replacement modalities, with kidney transplant being the most commonly known option. Only 11.1% were aware of both kidney transplants and PD. 60.2% of patients reported that their nephrologists had discussed other treatment options with them. However, overall knowledge about PD among patients was relatively low, with 43.5% having good knowledge and 56.5% having poor knowledge. Lack of information, considering HD as a better method, and fear of complications were the primary reasons for not considering PD as the first treatment option. Conclusion This study highlights the inadequate knowledge about PD among HD patients and identifies factors contributing to the underutilization of PD. Lack of information, misconceptions about the effectiveness and safety of PD, and preference for HD were significant barriers. Enhancing patient education and addressing misconceptions are crucial in promoting PD as a viable treatment option for ESKD, thereby improving patients’ quality of life.

Association Between Perceived Stress with Anxiety, Depression, and Resilience in Hemodialysis Patients During Coronavirus Disease 2019 Pandemic

Association Between Perceived Stress with Anxiety, Depression, and Resilience in Hemodialysis Patients During Coronavirus Disease 2019 Pandemic

Quality of Life and Complications Among Hemodialysis Patients

Quality of Life and Complications Among Hemodialysis Patients

Calculation of Aortic Arch Calcification Degree in Hemodialysis Patients Using Deep Learning

Abdominal Aortic Calcification (AAC) is a common form of vascular calcification closely associated with atherosclerosis and serves as an important marker for measuring increased risk of cardiovascular, cerebrovascular, and peripheral vascular diseases. Particularly in patients with Chronic Kidney Disease (CKD) and those undergoing dialysis, the risk of AAC significantly increases due to a combination of traditional and non-traditional risk factors. Therefore, developing a rapid and accurate method to assess the extent of AAC is crucial for preventing the progression of vascular calcification and the associated risk of cardiovascular diseases. Dialysis patients are required to undergo an abdominal X-ray annually, and the degree of calcification of the abdominal aorta is assessed manually through these X-ray images. However, these methods have limitations in identifying subtle calcifications in the abdominal aorta and the assessment process is time-consuming and depends on the experience and subjective judgment of physicians. To overcome these limitations, we propose a new method that incorporates deep learning technology to improve the accuracy of assessing the extent of AAC. Our method utilizes CNN models and attention modules to enhance the model's ability to recognize features of abdominal aortic calcification.

Incorporation of Calcimimetics into ESRD Bundle: Changes in Etelcalcetide Utilization and PTH Control Following End of TDAPA Designation

Introduction: Calcimimetics, including intravenous etelcalcetide and oral cinacalcet, are often prescribed to hemodialysis patients to prevent complications of elevated parathyroid hormone (PTH) levels. In January 2021, US dialysis reimbursement policy switched from the transitional drug add-on payment adjustment (TDAPA) to an increased bundled payment, with $10.09 per session added for all hemodialysis patients to cover the expense for calcimimetics, whether or not patients are administered etelcalcetide. We leveraged this natural experiment to investigate the impact of this policy change. Methods: This analysis included 713 US in-center hemodialysis patients enrolled in the United States Dialysis Outcomes and Practice Patterns Study (US-DOPPS) who discontinued etelcalcetide during the TDAPA transition period (December 2020 – April 2021). Within a self-matched longitudinal design, within-patient changes in mean PTH, calcium, and phosphorus were assessed in the six months pre- vs. post- etelcalcetide discontinuation, using linear regression adjusted for potential confounders. Results: Etelcalcetide use in US-DOPPS decreased 58%, from 12% to 5% from July 2020 to July 2021; 73% of etelcalcetide discontinuers switched to cinacalcet within six months. Comparing the six months pre- vs. post- etelcalcetide discontinuation, mean PTH levels increased by 107 (95% CI: 80, 133) pg/mL, and the prevalence of PTH >600 pg/mL increased by 15% (95% CI: 11%, 19%), from 28% to 43% overall, and increased from 26% to 49% among Black patients. Mean serum calcium and phosphorus levels increased by 0.42 and 0.16 mg/dL, respectively. Conclusion: Etelcalcetide use decreased substantially after TDAPA ended in January 2021, with most patients switching to cinacalcet. The subsequent increase in PTH levels was swift and sustained, and especially pronounced among Black patients, raising concerns about disparities and potential downstream impact on clinical outcomes. Despite the spirit of the policy change, the flat per-treatment increased payment may have inadvertently created a financial incentive to restrict patient access to a more effective therapy, and potentially stifle drug innovation.

Impact of convective clearance on intra-dialytic potassium removal in chronic dialysis patients.

Hyperkalemia is frequently encountered and associated with cardio-vascular mortality in chronic hemodialysis (HD) patients. While online hemodiafiltration (OL-HDF) is thought to offer clinical benefit over high-flux HD, the impact of convective clearance on intra-dialytic potassium removal is unknown. Chronic dialysis patients undergoing outpatient HD or OL-HDF at a single center attached to a university hospital were recruited in a prospective observational study. Spent dialysate along with clinical and biological variables were collected during a single mid-week session. We included 141 patients, with 21 treated with HD and 120 with OL-HDF. Mean age was 65.7 ± 15.6 years with 87 (61.7%) men. Mean intra-dialytic potassium removal was 69.9 ± 34.2 mmol. Patients on OL-HDF and HD have similar intra-dialytic potassium removal, with mean values of 69.1 ± 34.2 and 74.3 ± 35.0, respectively. In multivariate analysis, factors associated with intra-dialytic potassium removal were (decreasing order of effect size): dialysate potassium (β -15.5, p < 0.001), pre-HD serum potassium (β 9.1, p < 0.001), and session time (β 7.8, p = 0.003). In OL-HDF patients, substitution flow was not associated with potassium removal. In chronic dialysis patients, convective therapy provided by OL-HDF does not affect potassium removal when compared with high-flux HD. Moreover, the importance of convective volume is not associated with potassium clearance in OL-HDF. Overall, session length and serum-to-dialysate potassium gradient are the main determinants of potassium clearance regardless of dialysis modality. Those results should inform clinicians on the optimal therapy in chronic dialysis patients in the era of OL-HDF.

The Development of a Family Support Program for Caregivers of Hemodialysis Patients

Family caregivers of hemodialysis patients have a heavy burden based on negative experiences, long-term care hours, total physical dependence of patients, comorbid health conditions, and financial stress treatment procedures. This study design is a mixed method followed by 114 participants in the quantitative phase and eight participants in the qualitative phase. The research instrument used Zarit Burden, a demographic profile form, semi-structured interview questions, and a recorder. Data analysis used ANOVA, t-test, and thematic analysis. The results showed that most participants were 51 to 60 years old, patients' wives, college graduates, had a monthly income below ph10,000.00 and had cared for patients for 20 to 24 hours. Participants have experienced high physical and financial burdens and loss of control over life, as well as very high emotional and social burdens. Significant differences were found in the levels of emotional, social, and financial burdens when grouped by education level. Monthly income affects the level of social and financial burdens. Physical exhaustion, emotional suffering, limited social life, role conflict, financial poverty, and fear of the future are the themes of challenges in caregiving. Participants coped with their challenges by seeking help and sleep, emotional adjustment, acceptance, maintaining friendships, resisting the urge to participate in social activities, utilizing family resources, seeking financial support from politicians and government agencies, and borrowing money. The proposed stress relief support program has the potential to be an intervention to enable family care with various forms and levels of caregiving burden.

Association between Visit-to-Visit Ultrafiltration Volume Variability, Vascular Biomarkers and Cardiovascular Parameters in Chronic Hemodialysis Patients

Background. Cardiovascular (CV) diseases are the most common causes of morbidity and mortality in hemodialysis (HD) patients. We studied the effect of high visit-to-visit ultrafiltration (UF) variability on CV abnormalities in HD patients. Methods. Twenty-nine consecutive patients (age: 65.6 ± 10.4 years) were recruited. Samples for routine lab tests were drawn pre-HD for syndecan-1 (SDC-1) and endothelin-1 (ET-1) measurements pre-, mid- and post-HD. Applanation tonometry was performed pre-, mid- and post-HD. Visit-to-visit ultrafiltration volume variability (UVSD) was calculated as the standard deviation of the UF volume/dialysis session in the preceding 12 months. Echocardiography was performed post-HD. Results. Patients were divided into two groups based on the median of UVSD (500 mL). The average UF volume/HD was not different between the groups. Blood pressure (BP) values were similar. Pre-HD cfPWV (10.75 m/s) was lower in the high UVSD group (14.1 m/s, p = 0.03). In the high UVSD group, post-HD cfPWV (13.9 m/s) was higher than the pre-HD cfPWV (p &lt; 0.05). Pre-HD ET-1 was lower in the high UVSD group (8.6 ± 3.9 vs. 10.8 ± 2.7 pg/mL, p &lt; 0.05). Left ventricular end-diastolic diameter (LVEDD) and left ventricular mass index (LVMI) were higher in the high UVSD group (55.7 ± 7.3 vs. 51.0 ± 5.4 mm and 449.9 ± 180.5 vs. 350.3 ± 85.9 g/m², p &lt; 0.005, respectively). Left ventricular ejection fraction (LVEF) was lower in the high UVSD group (53.5 vs. 60, p &lt; 0.05). Conclusions. High UVSD was associated with increased left ventricular hypertrophy and dysfunction and decreased LVEF compared to low visit-to-visit UV variability despite similar UF volumes temporarily compensated by more elastic arteries. The observed abnormalities may increase CV risk.

Efficacy of Using a Vessel Dilator during Surgery to Evaluate Vein Diameter and Predict Radiocephalic Arteriovenous Fistula Maturation and Patency

Background: We use vessel dilators to assess the diameter of the target vein during surgery for arteriovenous fistula (AVF) creation in hemodialysis patients. This study investigates the efficacy of using vein diameter as measured using dilators (surgical diameter; SD) versus that as measured by preoperative ultrasonography (ultrasonographic diameter; UD) to predict postoperative complications and patency. Methods: Sixty-three patients who underwent radiocephalic AVF creation and had measurements of UD and SD were retrospectively analyzed. Cutoff values for UD and SD regarding complications were used to dichotomize the patients into high and low groups for comparisons. Results: The 2-year primary and secondary patency rates overall were 66.5% and 88.9%, respectively. The optimal UD and SD cutoff values were 2.4 and 3.5 mm, respectively. The 2-year primary patency rate was higher in the high-SD group than the low-SD group (88.2% vs. 58.6%; p = 0.0426). The 2-year secondary patency rate was significantly higher in the high-UD/high-SD group than the low-UD/low-SD group (91.7% vs. 68.4%; p = 0.0067). Conclusions: Intraoperative measurement of vein diameter using dilators during AVF creation might be a useful method of predicting patency, particularly when SD is used in combination with UD.

Network Analysis of Dysregulated Immune Response to COVID-19 mRNA Vaccination in Hemodialysis Patients

Introduction: End-stage renal disease (ESRD) results in immune dysfunction that is characterized by both systemic inflammation and immune incompetence, leading to impaired responses to vaccination. Methods: To unravel the complex regulatory immune interplay in ESRD, we performed the network-based transcriptomic profiling of ESRD patients on maintenance hemodialysis (HD) and matched healthy controls (HCs) who received the two-dose regimen of the COVID-19 mRNA vaccine BNT162b2. Results: Co-expression networks based on blood transcription modules (BTMs) of genes differentially expressed between the HD and HC groups revealed co-expression patterns that were highly similar between the two groups but weaker in magnitude in the HD compared to HC subjects. These networks also showed weakened coregulation between BTMs within the dendritic cell (DC) family as well as with other BTM families involved with innate immunity. The gene regulatory networks of the most enriched BTMs, likewise, highlighted weakened targeting by transcription factors of key genes implicated in DC, natural killer (NK) cell, and T cell activation and function. The computational deconvolution of immune cell populations further bolstered these findings with discrepant proportions of conventional DC subtypes, NK T cells, and CD8+ T cells in HD subjects relative to HCs. Conclusion: Altogether, our results indicate that constitutive inflammation in ESRD compromises the activation of DCs and NK cells, and, ultimately, their mediation of downstream lymphocytes, leading to a delayed but intact immune response to mRNA vaccination.

Effect of acupuncture on the sleep quality of hemodialysis patients in a capital city in the Northeast of Brazil

Objective: Analyze the effect of auricular acupuncture on the sleep quality of hemodialytic patients with chronic pain in a capital city in the Northeast of Brazil. Methods: This study includes double-blind, randomized in blocks and allocated at a rate of 1:1, controlled trial that was conducted in two hemodialysis clinics, with 94 chronic renal patients with chronic pain (auricular acupuncture [AA]: 47, sham acupuncture [SA]: 47). Both received 12 sessions for three months. We collected data using the Pittsburg Sleep Quality Index (PSQI). Data were analyzed using t-tests, Wilcoxon test and ANOVA. Results: Comparing the SA and AA groups, there was a statistically significant difference at baseline (p &lt; 0.001), a significant intergroup difference, and the AA group had better sleep quality than the SA group during and at the end of the 12 sessions (&lt; 0.001). A high magnitude of the effect of auricular acupuncture on sleep quality was found at the end of the sessions (D= -1.94). Conclusion: The auricular acupuncture intervention proved to be effective in improving the subjective sleep classification of renal patients.

Performance of SARC-F and SARC-CalF scores to predict risk of mortality in hemodialysis patients: a cohort study

This study aimed to evaluate the association between the questionnaires SARC-F and SARC-CalF with risk of mortality in patients undergoing hemodialysis (HD). A cohort study, with patients on HD age ≥ 18 years, both sex, between June 2019 and April 2023. Body composition (anthropometry and bioelectrical impedance), muscle functional (handgrip strength and gait speed), screening of sarcopenia using the SARC-F and SARC-CalF, nutritional status and laboratory data were assessed. Follow-up for mortality up to 47 months. The sample consisted of 243 participants and the prevalence of risk of sarcopenia using SARC-F and SARC-CalF were 30% and 45%, respectively; 65 died for all reasons and three patients were censored due to transplantation. Multivariate analysis identified SARC-CalF as predictor of mortality in HD patients [hazard ratio 1.96; 95% CI (1.01–3.79); p = 0.04]. The survival analysis showed that there was a significant difference in the survival curves among the groups stratified by SARC-F and SARC-CalF for log-rank test. A higher specificity was found for SARC-CalF than SARC-F (80% vs. 77%) in receiver operating characteristic (ROC) curve. Both questionnaires were associated with anthropometric, parameters of body composition, physical measurements, and SARC-CalF was predictor of risk for mortality in HD patients.

7378 Glargine Induced Neuroglycopenia in Patients with End-Stage Renal Disease: Importance of Insulin Regimen Optimization in Haemodialysis Patients

Abstract Disclosure: M. Shrivastava: None. L. Kaur: None. B. Armendariz: None. R. Kaur: None. A. Shetty: None. In patients with end stage renal disease (ESRD), hypoglycemia accounts for up to 3.6% of all the admissions with mortality rates of up to 30%. A combination of impaired insulin clearance, changes in glucose metabolism and dialysis process makes the patients with end stage renal disease vulnerable to neuroglycopenia.Case description:53 year old female with past medical history of insulin dependent type 2 diabetes mellitus, ESRD secondary to diabetes, on hemodialysis(HD) thrice weekly since two years, presented to the emergency with altered mental status, respiratory distress, tachycardia. Lab work revealed blood glucose(BG) of 23 mg/dl, HbA1c of 8.4%, eGFR of 6, and arterial blood gas showed hypercapnic respiratory acidosis. Patient received dextrose, with no improvement of symptoms. Eventually she developed acute hypercapnic respiratory failure requiring endotracheal intubation with mechanical ventilation, and was transferred to the ICU. As per family, a night prior to presentation, last recorded BG after dinner was 253 mg/dl, she took her night time glargine, which was recently increased by her primary care for poorly controlled HbA1c levels. Brain MRI and long term EEG monitoring findings were consistent with underlying extensive brain injury secondary to prolonged hypoglycemia. Unfortunately, the patient's condition did not improve despite HD and BG correction, eventually she underwent compassionate extubation. Case Discussion:The insulin requirements in ESRD patients are reduced by approximately 50%, regardless of residual insulin secretion. Malnutrition and acidosis reduce hepatic glycogen stores and availability of gluconeogenic precursor, expected compensatory renal gluconeogenesis is compromised by decreased renal function causing hypoglycemia, which is further worsened by inappropriately high plasma insulin levels caused by reduced renal insulin breakdown. Diabetes mellitus patients with ESRD are frequently managed with basal-bolus insulin regimen, and HD up to thrice weekly, leaving them without HD for up to 3 days especially over the weekend. This can result in accumulation of insulin metabolites causing delayed insulin clearance as seen in our patient. In such cases even long acting insulin, such as glargine, can have compounding effects, which could possibly cause fatal complications such as neuroglycopenia. In such patients continuous glucose monitor use with tapering dose glargine regimen may help eliminate this compounding effect. Conclusion: Neuroglycopenia is a rare manifestation of diabetes mellitus with ESRD. Compromised renal gluconeogenesis and impaired insulin clearance can cause inappropriately high plasma levels of insulin. In such patients continuous glucose monitoring along with tapering dose of long acting insulin should be utilized for proper glycemic control to limit compounded effect of insulin metabolite accumulation. Presentation: 6/3/2024

7987 Ravenous Bone

Abstract Disclosure: Y. Oo: None. L. Srisawitri: None. P. Patel: None. M. Thein: None. Introduction Hungry bone syndrome ( HBS ) is the rapid drop in serum total calcium concentration of less than 2.1 mmol/L and/or prolonged hypocalcemia for more than 4 days postparathyroidectomy. It is more frequent in hemodialysis patients with secondary hyperparathyroidism (SHPT). The severe hypocalcemia after the parathyroidectomy is believed to be due to the increased usage of calcium by the starving bones. The key management is to replenish the severe calcium deficit aggressively. Clinical Case A 44-year-old Hispanic male patient with ESRD on hemodialysis was admitted for elective parathyroidectomy for SHPT from ESRD. The hospital course was complicated with profound hypocalcemia after the surgery. The pertinent lab results before surgery were total calcium level of 7.2 mg/dl ( normal 8.4 - 10.2 ), ionized calcium level of 4.9 ( normal 4.48 - 4.92 ), and PTH level of 2184 pg/ml (normal 15 - 65). After the parathyroidectomy, the ionized calcium level became 3.4 mg/dl and the PTH level trended down to 56 pg/ml. On the post-op day ( POD ) 1, the patient was started on calcitriol 1 mcg BID and calcium carbonate 600 mg QID and also got the hemodialysis with a high calcium bath. Even with the replacement, the calcium level kept worsening and calcium gluconate infusion was started on POD 4. On POD 5, calcium gluconate infusion was on hold as the ionized calcium was improved. On POD 7, calcitriol was increased to 2 mcg BID as ionized calcium was 3.2 mg/dl and restarted on calcium gluconate infusion. On POD 8, ionized calcium was 3.5 mg/dl, and calcium gluconate infusion was titrated down. On POD 9, as the total calcium level was 8.8 mg/dl, the calcium gluconate infusion was discontinued and he was discharged with calcium carbonate 1200 mg TID and calcitriol 2 mcg TID. Unfortunately, 13 days from the discharge date, he was readmitted with the volume overload, and on this second admission, the total calcium was 7 mg/dl and ionized calcium was 3.2 mg/dl. The calcitriol dose was increased to 2 mcg TID and the same dose of calcium carbonate which was 1200 mg TID. He got hemodialysis with a high calcium bath. After being treated for the volume overload, he was discharged with calcitriol 2 mcg TID and calcium carbonate 1200 mg TID and followed up with the endocrinology team in 2 weeks. Conclusion Even with the aggressive and constant replacement of calcium, the HBS cases are challenging in terms of achieving and maintaining a normal calcium level after surgery. We, the clinicians, need a better understanding of how to avoid the development of HBS or at least minimize the severity of hypocalcemia in the postoperative course and the ultimate management regimen to maintain the normal calcium level in both inpatient and outpatient settings. Presentation: 6/1/2024

Nutritional Challenges and Interventions in Hemodialysis Patients: A Literature Review

Nutritional Challenges and Interventions in Hemodialysis Patients: A Literature Review

Utility of ultrasound in measuring quadriceps muscle thickness in patients receiving maintenance hemodialysis: comprehensive systematic review and meta-analysis.

Muscle wasting, a prevalent issue in hemodialysis patients, is effectively assessed by measuring quadriceps muscle thickness, a crucial health indicator. This meta-analysis integrates findings from various studies on the application of ultrasonography (US) for measuring the thickness of quadriceps muscles in patients undergoing maintenance hemodialysis. We conducted a thorough literature search across PubMed, Scopus, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science up to April 2023. The R software's Meta package was used for mean difference analysis of quadriceps rectus femoris thickness (QRFT) and quadriceps vastus intermedius thickness (QVIT) between hemodialysis patients and healthy controls. All of the patients entered the meta-analysis are Caucasians. Sub-group analyses based on measurement sites and pre- and post-dialysis comparisons were performed. Among 15 studies with 1584 patients, a significant decrease in QRFT and QVIT was observed in hemodialysis patients compared to healthy controls (mean difference = 0.40cm, 95% CI: -0.49 to -0.31 and 0.46cm, respectively). Right and left QRFT were notably thinner in hemodialysis patients (RT: mean difference = 0.39cm; LT: mean difference = 0.42cm). Similarly, right and left QVIT were notably thinner in hemodialysis patients (RT: mean difference = 0.45cm; LT: mean difference = 0.47cm). No significant pre- and post-dialysis QRFT differences were found. Ultrasonography is a reliable, accessible tool for assessing quadriceps muscle thickness in hemodialysis patients, revealing consistent muscle thickness reduction. These findings emphasize the need for routine muscle health monitoring in this population and support ultrasound use for regular assessments.

The benefit of reduced serum phosphate levels depends on patient characteristics: a nationwide prospective cohort study.

In cohort studies of hyperphosphatemic hemodialysis patients, reduced serum phosphate levels have been linked to a lower mortality risk. To investigate whether this benefit is influenced by patient characteristics, we calculated the number needed to be exposed (NNE), stratified by patient characteristics. In this 9-year prospective cohort study using the nationwide Japanese registry, we enrolled 78256 hemodialysis patients aged 18years or older. We investigated the relationship between time-averaged (TA) phosphate levels and mortality due to cardiovascular disease (CVD) using Cox proportional models. We estimated the 1-year NNE for CVD death in patients with baseline serum phosphate levels ≥6.0mg/dL and exposure to TA phosphate levels decreasing to 3.5-<5.0mg/dL using mixed-effects Poisson models. The hazard ratio of CVD mortality decreased linearly with lower serum TA phosphate levels in those with prior atherosclerotic CVD (ACVD) or diabetic nephropathy (DN) but plateaued with serum phosphate <5.0mg/dL in those without. The hazard ratios (95% confidence interval) for phosphate ≥7.0mg/dL compared with 3.5-<3.9mg/dL were 1.58 (1.38-1.81) in those with prior ACVD, 1.91 (1.68-2.17) in those without, 1.87 (1.63-2.16) in those with DN and 1.65 (1.46-1.87) in those without. However, the NNE for one more person to benefit (NNEB) for CVD death was lower in patients with a history of ACVD than in those without (61 vs 118). Patients with DN had lower NNEB than those without (69 vs 113). In patients with TA albumin ≥3.8g/dL, older patients had lower NNEB, while patients with TA albumin <3.45g/dL showed no benefit in some groups, including the elderly. The benefit of intensive phosphate management may be pronounced in patients with a history of ACVD or DN. A comprehensive approach that considers both age and nutritional status may be necessary when managing serum phosphate levels.

Efficacy of balloon angioplasty and stent placement in the treatment of central venous stenosis in patients with chronic kidney disease on hemodialysis

Background: Central venous stenosis is a common complication in hemodialysis patients, often caused by multiple long-term catheter use. This retrospective observational study evaluated the efficacy of balloon angioplasty and stent placement in treating central venous stenosis secondary to hemodialysis catheter use. Methods: A retrospective observational study was conducted at the Hospital General de México Dr. Eduardo Liceaga, analyzing clinical records of 16 chronic kidney disease patients diagnosed with central venous stenosis who underwent endovascular surgery between January 2022 and August 2024. The study evaluated demographic characteristics, comorbidities, stenosis location, and technical success. Statistical analysis included descriptive measures, Shapiro-Wilk test for normality, and paired Student's t-test (α=0.05) to compare pre- and post-angioplasty venous diameters. Results: The mean age of patients was 44.6±13.5 years, with a slight female predominance. The most common stenosis location was the right subclavian vein (31.2%), followed by the left brachiocephalic trunk (25%). Pre-procedure stenotic vessel diameter averaged 3.86±1.5 mm, increasing to 9.19±2.03 mm post-procedure. Statistical analysis showed a significant 138% increase in vessel diameter (p&lt;0.001). Of the 16 procedures, 11 patients underwent successful angioplasty, with 37.5% requiring stent placement due to recoil greater than 30%. In 5 cases, crossing the occlusive lesion was not possible. Conclusions: The study demonstrated the effectiveness of balloon angioplasty and stent placement in treating central venous stenosis, with a statistically significant improvement in vascular diameter. However, further studies with long-term follow-up are needed to evaluate the durability of these results and optimize management of complex cases.

The effects of dialysate calcium prescription on mortality outcomes in incident patients on hemodialysis.

The appropriate prescription of dialysate calcium concentration for hemodialysis is debated. We investigated the association between dialysate calcium and all-cause, cardiovascular mortality and sudden cardiac death. In this historical cohort study, we included adult incident hemodialysis patients who initiated dialysis between 1 January 2010 and 30 June 2017 who survived for at least 6 months (grace period). We evaluated the association between dialysate calcium 1.25 or 1.50mmol/l and outcomes in the 2 years after the grace period, using multivariable Cox regression models. Moreover, we examined the association between the serum dialysate to calcium gradient and outcomes. We included 12 897 patients with dialysate calcium 1.25mmol/l and 26 989 patients with dialysate calcium 1.50mmol/l. The median age was 65 years, and 61% were male. The unadjusted risk of all-cause mortality was higher for dialysate calcium 1.50mmol/l [hazard ratio (HR) 1.07, 95% confidence intervals (CI) 1.01-1.12]. However, in the fully adjusted model, no significant differences were noted (HR 1.05, 95% CI 0.99-1.12). Similar results were observed for the risk of cardiovascular mortality (HR 1.03, 95% CI 0.94-1.13). Adjusted risk of sudden cardiac death was lower for dialysate calcium 1.50mmol/l (HR 0.81, 95% CI 0.67-0.97). Significant and positive associations with all outcomes were observed with larger serum-to-dialysate calcium gradients, primarily mediated by the serum calcium level. In contrast to the unadjusted analysis that showed a higher risk for dialysate calcium of 1.50mmol/l, after adjusting for confounders, there were no significant differences in the risk of all-cause and cardiovascular mortality between dialysate calcium concentrations of 1.50 and 1.25mmol/l. After adjustment, a lower risk of sudden cardiac death was observed in patients with dialysate calcium 1.50mmol/l. A higher serum-to-dialysate calcium gradient is associated with an increased risk for adverse outcomes.

Breaking point: Case series of tendon ruptures in Hemodialysis patients

Breaking point: Case series of tendon ruptures in Hemodialysis patients