Hemodialysis Therapy Research Articles

Thrombophilia’s in Patients with Diabetes Mellitus

A clinical case of severe manifestation of type 2 diabetes mellitus in a teenage boy with obesity and the development of severe ketoacidosis as part of multiple organ failure syndrome is described. Timely elimination of diabetic ketoacidosis, hemodialysis and complex therapy in a multidisciplinary hospital made it possible to improve the teenager’s condition and avoid death.

Transfemoral leadless pacemaker implantation after tricuspid valve surgery and intervention

Abstract Background and Purpose Pacemaker (PM) implantation after surgical or transcatheter tricuspid valve (TV) repair or replacement may be challenging. Transcatheter leadless pacemaker (LPM) implantation has become a routine procedure and is frequently adopted in patients without the need for an atrial lead, in cases with cardiac implantable device infection or in patients with marked comorbidities. The use of LPM in patients with previous TV repair or replacement has only been described in singular cases in literature. We present our single center experience of LPM implantation after TV repair. Methods Patients with a history of TV repair or replacement who underwent LPM in our institution between 01/2020 and 11/2023 were retrospectively analyzed. All patients underwent routine clinical follow-up investigations including LPM interrogation and transthoracic echocardiography to assess for TV status. For LPM implantation right anterior oblique (RAO) and left anterior oblique (LAO) caudal fluoroscopy projections were utilized to enable LPM device passage across the TV. Results The study population consisted of 10 patients (9 females, mean age 74.0±10.0 years). Two patients had a history of surgical TV annuloplasty repair and two patients a history of surgical valve replacement, four patients of transcatheter TV repair (one through the mitral clip), one patient of transcatheter valve-in-ring bio prosthesis implantation prosthesis after previous surgical ring deployment and one patient transcatheter TV replacement (Figure1). All patients suffered from permanent atrial fibrillation previous to implantation procedures. Three patients were on chronic hemodialysis therapy before LPM implantation. LPM systems were successfully implanted in all cases with a mean procedure time of 43.5±26.5 minutes and a mean fluoroscopy time of 5.9±5.5 minutes and a radiation dose of 1148,7±1424,9 cGy·cm2. For fluoroscopically guided TV crossing a mean LAO angle of 43.6±14.1° (range 22 to 53°) and caudal angle of 8.5±6.9° (range 0 to 20°) was utilized (Figure 2). The LPM device was positioned in the first positioning attempt in a right ventricular high septal localization in 8 cases. Mean pacing threshold was 0.36±0.07 V at 0.25 ms, with a mean sensing amplitude of 10.5±2.9 mV and a mean of 853±324 Ohms pacing impedance. No periprocedural complications occurred. Mean duration of follow-up was 8.1±9.2 months. There were no newly developed TV regurgitations noted. Pacing thresholds (0.37±0.1 V/0.25 ms), sensing amplitude (11.8±4.5 mV) as well as pacing impedances (865±365 Ohms) remained stable until the last follow-up investigation. Conclusion LPM implantation was feasible in patients with a history of TV repair or replacement. LPM implantation was safe and effective in various modalities of TV repair. LPM may be an alternative to conventional pacemaker implantations as well as surgical lead placement in selected patients.Figure 1.Figure 2.

#1792 Phenotypic variability in PAX2-related nephropathies: a monocentric study

Abstract Background and Aims Pax2 mutations are known to cause kidney disease; both syndromic conditions, as kidney coloboma syndrome, and kidney specific disorders, as FSGS, have been described. Due to the rarity of Pax2-related nephropathies, data on genotype-phenotype correlation are limited. Method This observational and mono-centric study describes three families (A, G, P) referring to our Nephrology center, carrying Pax2 mutations. A total of 12 subjects were investigated: 2 individuals in family A, 4 in family G and 6 in the family P. Genetic analysis was carried out by NGS; detected mutations were confirmed by Sanger sequencing. Results Family A It includes 2 affected subjects, a 40 year-old woman and her mother (Fig. 1A). The mother had chorioretinic coloboma and was under hemodialytic therapy since the age of 50. The daughter had chorioretinic coloboma and bilateral renal hypodysplasia, proteinuria and a progressive decline of the eGFR since 34 years; renal biopsy excluded the presence of GN (Table 1). Both have the heterozygote c.890delC variant (p.Thr297fs) in Pax2. Family G It includes 4 affected individuals belonging to 3 different generations (Fig. 1B). The disorder was discovered after the evidence of advanced renal failure in a pregnant 27 y-old lady. The study of her family revealed the presence of kidney disease in her sister (transplanted on young age) and her father; one of her children has the mutation (Table 1). The PAX2 c.194T>C(p.Val65Ala HET) mutation segregates with the phenotype in the family. Family P It includes 6 affected individuals of 3 different generations (Fig. 1C); the index-case presented with heavy proteinuria: kidney biopsy revealed a C3 nephropathy. His son was transplanted when 18 years old for bilateral renal hypoplasia. His mother died after some years of dialysis (Table 1). PAX2 mutation on exon3: c.361G>A(p.Glu121Lys HET). Conclusion This case series demonstrates the phenotypic variability of patients with Pax2 mutations and suggests the utility of new generation genetics (NGS) to get the diagnosis in atypical conditions. The implementation of international registers and basic studies will be indispensable to define the mechanisms involved in the development of the disease and to address the reasons of clinical variability.

#2889 Multiple renal tumors as an atypical clinical manifestation of granulomatosis with polyangiitis

Abstract Background and Aims Granulomatosis with polyangiitis (GPA) is a systemic small- vessel vasculitis associated with antineutrophilic cytoplasmic antibody (ANCA), in which kidney involvement often occurs. In some cases the course of vasculitis with kidney involvement is atypical, what complicates the diagnostic process and makes appropriate treatment difficult. Finding nodular masses in the kidneys always causes an oncological concern, while in the differential diagnosis a systemic vasculitis is rarely taken into account, what may lead to an unnecessary nephrectomy. Method We present a case of granulomatosis with polyangiitis (GPA) who presented with multiple tumors in the kidneys and adrenal gland. Results 29-year-old man experienced a sudden disease onset, at the age of 18 years, when due to peripheral oedema, nephrotic grade proteinuria (13.7 g/24 h), hematuria and presence of renal failure markers (serum creatinine 3.4 mg/dL), he was admitted to hospital. A suggestion of a rapidly progressive glomerulonephritis (RPGN) was put forward and a renal biopsy was performed (in the histopathological examination of the kidney, pauci-immune crescentic necrotizing glomerulonephritis was revealed). A treatment with plasmaphereses, high glucocorticosteroid doses and cyclophosphamide pulses was instituted. Haemodialysis therapy was also applied temporarily. ANCA and anti-glomerular basement membrane (GBM) antibodies were determined to give negative results. As a result of the remission-inducing treatment, an improvement of the renal function was obtained (serum creatinine 1.6-1.9 mg/dL). In spite of the remission-maintaining treatment with mycophenolate mofetil (MMF) and oral prednisone, after 10 years again a dramatic renal function impairment occurred, with a necessity of institution of a long-term haemodialysis therapy. Furthermore, on abdominal ultrasound examination multiple focal lesions were found in both kidneys, which rendered a kidney transplantation procedure in the patient impossible. In order to extend the diagnostic procedures, a magnetic resonance imaging (MRI) of the abdominal cavity without contrast agent administration was carried out (in both kidneys disseminated focal lesions were described: non-homogeneous, with moderately enhanced signal on T2-weighted images in the central part, without signs of water diffusion restriction; in the left kidney, of 23 x 22 mm and 19 x 15 mm dimensions; in the right kidney, of 30 x 32 mm, 26 x 22 mm and 22 x 18 mm dimensions. The picture of the lesions was unspecific and atypical. In the differential diagnosis granulomas could not have been ruled out, while disseminated proliferative lesions were less likely. Besides that, in both kidneys cysts of up to 7 mm diameters were present. In the lateral limb of the left adrenal gland a focal lesion was visible, of 23 x 14 mm dimensions, of a structure identical to that of the foci in both kidneys). On high-resolution computed tomography (HRCT) of the chest at the same time, small ground glass areas were found in the lungs. On positron emission tomography/computed tomography (PET/CT) no changes were visualised, suggesting presence of a metabolically active proliferative process. Tests for ANCA, antinuclear antibodies (ANA), anti- double-stranded DNA (dsDNA) antibodies, anti- GBM antibodies were again performed and gave negative results. He was diagnosed with granulomatosis with polyangiitis without ANCA and treated with corticosteroid and intravenous rituximab (4x 787 mg). Three months later, follow-up showed reduced mass lesions in the kidney and adrenal gland by MRI. Conclusion The case highlights the atypical clinical presentation of vasculitis and the significance of considering this possibility in differential diagnosis when confronting mass lesions present in the kidney.

#705 Survival of expanded hemodialysis and high-flux hemodialysis patients in Colombia: a cohort's study

Abstract Background and Aims Survival is a core outcome of hemodialysis (HD) therapy. Progressive improvement in the permeability and biocompatibility of membranes for HD, dialysis techniques and clinical processes around these therapies have been developed. Recently, expanded hemodialysis (HDx) enabled by the medium cut-off membrane Theranova® has demonstrated encouraging efficacy outcomes in terms of better clearance of medium molecules and better outcomes reported by patients when compared to high-flux hemodialysis membranes (HF HD). The objective of the present study is to compare survival in an HDx cohort versus an HF HD cohort at a 48-month follow-up. Method Cohort study, one group with expanded haemodialysis (HDx) enabled by Theranova® and the other with HF HD, adult prevalent HD patients (> 90 days) at Baxter Renal Care Services Colombia starting between September 1, 2017, and November 30, 2017, with follow-up for up to 48 months. The sociodemographic and clinical characteristics of all patients were summarized descriptively. A Fine-Gray regression model was performed to evaluate the factors associated with time to death from causes other than COVID-19, death attributable to COVID-19 cause is a competing risk. A sensitivity analysis was performed using different statistical methods, such as extended Cox regression and Cox regression, after adjusting for imbalance between the cohorts with the inverse probability of treatment weighting (IPTW) method. Results We evaluated 1092 patients, 533 in HF-HD vs 559 in HDx; the mean age 61 years; 42% had diabetes, and 19% had cardiovascular disease. All patients' sociodemographic and clinical characteristics are summarized descriptively by cohort arm (Table 1). A multivariate analysis was performed to evaluate the effect of demographic, clinical, and laboratory variables on the risk of death, adjusting for the competing risk of death from COVID-19 during four years of follow-up. Our results indicate that the Theranova dialyzer has a protective effect on mortality risk when controlling for confounding variables SHR = 0.75 [95% CI: 0.58 to 0.95, p-value = 0.019] (Table 2). The different sensitivity analyses report a statistically significant beneficial effect of Theranova versus HF dialyzer. See Table 3. Fig. 1 shows a difference in the survival functions according to the type of dialyzer. Conclusion HDx enabled by Theranova dialyzer was associated with an approximately 25% reduction in mortality risk compared to HF HD patients followed for up to 4 years; this effect was consistently observed using different survival analysis methods.

#730 Dialysis-induced changes in systolic, diastolic, and pulse pressure in maintenance hemodialysis patients

Abstract Background and Aims Hemodialysis (HD) therapy has a strong impact on cardiovascular function in both the short and long term. In the short term, the dialysis-induced changes in blood volume directly affect the arterial blood pressure (BP), frequently leading to intradialytic hypotension or hypertension, both associated with adverse outcomes. The aim of this study was to investigate the dialysis-induced changes in systolic (SBP), diastolic (DBP), and pulse pressure (PP) in maintenance HD patients and to assess their relationship with pre-HD BP. Methods 197 maintenance HD patients were studied during the middle dialysis session of the week. The mean pre-dialysis fluid overload was 2.0 ± 1.6 L (calculated as the difference between the pre-dialysis body weight and the target weight). All HD sessions lasted approximately 4 h and were performed using mainly low-flux dialyzers. SBP and DBP were measured pre-HD and post-HD using a sphygmomanometer. PP was calculated as SBP minus DBP. The patients were divided into two groups: A) patients with an intradialytic decline in SBP (∆SBP <0), and B) patients with an increase or no change in SBP during HD (∆SBP ≥0). Paired data were compared using the Student's t-test. Correlations between variables were assessed using Spearman's rho (ρ). Results During HD, SBP decreased in 120 (61%) patients (in 20 cases by more than 30 mmHg), remained unchanged in 11 (6%) patients, and increased in 66 (33%) patients (in 13 cases by more than 20 mmHg). DBP decreased in 94 (48%) patients, remained unchanged in 46 (23%) patients, and increased in 57 (29%) patients. In 76 (39%) patients both SBP and DBP decreased, whereas in 33 (17%) patients both SBP and DBP increased. In group A (n = 120), SBP, DBP, and PP decreased by 21 ± 16 mmHg (P < 0.001), 8 ± 11 mmHg (P < 0.001), and 13 ± 14 mm Hg (P < 0.001), respectively. In group B (n = 77), SBP, DBP, and PP increased by 12 ± 10 mmHg (P < 0.001), 4 ± 11 mmHg (P < 0.001), and 8 ± 13 mmHg (P < 0.001), respectively. Pre-HD SBP was 144 ± 23 mmHg in group A and 128 ± 25 mmHg in group B (P < 0.001). Pre-HD DBP was 80 ± 15 mmHg in group A and 68 ± 11 mmHg in group B (P < 0.001). In all patients combined, ∆SBP was similarly correlated with pre-HD SBP and pre-HD DBP (ρ = −0.42 in both cases, P < 0.001), whereas ∆DBP was more strongly correlated with pre-HD DBP (ρ = −0.52, P < 0.001) than with pre-HD SBP (ρ = −0.22, P < 0.01). ∆SBP was correlated with ∆DBP (ρ = 0.55, P < 0.001) and highly correlated with ∆PP (ρ = 0.78, P < 0.001). According to linear regression, SBP tended to increase during HD in patients with pre-HD SBP <118 mmHg (Fig. 1A), whereas DBP tended to increase in patients with pre-HD DBP <68 mmHg (Fig. 1B). Conclusions Patients with dialysis-induced decline in SBP (group A) had a significantly higher pre-HD BP (both SBP and DBP) compared with patients with an increasing or stable SBP (group B). This suggests that a high decline in SBP during HD appears to be more likely in patients with elevated pre-HD BP and that HD appears to have a pressure-normalizing effect in such patients. Similarly, a dialysis-induced increase in SBP or DBP appears to be more likely in patients with low values of pre-HD SBP or DBP, respectively.

#2019 Comparing survival outcomes between hemodialysis and hemodiafiltration using real-world data from Brazil

Abstract Background and Aims The CONVINCE trial and others studies, demonstrates that high-dose hemodiafiltration offers a survival advantage and benefits in reducing cardiovascular complications for patients in high-flux hemodiafiltration group compared to hemodialysis. Method We compared the outcomes of hemodialysis and hemodiafiltration using real-world data. We conducted an analysis on a cohort of patients who underwent hemodiafiltration therapy (HDF) at a single center, NefroStar Clinics from 28/06/2021 to 30/05/2023. The results obtained were then compared with data from patients receiving hemodialysis (HD) therapy within the Brazilian Public Health System (SUS). Baseline data, type of access for dialysis and adequacy tests obtained through the average of monthly tests were collected. The HDF data were obtained through automatic extraction of electronic medical records and the HD data were obtained by Datasus. The primary outcome was mortality from any cause. Results 85 patients undergoing hemodiafiltration were compared with 149,372 patients receiving hemodialysis through the Brazilian Public Health System (SUS). Using a 2:1 propensity score, we compared the 170 best-match HD patients along with 85 HDF patients. The percentage of vascular access and male sex were similar in both groups. The mean age of HDF and HD patients was 54 [41-67] and 58 [46-68] years, p=0.054, respectively. The adequacy tests show higher hemoglobin values and mores PTH values in the HDF group. In the Cox analysis, HDF therapy showed a reduced risk of mortality with an HR of 0.29 [0.11 – 0.77]. The propensity score analysis showed a HR of 0.32 [95% CI: 0.11 – 0.91]. This analysis was adjusted for age, type of access, KT/v, hemoglobin, and phosphorus. The Kaplan-Meier analysis showed respective survival rates for HDF and HD at the end of one year, 92.1% and 79.9%, p<0.001. Conclusion These results suggest high flux hemodiafiltration had survival advantages over hemodialysis in real word scenario.

#826 Protein-energy wasting and sarcopenia in assessing the outcomes and quality of dialysis

Abstract Background and Aims Sarcopenia is one of the serious complications of long-term hemodialysis (HD) therapy and is one of the independent predictors of morbidity and mortality in this population. Sarcopenia is associated with low physical activity, depression and low social adaptation. There are few estimates of the sarcopenia prevalence in HD patients, and they fit into the range of 15-30% in the general group and 45-60% among patients over 60 yo. The aim: in a prospective study, to clarify the prevalence, outcomes and risk factors of sarcopenia in comparison with protein and energy wasting (PEW) severity data. The results of the first year follow-up of the first cohort in the ongoing study are presented below. Method In the group of 99 prevalent patients of single HD center (vintage 26.4; 21.8-93.3 months; age 55±17 years, HD/HDF for 4-4.5 hours three-time weekly; Kt/V 1.57±0.31), the prevalence of sarcopenia was estimated (muscle mass was assessed anthropometrically and by bioimpedance (BIA), BodyStat 5000). The presence of sarcopenia was assessed by EWGSOP2 criteria, muscle strength - by wrist expander. The reference values for men and women were >27 kg and >16 kg. The PEW degree was assessed by 24-point scale (BMI, arm circumference, skin-fat fold above the triceps, arm muscle circumference, total protein, albumin, transferrin, absolute lymphocytosis; max 3 point for each). Obesity was established at BMI >30 kg/m² or according to the fat mass index >9 kg/m² in men and >13 kg/m² in women. The quality of life was assessed by KDQOL-SF™ after exclusion of patients with significant depression by the Beck scale. Results The muscle mass indices calculated anthropometrically (IMMA) and by bioimpedance (IMMB) were well correlated: IMMA=0.15+1.06×IMMB, R²=76%; diagnostic efficacy (in detecting sarcopenia) IMMA to IMMB was 86%. The prevalence of PEW by stage: absent (scores of all assessed scales - 3) – 59%, grade 1 (average score ≥2 and <3) – 32%, grade 2 (average score ≥1 and <2); in one patient, PEW was classified as severe (average score of scales <1). In the univariate and in the multiple adjusted analysis (for age, gender, provided dialysis dose and average ultrafiltration, hemoglobin and phosphate levels), the degree of PEW or the presence of PEW was not associated with the risk of death. At the same time, the phase angle (PA) of bioimpedance had such a link: the PA increase in by 1° was associated with a 24.4% reduction in the risk of death (95%CI 3.9-40.4%; p=0.022), and the inclusion of the same set of variables in the regression analysis model as for the PEW only weakened, but did not eliminated the link (OR decrease by 26.9%; 0.3-46.4%; p=0.048). The risk of death was not associated with obesity. Sarcopenia was detected in 52% of patients. It was not associated with the presence (severity) of PEW in women, but in men it was 1.48 times more common in the presence of PEW (p=0.049); in the entire group, the higher prevalence of sarcopenia in the presence of PEW (by 34%) did not reach significance (p=0.3). In multiple regression analysis, the presence of sarcopenia was associated with a 1.95-fold higher risk of death (95% CI 1.001-3.809; p=0.050). In the presence of sarcopenia, the quality of life scores were significantly lower for the scales of Physical functioning, Energy, and Physical Composite Score. The higher prevalence of sarcopenia among men than in women remains unexplained. It is possible that uniform thresholds for muscle mass and muscle strength are not suitable for all populations and require clarification. Conclusion Sarcopenia is the feature of more than half of HD patients and is significantly associated with an increased risk of death. PEW and sarcopenia, including partially similar indicators in their estimates, turned out to be poorly related in HD patients, and sarcopenia is more closely associated with hard outcomes than PEW. A separate assessment of these conditions and a search for contributing factors for its development/progression are required in prospective studies. One of the key objectifying indicators of the PEW and sarcopenia assessment could be the phase angle of bioimpedance associated with both clinical predictors and outcomes.

#226 Outcome of intermittent hemodialysis vs. continuous kidney replacement therapy for acute kidney injury: observational prospective multi-center study

Abstract Background and Aims Continuous hemodialysis in hemodynamically stable acute kidney injury (AKI) patients may impact outcome differently compared to intermittent hemodialysis, although this issue is controversial. We look at differences in AKI outcomes between patients treated with intermittent hemodialysis (IHD) and patients treated with continuous kidney replacement therapy (CKRT) modalities in in Kuwait. Method Clinically and hemodynamically stable adult inpatients with native kidneys (i.e., did not need inotropic support or mechanical ventilation) who received IHD or CKRT for AKI, in seven public hospitals in Kuwait between 1/January to 31/December 2021 were recruited. CKRT was selected due to lack of access to water treatment in patients wards in some of the participating hospitals. Demographics, comorbidities, dialytic and non-dialytic management data, and 30-day kidney and patient outcome data for, were prospectively collected and analyzed. Results Total number of AKI patients not on inotropic support and not mechanically ventilated who received dialysis during study period was 229 (age: 59.9 years; males: 60.3%; baseline eGFR: 56 ml/min). IHD (group 1) was performed in 27.1% of the cohort whereas CKRT (group 2) was performed in 72.9%. There was no statistically significant difference between the two groups in age (58.4 for IHD and 59.9 for CKRT, p=0.6), baseline eGFR (55 ml/min for IHD and 56.4 for CKRT, p=0.8), sex ratio, incidence of diabetes, hypertension or cardiovascular disease, or cause of AKI. However, renin angiotensin aldosterone system inhibitors (RAASi) were precipitating factors for AKI more significantly in the IHD group (25.8% vs. 6% for CKRT, P ≤ 0.001). Intensive care unit (ICU) contributed 21% of cases (14.5% for IHD and 23.4% for CKRT, insignificant p value of 0.1). Also, there was no statistically significant difference in receiving intravenous fluids between the two groups (71% for IHD vs. 71.5% for CKRT, p=0.8), however, more patients in the IHD group received diuretics (62.9% vs 43.1% for CKRT, p=0.008). Dialysis vascular access was right internal jugular vein in 59% (75.8% FOR IHD vs. 52.7% for CKRT) followed by femoral vein in 35% of cases (19.4%). Extracorporeal membrane oxygenation (ECMO) was used in only two cases in the CKRT group. Of the total cohort, 21.8% died, with no difference between the two groups (16.1% for IHD vs 24% for CKRT, p=0.2). Partial recovery was higher in IHD group (30.8% vs.17.3%, p=0.046) and complete recovery higher in CKRT group 33.1% vs 13.5%, p=0.009). eGFR at 30 days was 53.2 ml/min with no statistically significant difference between the two groups (44.6 for IHD vs 56.1 for CKRT, p=0.15). Conclusion The IHD group and the CKRT group were statistically similar in basic characteristics and received similar lines of management, except for the diuretics. At 30 days, they had similar death rates but CKRT group had higher rates of complete recovery than the IHD group. This is in line with published literature that suggest CKRT may not improve mortality but may improve kidney recovery.

#2868 Clinical outcomes of octogenarians starting haemodialysis: a single center experience

Abstract Background and Aims Simultaneously with the aging of the general population, the number of patients with ESRD is also increasing. The question of the most favorable dialysis treatment arises, but the most frequently used method is still haemodialysis (HD). Method Retrospective data from patients aged 80 years or older treated with chronic HD treatments in our Dialysis Center and followed between 2009 and 2023. were studied. Results This study included 33 octogenarians (83.5 ± 5.4 years, 25M, 8F) Underlying renal diseases were hypertensive/ischaemic nephropathy (76%), diabetic nephropathy (10%), obstructive nephropathy (4%) and UN in 3 (10%). Vascular access was AV fistula in 72%, AV graft in 4%, long-term HD catheter in 17%, temporary catheter in 7%. Over half of them (i.e., 55%) were mobile, 35% mobile with assistance and 10% were immobile. Out of thirty-three, 3 died during the first 90 days of HD therapy and they were excluded from further analysis. During the observation period, 19 of 30 have died (63%). There was no statistically significant difference between those who were still alive and who died regarding their vascular access status, though all four of our patients with temporary catheters died (21% of all died, p 0.26). Also, their age (82.8±2.5 vs. 83.5±3.3 y), Charlson score (8.4±1.7 vs. 8.4±1.2), their Kt/V (1.45±0.24 vs. 1.43±0.31), Hb (104.4±6.2 vs 106.1±7.9 g/L) or albumin level (37.8±5.3 vs. 36.9±4.6 g/L) and other of blood analysis did not differ significantly between live and died patients. The only 2 parameters that were statistically significantly different were their HD vintage (34.3±21.0 vs. 57.1±39.2 p 0.05) and the last obtained lean tissue index (LTI, assessed by “Body Composition monitor” bioimpedance apparatus). Namely, their LTI was less than 10 kg/m2 BSA (present in 6 of 19, i.e. 32% of died patients and in none of the survivors, p<0.05) The 1-year, 2-year, 5-year survival has a favorable rate, i.e. 86%, 77%, 42% respectively (Figure:). The main causes of death were cardiovascular disease (47%), COVID (26.3%), sepsis, gastrointestinal bleeding, disseminated malignancy, stroke (1 case each) and 1 patient decided not to continue his HD treatments. Conclusion With careful clinical assessment and timely created vascular access, HD is a good choice for the treatment of very old ESKD patients. The outcomes in observed population would probably be better without pandemic COVID scenario.

Effectiveness of Combined Hemodialysis-Hemadsorption Therapy in Improving Uremic Toxin Clearance, Inflammatory Markers, and Symptoms in Maintenance Hemodialysis Patients

Introduction: Combined hemodialysis (HD) and hemadsorption (HA) therapy has shown the highest clearance rates for middle and large-sized uremic toxin molecules and reduced mortality rates among maintenance HD (MHD) patients. This study aimed to investigate the effectiveness of combined HD and HA therapy in patients undergoing MHD. Methods: Forty patients with end-stage renal disease (ESRD) were divided into three groups: HD only (14), HD + biweekly HA (14), and HD + weekly HA (12). The duration of the study was 8 weeks. Uremic toxins (β2-microglobulin, leptin, parathyroid hormone), inflammatory markers (interleukin-6, C-reactive protein), and symptoms (appetite, pruritus, sleep quality) were assessed before the start and at the completion of therapy. Changes in the parameters were compared between the three groups. Mean differences of parameters in each group were also compared between before and after therapy. Results: Decrease in BUN level (−61.34 mg/dL [95% CI: −71.33 to −51.34], p < 0.0001) and pruritus score (−3.93 [95% CI: −6.89 to −0.97], p = 0.013) was significantly larger in HD + biweekly HA group compared to the others. Only HD + biweekly HA group showed significant reductions in CRP level (−0.10 mg/L [95%: −0.18 to −0.01], p = 0.034), VAS appetite score (10.43 [95% CI: 4.99–15.87], p = 0.001), and pruritus score (−3.93 [95% CI: −6.89 to −0.97], p = 0.013) after therapy. Both HD + biweekly HA (−2.79 [95% CI: −4.97 to −0.60], p = 0.016) and HD + weekly HA group (−2.33 [95% CI: −4.59 to −0.08], p = 0.044) exhibited a significant improvement in sleep quality score after therapy. Conclusions: HD combined with a biweekly HA is associated with a greater reduction in BUN level and better improvement of pruritus in ESRD patients compared to HD alone. HD + biweekly HA can significantly reduce CRP levels, alleviate pruritus, improve appetite, and enhance sleep quality.

Depression in hemodialysis patients: gender and age analysis

The purpose of this work was to estimate the prevalence of depressive disorders in hemodialysis patients and conduct a gender comparison of depression. The study group consisted of 25 men and 25 women with chronic kidney disease receiving hemodialysis therapy. The Hamilton Depression Inventory was used for diagnosis. The prevalence of depression in the study population was 26%. The incidence of depression in women was 12% higher than in men. With increasing age, the level of depression in men went up. Suicidal behavior was observed 4% more often in the group of men than in women.

Pengaruh Kombinasi Terapi Foot Massage dan Murottal Alquran terhadap Tingkat Kelelahan Pasien yang Menjalani Hemodialisa

Chronic kidney failure occurs due to a decrease in kidney function, causing an imbalance in the body's metabolism, fluids and electrolytes which can result in uremia. Patients with chronic renal failure must undergo routine hemodialysis therapy. Hemodialysis therapy can cause nursing problems, namely fatigue. Fatigue can be caused by a lack of hemoglobin levels in patients or the length of the hemodialysis process. The research method used in this research is a case report by evaluating the implementation of a combination intervention of foot massage and murottal therapy Surat Ar Rahman. The instrument for measuring fatigue levels uses the FACIT-fatigue scale questionnaire. The results of this study showed that the patient experienced high fatigue with a score of 10.5 and after being given a combination of relaxation intervention of foot massage and murottal Al-Quran therapy, the patient's fatigue level score became 18.2 or moderate fatigue. From these results, it can be concluded that there is an effect of providing a combination of relaxing foot massage and murottal therapy on reducing the level of fatigue in chronic kidney failure patients undergoing hemodialysis.

Evaluation of Hemoglobin and Creatinine Levels in Chronic Renal Failure Patients Undergoing Hemodialysis Therapy

Chronic Renal Failure (CKD) is a disease that occurs when the kidneys fail to maintain the body's fluid composition. Hemodialysis is one of the therapies to replace deteriorating kidney function. Deteriorating kidney function conditions cause the ability of erythropoietin to be disrupted and anemia occurs, so checking hemoglobin levels is useful to control the patient's hemoglobin levels and creatinine examination to detect the severity of kidney function disorders. This study aims to determine the relationship of hemodialysis therapy with hemoglobin and creatinine levels in CKD patients at Baptist Hospital, Kediri City. This study is important to obtain information and provide education to patients regarding the significant effect of hemodialysis therapy for chronic renal failure patients so that chronic renal failure patients are motivated and disciplined to carry out hemodialysis therapy according to a set schedule. The design of this study was a cross-sectional survey with independent variables being hemodialysis therapy in patients with chronic renal failure and dependent variables being hemoglobin and creatinine levels. 30 respondents were using the quota sampling method. The results of this study were the average examination results of hemoglobin levels of 9.0 g/dL and creatinine of 4.45 mg/dL. Based on the Pearson Correlation test, the correlation coefficient (r) is 0.369, and the p-value = (0.045) &gt; alpha = 0.05 (5%), thus H1 is accepted. The relationship between hemoglobin and creatinine levels in patients with chronic renal failure undergoing therapy hemodialysis at Baptist Hospital in Kediri City.

The Relationship Between Fluid Intake Compliance with The Occurrence of Hypervolemia in Chronic Rentalfailure Patients Undergoing Hemodialysis at Grandmed Hospital Lubuk Pakam

Chronic kidney failure is irreversible damage to kidney function that requires kidney replacement therapy. Failure during hemodialysis therapy often occurs due to non-compliance. Actions taken for hemodialysis patients are regarding fluid intake. Compliance with limiting fluid intake is a key factor in determining the health level of hemodialysis patients. The research method used was cross sectional. The population were all chronic kidney failure patients in the Hemodialysis Room at Grandmed Lubuk Pakam Hospital with a total sample of 40 people taken using the purposive sampling method. The results showed that as many as 20 respondents or 50.0% were in the category of less compliant with limiting fluid intake. On the other hand, it showed that as many as 22 respondents or 55% experienced mild hyperlovemia. The results of statistical tests show that there is a relationship between compliance with fluid intake and the occurrence of hypervolemia in chronic kidney failure patients undergoing hemodialysis at Grandmed Lubuk Pakam Hospital in 2023 with a p-value of 0.000. If the patient is increasingly disobedient in limiting fluid intake in the body, the greater the fluid accumulation or hypervolemia will occur.

Iron Management and Anemia in Patients on the Active Kidney Transplant List

IntroductionIron metabolism disorders and anemia are one of the main complications of end-stage renal disease that may affect the evaluation process for kidney transplantation. The study aimed to assess the iron metabolism in hemodialysis patients in relation to waiting list status. Study MethodThe study included 5068 hemodialysis patients, including those on the active waiting list (N = 449) and those who were not eligible for the waitlist (N = 4619). Demographic and biochemical data, Charlson's comorbidity index, duration of hemodialysis therapy and, respectively, hemoglobin, ferritin, and transferrin saturation levels were compared in both groups of patients. ResultsPatients on the active waiting list were significantly younger −53.2 vs 67.2 years (P < .001), with a lower Charlson comorbidity index score: 3.33 vs 4.42 (P < .001). The duration of hemodialysis therapy was similar: 66.0 vs 63.2 months (P = .416), the incidence of anemia according to World Health Organization (90.6%, vs 91.2%) and KDIGO (72.4% vs 70.4%). The degree of anemia correction in terms of hemoglobin concentration and transferrin saturation was comparable in both groups and amounted to an average of 10.9 g/dL (P = .349) for hemoglobin concentration and 32.7% vs 33.4% (P = .513) for transferrin saturation. However, there was a statistically significant difference in ferritin concentration: 554 ug/L vs 733 ug/L (P = .001). ConclusionsPatients on the active list have significantly lower ferritin levels despite similar duration of hemodialysis treatment and comparable hemoglobin values. This may be due to lower inflammation, and less frequent blood transfusions, and lead to a lower risk of immunization and an increased chance of potential kidney transplantation.

The Relationship Between Motivation and Adherence of Chronic Kidney Disease in Undergoing Hemodialysis Therapy in The Hospital

The prevalence of chronic kidney disease (CKD) continues to increase and hemodialysis therapy is one of the main renal replacement therapies in CKD patients. There is a relationship between motivation and adherence to hemodialysis therapy in several previous studies. However, this study has never been conducted at the research location so this study aims to investigate the relationship between motivation and adherence of patients with CKD in undergoing hemodialysis therapy. The research design used in the study was descriptive quantitative correlation with a cross-sectional approach to explore the relationship between motivation and adherence of CKD patients in undergoing hemodialysis therapy. The population in this study were CKD patients who were undergoing hemodialysis therapy at Advent Hospital Bandung, totaling 100 patients. With the Simple Random Sampling technique and using the Michael and Isaac table, 79 respondents participated in the study. The instruments used in this study were the ESRD-AQ questionnaire (The End-Stage Renal Disease Adherence Questionnaire) and a valid motivation questionnaire to measure the motivation and adherence of patients with CKD in undergoing hemodialysis therapy. Univariate descriptive analysis and Spearman's rank bivariate correlation were used to answer the identified research questions. The results showed that most of the GHG patients had high motivation in undergoing hemodialysis therapy. It is suggested that healthcare should improve the quality of medical services for patients with GGK who undergo hemodialysis therapy. Further research is needed to investigate the factors associated with motivation and adherence using qualitative design. Kepatuhan dan motivasi merupakan hal penting untuk menetukan keberhasilan pengobatan terapi hemodialisa. Penelitian ini bertujuan untuk menginvestigasi hubungan antara motivasi dan kepatuhan pasien GGK dalam menjalani terapi hemodialisa. Desain penelitian yang digunakan dalam penelitian adalah deskriptif kuantitatif korelasional dengan pendekatan cross-sectional untuk mengeksplorasi hubungan antara motivasi dan kepatuhan pasien GGK dalam menjalani terapi hemodialisa. Populasi dalam penelitian ini adalah pasien GGK yang sedang menjalankan terapi hemodialisa di Rumah Sakit Advent Bandung yang berjumlah 100 pasien. Dengan teknik pengambilan sampel Simple Random Sampling dan menggunakan tabel Michael dan Isaac, 79 responden berpartisipasi dalam penelitian. Instrumen yang digunakan dalam penelitian ini adalah kuesioner ESRD-AQ (The End-Stage Renal Disease Adherence Questionnaire) dan kuesioner motivasi yang telah valid untuk mengukur motivasi dan kepatuhan pasien GGK dalam menjalani terapi hemodialisa. Analisis deskriptif univariat dan korelasi bivariat Spearman’ rank digunakan untuk menjawab identifikasi masalah penelitian. Hasil penelitian menunjukkan bahwa sebagian besar pasien GGK memiliki motivasi tinggi dalam menjalani terapi hemodialisa yaitu berjumlah 44 responden (55,7%), sebagian besar pasien GGK patuh dalam menjalani terapi hemodialisa dengan jumlah 46 pasien (58,23%) dan terdapat hubungan antara motivasi dengan kepatuhan pasien GGK dalam menjalani terapi hemodialisa dengan nilai p-value adalah 0,001. Disarankan agar pelayanan kesehatan meningkatkan kualitas pelayanan medis bagi pasien GGK yang menjalani terapi hemodialisis. Penelitian lebih lanjut diperlukan untuk menyelidiki faktor-faktor yang berhubungan dengan motivasi dan kepatuhan dengan menggunakan desain kualitatif.

The Relationship Between Self Efficacy and Quality Of Life and Anxiety In Patients With Chronic Kidney Failure Patients Undergoing Hemodialysis Therapy At Grandmed Hospital Lubuk Pakam

Chronic kidney failure is an irreversible disease, where if you have experienced this disease you cannot return to normal as before. One way that can be done to maintain the condition and function of the kidneys so that the damage does not get worse is by carrying out dialysis therapy throughout the patient's life (usually done 1 to 3 times a week) or until a new kidney donor is obtained by undergoing transplantation surgery. kidney. Situations like this interfere with the patient's quality of life and psychological disorders such as anxiety. With the emergence of feelings of anxiety and decreased quality of life, the condition of the disease experienced will worsen. One effort that can be made to manage feelings of anxiety and maintain quality of life is by exercising self-efficacy. The aim of this research activity is to see whether there is a relationship between self-efficacy and quality of life and anxiety in patients suffering from chronic kidney failure who are being treated at Grandmed Lubuk Pakam Hospital. This research is a descriptive analytical study using a cross sectional approach. There were 80 patients who were samples from the 100 patients who were the population in this study. The statistical test used in this research is the chi-square test, which shows that the p value is for quality of life (p= 0.000), and the p value is for anxiety (p= 0.003). Through these results, it can be proven that there is a significant relationship between self-efficacy and quality of life and anxiety in patients with chronic kidney failure who are undergoing hemodialysis therapy at Grandmed Lubuk Pakam Hospital.

Renal Embolism Associated with the Atrial Myxoma: A Case Report and Literature Review

Renal embolisms due to cardiac myxomas are extremely rare; the clinical course, treatment, and prognosis of this disease are not established. A 69-year-old Japanese woman who underwent a nephrectomy for renal cell carcinoma 3 years earlier was hospitalized with a right occipital lobe cerebral infarction. Her renal function suddenly worsened 3 days post-admission: her serum creatinine rose from 1.46 mg/dL to 6.57 mg/dL and then to 8.03 mg/dL the next day, and hemodialysis therapy was started. Abdominal computed tomography (CT) scans showed patchy non-contrasted low-density areas in the right kidney, and chest CT scans and transesophageal ultrasonography revealed a left atrial tumor. We diagnosed renal infarction due to a left atrial myxoma. Hemodialysis and anticoagulant therapy (heparin) were continued, followed by the cardiac myxoma’s resection. The patient’s renal function gradually improved post-surgery, and the hemodialysis was discontinued. Considering our patient and 19 other case reports of renal infarction associated with cardiac myxoma, the treatment for such a renal infarction and the outcomes differ depending on the embolus site. The poor outcome of abdominal aortic embolism requires a prompt embolectomy, whereas a branch renal artery embolism requires anticoagulation therapy to prevent thrombosis formation around the myxoma.

Urosepsis: pathophysiology, diagnosis, and management-an update

Urinary tract infections vary widely in their clinical spectrum, ranging from uncomplicated cystitis to septic shock. Urosepsis accounts for 9-31% of all cases of septicemia and is often associated with nosocomial infections. Amajor risk factor for urosepsis is the presence of obstructive uropathy, caused by conditions such as urolithiasis, tumors, or strictures. The severity and course of urosepsis depend on both the virulence of the pathogen and the patient's specific immune response. Prompt therapy, including antimicrobial treatment and eradication of the infection source, along with supportive measures for circulatory and respiratory stabilization, and adjunctive therapies such as hemodialysis and glucocorticoid therapy, is crucial. Due to demographic changes, an increase in cases of urosepsis is expected-thus, it is of utmost importance for urologists to be familiar with targeted diagnostics and effective treatment.