Hemodialysis Group Research Articles

Association between renal function and the Treatment of Diabetic Macular Edema in Long-Term Cohort Study

To determine the correlation between the severity of chronic kidney disease (CKD) and treatment of diabetic macular edema (DME). The retrospective 2-year cohort study included eyes with DME confirmed using spectral-domain optical coherence tomography in Taipei Veterans General Hospital, Taiwan, between 2010 and 2020. All the eyes were treated with an intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) during regular follow-up around 2 years. They were categorized into 3 different groups: an estimated glomerular filtration rate ≥ 60 (mL/min per 1.73 m2) (group A), < 60 (group B), and patients undergoing hemodialysis (group C). The main outcome measures were (1) visual improvement, (2) structural improvement, and (3) the injection frequency of anti-VEGF in the different groups. In this study, 167 eyes from 120 patients were enrolled. Compared with groups B and C, the eyes in group A experienced the only significant visual improvement at month 3, month 6, and month 12 (P = 0.0001, 0.0002, 0.0013, respectively). The presence of subretinal fluid and intraretinal cysts was significantly decreased in groups A and B. In the treatment frequency analysis, the number of injections was the highest in group A and lowest in group C during the study period (P = 0.04). The severity of CKD had an impact on the DME treatment. The less severe CKD was, the greater the visual improvement that could be achieved. In addition, relatively poor renal function required a lower anti-VEGF injection frequency. The active prevention of the progression of CKD may play a key role in DME treatment.

Diastolic hyperemia-free ratio for the assessment of intermediate coronary artery stenosis in patients with hemodialysis

Abstract Background Diastolic hyperemia-free Ratio (DFR) is new resting index and uses a pragmatic definition by including areas below the average aortic pressure with negative slope. Hemodialysis (HD) exhibits left ventricular hypertrophy and impaired microcirculation. The relationship between DFR and fractional flow reserve (FFR) in the patients with HD has not been yet investigated. Purpose We aimed to compare the rate of physiological discordance between HD patients and non-HD patients, and to elucidate the best DFR cut-off value predicting less than 0.80 of FFR in HD patients. Methods We enrolled 761 consecutive patients (1033 vessels) who underwent both DFR and FFR in the intermediate coronary artery stenosis between July 2020 and December 2023 in our hospital. The cutoff values of DFR 0.89 or less and FFR 0.80 or less were used for the study. We compared the DFR values with FFR values between HD group and Non-HD group. Results HD group consisted of 110 patients and Non-HD group consisted of 651 patients. A good correlation between DFR and FFR was observed in HD group (R=0.780 ; p &amp;lt; 0.0001) and Non-HD group (R=0.770 ; p &amp;lt; 0.0001). The rate of physiological discordance between HD group and non-HD group was each 31.3% and 20.5% (p &amp;lt; 0.01). Receiver operating characteristic curve showed that a suitable cut off value of DFR for equivalent FFR value of 0.80 was 0.84 in HD group and 0.89 in Non-HD group, respectively (Figure). Conclusion In the patients with HD, DFR may overestimate intermediate coronary artery stenosis and the suitable cut off value was 0.84.2024 ESC HD DFR Figure

Maintenance hemodialysis patients participate in a virtual reality rehabilitation training experience: a qualitative study

Maintenance hemodialysis patients’ psychology and physiology will have negative effects. Adherence to exercise can effectively enhance the physical function of maintenance hemodialysis patients and reduce the negative psychological emotions. In recent years, virtual reality technology has been gradually applied to the hemodialysis group, providing a new way for the rehabilitation training and healthy life of maintenance hemodialysis patients. Objectives To understand the real experience of maintenance hemodialysis patients participating in virtual reality rehabilitation training, and to make reference for the future clinical development of a more perfect virtual reality rehabilitation training program. Metchods Phenomenological research method was used to conduct semi-structured interviews with 10 maintenance hemodialysis patients, and the interview data were compiled and analyzed using Colaizzi’s seven-step analysis. Results Four themes were distilled: (1) Maintenance hemodialysis patients’ overall perceptual experience of the virtual reality rehabilitation system; (2) Physical and psychological improvement of maintenance hemodialysis patients with virtual reality rehabilitation system; (3) Individualized needs of maintenance hemodialysis patients during virtual reality rehabilitation training; (4) Future improvements and recommendations for the virtual reality rehabilitation system. Conclusion The results of the study suggest that virtual reality improves patients’ motivation to recover and shows positive results and potential benefits in improving physical functioning and negative emotions in maintenance hemodialysis patients.

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.

Influence of Kidney Diseases on Lipid Profile in Patients Undergoing Conservative Managements and Hemodialysis

Kidney function gradually declines as a result of chronic kidney disease (CKD). The current study was conducted at Princess Iman Hospital in Muadi, Jordan from December to March 2024. It aimed to investigate the association between lipids and chronic renal failure (CRF), which refers to the advanced stages of CKD where kidney function has declined significantly, and to understand how dyslipidemia affects the development of CKD and general health outcomes. The study involved three groups of participants: patients with CRF who were on hemodialysis, those receiving conservative management for CRF, and healthy individuals as controls. According to the findings, CRF patients (hemodialysis and conservative management) had significantly higher lipid levels than the control group besides showing low indicators for kidney function (p&lt;0.001). In addition, triglyceride, cholesterol, low-density lipoprotein (LDL) levels, Cholesterol/high-density lipoprotein (HDL) ratio, and LDL/HDL ratio were also found to be significantly high in the hemodialysis group when compared to the conservative group (p&lt;0.001). In this population with CRFs, it was observed that lipid levels correlated positively with markers for kidney disease progression. Therefore, monitoring of lipids should be done regularly across all stages of CKDs to reduce cardiovascular complications associated with atherosclerosis. Hence, incorporating lipid evaluations into standard CKD care regimens, even during the initial phases, is vital for enhancing patient outcomes and lowering mortality risks. In essence, the results highlight the importance of proactive management of lipid levels in CKD individuals to tackle cardiovascular complications effectively. By understanding dyslipidemia's impact on CKD advancement, healthcare practitioners can customize interventions to enhance patient care and diminish related risks, ultimately improving prognosis and decreasing mortality rates among CKD cohorts.

Monitoring the Seroprevalence of Herpes Simplex Virus-1 Among Egyptian Hemodialysis Patients

Background: Hemodialysis patients are at high risk for infections due to their compromised immune systems. Herpes Simplex Virus (HSV) infections can lead to severe complications in this population. Despite its clinical significance, comprehensive data on the seroprevalence of HSV among hemodialysis patients are limited. Objective: This study aims to evaluate the seroprevalence of HSV-1 among Egyptian hemodialysis patients. Methods: A cross-sectional study was conducted with 218 participants (116 females and 102 males). Among these, 132 (60.6%) were undergoing hemodialysis, while 86 (39.4%) had normal kidney function and were free from HCV, CMV, and HIV infections. Serum samples were analyzed for IgG antibodies against HSV-1. Statistical analyses were performed to determine HSV seroprevalence. Results: The study observed a significantly higher prevalence of HSV-1-IgG antibodies in hemodialysis patients (84.1%) compared to the control group (66.3%, P&lt;0.01). Additionally, HSV-1-IgM positivity was also higher in the hemodialysis group (41.6%) compared to the control group (32.6%, P&lt;0.05). These findings highlight the need for vigilant monitoring and preventive strategies for HSV infections in hemodialysis patients.

Association Of Hyperkalemia With T-Wave Changes In Chronic Kidney Disease Patients Versus Hemodialysis Patients.

Hemodialysis (HD) patients often face hyperkalemia due to various reasons. Level of hyperkalemia and ECG changes may be discordant among HD patients in a significant number of patients. This study was conducted to investigate whether or not there is a unique ECG characteristic that predicts hyperkalemia in individuals with chronic kidney disease (CKD). OBJECTIVE: To determine an association between hyperkalemia (raised serum potassium) and T- (atypical T-wave) changes on ECG in CKD patients versus HD patients. METHODOLOGY 200 patients on HD and CKD 4 &amp; 5 not on HD, fulfiling the inclusion criteria were enrolled in the study. Sampleing for seum potassium levels were done and ECG obtained. RESULTS Mean age in HD and CKD groups respectivley was 51.46 ± 26.96 and 56.16 ± 21.68 years. In HD group there were 61 males and 39 females whereas in CKD group there were 57 males and 43 females. Mean serum potassium levels were 5.20 ± 0.85 (mEq/L) in HD group whereas in CKD group mean serum potassium levels were 5.50 ± 0.62 (mEq/L). The mean T-wave duration in HD group was 168.01 ± 2.94 (msec), while in CKD group the mean T-wave duration was 173.76 ± 2.33 (msec). In HD group Pearson correlation coefficient was -0.779 with a P -value of 0.000, whereas in CKD group Pearson correlation coefficient was -0.02 with P -value was 0.985. CONCLUSION In our study, there was a negative correlation between serum K+ levels and duration of T-wave in patients on maintenance HD. T

Quality of life and psychological distress in end-stage renal disease patients undergoing hemodialysis and transplantation.

Among diverse profound impacts on patients' quality of life (QoL), end-stage renal disease (ESRD) frequently results in increased levels of depression, anxiety, and stress. Renal replacement therapies such as hemodialysis (HD) and transplantation (TX) are intended to enhance QoL, although their ability to alleviate psychological distress remains uncertain. This research posits the existence of a significant correlation between negative emotional states and QoL among ESRD patients, with varying effects observed in HD and TX patients. To examine the relationship between QoL and negative emotional states (depression, anxiety, and stress) and predicted QoL in various end-stage renal replacement therapy patients with ESRD. This cross-sectional study included HD or TX patients in the Eastern Region of Saudi Arabia. The 36-item Short Form Survey and Depression Anxiety Stress Scale (DASS) was used for data collection, and correlation and regression analyses were performed. The HD and TX transplantation groups showed statistically significant inverse relationships between QoL and DASS scores. HD patients with high anxiety levels and less education scored low on the physical component summary (PCS). In addition, the results of the mental component summary (MCS) were associated with reduced depression. Compared with older transplant patients, TX patients' PCS scores were lower, and depression, stress, and negative working conditions were highly correlated with MCS scores. The findings of this study revealed notable connections between well-being and mental turmoil experienced by individuals undergoing HD and TX. The PCS of HD patients is affected by heightened levels of anxiety and lower educational attainment, while the MCS of transplant patients is influenced by advancing age and elevated stress levels. These insights will contribute to a more comprehensive understanding of patient support.

Evaluation of Inflammatory Status in Chronic Kidney Disease Patients and a Comparison Between Hemodialysis and Peritoneal Dialysis Patients.

Introduction Inflammation is a common denominator in patients with chronic kidney disease (CKD), which is not explained by the pre-morbid risk factors and can lead to atherosclerosis and increased cardiovascular mortality. We have compared inflammatory markers like high-sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in patients with CKD undergoing continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) in both pre-dialysis phase at baseline and post-dialysis phase at three months to determine which dialysis has a more inflammatory burden on the patient. Materials and methods Fifty CKD patients diagnosed with end-stage renal disease (ESRD) who fulfilled eligibility criteria were recruited in this prospective observational study over two years. We measured levels of IL-6, hs-CRP, serum albumin, and body mass index (BMI) in both pre-dialysis and post-dialysis phases. Our results were obtained by analyzing 50 patients of ESRD who were planned for renal replacement therapy in the form of bridge dialysis, out of which 25 were put on HD and CAPD each. Pre-dialysis assessment was done at baseline and post-dialysis at three months. Each group served as its own control. IL-6 and hs-CRP levels were performed using commercially available kits employing the enzyme-linked immunosorbent assay (ELISA) method. Results Inflammatory markers (hs-CRP, IL-6) were elevated in both the pre-dialysis and post-dialysis phases of CKD, regardless of the dialysis modality. hs-CRP was significantly elevated in the HD group as compared to the CAPD group; however, the difference in IL-6 between the two groups was not significant. Albumin and BMI were significantly low in both groups from baseline, with patients on HD exhibiting lower albumin than the CAPD group, although the result was insignificant. Conclusion Markers of inflammation, like hs-CRP and low albumin, are more pronounced in HD than in CAPD. We conclude that the inflammatory burden is higher in patients undergoing HD.

The Quality of Life in Elderly Patients in Comprehensive Conservative Management or Hemodialysis: A Case-Control Study in Analogous Basal Conditions.

Comprehensive conservative management (CCM) is a viable treatment option for elderly patients with end-stage kidney disease (ESKD). However, it involves a significant change in dietary habits, such as adopting a low-protein diet. Therefore, it is crucial to understand its impact on the patient's quality of life (QoL), particularly when compared to hemodialysis (HD). The study aims to evaluate the differences in the QoL between patients undergoing CCM and HD. The study included 50 patients over 75 with ESKD, with 25 patients in the CCM group and 25 in the HD group. The CCM group followed a personalized low-protein diet, while the HD group did not have protein restrictions. Various parameters were assessed, including demographic data, urine output, blood tests, comorbidity index, Visual Analog Scale (VAS), and hospitalization. The SF-12 questionnaire assessed the QoL, and the Physical Composite Score (PCS) and Mental Composite Score (MCS) were calculated. The study revealed no age and comorbidity index differences between CCM and HD patients. In contrast, CCM patients reported significantly better physical and mental well-being than HD patients. In univariate analysis, CCM (B 0.24, p = 0.001), protein intake (B -0.004, p = 0.008), hospitalization (B -0.18, p = 0.024), urine output (B 0.25, p = 0.001), and VAS (B -0.26, p < 0.001) influenced the PCS. At the same time, only the type of treatment (B = 0.15, p = 0.048), urine output (B 0.18, p = 0.02), and VAS (B -0.14, p = 0.048) influence the MCS. In contrast, in multivariate analysis, only CCM contributed to an improved PCS (B 0.19, p = 0.003) and MCS (B 0.16, p = 0.03), while a higher VAS worsened the PCS (B -0.24, p < 0.001) and MCS (B -0.157, p = 0.0024). In elderly patients with similar basal conditions, health-related QoL perception is better in CCM than in HD patients.

The effect of itching on sleep quality and comfort in patients with hemodialysis and renal transplantation: A multi-center cross-sectional study

BackgroundThe aim of this study was to determine the effect of itching on sleep quality and comfort in hemodialysis (HD) and renal transplant (Tx) patients with itching. MethodsThis descriptive, correlational seeking and cross-sectional study was conducted in four hospitals affiliated with a private health group in Istanbul between April and June 2021. The sample of the study consisted of 42 patients receiving HD treatment and 49 patients with renal transplantation. Data were collected using the Patient Information Form, 5-D Itch Scale, Richards-Campbell Sleep Questionnaire and General Comfort Questionnaire. ResultsThere was a significant difference between the HD and renal transplantation groups in the Direction (p = 0.01) and Disability dimension (p = 0.002) of the 5- D Itch scale in favor of the renal transplant group. The mean sleep quality and comfort scores of the groups were similar and moderate. Itching negatively affects sleep quality in patients receiving HD treatment, and 22 % of the change in sleep quality is explained by disability of itching (R2 = 0.22; p = 0.002). Itching negatively affects comfort in both groups. Itching explains 27 % of the change in comfort level in the HD group (R2 = 0.27; p = 0.002) and 25 % of the change in comfort level in the renal transplantation group (R2 = 0.25; p = 0.001). ConclusionsAccording the study results during the hemodialysis treatment process, itching is more intense in terms of distribution and disability and affects the quality of sleep of patients. Itching has a significant impact on patients' perception of comfort. Patients experience itching both during HD treatment and after renal transplantation, which significantly impairs their comfort. Therefore, itching should be carefully monitored during renal replacement therapy and its effects on patients should be evaluated.

Serum selenium level and its relation with inflammatory profile in hemodialysis children

Introduction: Chronic kidney disease (CKD) is described by structural or functional defects staying for three months. End-stage kidney disease (ESKD) patients undergoing renal replacement therapy (RRT) face complications and increased susceptibility to infections due to their compromised immune system. In addition, malnutrition and chronic inflammatory conditions are prevalent in CKD patients. Selenium, an essential trace element, plays a crucial role as a cofactor in antioxidant enzymes like glutathione peroxidase (GPX), contributing to vascular endothelial function. Selenium deficiency in patients with ESKD may intensify oxidative stress, increase susceptibility to cardiovascular complications, and impact mortality rates. Despite the significance of selenium in this context, studies on its levels in children undergoing hemodialysis (HD) are limited. Objectives: This study assessed serum selenium levels in children undergoing HD, compared with healthy children. Furthermore, we sought to establish correlations between selenium levels and inflammatory profiles in the HD group. Patients and Methods: An observational cross-sectional study was conducted with 30 pediatric patients with ESKD undergoing HD (HD group) and 50 healthy children (control group) in Tehran, Iran. Blood samples were collected from both groups, and serum selenium levels along with inflammatory markers were analyzed. The inclusion criteria encompassed pediatric ESKD patients undergoing HD for at least six months without recent inflammation or infections. The exclusion criteria comprised active infections, immunodeficiency syndromes, and corticosteroid therapy. Statistical analyses were performed using SPSS statistics. Results: Significant differences were observed in serum selenium levels between the HD and control groups (P=0.039). Correlation analysis disclosed a direct relationship among selenium levels and participant age (r = 0.235, P=0.036), with no significant difference between genders. Notably, significant correlations were found between selenium levels and erythrocyte sedimentation rate (ESR) and platelet-to-lymphocyte ratio (PLR). In contrast, no significant correlation between selenium levels and other inflammatory profiles was established. Conclusion: This study underscores the importance of assessing serum selenium levels in pediatric ESKD patients undergoing HD. Understanding the interplay between selenium deficiency and inflammatory profiles can inform interventions aimed at improving outcomes and reducing complications in this vulnerable population. Further researches are necessary to explain these associations and to explore possible therapeutic interventions.

A cross-sectional study on the impact of hemodialysis duration on retinal nerve fiber layer thinning in hemodialysis patients

This study aimed to investigate the relationship between hemodialysis duration (HDD) and retinal nerve fiber layer (RNFL) thickness. A total of 60 patients receiving maintenance hemodialysis and 67 healthy controls were analyzed. Spectral domain optical coherence tomography (SD-OCT) was employed to measure annular RNFL thicknesses. The hemodialysis group exhibited reduced temporal and inferior RNFL thicknesses relative to the control group. In hemodialysis patients, the inferior RNFL thickness was negatively correlated with HDD and positively correlated with intraocular pressure (IOP). Moreover, IOP was positively correlated with HDD. Mediation analysis showed that the negative correlation between HDD and inferior RNFL thickness was mediated by IOP. In conclusion, hemodialysis leads to temporal and inferior RNFL thinning, and the thickness reduction is proportional to hemodialysis duration. However, such changes are not induced by an increase in IOP.

Acetate-containing bicarbonate dialysate increases all-cause mortality more than acetate-free bicarbonate dialysate containing citrate in hemodialysis patients

BackgroundNo studies have compared mortality between acetate-containing bicarbonate dialysate (ABD) and acetate-free bicarbonate dialysate containing citrate (AFD) in hemodialysis (HD) or online hemodiafiltration (OHDF). We therefore compared mortality between ABD and AFD in each modality.MethodsThis retrospective observational study included 738 patients who were receiving super high-flux (SHF) or SHF albumin-leaking HD (n = 310: ABD 235 and AFD 75) or OHDF (n = 428: ABD 321 and AFD 107) at our institution between 1 April and 1 July 2017. Three-year all-cause mortality was compared between ABD and AFD in the HD or OHDF groups using a propensity score matching model. Kaplan–Meier survival curves were compared using the log-rank test, and then Cox regression analysis with adjustments was performed for some covariates that remained significant.ResultsAfter propensity score matching, mortality on ABD was not significantly different from that on AFD in the HD group [n = 75; hazard ratio (HR) 2.271, 95% confidence interval (CI) 0.863–5.981, P = 0.087] or in the OHDF group (n = 107; HR 1.944, 95% CI 0.585–6.458, P = 0.269) without adjustments. However, with adjustments using some covariates, mortality was significantly higher on ABD than on AFD (adjusted HR 4.501, 95% CI 1.434–14.125, P = 0.010) in the HD group, but not in the OHDF group.ConclusionsThese findings suggest that ABD worsens mortality more than AFD in patients on SHF and SHF albumin-leaking HD.Trial registration: UMIN Clinical Trials Registry, UMIN000053090. Prospectively registered 13 December 2023, https://center6.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000060581.

Long-term humoral and cellular responses elicited by Gam-COVID-Vac vaccine in hemodialysis patients: A prospective cohort study

&lt;b&gt;Purpose: &lt;/b&gt;The aim of this study is to assess long-term immunogenicity of the recombinant adenoviruses 26 and 5 vector-based COVID-19 vaccine Gam-COVID-Vac (Sputnik V, developed by N. F. Gamaleya National Research Centre, Russia) in patients receiving maintenance hemodialysis (HD) compared to healthy subjects.&lt;br /&gt; &lt;b&gt;Materials &amp;amp; methods: &lt;/b&gt;A prospective cohort study included patients treated with maintenance HD (n=23) and healthy volunteers (n=28). The levels of anti-severe acute respiratory syndrome coronavirus-2 specific IgG as well as specific T-cell responses were quantified in all participants at two time points: one and six months after complete vaccination. All participates were adults, had been vaccinated twice with Gam-COVID-Vac and had no prior history of confirmed COVID-19.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;In both groups, IgG levels decreased from month one to six, however, antibodies did not decline more rapidly in HD group (analysis of variance p=0.7214 for the “time×group” interaction, non-adjusted model). At the end of the study, 48.0% of non-HD and 67.0% of HD participants showed T-cell positivity. T-spot counts dropped over time in non-HD controls, but not in HD subjects (p=0.0080 and p=0.1800, respectively).&lt;br /&gt; &lt;b&gt;Conclusions: &lt;/b&gt;Patients receiving HD maintain significant long-term humoral response after Gam-COVID-Vac vaccination, which is comparable to that in subjects with normal kidney function. Cellular response turned up to be more sustained over time in HD group.

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

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

A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRD

Peritoneal dialysis (PD) shows promise for urgent-start dialysis in end-stage renal disease (ESRD), with automated PD (APD) having advantages. However, there is limited multicenter randomized controlled trial (RCT) evidence comparing APD with temporary hemodialysis (HD) for this indication in China. This multicenter RCT enrolled 116 patients with ESRD requiring urgent dialysis from 11 hospitals, randomized to APD or HD. Patients underwent a 2-week treatment with APD or HD via a temporary central venous catheter (CVC), followed by a maintenance PD. Outcomes were assessed over 12 months during 8 visits. The primary outcome was dialysis-related complications. The 1-year incidence of dialysis-related complications was significantly lower in the APD group than in the HD group (25.9% vs. 56.9%, P= 0.001). No significant differences were found between the groups in terms of PD catheter survival rates (P= 0.388), peritonitis-free survival rates (P= 0.335), and patient survival rates (P= 0.329). In terms of health economics, the total direct medical cost of the initial hospitalization for patients with ESRD was significantly lower in the APD group (27,008.39 CNY) than in the HD group (42,597.54 CNY) (P= 0.001), whereas the duration of the first hospital stay showed no significant difference (P= 0.424). For patients with ESRD needing urgent initiation of dialysis, APD was associated with a lower incidence of dialysis-related complications and lower initial hospitalization costs compared with HD, with no significant differences in PD catheter survival rate, peritonitis-free survival rates, or patient survival rates. These findings can guide clinical decision-making for the optimal dialysis modality for patients requiring urgent dialysis initiation.

Radiofrequency Catheter Ablation for Atrial Fibrillation Patients on Hemodialysis (From the Kansai Plus Atrial Fibrillation Registry) - Clinical Impact of Early Recurrence.

Catheter ablation (CA) for atrial fibrillation (AF) in patients on hemodialysis (HD) is reported to have a high risk of late recurrence (LR). However, the relationship between early recurrence (ER) within a 90-day blanking period after CA in AF patients and LR in HD patients remains unclear.Methods and Results: Of the 5,010 patients in the Kansai Plus Atrial Fibrillation Registry, 5,009 were included in the present study. Of these patients, 4,942 were not on HD (non-HD group) and 67 were on HD (HD group). HD was an independent risk factor for LR after the initial CA (adjusted hazard ratio 1.6; 95% confidence interval 1.1-2.2; P=0.01). In patients with ER, the rate of sinus rhythm maintenance at 3 years after the initial CA was significantly lower in the HD than non-HD group (11.4% vs. 35.4%, respectively; log-rank P=0.004). However, in patients without ER, there was no significant difference in the rate of sinus rhythm maintenance at 3 years between the HD and non-HD groups (67.7% vs. 74.5%, respectively; log-rank P=0.62). ER in HD patients was a strong risk factor for LR. However, even HD patients could expect a good outcome without ER after the initial CA.

The effect of dialysis modality on annual mortality: A prospective cohort study

Despite numerous studies on the effect of each dialysis modality on mortality, the issue remains controversial. We investigated the hazard rate of mortality in patients with incident end-stage renal disease (ESRD) concerning initial dialysis modality (hemodialysis vs. peritoneal dialysis). Using a nationwide, multicenter, prospective cohort in South Korea, we studied 2207 patients, of which 1647 (74.6%) underwent hemodialysis. We employed the weighted Fine and Gray model over the follow-up period using inverse probability of treatment and censoring weighting. Landmark analysis was used for identifying the changing effect of dialysis modality on individuals who remained event-free at each landmark point. No significant difference in hazard rate was observed overall. However, the peritoneal dialysis group had a significantly higher hazard rate than the hemodialysis group among patients under 65 years after 4- and 5- year follow-up. A similar pattern was observed among those with diabetes mellitus. Landmark analysis also showed the higher hazard rate for peritoneal dialysis at 2 years for the education-others group and at 3 years for the married group. These findings may inform dialysis modality decisions, suggesting a preference for hemodialysis in young patients with diabetes, especially for follow-ups longer than 3 years.

Changes of Dissociative Properties of Hemoglobin in Patients with Chronic Kidney Disease.

Background: The ability of hemoglobin to bind and dissociate oxygen is crucial in delivering oxygen to tissues and is influenced by a range of physiological states, compensatory mechanisms, and pathological conditions. This may be illustrated by the oxyhemoglobin dissociation curve (ODC). The key parameter for evaluating the oxygen affinity to hemoglobin is p50. The aim of this study was to evaluate the impact of hemodialysis on p50 in a group of patients with chronic kidney disease (CKD). An additional goal was to assess the correlation between p50 and the parameters of erythropoiesis, point-of-care testing (POCT), and other laboratory parameters. Methods: One hundred and eighty patients (106 male, 74 female), mean age 62.5 ± 17 years, with CKD stage G4 and G5 were enrolled in this cross-sectional study. Patients were divided into two groups, including 65 hemodialysis (HD) patients and 115 patients not receiving dialysis (non-HD). During the standard procedure of arteriovenous fistula creation, blood samples from the artery (A) and the vein (V) were taken for POCT. The causes of CKD, as well as demographic and comorbidity data, were obtained from medical records and direct interviews. Results: The weekly dose of erythropoietin was higher in HD patients than in non-HD patients (4914 ± 2253 UI vs. 403 ± 798 UI, p < 0.01), but hemoglobin levels did not differ between these groups. In the group of non-HD patients, more advanced metabolic acidosis (MA) was found, compared to the group with HD. In arterial and venosus blood samples, the non-HD group had significantly lower pH, pCO2 and HCO3-. This group had a higher proportion of individuals with MA with HCO3- < 22 mmol/L (42% vs. 24%, p < 0.01). The absolute difference of p50 in arterial and venous blood was determined using the formula Δp50 = (p50-A) - (p50-V). Δp50 was significantly higher in the HD group in comparison to non-HD (0.08 ± 2.05 mmHg vs. -0.66 ± 1.93 mmHg, p = 0,02). There was a negative correlation between pH and the p50 value in arterial (pH-A vs. p50-A, r = -0.56, p < 0.01) and venous blood (pH-V vs. p50-V, r = -0.45, p < 0.01). In non-HD patients, hemoglobin levels correlated negatively with p50 (r = -0.29, p < 0.01), whereas no significant relation was found in HD patients. Conclusions: The ODC in pre-dialysis CKD (non-HD) patients is shifted to the right due to MA, and this is an additional factor influencing erythropoiesis. Hemodialysis restores the natural differences in hemoglobin's dissociation characteristics in the arterial and venous circulation.