Hemodialysis access (HA) may induce distal ischemia and impair peripheral nerve function in the ipsilateral limb. Peripheral neuropathy is common in end-stage renal disease (ESRD) and may remain subclinical without electrophysiological testing. This study evaluated the effect of arteriovenous fistula (AVF) on electrophysiological parameters of the median (MN) and ulnar (UN) nerves and examined the impact of HA localization and flow. Ninety ESRD patients with functioning AVF underwent bilateral nerve conduction studies (DML, CMAP, CSAP, MCV, SCV) one hour before dialysis. HA flow was measured by Doppler sonography. Sensory symptoms and clinical tests (Phalen, Tinel) were recorded. Compared to the contralateral arm, the HA arm showed longer DML and reduced CMAP, CSAP, MCV, and SCV in both MN and UN. CSAP and MCV reductions were significant in both nerves, CMAP in UN. Electrophysiological impairment was greater with forearm HA and high flow (>979ml/min). Patients with sensory complaints exhibited significantly worse parameters than asymptomatic patients. AVF is associated with mixed axonal sensory-motor neuropathy, likely due to chronic distal ischemia. Sensory fibers are particularly vulnerable. Forearm location and high flow exacerbate deficits. Early electrophysiological screening may enable timely detection and intervention.

Sarcopenia has been associated with an increased risk of falls in diverse populations. Patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) have an increased prevalence of muscle weakness and wasting. The aim of this study was to investigate the association between parameters of sarcopenia and a history of falls in ESRD patients on HD. A cross-sectional study was utilized to assess 111 participants with ESRD on HD (54 ± 15.6 years; 59.5% men). Sarcopenia was defined by low muscle strength (handgrip dynamometry) and low muscle mass (bioelectrical impedance). History of falls was self-reported. Bivariate analyses were performed, and a multivariate logistic regression model was used to assess the association between sarcopenia and falls while adjusting for confounders. In the multivariate analysis, sarcopenia was not independently associated with a history of falls (OR = 1.73; p = 0.40). However, advanced age (OR = 1.04 per year; p = 0.03) and a history of stroke (OR = 6.07; p = 0.05) were identified as significant independent predictors of falls. History of falls was not independently associated with muscle strength or mass in ESRD patients on HD. Future longitudinal studies are needed to investigate other factors associated with this outcome.

Globally, quantitative information on healthcare coverage for chronic kidney disease (CKD) is scarce. Our objective was to estimate the supply/demand ratio for CKD-related procedures in the Brazilian Unified Health System (SUS) between 2015 and 2024. The volume of tests, consultations and treatments related to CKD was retrieved from the website of the SUS Information Technology Department. The requirement parameters of these procedures were obtained from the Ministry of Health ordinances as well as from literature review. The percentage coverage of each procedure was defined by the ratio between the volume performed and the estimated need. Coverage of the following procedures increased between 2015 and 2024: serum creatinine dosage (70% to 122%), proteinuria testing (4% to 12%), kidney ultrasonography (76% to 107%), outpatient consultation with a nephrologist (48% to 164%), multidisciplinary care of pre-dialysis CKD (0% to 3%), and chronic dialysis (69% to 81%). Coverage of kidney biopsy remained nearly stable (19% to 21%). There was a reduction in coverage of arteriovenous fistula for hemodialysis (HD) (66% to 59%) and of kidney transplantation (46% to 37%). The use of peritoneal dialysis (PD) among chronic dialysis methods (PD and HD) declined from 7% to 4%. Possible explanations for these results include excessive creatinine testing and nephrology consultations, neglect of CKD screening for proteinuria, lack of adherence to multidisciplinary pre-dialysis follow-up, underutilization of PD, and insufficient availability of kidney biopsy and kidney replacement therapy (lower coverage of kidney transplantation compared to chronic dialysis).

Patients with severe renal impairment and COVID-19 are at high risk for severe disease and death. Nirmatrelvir/ritonavir, an antiviral therapy for COVID-19, is eliminated by renal excretion and can accumulate in patients with severe renal impairment. The phase 1 Evaluation of Protease Inhibition for COVID-19 in Patients with Severe Renal Impairment (EPIC-SRI)study evaluated the safety and pharmacokinetics of nirmatrelvir/ritonavir for this population. Fifteen participants (3 not requiring hemodialysis, 12 requiring intermittent hemodialysis) received oral nirmatrelvir/ritonavir 300/100 mg on Day 1, followed by nirmatrelvir/ritonavir 150/100 mg once daily on Days 2-5. No treatment-related adverse events were reported. Geometric mean (coefficient of variation) maximum plasma concentration, plasma trough concentration, and area under the concentration-time curve from 0 to 24 hours for daily dosing of nirmatrelvir for participants from the Intermittent Hemodialysis Cohort were 3280 ng/mL (48%), 2188 ng/mL (81%), and 65,700 ng*h/mL (59%), respectively. Geometric mean (coefficient of variation) nirmatrelvir hemodialysis clearance and fraction removed from the body by hemodialysis were 30.5 mL/min (35%) and 6.9% (138%), respectively. Population pharmacokinetic modeling demonstrated that simulated distributions of nirmatrelvir maximum plasma concentration, minimum trough concentration, and area under the concentration-time curve from 0 to 24 hours for daily dosing at the studied regimen were similar to those for virtual subjects with normal to moderate renal function receiving the approved dose of nirmatrelvir/ritonavir. SARS-CoV-2 RNA levels were substantially reduced across both cohorts. Findings suggest that the studied regimen is well tolerated, achieves and maintains adequate exposure, and is suitable for patients with COVID-19 and severe renal impairment. NCT05487040.

Arteriovenous fistulas (AVF) are the preferred vascular access for hemodialysis, however patency rates remain low. Animal AVF models are essential for uncovering mechanisms of AVF remodeling. Yet most lack coexisting chronic kidney disease (CKD), critical to AVF failure. Existing CKD-AVF models are often acute surgical models and cause substantial discomfort and high mortality, limiting their translational value. This study assessed high-oxalate diet-induced kidney injury in a mouse AVF model and its effect on AVF remodeling. Male and female C57BL/6J mice were fed either a high-oxalate or control diet for six weeks. AVF surgery was performed at week three. Kidney function (glomerular filtration rate [GFR], plasma urea), blood pressure, and ultrasound-assessed AVF volume were monitored. Three weeks post-surgery, AVFs, blood, and kidneys were analyzed by immunohistochemistry and flow-cytometry to assess morphometry, endothelial damage, inflammation, and immune activation. High-oxalate diet reduced GFR by 49% (P<0.001) and increased plasma urea, confirming kidney injury. AVF volume did not differ between groups, whereas mean arterial pressure was 23% higher in the high-oxalate group (P=0.024). AVFs from these mice showed 13% less outward remodeling (P=0.026), increased endothelial damage, immune cell infiltration and vascular calcification. Flow-cytometry demonstrated increased systemic immune activation in the high-oxalate group. The high-oxalate-induced chronic kidney injury-AVF model express key similarities to human impaired AVF remodeling, including long-term kidney failure, hypertension, endothelial damage and immune activation. By reducing animal burden and improving disease representation, this model advances preclinical AVF research towards greater translational applicability.

Hybrid arteriovenous grafts (AVGs) incorporating a stented venous outflow were developed to facilitate access creation in patients with unfavorable venous anatomy. Following discontinuation of dedicated hybrid graft devices, off-the-shelf (OTS) stent-graft configurations have been adopted. We report our 10-year institutional experience and evaluate patency outcomes and reintervention burden. A retrospective review of consecutive hybrid AVGs created between 2014 and 2024 was performed. Patients were stratified by configuration: dedicated Gore Hybrid Vascular Graft (GHVG) versus OTS graft plus covered stent. Primary, assisted primary, and secondary patency were calculated using Kaplan-Meier analysis. Reinterventions were analyzed descriptively and expressed per patient-year. Forty hybrid AVGs were created (GHVG, 7 (17.5%); OTS, 33 (82.5%)). Median follow-up was 37.3 months. Primary patency was 50.7% at 6 months and 31.0% at 12 months (median 6.4 months). Assisted primary patency was 68.8% at 6 months and 52.3% at 12 months (median 12.1 months). Secondary patency was 89.3% at 12 months and 83.6% at 24 months (median 71.2 months). A total of 172 reinterventions were performed (1.30 per patient-year). The most frequent lesions were venous stent-edge and cannulation-site stenoses. No statistically significant difference in patency was observed between GHVG and OTS configurations. Hybrid AVG construction provides durable secondary patency despite limited primary patency, with an acceptable reintervention burden. Off-the-shelf configurations demonstrate outcomes comparable to dedicated hybrid devices and represent a practical option for patients with complex venous outflow anatomy.

Anemia of inflammation (AI) represents the second most prevalent anemia globally particularly in conditions of prolonged immune activation including hemodialysis (HD). While the role of pro-inflammatory cytokines in disrupting iron homeostasis and erythropoiesis is well-established, the regulatory mechanisms involving microRNAs (miRNAs) remain incompletely elucidated. The current study investigates the intricate relationships between cytokines and miRNAs in the pathogenesis of AI among HD patients. The study comprised 30 HD patients with AI and 30 healthy controls. Expression profile of inflammatory cytokines (IL-6, TNF-α) and inflammation-associated miRNAs (miR-34, miR-130, miR-16b) were analyzed using quantitative real-time PCR. Serum C-reactive protein (CRP) and iron metabolism markers (serum iron, ferritin, transferrin saturation and total iron binding capacity) were analyzed. Correlation analyses and pathway enrichment studies were performed to identify cytokine-miRNA regulatory networks. HD with AI exhibited significant overexpression of IL-6, TNF-α and miR-34 (p < 0.001), while miR-130 and miR-16b were significantly downregulated (P < 0.001) compared to control group. MiR-34 was positively correlated with IL-6 (r = 0.96, p = 0.001) and TNF-α (r = 0.98, p = 0.001), while it showed significant inverse correlation with miR-130 and miR-16b (p = 0.001 for both). Furthermore, strong positive associations were observed between lower levels of transferrin saturation and decreased expression of IL-6, TNF-α and miR-16b (p = 0.01, 0.009, 0.001 respectively). The markedly increased ferritin levels (> 600mg/mL) showed direct positive relationship with elevated expression of IL-6 and TNF-α in HD with AI. The present findings are exploratory and hypothesis-generating, suggesting possible relationship between miRNA dysregulation and the development of AI in HD patients, and provide the rationale for external validation in larger, independent HD cohorts. The interaction between miRNA expression and cytokine signaling may provide novel insights into the mechanism that could perpetuate AI in HD unravelling potential therapeutic targets that could mitigate the inflammatory response ultimately improving patient outcomes.

Introduction This study investigated the prevalence and severity of psychological distress among Taiwanese dialysis patients during the COVID-19 Omicron outbreak, compared differences between hemodialysis (HD) and peritoneal dialysis (PD) patients, and identified risk and protective factors associated with mental health. Methods A cross-sectional survey was administered to 245 dialysis patients (117 HD, 128 PD) at an academic medical center in central Taiwan. Data collected included demographic and clinical characteristics, the Depression, Anxiety, and Stress Scale-21 (DASS-21), the Insomnia Severity Index (ISI), and the Pandemic Worsening Index (PWI). Statistical analyses involved descriptive statistics, generalized linear modeling (GLM), and stepwise regression to identify significant predictors. Results Insomnia was the most prevalent symptom (54.7%), followed by stress (41.2%), anxiety (40.4%), and depression (14.3%). PD patients reported significantly greater psychological distress than HD patients. Regression analyses identified unemployment, reduced household income, comorbidities, and unhealthy behaviors (smoking and alcohol use) as significant risk factors. Conversely, complete vaccination and independence in daily activities were significant protective factors. Conclusions Both HD and PD patients experienced substantial psychological burdens during the pandemic, though their stressors and coping mechanisms differed. Routine psychological assessment should be integrated into dialysis care, particularly for patients facing socioeconomic hardship or multiple comorbidities. Timely supportive interventions, together with strategies to maintain functional independence, ensure full vaccination coverage, and strengthen social safety nets, may help address psychological distress and enhance resilience in dialysis populations during public health crises.

Intradialytic hypotension (IDH) is a frequent complication of hemodialysis (HD). Although nadir blood pressure-based definitions are prognostically relevant, their use in daily practice is limited because accurate identification requires frequent blood pressure monitoring. Because blood pressure (BP) is routinely measured during HD, the magnitude of the systolic BP rise during blood return may provide a simple and practical marker for identifying IDH. This cross-sectional study was conducted at a single HD center. Study 1 evaluated factors associated with the pressor response index in 53 HD patients across 159 sessions using analysis of covariance (ANCOVA). Study 2 examined the ability of the index to discriminate HD sessions with and without IDH as defined by McCausland etal. The pressor response index was significantly associated with maximum systolic BP drop and hypovolemic symptoms. The index clearly distinguished sessions with and without IDH. The effect size was large (Cohen's d = 1.41), and ROC analysis showed good discrimination (AUC 0.823). The optimal cut-off value was 10.3% (sensitivity 0.84, specificity 0.65). The pressor response index may represent a simple, objective, and practical marker for identifying IDH in routine clinical practice.

Intradialytic parenteral nutrition (IDPN) is recommended for patients on hemodialysis (HD) with protein-energy wasting (PEW) who cannot meet nutritional needs through oral or enteral intake. However, its use is highly variable and overall, this option is underutilized. We surveyed European practitioners to investigate barriers, facilitators and key factors related to IDPN implementation. We developed and distributed an online survey containing 27 questions about practice patterns of IDPN to the members of the European Renal Association (ERA) and other European Societies of Nutrition or Nephrology. A total of 208 replies from practitioners from 30 countries were received; most respondents were aged 25-54 years (73.2%), and were female (68.4%). Only 23% of respondents frequently prescribed IDPN, 43% rarely used it, and 34% had no experience. Costs, perceived non-efficacy, lack of protocols, and staff inexperience were the main barriers for prescribing IDPN. The main indications were failure to improve spontaneous oral intake, malabsorption, and unintentional weight loss. The outcomes were mainly monitored through changes in serum albumin and post dialysis weight. The most commonly reported clinical contraindications were the risk of volume overload, hepatic dysfunction and vascular access problems. This survey reports low use of IDPN by European healthcare professionals. To exploit the potential of this treatment there is a need for educational programs regarding implementation and monitoring of IDPN.

Decoding the DKK1/CKAP4 signaling Axis: A novel mechanism driving Neointimal hyperplasia in arteriovenous fistulas.

ABSTRACT Routine hemodialysis (HD) is a life-saving yet stressful procedure, frequently accompanied by high rates of anxiety and depression, which negatively impact nutritional status and prognosis. Although anxiety sensitivity (AS), defined as the fear of anxiety-related bodily sensations, is a well-established vulnerability factor for psychopathology, to date it has not been evaluated in patients undergoing HD. The present study aimed to assess AS in a cohort of HD patients and examine its relationship with nutritional status. Fifty-one HD patients (30 men and 21 women) were assessed using the Anxiety Sensitivity Index-Revised 36 questionnaire, and their nutritional status was evaluated through anthropometry, Bioelectrical Impedance Analysis (BIA), and dietary intake (FFQ). The mean age was 63.98 ± 14.41 years, and the average duration of HD treatment was 8.79 ± 5.22 years. Female patients exhibited significantly higher AS scores than males (64.95 ± 29.18 vs. 40.97 ± 32.72; p < 0.01). The study revealed significant novel correlations between AS and BIA-derived parameters, particularly phase angle (Φ), an established indicator of muscle quality and nutritional status. Regression analysis showed that higher AS was associated with lower Φ, lower skeletal muscle index (SMI), and higher extracellular water (ECW). The study revealed a novel association between a psychological factor and key health indicators in HD patients. These findings underscore the potential value of integrating AS screening into holistic patient care, as it may help identify individuals with less favorable psychological and physiological profiles among this vulnerable patient population.

The optimal timing for vascular access creation in hemodialysis (HD) patients is critical for improving patient outcomes. This study aimed to investigate the association between preemptive vascular access placement and all-cause mortality in HD patients. A retrospective cohort of 489 adult HD patients from 2009 to 2022 was analyzed. Patients were categorized into preemptive and non-preemptive vascular access groups. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics, and survival analyses were performed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models. Preemptive vascular access was found in 20.7% (101/489) of patients. After IPTW adjustment, the preemptive group had lower mortality (8.9% vs. 18.8%, p < 0.001) and a 65% reduction in all-cause mortality risk (adjusted HR = 0.35, 95% CI 0.15-0.80). Elderly patients (≥ 60 years) showed greater survival benefits (p for interaction < 0.05). Preemptive vascular access placement significantly improves survival in HD patients, particularly in older adults. However, excessively early placement (> 6 months) offers no additional prognostic advantage.

Integrating electronic patient-reported outcome measures (ePROMs) into routine hemodialysis (HD) care offers a way to enhance patient-centered decision-making. This prospective matched cohort study involved adults on in-center HD followed for 6 months. The intervention group completed monthly ePROMs (SF-VAQ and SF-36v2), while the control group received standard care. Outcomes included changes from baseline in Vascular Access (VA) related interventions, hospitalizations, SF-VAQ domain scores, and Health-Related Quality of Life (HRQoL). Integrating ePROMs did not significantly impact the frequency of VA-related interventions or hospitalizations during the study period. Significant improvements were observed in the SF-VAQ domains, including reductions in perceived VA-related burden in the Physical (p = 0.002), Social (p = 0.001), and Dialysis-Related Complication (p = 0.001) domains. The Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36v2 also improved significantly (PCS: p = 0.001; MCS: p = 0.000). A total of 31 (55%) of patients in the ePROM group achieved the Minimal Clinically Important Difference. Implementation of an ePROM-guided care pathway is feasible and associated with improved patient-reported well-being and reduced VA-related burden. While these results suggest a benefit, the absence of longitudinal process data in the control arm means further research is required to distinguish ePROM-induced changes from standard care evolution.

Metformin-associated lactic acidosis (MALA) is a rare but fatal complication of metformin therapy, typically precipitated by acute kidney injury (AKI), dehydration, or sepsis. Natural disasters disrupt healthcare access and increase gastrointestinal illness, data on MALA within the disaster settings are limited. We report 12 patients presenting with severe MALA during a major flooding event in Hat Yai, Southern Thailand, in late 2025. Disrupted infrastructure led to poor oral intake, dehydration, and delayed presentation, with many patients continuing metformin despite acute illness. At presentation, patients exhibited high-anion gap metabolic acidosis (pH range 6.78-7.31, peak lactate 24mmol/L) and advanced AKI. All patients required emergent renal replacement therapy (RRT), utilizing intermittent hemodialysis, slow low-efficiency dialysis, or continuous RRT depending on hemodynamic stability and clinical context. Timely RRT facilitated rapid biochemical correction and renal recovery. All the cohort survived to hospital discharge. This case series highlights flood-related healthcare disruption as an under-recognized precipitating factor for MALA. Severe MALA may occur despite therapeutic metformin dosing when acute illness, dehydration, and AKI coexist. Early recognition, prompt discontinuation of metformin, and timely initiation of RRT are critical for favorable outcomes. These findings underscore the importance of disaster-specific preventive strategies, including proactive dissemination of "sick-day rules," early nephrology involvement, and ensuring timely access to medical care for high-risk patients during natural disasters.

Chronic kidney disease has a major impact on the quality of life and mortality, and affects nearly 10% of the global population, with 4.8% prevalence in Saudi Arabia, and the rates increase sharply with age. Despite advances in hemodialysis (HD) technology, several studies have demonstrated that it exposes patients to immune dysregulation, increasing vulnerability to infections and inflammation-related problems. This study aims to examine Complete Blood Count (CBC) alterations associated with HD, offering insight into hematological stability and immune cell dynamics that could refine patient monitoring and improve clinical outcomes. A total of 107 patients were included in this study, of whom 55.1% were male and 44.9% were female. According to our results, HD changes the dynamics of immune cells. Males showed higher percentages of neutrophils, while females showed higher counts of lymphocytes and monocytes before HD, indicating sex-based immune differences. Additionally, HD was linked to decreases in WBCs and RBC parameters, emphasizing immunological suppression and anemia as major clinical challenges. These results highlight the significance of taking age, sex, and comorbidities into account when interpreting CBC changes in HD patients. They also highlight the need for biomarkers and that accurately evaluate the immune and hematological health of this population.

IntroductionAcross Latin America (LA), accessibility and affordability of kidney replacement therapy varies, but the prevalence of treated kidney failure generally lags behind higher income regions. Hemodialysis (HD) is more common than peritoneal dialysis (PD) in most LA countries. Expanding PD may help increase dialysis access in acute and chronic kidney disease. This study explored trends in existing kidney replacement therapy programs in LA and the opportunities and challenges for improving PD services from the perspective of physicians.MethodsQualitative data were collected using open-ended, semistructured interviews. Physician participants were recruited from trainees attending a Saving Young Lives workshop on acute kidney injury and acute PD. Thematic analysis was used to identify emergent themes.ResultsThere were 15 study participants. We identified and explored two main themes: (1) Physicians face many barriers to adequately caring for all dialysis patients, including high costs, geography, equipment and supply limitations, and lack of specialists; and (2) Increasing dialysis access through PD presents opportunities and challenges.ConclusionsWhile there are some dialysis programs in LA in which all patients have access to adequate care and dialysis is fully funded, there are many programs with inadequate capacity and funding. PD presents an opportunity to improve dialysis access in LA, particularly for currently underserved patient populations, but challenges related to staff training, supply access, and patient factors must be addressed for PD programs to be sustainable.

To evaluate the risk of receiving intraocular pressure (IOP)-lowering treatment in patients with end-stage renal diseases (ESRD) undergoing hemodialysis (HD). Retrospective cohort study using electronic health record data obtained from the TriNetX US Collaborative Network. Patients aged ≥ 20 and ≤ 85 years with a diagnosis of ESRD and HD dependence compared to a healthy control cohort. Incidence and relative risk for needing IOP-lowering medication or surgery were calculated in the ESRD-HD and control cohorts in an unadjusted analysis. Then, propensity score matching (PSM) was performed to match the cohorts for age and sex (Model 1). Model 2 included Model 1 with additional PSM for systemic comorbidities including diabetes, hypertension, and others. Standardized mean difference (SMD) values were used to assess matching quality. Cumulative incidences and hazard ratios (HR) with 95% confidence intervals (CI) for IOP-lowering treatment were calculated for glaucoma treatment endpoints at 5 years after the index date. Risk of new IOP-lowering treatments including medication and surgery. The unadjusted analysis demonstrated that the ESRD-HD cohort had a higher incidence proportion of receiving IOP-lowering medication or surgery (9.57% vs. 4.38%, P <0.001). After PSM, SMD was <0.1 for all variables, indicating good matching. In Model 1, the ESRD-HD cohort demonstrated statistically significant higher incidence and increased HRs for receiving new IOP-lowering treatment including medication or surgery 5 years after the index date (1.94,1.81-2.07; HR, 95%CI). In Model 2, the ESRD-HD cohort showed significantly higher HRs for new IOP-lowering treatment including medication or surgery (1.36, 1.26-1.46), medication use (1.38,1.32-1.44; HR, 95CI), new medication use (1.36,1.27-1.46), and new surgeries (1.57,1.20-2.05), at the 5-year timepoint. More specifically particularly high HRs in Model 2 were observed for the ESRD-HD cohort needing glaucoma drainage devices (2.09,1.34-3.25) and cyclodestruction (3.72,2.10-6.59). The ESRD-HD cohort was at significantly higher risk of receiving IOP-lowering treatment, ranging from medications to surgery. In particular, the ESRD-HD cohort had a higher risk of undergoing glaucoma drainage device implantation or cyclodestructive procedures, surgical interventions sometimes reserved for patients with more advanced glaucoma. Therefore, ESRD-HD patients require heightened ophthalmic surveillance to achieve timely intervention.

Stigma is a significant psychosocial challenge among patients receiving maintenance hemodialysis (HD). Evidence from conflict-affected, resource-limited settings is scarce, particularly regarding anticipated stigma, perceived social support, and site-level differences in dialysis care. To assess the prevalence of anticipated stigma and its association with perceived social support and clinical factors among maintenance HD patients in Syria. This multicenter cross-sectional study was conducted from June 30 to December 4, 2025, among 507 adult patients receiving maintenance hemodialysis across five Syrian governorates. Data were collected using interviewer-administered questionnaires. Perceived social support measured by the Multidimensional Scale of Perceived Social Support (MSPSS), and clinical and dialysis-related characteristics, including blood transfusion history, erythropoietin therapy, chronic pruritus, perceived dialysis-related financial burden, and hemodialysis hospital/governorate. The primary outcome was anticipated stigma, defined operationally as a Chronic Illness Anticipated Stigma Scale (CIASS) total score > 24. Secondary measures included CIASS and Multidimensional Scale of Perceived Social Support (MSPSS) total and domain scores. Analyses included Spearman correlations, nonparametric group comparisons, hierarchical block-wise binary logistic regression, and a sensitivity analysis treating CIASS total score as a continuous variable. The mean age was 48.3 years (SD 14.9), and 57.0% of participants were male. Anticipated stigma was identified in 39.6% of patients, with a median CIASS score of 24 (IQR 19-28). Median MSPSS score was 67 (IQR 58-73), and 66.9% of participants reported high perceived social support. CIASS and MSPSS scores were inversely correlated (rₛ = -0.170, p < 0.001). In the fully adjusted hierarchical model, blood transfusion history was independently associated with higher odds of anticipated stigma (OR 2.09, 95% CI 1.27-3.45), while higher MSPSS score was associated with lower odds (OR 0.965, 95% CI 0.949-0.983). Hemodialysis hospital/governorate remained significantly associated with anticipated stigma in the final model (p < 0.001). Sensitivity analysis using CIASS as a continuous outcome showed consistent direction of associations. Anticipated stigma was common among maintenance HD patients in this conflict-affected setting. Higher perceived social support was consistently associated with lower anticipated stigma, whereas blood transfusion history was associated with higher stigma. These findings should be interpreted as associative and exploratory rather than predictive, and do not represent a clinical screening or prediction tool. Future research should address psychological and institutional determinants to better explain stigma mechanisms in this population.

Neurovascular coupling (NVC) reflects the coordination between brain activity and cerebral blood flow, while glymphatic function indicates the capacity to clear metabolic waste from the brain. However, differences in these two factors between patients on peritoneal dialysis (PD) and hemodialysis (HD), as well as their interrelationship, remain unclear.Functional magnetic resonance imaging, three-dimensional pseudo-continuous arterial spin labeling, and diffusion tensor imaging were prospectively performed in 56 patients on PD, 54 patients on HD, and 52 healthy controls (HC). The study calculated the amplitude of low frequency fluctuation-cerebral blood flow (ALFF-CBF) coupling coefficient and the diffusion tensor image analysis along the perivascular space (DTI-ALPS) index, which respectively represent the overall NVC level and the glymphatic function.Compared to HC, patients on PD and HD exhibited lower ALFF-CBF coupling coefficients and DTI-ALPS indices, but there were no significant differences between the PD and HD groups. Additionally, positive correlations were observed between ALFF-CBF coupling coefficients and DTI-ALPS indices across all three groups.he degrees of neurovascular decoupling and altered glymphatic function are comparable between patients on PD and HD. Importantly, neurovascular decoupling may be associated with altered glymphatic function in patients on dialysis.The degrees of neurovascular decoupling and altered glymphatic function are comparable between patients on PD and HD. Importantly, neurovascular decoupling may be associated with altered glymphatic function in patients on dialysis.