Initiation Of Hemodialysis Research Articles

Use of SGLT2i in Non-Diabetic Kidney Transplant Recipients.

The potential anti-proteinuric effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) is of special interest in kidney transplantation. Its benefits have been demonstrated in diabetic kidney transplant recipients (KTRs). We analyzed the efficacy and safety of SGLT2i in non-diabetic KTRs collecting clinical and analytical data at baseline and 6 months after the introduction of the drug. We performed a unicenter observational study including all non-diabetic KTRs who were prescribed SGLT2i as antiproteinuric therapy. We analyzed clinical and analytical data at baseline and after 6 months of starting SGLT2i. We included 22 patients (68.2% men), median age 58 years, with a median post-transplant period of 67 months. Hypertension was present in 95% of the patients, 90% had dyslipidemia, and 68.2% were receiving treatment with renin-angiotensin-aldosterone system blockade agents plus antialdosterone drugs. The most used SGLT2i was dapagliflozin (91%). The median baseline creatinine was 2.1 (1.48 to 2.85) mg/dL, estimated glomerular filtrate rate (eGFR) 31 (23.7 to 45,2) mL/min, and urinary protein/creatinine ratio 1.68 (0.58 to 2.9) g/g. After 6 months of follow-up, we found a significant reduction in proteinuria (1.68 to 1.06 g/g, P = .025), as well as a reduction in uric acid and high-density lipoprotein (HDL). There was a mild significant reduction in eGFR (31 to 28.5 mL/min, P = .001), which was greater in patients with recurrence of the underlying disease or chronic rejection. The drug was discontinued in two patients (9.1%): one due to a urinary tract infection (UTI) and another one due to hemodialysis initiation. There were no cardiovascular events or death. The use of SGLT2i in our cohort was effective to reduce proteinuria in non-diabetic KTRs after 6 months of treatment with an acceptable safety profile.

Effect of intermittent infusion hemodiafiltration on cerebral and hepatic oxygenation

BackgroundHepatosplanchnic circulation plays a crucial role in maintaining hemodynamic stability during hemodialysis (HD). In patients undergoing HD, hepatic oxygenation decreases before the onset of intradialytic hypotension. However, clinical studies comparing systemic tissue oxygenation, particularly in the brain and liver, between HD and intermittent infusion hemodiafiltration (I-HDF) are limited. We aimed to compare changes in the cerebral and hepatic oxygenation during I-HDF and HD.MethodsThis single-center prospective observational study included 25 patients undergoing dialysis therapy. I-HDF involved a dialysate infusion volume of 200 mL, administered at a rate of 150 mL/min via back-filtration every 30 min. Cerebral and hepatic regional oxygenation saturation (rSO2) levels were monitored during HD and I-HDF using the INVOS 5100C oxygen saturation monitor. Changes in these parameters were compared between the two modalities.ResultsThe relative blood volume change (%ΔBV) at the end of therapy was significantly smaller with I-HDF compared with HD (−8.0 ± 4.4% versus −10.0 ± 5.0%, p = 0.019). No significant differences in cerebral and hepatic rSO2 were observed at the initiation of HD and I-HDF (cerebral rSO2: 54.5 ± 6.3% versus 54.0 ± 6.0%, p = 0.444; hepatic rSO2: 63.4 ± 11.8% versus 63.4 ± 12.3%, p = 0.977). During I-HDF, cerebral and hepatic rSO2 levels significantly increased in response to dialysate infusion, compared with corresponding time points during HD. The percentage (%) change in hepatic rSO2 after the seventh dialysate infusion was significantly greater than those after the first, third, and fifth infusions. Additionally, percentage changes in hepatic rSO2 were negatively correlated with %ΔBV (ρ = −0.394, p < 0.001) and positively correlated with the ratio of the dialysate infusion volume to circulating BV just before infusion (ρ = 0.387, p < 0.001).ConclusionsThis study demonstrated that BV reduction at the end of I-HDF was significantly smaller than that of HD, and that hepatic oxygenation increased rapidly after dialysate infusion during I-HDF. Further studies are required to elucidate the impact of increased hepatic oxygenation during I-HDF on intradialytic hemodynamic stability.

Release of apoptosis inhibitor of macrophage (AIM) from pentameric IgM in serum predicts prognosis after hemodialysis initiation

BackgroundThe optimal timing for initiating dialysis and prognostic markers in chronic kidney disease (CKD) patients are under debate, with mortality and cardiovascular risks varying among patients. This study investigates whether the apoptosis inhibitor of macrophage (AIM), which is mostly bound to pentameric IgM, could serve as an effective indicator.MethodsWe prospectively followed 423 patients at dialysis initiation and 563 at various CKD stages. AIM dissociation from IgM and other serum components were measured in their serum samples. In vitro treatment of IgM-AIM complexes with their serum was conducted to assess AIM release from IgM. Survival analysis determined the associations of each variable with mortality and cardiovascular risk, and a cutoff value was calculated and validated using cross-validation.ResultsAIM dissociation from IgM increases with CKD progression and correlates with the serum uremic state, as shown by enhanced AIM release from IgM in vitro with sera from patients starting dialysis, but not those at earlier CKD stages. Patients at dialysis initiation with high proportion of serum IgM-free AIM (fAIM%) show elevated uremic toxins and other toxic metabolites, higher mortality, and increased cardiovascular risk compared to those with low fAIM%. This prognostic association is not seen with other CKD biomarkers, such as eGFR, creatinine, or inositol-phosphate. We determined the fAIM% cutoff of 46.27%, which predicts mortality two years post-dialysis initiation.ConclusionsThese findings suggest that the serum fAIM% could function as a prognostic marker at dialysis initiation and may have potential as a criterion for determining dialysis timing.

Sex differences in the risk of bladder cancer among kidney transplant recipients and patients with kidney failure receiving hemodialysis: a nationwide cohort study.

Although both patients with kidney failure (KF) receiving hemodialysis (HD) and kidney transplant (KT) recipients (KTRs) have a high risk of bladder cancer, how this risk changes in the transition from dialysis to KT is unknown. In this study, we aimed to investigate the risk of bladder cancer in KTRs and patients on HD. This was a nationwide longitudinal cohort study of 66,547 participants from the National Health Insurance Service cohort who started HD for KF or received KT from 2002 to 2020. The primary outcome was the diagnosis of bladder cancer, which was defined as the composite of diagnostic codes and either hospitalization or ≥2 outpatient visits for bladder cancer. During mean follow-ups of 4.2 and 7.9 years in the HD and KT groups, respectively, the incidence rates of bladder cancer were 1.1/1,000 and 0.3/1,000 person-years, respectively. In the time-dependent multivariable Cox models, compared to patients on HD, the adjusted hazard ratio (aHR) for bladder cancer among KTRs was 0.36 (95% confidence interval [CI], 0.21-0.60; p<0.001). Among men, this aHR was 0.29 (95% CI, 0.15-0.55; p<0.001); however, no statistically significant association between the kidney replacement therapy modality and the risk of bladder cancer was observed among women. Landmark analysis performed to avoid immortal time bias by redefining time zero as a specific landmark time (2 and 5 years after HD initiation or KT) revealed similar results. The risk of bladder cancer was significantly lower among KTRs than that among patients receiving HD, particularly among men.

Analysis of fatty acid-derived lipids in critically ill patients after cardiac surgery yields novel pathophysiologically relevant mediators with possible relevance for systemic inflammatory reactions

IntroductionCritically ill patients suffer from a wide variety of clinical events, most of them leading to pro-inflammatory states such as sepsis or simply as consequence of major surgery. Many of these patients develop forms of acute kidney injury, heart or acute liver failure during intensive care. Lipid signaling is critically involved in triggering systemic inflammation processes, pain and vascular tone. We therefore hypothesized that fatty-acid-derived lipid mediators might be regulated during inflammatory stages and other clinical events in critically ill patients and might serve as potential biomarker candidates.Methods and study designUsing liquid chromatography-tandem mass spectrometry (LC-MS/MS), we determined the levels of 53 lipid mediators in plasma from nine patients. These patients were hospitalized at Frankfurt University Hospital’s intensive care unit (ICU) after cardiac surgery. Inflammatory stages were illustrated over time using clinically established biomarkers such as interleukin-6 (IL-6) and leukocyte count. Normal range values of the lipids were obtained from healthy volunteers.ResultsPlasma levels clearly outside the normal range were observed for 22 of 53 lipid mediators, of which 13 were increased (including ceramides Cer (d18:0/18:0), Cer (d18:1/16:0), Cer (d18:1/18:1), glucosyl-ceramide GluCer (d18:1/24:1), lactosylceramide LacCer (d18:1/18:0), and LacCer (d18:1/24:1), 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha), 11,12- and 14,15-DHET and 1- and 2-arachidonoyl glycerol (1-AG and 2-AG), Sphingosine SPH (d18:1) and 20-HETE. Furthermore, nine lipids were decreased (Cer (d18:1/24:0), LacCer (d18:1/16:0), LacCer (d18:1/24:0), sphingosine-1-phosphate S1P (d18:1), S1P (d18:0), the lysophosphatidic acids LPA (16:0), LPA (18:0), LPA (18:1) and 9-HODE. Among increased lipids, the remarkable changes in 1-AG, 2-AG, and to a lower extent of 6-keto-PGF1-alpha plasma levels showed a certain agreement with inflammatory phases. Furthermore, 6-keto-PGF1alpha had its peak shortly before initiation of continuous veno-venous hemodialysis (at least in 5 of the observed patients), 2-AG was elevated in all our nine patients during (right) heart failure in the context of either re-opening patient’s chest, implementation of veno-arterial ECMO or at least while significantly increasing the amount of catecholamines.DiscussionIn this pilot trial we identified several evaluated lipids in critically ill patients representing either potentially (patho-) physiologically relevant mediators of the pro-inflammatory processes and during heart failure or possible markers preceding veno-venous hemodialysis.

Circumstances of Initiation of Hemodialysis: Importance of Nephrological Follow-Up

Circumstances of Initiation of Hemodialysis: Importance of Nephrological Follow-Up

Predicting early mortality in hemodialysis patients: a deep learning approach using a nationwide prospective cohort in South Korea

Early mortality after hemodialysis (HD) initiation significantly impacts the longevity of HD patients. This study aimed to quantify the effect sizes of risk factors on mortality using various machine learning approaches. A cohort of 3284 HD patients from the CRC-ESRD (2008–2014) was analyzed. Mortality risk models were validated using logistic regression, ridge regression, lasso regression, and decision trees, as well as ensemble methods like bagging and random forest. To better handle missing data and time-series variables, a recurrent neural network (RNN) with an autoencoder was also developed. Additionally, survival models predicting hazard ratios were employed using survival analysis techniques. The analysis included 1750 prevalent and 1534 incident HD patients (mean age 58.4 ± 13.6 years, 59.3% male). Over a median follow-up of 66.2 months, the overall mortality rate was 19.3%. Random forest models achieved an AUC of 0.8321 for first-year mortality prediction, which was further improved by the RNN with autoencoder (AUC 0.8357). The survival bagging model had the highest hazard ratio predictability (C-index 0.7756). A shorter dialysis duration (< 14.9 months) and high modified Charlson comorbidity index scores (7–9) were associated with hazard ratios up to 7.76 (C-index 0.7693). Comorbidities were more influential than age in predicting early mortality. Monitoring dialysis adequacy (KT/V), RAAS inhibitor use, and urine output is crucial for assessing early prognosis.

Community Health Center Penetration and Kidney Care Outcomes among Low-Income, Nonelderly Adults with Kidney Failure.

Key Points Populations who experience health disparities often rely on community health centers (CHCs) for ambulatory care.Among low-income populations, higher CHC penetration is associated with greater preparedness for, and better outcomes after, kidney failure onset.Our study suggests that CHCs provide essential ambulatory care for nonelderly adults who experience kidney health disparities. Background In the United States, historically minoritized populations experience disproportionately high incidence of progressive kidney disease but are often unprepared for kidney failure. Owing to limited options for health care, many minoritized patients with kidney disease rely on community health centers (CHCs) for affordable ambulatory care. Methods We conducted a retrospective cohort study of 139,275 adults aged 18–64 years who were enrolled in Medicaid or uninsured at the time of ESKD onset during 2016–2020. We examined whether CHC penetration of the state-level low-income population was associated with ESKD incidence, process measures reflective of pre-ESKD care quality, and survival and kidney transplant waitlisting 1 year after ESKD onset. We obtained population characteristics of the 1370 Health Resources and Services Administration CHCs and 50 states (and DC) for the same period. Results Mean CHC penetration among low-income residents (percentage of low-income residents who were CHC patients in each state) was 36% (SD, 19%). The Northeast (census region) had the highest proportion of states with high CHC penetration, and the South had the highest proportion of states with low CHC penetration. The prevalence of diabetes mellitus, high BP, and obesity were lower in states with high versus low CHC penetration. There were no significant differences in age- and sex-standardized ESKD incidence according to CHC penetration. In individual-level analyses, higher CHC penetration was significantly associated with a higher likelihood of prolonged nephrology care (adjusted odds ratio [OR], 1.04 [95% confidence interval (CI), 1.03 to 1.05]), arteriovenous fistula or graft usage at hemodialysis initiation (OR, 1.11 [95% CI, 1.09 to 1.12]), home dialysis usage (OR, 1.04 [95% CI, 1.02 to 1.05]), and 1-year kidney transplant waitlisting (OR, 1.19 [95% CI, 1.18 to 1.21]) and ESKD survival (OR, 1.06 [95% CI, 1.04 to 1.07]). Conclusions Among Medicaid enrollees and uninsured adults with incident kidney failure, higher CHC penetration was associated with a lower prevalence of kidney disease risk factors and better preparedness for, and higher survival after, ESKD onset. These findings warrant additional study into the role and effect of CHCs in addressing long-standing disparities in kidney health.

Nutritional outcomes between different techniques of intradialytic amino acid replacement: a randomized controlled trial

Abstract Background Amino acid (AA) depletion during dialysis deteriorates protein-energy status of hemodialysis (HD) patients. This study aimed to determine whether intradialytic amino acid (IDAA) replacement by continuous infusion versus acute load could provide better nutritional outcomes. Methods HD patients with mild protein-energy wasting, defined as serum albumin level of 3.5–3.9 mg/dL despite 7-point SGA in category A or malnutrition inflammation score ≤ 5, were randomly assigned to receive IDAA by continuous infusion or acute load for 3 months. In continuous infusion (n = 24), 50% glucose followed by 7.2% branched-chain enriched AA solution were instilled at first 15 mins after HD initiation with high-flux dialyzer through the end of session. Similar parenteral nutrition compositions containing the same total amount of glucose and AA were rapidly added into venous drip chamber within the last hour of HD in the acute load group (n = 24). Primary outcome was the change in serum albumin level. Secondary outcomes were changes in muscle parameters, and plasma as well as dialysate AA concentrations. Results Mean age of patients was 68.9 ± 12.7 years and average body mass index of 22.8 ± 4.4 kg/m2 with 45.8% men. After 3 months, serum albumin levels were significantly elevated in continuous infusion (P = 0.001) whereas it was unchanged in acute load (P = 0.13). Despite comparable energy and protein intake, total-body muscle mass was also increased in continuous infusion group at 3 months (P = 0.03) compared with no significant change in acute load group (P = 0.45). Amount of AA loss into dialysate was similar between two groups (P = 0.17). At post-dialysis, most plasma essential and non-essential AA levels were significantly lower in patients receiving continuous infusion than acute load while branched-chain AA concentrations including leucine (P = 0.61) and valine (P = 0.09) were comparable between two groups. Despite enhancing muscle mass in continuous infusion, handgrip strength and gait speed were unaltered in both techniques of IDAA replacement. Conclusions IDAA using continuous infusion appears to be superior to acute load in terms of serum albumin and muscle mass improvement. The impact of IDAA on hard clinical outcomes may require larger scale with longer period of study (TCTR20230401003).

Risk of cardiovascular events following hemodialysis initiation: a self-controlled case series study.

Patients with chronic kidney disease (CKD) are at high risk for cardiovascular disease (CVD). We aimed to evaluate whether hemodialysis (HD) initiation is associated with CVD risk in patients with CKD. This self-controlled case series, using data from a nationwide Korean health claims database, included patients with CKD who initiated HD between 2007 and 2019 and experienced CVD, including acute stroke or myocardial infarction (MI), between 2008 and 2020. The risk periods were categorized relative to HD initiation (-60 to -31, -30 to -11, -10 to -1, +1 to +10, +11 to +30, +31 to +60, and +61 to +150 days); the remaining period was set as baseline. The age-adjusted incidence rate ratio (IRR) of CVD in each risk period relative to the baseline was calculated. Of the 74,584 patients with CKD on incident HD, 12,875 patients with CVD (6,367 with ischemic stroke, 2,396 with hemorrhagic stroke, and 4,112 with MI) were included. Compared with the baseline period, the risk of CVD increased in the post-dialysis periods, decreasing with time since HD initiation; the adjusted IRR during the first 10 days after HD initiation was 2.95 (95% confidence interval, 2.44-3.56). Although the risks of ischemic stroke and MI decreased at 1 to 2 months after HD initiation, the hemorrhagic stroke risk was higher for 5 months. After HD initiation, the CVD risk increases in patients with CKD. For CVD prevention, the CVD risk should be carefully evaluated in patients with CKD who require HD.

Effects of supportive hemodialysis on the management of a pregnant woman with advanced chronic kidney disease: a case report and literature review

BackgroundPregnancy in women with chronic kidney disease (CKD) is associated with an increased risk of adverse maternal and fetal outcomes, including worsening renal function, hypertension, proteinuria, preeclampsia, preterm delivery, stillbirth, and intrauterine growth restriction. Some pregnant women with CKD may require dialysis after conception. Clinical guidelines provide recommendations for optimal hemodialysis prescription in pregnant women undergoing maintenance hemodialysis for end-stage kidney disease. However, the timing of initiation and optimal doses of hemodialysis for pregnant women with non-dialysis advanced CKD remain uncertain.Case presentationWe describe the case of a 29-year-old woman with a history of CKD for at least 2 years. She was referred to our department with a serum creatinine level of 2.48 mg/dL and an estimated glomerular filtration rate of 20 mL/min/1.73 m2. Because she was found to be pregnant at the initial visit, she was referred to the Department of Obstetrics. At 23 weeks’ gestation, she was admitted due to threatened premature delivery and urinary tract infection, which were managed with ritodrine hydrochloride and antibiotics. Owing to maternal weight loss and asymmetrical fetal growth restriction, daily protein intake was increased from 40 g/day to 60–80 g/day. Additionally, supportive hemodialysis (three times per week) was initiated at 26 weeks’ gestation, and the pre-dialysis blood urea nitrogen (BUN) level was consistently maintained < 40 mg/dL. Consequently, the patient’s weight increased, and fetal growth recovered. Because her blood pressure increased particularly during and after dialysis sessions, dialysis was discontinued at 32 weeks’ gestation. Urinary protein increased to a nephrotic level, and blood pressure was poorly controlled by medication, suggesting the onset of preeclampsia. Thus, a cesarean section was performed at 33 weeks’ gestation, and she delivered a male baby weighing 1449 g. Following childbirth, the patient did not require hemodialysis.ConclusionsSupportive hemodialysis during pregnancy in women with advanced CKD can increase maternal protein intake without elevating BUN levels, leading to improved fetal growth.

Effectiveness of tolvaptan on renal replacement therapy in patients with autosomal dominant polycystic kidney disease: a retrospective cohort study from the TriNetX global collaborative network

Background and hypothesis Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a major genetic contributor to end-stage kidney disease (ESKD). Current evidence on tolvaptan primarily focuses on slowing estimated glomerular filtration rate (eGFR) decline and kidney volume growth. However, direct confirmation of its effectiveness in reducing the need for hemodialysis in ESKD remains limited. Methods We included ADPKD patients aged ≥18 years using TriNetx data from Sep 2, 2018, to Sep 3, 2023. Propensity score matching (PSM) ensured baseline comparability (standardized mean difference (SMD) <0.1). Hazard ratios (HRs) with 95% confidence intervals (CIs) evaluated outcomes, and subgroup analyses were performed. Results After 1:1 PSM, both groups comprised 673 patients. The average age was 45, with generally good health (3–5% diabetes, 2-3% ischemic heart disease). Baseline eGFR averaged ∼55 ml/min/1.732m2. Post-matching, all SMDs were <0.1, indicating successful matching. Tolvaptan users exhibited lower eGFR (51.45 ± 30.09 vs. 57.37 ± 33.65, p < 0.001) and higher risk of stage 4-CKD (HR: 2.436, 95% CI:1.649, 3.599) compared to non-users. However, tolvaptan users showed significantly reduced chances of initiating hemodialysis (HR:0.362, 95%CI:0.176, 0.745), experiencing urinary tract infections (HR:0.581, 95%CI:0.354, 0.956), and all-cause mortality (HR:0.355, 95% CI:0.180, 0.700). Kaplan-Meier curves for hemodialysis initiation indicated higher survival rates among tolvaptan users across age and number of medication refill subgroups. Conclusions This real-world study, employing precise matching, reveals tolvaptan’s role in reducing hemodialysis initiation risk in ADPKD, despite initial hemodynamic-induced lower eGFR.

Study on Echocardiographic Parameters of Left Ventricular Dysfunction Before and After Initiation of Maintenance Hemodialysis in End-stage Kidney Disease Patients

Study on Echocardiographic Parameters of Left Ventricular Dysfunction Before and After Initiation of Maintenance Hemodialysis in End-stage Kidney Disease Patients

Quality of life and social reinsertion of patients on maintenance haemodialysis in four government funded hospitals in Cameroon.

Reduced quality of life is associated with shorter survival in chronic illnesses. However, the health-related quality of life (HRQOL) and social reinsertion of patients on maintenance haemodialysis is much more underappreciated in resource-limited countries such as Cameroon. A hospital-based cross-sectional study was carried out from February 22nd to May 20th, 2022, in 4 government-funded haemodialysis centres in three randomly selected regions of Cameroon. Patients received twice-weekly dialysis sessions. Social reinsertion and HRQOL were assessed using a structured questionnaire and the kidney disease quality of life instrument (KDQOL-36™). HRQOL scores < 50 were categorized as low, while scores > 50 reflected better HRQOL. Data were analysed using the software statistical package for Social Sciences version 25.0. Statistical significance was set at a p value < 0.05. The study included 434 patients. The mean age was 48.33 (13.55) years, 65.7% (285/434) were male, 62.3% (269/434) had no monthly income, and the mean dialysis vintage was 3.74 (3.83) years. The mean HRQOL score was 44.34 (9.77), and 76.2% (325/434) had HRQOL scores < 50). Overall HRQOL was associated with older age (aOR: 2.344, CI 1.089-5.04). After the initiation of maintenance haemodialysis, 67.1% (49/73) of students dropped out of school. The main reason for school absenteeism and unemployment was physical insufficiency, with 82.4% (19/24) and 52.4% (75/144), respectively. There were no promotions or marriages after initiation; 51% (221/434) of relationships with relatives and friends were affected negatively, while 83.3% (66/79) of those of marriageable ages could not find suitors. The social participation score was poor in 61.5% (267/434) of participants. There was an association between low QOL and social participation (p = 0.009). The HRQOL of patients on maintenance haemodialysis is greatly reduced, especially their physical health status. Older age was a determinant of low QOL. Additionally, social reinsertion remains poor due to adverse changes that occur to these patients and their families after dialysis initiation. Not applicable.

Forearm Versus Upper Arm Location of Arteriovenous Access Used at Hemodialysis Initiation: Temporal Trends and Racial Disparities

Race and ethnicity differences exist in the type of arteriovenous access (AVA, including fistulas and grafts) used at hemodialysis (HD) initiation. The preferred anatomic location for the creation of an initial HD AVA is typically in the forearm We evaluated race and ethnicity differences in the use of an AVA in the forearm location at HD initiation. Retrospective cohort study. Using records from DaVita Kidney Care linked to the US Renal DataSystem (USRDS), we evaluated patients aged≥16 years who initiated in-center HD with an AVA between 2006 and2019. Race and ethnicity, categorized as non-Hispanic White, non-Hispanic Black, Hispanic, or Other. Forearm versus upper arm AVA location. Multivariable modified Poisson regression to estimate adjusted trends in AVA location over time and race and ethnicity differences in AVA location. Nested models helped assess the relative confounding by groups of variables on estimates of race and ethnicity differences. Among 70,147 patients (51.7% White, 28.8% Black, 12.6% Hispanic, 6.9% Other), White patients were older and more likely to have peripheral vascular disease but less likely to have diabetes compared with the other groups. The proportion initiating HD using a forearm AVA decreased from 49% in 2006 to 29% in 2019 and by 3.6% (95% CI, 3.3%-3.9%) annually, with no difference in this trend among groups (race and ethnicity by calendar year interaction P=0.32). Black patients were 13% (95% CI, 10%-15%) less likely and Hispanic patients were 5% (95% CI, 1%-9%) less likely than White patients to initiate HD with a forearm AVA. Findings may not apply to home HD. Use of a forearm AVA for HD initiation has declined and racial differences have persisted, with Black and Hispanic patients being less likely than White patients to have an AVA in the forearm location. Research toward understanding the causes and consequences of these trends and disparities is warranted.

Construction of a coagulation prediction model of the extracorporeal circulation circuit during hemodialysis with regional citrate anticoagulant (RCA).

To construct a prediction model of coagulation in the extracorporeal circulation circuit during hemodialysis with regional citrate anticoagulant(RCA) conditions. This was a single-center, retrospective study. The clinical data of patients who received hemodialysis with RCA from February 2021 to March 2022 were collected. The risk predictors of coagulation in the extracorporeal circulation circuit were screened by LASSO regression. On this basis, we used multivariate logistic regression analysis to establish a nomogram prediction model. A total of 98 patients received RCA hemodialysis for 362 times. Among them, 155 treatments with complete data were included in the study. Among the 155 treatments, coagulation of the extracorporeal circulation circuit occurred 12 times. The use of arteriovenous fistulas(AVF), the venous pressure at 4 h after hemodialysis initiation, blood flow velocity, dialyzer manufacturer, Systemic iCa2+ at 1 h after hemodialysis initiation, plasma albumin level, and plasma d-dimer level were influencing factors of coagulation in the extracorporeal circuit during hemodialysis with RCA (p < 0.05). A nomogram model was made out of the above indicators. The area under the receiver operating characteristic (ROC) curve for predicting coagulation in the circuit was 0.967 (95% CI: 0.935-0.998). The internal validation result of the memory testing (bootstrap method) showed that the area under the ROC curve was 0.967 (95% CI: 0.918-0.991). The nomogram model has good discrimination and calibration and can intuitively and succinctly predict the risk of coagulation in the extracorporeal circulation circuit during hemodialysis with RCA.

Lupus Activity in Lupus Nephritis Patients with End Stage Renal Disease Treated with Haemodialysis

Abstract Background End-stage renal disease (ESRD) is the advanced stage of a progressive loss of kidney function. About 10% of all patients with lupus nephritis (LN) eventually progress to ESRD, which may necessitate renal replacement therapy (RRT), such as haemodialysis (HD). Assessment of lupus activity after haemodialysis initiation is crucial in improving outcomes. This issue is still under consideration by researchers. Aim of the Work The goal of this study is to analyze lupus activity in LN patients with ESRD treated with hemodialysis Patients and Methods 70 LN patients were divided into two groups: group A (35 patients) who were ESRD treated with haemodialysis, while group B (35 patients) who were chronic kidney disease (CKD) stage 3, 4. Non-renal systemic lupus erythematosus disease activity index (nrSLEDAI) score was used to assess lupus activity in both groups. Results Group A (haemodialysis group) exhibited considerably declined lupus activity compared to group B (CKD) group. With long term period maintenance on haemodialysis, there was an obvious remission in both clinical and serological parameters of lupus activity. Current doses of oral corticosteroids were less in group A than group B. Conclusion The current study's findings suggest that haemodialysis improves lupus activity clinically and serologically in what has been called burn-out phenomenon.

Unplanned Initiation of Maintenance Hemodialysis: Patient Background and Survival in Pre- and Post-COVID-19 Emerging

Unplanned Initiation of Maintenance Hemodialysis: Patient Background and Survival in Pre- and Post-COVID-19 Emerging

Morphological Changes in a Nephrectomized End-Stage Kidney 10 Years after Hemodialysis (HD) Initiation for Atypical Hemolytic Uremic Syndrome (aHUS)

Morphological Changes in a Nephrectomized End-Stage Kidney 10 Years after Hemodialysis (HD) Initiation for Atypical Hemolytic Uremic Syndrome (aHUS)

An unusual case of thrombotic microangiopathy following autologous stem cell transplantation: A case report

Thrombotic microangiopathy (TMA) is a rare but potentially life-threatening complication following autologous stem cell transplantation (ASCT). The incidence is extremely low. Here, we present the case of a 54-year-old male with relapsed diffuse large B-cell lymphoma (DLBCL) who developed TMA within 92 days after ASCT. The patient exhibited signs of hemolysis, thrombocytopenia and rapid renal function deterioration, and necessitating initiation of hemodialysis. Kidney biopsy confirmed TMA and Genetic testing revealed Complement H factor deficiency. Treatment with plasma exchange and corticosteroids resulted in no significant response. The patient was ultimately managed with ravulizumab. Transplant associated TMA (TA-TMA) is a an entity in which TMA occurs following stem cell transplant. This case highlights the importance of considering TMA in the differential diagnosis of renal failure following ASCT and initiating prompt treatment as delayed management can lead to devastating outcomes.