Hemodialysis Program Research Articles

The importance of arteriovenous fistula assepsia in hemodialysis center:An ilustrative case of endocarditis

Hemodialysis (HD) is currently the most widely used renal replacement therapy for end-stage chronic renal disease. Native arteriovenous fistula (AVF) is the preferred access because of lower infectious and thrombotic risk, higher survival, shorter hospitalization time, lower mortality and associated morbidity. However, the risk of AVF infection, namely by methicillin-resistant staphylococcus aureus (MRSA), should not be underestimated. Especially when using the Buttonhole technique in which cannulation of the AVF is performed in exactly the same place in every dialysis session. We present an uncommon case of endocarditis with metastatic complications (multifocal septic arthritis, multiple pulmonary cavitations and disseminated purpuric rash), associated with presumed access-related S. aureus bacteremia in a patient undergoing regular HD program with an AVF cannulated with the buttonhole technique, with a surprising complete resolution of tricuspid valvular vegetation and all other secondary infections with 8 weeks of antibiotherapy.

Impact of the duration of program hemodialysis and heart failure on the pattern of lipid profile in patients with end-stage chronic kidney disease

Background and Aims : Patients with chronic kidney disease often have multiple comorbidities and the high cardiovascular mortality. Dyslipidemia is one of the possible risk factors associated with uremia and an increased risk of cardiovascular disease. The aim of our study was to evaluate the influence of the duration of program hemodialysis and presence of heart failure (HF) in patients with end-stage chronic kidney disease on the pattern of lipid profile.Methods: All patients were divided into groups: I group included 20 patients with end-stage chronic kidney disease (ESCKD) on hemodialysis (duration - 5 years),II group - 20 patients with ESCKD (over 10 years), III group - 16 patients with ESCKD on hemodialysis with HF (over 10 years). Control group – 12 healthy persons. Laboratory blood tests of lipid profile (Triglycerides (TG), Total Cholesterol, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), Very Low Density Lipoprotein (VLDL)), C Reactive Protein (CRP) were analyzed in addition to standard diagnostic program.Results: The pattern of lipid profile is characterized by increased plasma TG (p˂0.05) second and third groups due to elevated VLDL and decreased HDL compared to the control group. There were a significant difference (p˂0.05) in patients of the first and the third groups between of the lipid profile. We observed positive correlation of dyslipidemia with CRP (p˂0.05). Dyslipidemia is associated with uremia.Conclusions: ESCKD patients have increased risk of CVD. A higher prevalence of dyslipidemia is common among patients with ESCKD on the program hemodialysis. HF is associated with lipoprotein abnormalities and cardiovascular mortality. Background and Aims : Patients with chronic kidney disease often have multiple comorbidities and the high cardiovascular mortality. Dyslipidemia is one of the possible risk factors associated with uremia and an increased risk of cardiovascular disease. The aim of our study was to evaluate the influence of the duration of program hemodialysis and presence of heart failure (HF) in patients with end-stage chronic kidney disease on the pattern of lipid profile. Methods: All patients were divided into groups: I group included 20 patients with end-stage chronic kidney disease (ESCKD) on hemodialysis (duration - 5 years),II group - 20 patients with ESCKD (over 10 years), III group - 16 patients with ESCKD on hemodialysis with HF (over 10 years). Control group – 12 healthy persons. Laboratory blood tests of lipid profile (Triglycerides (TG), Total Cholesterol, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), Very Low Density Lipoprotein (VLDL)), C Reactive Protein (CRP) were analyzed in addition to standard diagnostic program. Results: The pattern of lipid profile is characterized by increased plasma TG (p˂0.05) second and third groups due to elevated VLDL and decreased HDL compared to the control group. There were a significant difference (p˂0.05) in patients of the first and the third groups between of the lipid profile. We observed positive correlation of dyslipidemia with CRP (p˂0.05). Dyslipidemia is associated with uremia. Conclusions: ESCKD patients have increased risk of CVD. A higher prevalence of dyslipidemia is common among patients with ESCKD on the program hemodialysis. HF is associated with lipoprotein abnormalities and cardiovascular mortality.

Patient and Clinician Perspectives on Shared Decision Making in Vascular Access Selection: A Qualitative Study

Collaborative approaches to vascular access selection are being increasingly encouraged to elicit patients' preferences and priorities where no unequivocally superior choice exists. We explored how patients, their caregivers, and clinicians integrate principles of shared decision making when engaging in vascular access discussions. Qualitative description. Semistructured interviews with a purposive sample of patients, their caregivers, and clinicians from outpatient hemodialysis programs in Alberta, Canada. We used a thematic analysis approach to inductively code transcripts and generate themes to capture key concepts related to vascular access shared decision making across participant roles. 42 individuals (19 patients, 2 caregivers, 21 clinicians) participated in this study. Participants identified how access-related decisions follow a series of major decisions about kidney replacement therapy and care goals that influence vascular access preferences and choice. Vascular access shared decision making was strengthened through integration of vascular access selection with dialysis-related decisions and timely, tailored, and balanced exchange of information between patients and their care team. Participants described how opportunities to revisit the vascular access decision before and after dialysis initiation helped prepare patients for their access and encouraged ongoing alignment between patients' care priorities and treatment plans. Where shared decision making was undermined, hemodialysis via a catheter ensued as the most readily available vascular access option. Our study was limited to patients and clinicians from hemodialysis care settings and included few caregiver participants. Findings suggest that earlier, or upstream, decisions about kidney replacement therapies influence how and when vascular access decisions are made. Repeated vascular access discussions that are integrated with other higher-level decisions are needed to promote vascular access shared decision making and preparedness.

Main Barriers to the Introduction of a Home Haemodialysis Programme in Poland: A Review of the Challenges for Implementation and Criteria for a Successful Programme.

Introduction: Home dialysis in Poland is restricted to the peritoneal dialysis (PD) modality, with the majority of dialysis patients treated using in-centre haemodialysis (ICHD). Home haemodialysis (HHD) is an additional home therapy to PD and provides an attractive alternative to ICHD that combines dialysis with social distancing; eliminates transportation needs; and offers clinical, economic, and quality of life benefits. However, HHD is not currently provided in Poland. This review was performed to provide an overview of the main barriers to the introduction of a HHD programme in Poland. Main findings: The main high-level barrier to introducing HHD in Poland is the absence of specific health legislation required for clinician prescribing of HHD. Other barriers to overcome include clear definition of reimbursement, patient training and education (including infrastructure and experienced personnel), organisation of logistics, and management of complications. Partnering with a large care network for HHD represents an alternative option to payers for the provision of a new HHD service. This may reduce some of the barriers which need to be overcome when compared with the creation of a new HHD service and its supporting network due to the pre-existing infrastructure, processes, and staff of a large care network. Conclusions: Provision of HHD is not solely about the provision of home treatment, but also the organisation and definition of a range of support services that are required to deliver the service. HHD should be viewed as an additional, complementary option to existing dialysis modalities which enables choice of modality best suited to a patient’s needs.

Mortality in elderly patients starting hemodialysis program.

The incidence of older patients over 80 years old with chronic kidney disease who start hemodialysis (HD) program has been increasing in the last decade. We aimed to identify risk factors for morbidity and mortality in patients older than 80 years with end-stage renal disease who started HD. We conducted a retrospective observational study of the Catalan Renal registry (RMRC). A total of 2833 patients equal or older than 80 years (of 15,137) who started HD between 2002 and 2019 from the RMRC were included in the study. In this group, the first dialysis was performed through an arteriovenous fistula in 44%, percutaneous catheter in 28.2%, and tunneled catheter in 26.6%. Conventional dialysis was used in 65.7% and online HD in 34.3%. The most frequent cause of death was cardiac disease (21.8%), followed by social problems (20.4%) and infections (15.9%). Overall survival in older HD during the first year was 84% versus 91% in younger than 80 years (p< 0.001). Cox regression analysis identified the start of HD in the period 2002-2010, chronic obstructive pulmonary disease (COPD), and the onset of HD through vascular graft depicted as risk factors for first-year mortality after dialysis initiation in patients older than 80 years with end-stage renal disease who started HD. In conclusion, patients older than 80 years who started HD program had higher mortality, especially those who presented exacerbation of kidney disease, those with COPD, and those who started with a vascular graft.

Peran Keluarga dan Jarak Tempuh Fasyankes Terhadap Kepatuhan Pasien Gagal Ginjal Kronik Dalam Melaksanakan Program Hemodialisis

Background: Hemodialysis is one of the therapies used for chronic kidney failure (CKD) apart from diet and fluid management and kidney transplantation. In addition to the distance from a health facility to the residence of a patient with CKD to carry out HD, there is a role for the family in carrying out the hemodialysis program.Objective: This study aims to determine the relationship between the role of the family and the distance of health facilities to the compliance of patients with chronic kidney failure in carrying out the hemodialysis program at Leuwiliang Hospital.Methods: The method used in this study is to use the concept of quantitative research using cross-sectional methods, carried out on a sample of 43 patients at Leuwiliang Hospital taken by a total sampling technique. Instrument in data collection using a questionnaire. Statistical test using chi-square.Results: The results showed that the compliance of patients with chronic kidney failure in carrying out the hemodialysis program in the hemodialysis room averaged 79.1%. The average family role is good as much as 81.4%. The average distance for health facilities from far away patients is 69.8%. The results of statistical tests showed that the relationship between the role of the family on the compliance of patients with chronic kidney failure in carrying out the hemodialysis program at the Leuwiliang Hospital (P-Value = 0.006 &lt; 0.05) with an OR value of 12.9 and the relationship between the distance of health facilities and the compliance of patients with chronic kidney failure. in implementing the hemodialysis program at Leuwiliang Hospital (P-Value = 0.699 &lt; 0.05) with an OR value of 0.597.Conclusion: There is a relationship between the role of the family in the compliance of chronic kidney failure patients in carrying out the hemodialysis program at Leuwiliang Hospital and there is no relationship between the distance traveled by health facilities to the compliance of chronic kidney failure patients in carrying out the hemodialysis program at Leuwiliang Hospital.

Epidemiology of End-Stage Renal Disease in Mogadishu, Somalia: First Report at a Tertiary Care Hospital.

BackgroundEnd-stage renal disease (ESRD) in Somalia remains unexamined due to a lack of a national registry system, and the impact of the disease in the country is not estimated yet. The present study is the first report that aims to evaluate the epidemiological characteristics, causes, and dialysis-related factors associated with readmissions in ESRD patients who were going to routine hemodialysis.Patients and methodsThis cross-sectional observational study enrolled 208 patients with ESRD. Also, this study investigated patients readmitted to the hospital (n=135) after they enrolled in hemodialysis. The sociodemographic characteristics, risk factors, and comorbidities associated with these patients were reviewed. Admission site, length of hospital stay, outcome, and dialysis-related factors associated with readmissions in the first six months after being on a regular hemodialysis program were also assessed.ResultsThe mean age of the patients was 52.7±15.0 years, 43.3% were >60 years, and 61.5% were male. The most common cause was diabetes at 39.4%, followed by hypertension (35.6%) and 12.5% for postrenal obstruction. The prevalence of 6-month hospital readmissions was 65%. The most common dialysis-related factor associated with readmissions was uremic complications due to missed hemodialysis sessions (40%), vascular access/catheter infection (20%), and anemia (17.8%) (95% CI: 0.825–5.357, OR: 3.017, p<0.04). Female cases were more vulnerable to vascular catheter site infection, anemia, and hyponatremia (p<0.001). 27.5% of the patients were admitted to the intensive care unit (ICU), and the most common reason for ICU admissions was pulmonary edema (53.8%), sepsis (42.8%), and uremia due to hemodialysis skip (26.4%) (95% CI: 1.507–13.632, OR: 2.08, p=0.01). The mortality rate was 5.2%.ConclusionThe prevalence of unplanned hospital readmissions within six months was very high, and a missed hemodialysis session was identified as the leading cause. Inadequate knowledge, wrong social beliefs about the concept of dialysis and a lack of a health insurance system that covers the higher costs of each dialysis session are believed to be the causes of missed dialysis occasions.

Selective vitamin D receptor activator Paricalcitol and its potential benefits in hemodialysis patients with secondary hyperparathyroidism

Currently, the incidence and prevalence of chronic kidney disease (CKD) are increasing annually worldwide, and clinical data show that CKD patients commonly experience relative vitamin D insufficiency or deficiency. Secondary hyperparathyroidism (SHPT) is a common complication in patients with end-stage renal disease and it is also common in hemodialysis patients. SHPT is an adaptive and in many cases ultimately maladaptive process that develops in response to declining kidney function, impaired phosphate excretion, failure to bioactivate vitamin D and hypocalcemia. SHPT is characterized by persistently elevated levels of parathyroid hormone (PTH) and complicated by important disturbances in mineral metabolism. Maintaining the level of vitamin D and parathyroid hormone concentrations in the target range reduce its associated complications (e.g., fractures, chronic kidney disease and cardiovascular calcification). Effective therapeutic interventions are highly desirable if the morbidity and mortality associated with uncontrolled SHPT are to be reduced. Major renal guidelines recommend use of vitamin D for secondary hyperparathyroidism in chronic kidney disease. However, because of the difficulties associated with lowering PTH while simultaneously controlling serum levels of calcium and phosphorous, traditional therapies for managing SHPT have several limitations. Selective vitamin D receptor activator paricalcitol mainly targets vitamin D receptors (VDR) in the parathyroid glands, has less effect on VDR in the intestine and other tissues, inhibits PTH strongly, triggers less hypercalcemia, and has less effect on intestinal absorption of calcium, phosphorus and bone metabolism and significantly lowers renin levels, albuminuria and blood pressure, which is supported by the results of most studies conducted over these decades. The article is devoted to the problem of treatment of patients with SHPT inpatient with renal replacement therapy with program hemodialysis.

STRATEGI PENINGKATAN MANAJEMEN DIRI PASIEN PENYAKIT GINJAL TAHAP AKHIR YANG MENJALANI HEMODIALISIS

End-stage kidney disease (ESRD) has an impact on the sufferer's physical, psychological, social, and spiritual well-being. These problems can reduce the quality of life of ESRD patients undergoing hemodialysis. This requires the patient to be fully involved, both in management and therapeutic decision-making, symptom management, and self-care. This literature review aims to describe various programs to improve the self-management skills of ESRD patients undergoing hemodialysis. The articles used in this literature review are sourced from the CINAHL, MEDLINE, and Google Scholar electronic databases with the keywords self-management, self-care, adherence, ESRD, and hemodialysis with inclusion criteria: published in 2015-2020, full text, using English or Indonesian, and experimental studies conducted on hemodialysis patients. Eight articles were obtained discussing programs that can be used to improve self-management of ESRD patients undergoing hemodialysis, including education and counseling programs, self-management programs, self-efficacy training, self-monitoring programs, and social support. The differences between each program include the time and technical implementation, while the similarities are that each program cannot be separated from education for providing health information to patients. Providing structured education and involving social support can be used as a program to improve self-management in ESRD patients undergoing hemodialysis.

'Relationship between of the quality of life indicators and neuromarker S100 in patients with type 2 diabetes mellitus on program hemodialysis'

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

"Characteristics of cerebral hemodynamics in patients with type 2 diabetes on program hemodialysis"

"Characteristics of cerebral hemodynamics in patients with type 2 diabetes on program hemodialysis"

MO546: Association Between T Scores, FRAX, Frailty, Falls and Fractures in Patients Undergoing Maintenance Hemodialysis

Abstract BACKGROUND AND AIMS Despite the negative impact of fracture in hemodialysis (HD) patients, optimal risk assessment tools in this population are not well explored. Frailty (a syndrome of diminished capacity to respond to health stressors) and falls—known risk factors for fracture—are common in HD patients. While the relationship between T scores in relation to fractures in these patients is recognized, there is a paucity of data to the additional contributions of fracture risk assessment tool (FRAX), frailty and falls in relation to fractures. The clinical, societal and economic impact of fractures necessitates an active response from the HD programs. Therefore, we intended to evaluate the clinical utility of adding these factors to T scores at the femoral neck to determine whether it enhances fracture discrimination in HD patients. METHOD We conducted a cross-sectional study on 131 adult patients receiving HD at two dialysis units in Regina, Saskatchewan, Canada (January 2017–December 2018). After undergoing frailty assessments, patients were referred for dual-energy X-ray absorptiometry (DXA) scans and FRAX questionnaires. They were additionally sent for lumbar X-rays and contacted for a history of falls. The presence of fracture (hips, femur, pelvis, knee, foot, leg, toe, shoulder, elbow, ankle, arm, wrist, spine and lumbar) was documented based on the review of medical charts, self-recall and additionally vertebral fractures were identified by an X-ray. Bone mineral density (BMD) was measured by DXA. FRAX score (the 10-year probability of hip and major osteoporotic fracture) was calculated using an online algorithm based on 11 clinical risk factors with and without the inclusion of BMD. Frailty was assessed using the FRIED criteria (Figure 1). Patients were enquired about the history and frequency of falls. Association between the BMD-T score, FRAX score, frailty status, falls, with fracture were examined with sequential multivariable logistic regression models. The area under the receiver operating characteristic curve analysis was conducted for each model to assess its discrimination ability for fracture outcome (α = 0.05). RESULTS A total of 109 HD patients were included in the data analysis. The composite of fracture occurred in 38% of patients. About 60% were identified as frail, and 29% had at least one fall in the last year. Low T score and FRAX were both independent risk factors in patients on HD therapy. On multivariate analysis, each lower standard deviation in T score was associated with 48% higher odds of fracture [odds ratio (OR) = 1.48; 95% confidence interval (95% CI) 1.20–1.68, P = 0.005]. With the inclusion of FRAX score for hip fracture, the OR for fracture remained significant at 1.38 (OR = 1.38, 95% CI 1.04–1.63, P = 0.04). The addition of frailty status and history of falls did not further improve the model. Model 2 showed better discrimination ability and goodness-of-fit for fracture compared to Model 1 (P = 0.004) (Table). CONCLUSION This is the first study to our knowledge that looked at the independent contribution of frailty and falls in addition to T scores and FRAX in assessing for fractures in patients on HD. Our study showed both BMD measurements by DXA scans and FRAX are useful tools to assess fracture in patients receiving HD. The addition of frailty status and history of falls is not associated with fractures in this population. Results of this study should lead to prospective studies with larger sample sizes prior to DXA scans, FRAX and falls assessment being recommended as standards of care.

MO872: Relationship Between Vitamin D Levels And SARS-COV-2 Infection in Dialysis Patients

Abstract BACKGROUND AND AIMS Hypovitaminosis D is highly prevalent in patients with Chronic Kidney Disease (CKD). This is considered a consequence of a decreased renal mass and a reduction in the number of proximal tubular cells, which absorb the filtered native vitamin D and then be hydroxylated to its active form by 1α-hydroxylase. Hypovitaminosis D is defined as serum levels of 25-hydroxy-vitamin D3 lower than 30 ng/mL. The decrease in vitamin D causes bone and mineral abnormalities and can also play a role in various pathologies, such as cardiovascular disease, insulin resistance, diabetes, autoimmune diseases and infections. Clinical practice guidelines recommend treating hypovitaminosis D. The role of vitamin D in acute respiratory tract infections and other viral infections has been widely studied. It has an immunomodulatory role due to the expression of the enzyme 1α-hydroxylase by the epithelium of the respiratory tract, dendritic cells and lymphocytes, which is essential for the activation of vitamin D in the lungs. In this way, an influence is created on the lung capacity to fight infections and respond to allergic stimuli. Vitamin D has the potential to influence the severity and outcomes of COVID-19. In fact, several studies have established a consistent relationship between hypovitaminosis D and the severity of COVID-19. We have a population of dialysis patients with a tendency to hypovitaminosis D and, on the other hand, an influence of hypovitaminosis D in respiratory infections such as SARS-CoV-2 infection. Thus, we consider it interesting to study whether the incidence of hypovitaminosis D is higher in dialysis patients with SARS-CoV-2 infection than in those who do not. METHOD An observational, analytical, ambispective, multicentre study was carried out under normal clinical practice conditions. The study subjects are patients on haemodialysis program of the province of Santa Cruz de Tenerife, in the period between January 2021 and January 2022. As variables we selected age, sex, personal history, haemodialysis time, serum levels of 25-hydroxy-vitD3, treatment with native vitamin D, presence of SARS-CoV-2 infection diagnosed by RT-PCR in nasopharyngeal swab, vaccination. The information collected is organized in a database of the SPSS Statistics v22 program. For quantitative variables, the comparison between groups is made by means of an analysis with the Student's t-test for independent samples. Qualitative variables are analyzed using the Chi-squared test or Fisher's exact test. All data were analyzed using the SPSS Statistics v22 program. The level of significance is established for a value of P &amp;lt; 0.05. RESULTS A total of 60 haemodialysis patients were included, 36 men (60%) and 24 women (40%). The mean age was 64 years. The most common cause of kidney disease was diabetic nephropathy (35%). The median time on dialysis was 24.5 months. 73.3% of the patients presented hypovitaminosis D and 35% received treatment with vitamin D. 23 patients had SARS-CoV-2 infection (38.3%). 2 patients (3.3%) died of COVID-19. There were no significant differences between the two comparison groups (patients with and without SARS-CoV-2 infection) in relation to sex, age, cause of kidney disease, diabetes, time on dialysis, vitamin D intake. We also did not observe significant differences in relation to vitamin D levels or the presence of hypovitaminosis D. There are significant differences in relation to vaccination (p 0.00). 39.1% of the patients with SARS-CoV-2 infection were not vaccinated. 90% of all unvaccinated patients had SARS-CoV-2 infection. 97.3% of the uninfected patients were vaccinated. CONCLUSION Hypovitaminosis D is very common in CKD patients on dialysis, however, despite its immunomodulatory role, we did not find a higher incidence of hypovitaminosis D in dialysis patients with SARS-CoV-2 infection. In our series, we have not found factors associated with SARS-CoV-2 infection in dialysis patients, with the exception of vaccination. Therefore, vaccination in our dialysis patients is being essential to prevent a higher number of cases of SARS-CoV-2 infection.

A simultaneous pancreas-kidney transplantation for type 1 diabetes mellitus after a long-term of receiving hemodialysis renal replacement therapy. Clinical сase

At the present time, a simultaneous pancreas-kidney transplantation (SPKT) is an effective method of treatment for patients on renal replacement therapy by hemodialysis program in the outcome of the terminal stage of diabetic nephropathy. This method of treatment solves several problems: it reduces the severity of intoxication syndrome, contributes to the achievement of euglycemia in most cases, which certainly allows to slow the progression of micro- and macrovascular complications of diabetes. Despite of positive effect of euglycaemia and kidney function normalization, the accumulated metabolic memory legacy of long-term uncompensated diabetes mellitus is realized, which makes a posttransplantational rehabilitation of patients difficult. A duration of hemodialysis therapy is known as a cardiovascular events risk factor, which affects the surgery result and favorable posttransplant period. More often after successful SPKT microvascular diabetic complications are stabilized, but macrovascular diabetic complications, diabetic neuroosteoarthropathy and mineral and bone disease are progressed. That’s why is necessary to perform regular examination after SPKT by a team of specialists, including nephrologist, endocrinologist, cardiologist, ophthalmologist with correction of ongoing therapy. Therefore both the preparation of the patient for transplantation with the earliest possible placement on the waiting list and the post-transplant rehabilitation afterwards are extremely important.

Kidney transplantation reduces the risk of chronic limb threatening ischemia and amputation among patients with end-stage renal disease on hemodialysis.

This study aimed to analyze the risk of chronic limb threatening ischemia (CLTI) or amputation among patients with end-stage renal disease (ESRD) entering a hemodialysis (HD) program and to evaluate the protective effect associated with kidney transplantation (KT). Retrospective cohort of all consecutive ESRD patients entering into a HD program at our institution between 2000 and 2010. Collected variables included baseline characteristics (pre-entry in hemodialysis), time on HD program, KT and the composite outcome of chronic limb threatening ischemia or need for any amputation (CLTI/AMP). Patients with previous symptomatic peripheral arterial disease or amputation were excluded. The study group included 336 patients (mean age 63years, 66% male). The mean follow up was 6.7years with an average time on HD of 4.2years. Ninety two patients (27.4 %) underwent transplantation. CLTI free survival rates were 90.3 % and 82.6 % at 5 and 10years, respectively. The episodes of CLT involved 28 revascularization procedures (17 endovascular and 11 open surgeries), 18 minor amputations and 20 major amputations. KT was associated with a protective effect over the development of CLTI (HR: 0.065; CI 95% 0.02-0.21) after adjustment for confounding factors. The long-term survival of non-transplanted patients was 45 % and 15 % at 5 and 10years, respectively and the long-term survival in transplanted patients was 89% and 80% at 5 and 10years, respectively; but decreased to 47 % at 1year and 18.2 % at 5years once CLTI occurred. Patients on HD program show a notorious risk of chronic limb threatening ischemia or amputation over time. Once this complication occurs, patient's survival is markedly reduced. Transplantation confers an independent protective effect over the development of chronic limb threatening ischemia or amputation.

Effect of kidney transplantation activity on arteriovenous fistula use in prevalent haemodialysis patients: A registry-based study.

Kidney transplantation (KT) is considered to be the best kidney replacement therapy (KRT) option for most end-stage kidney disease (ESKD) patients. Arteriovenous fistula (AVF) is considered to be the best vascular access (VA) for most haemodialysis (HD) patients. In this study, we investigated the effect of KT activity on AVF use in prevalent HD patients. The probability of receiving a kidney graft (KTx) over time, depending on the first VA used to start the HD program, was also evaluated. Data from the Catalan Registry of prevalent patients on KRT by either KT or HD were examined over a 20-year period (1997-2017). The percentage of prevalent ESKD patients with a functioning KTx increased from 40.5% in 1997 to 57.0% in 2017 and, conversely, the percentage of AVF utilisation in HD patients decreased from 86.0% to 63.2% during the same period (for both comparisons, p < 0.001). This inverse relationship was also demonstrated in other countries and regions worldwide by performing a simple linear regression analysis (R2 = 0.4974, p = 0.002). The probability of prevalent patients dialysed through an AVF in Catalonia was independently associated with the percentage of functioning KTx among KRT population, after adjusting by age, gender, primary kidney disease, time on KRT, cardiovascular disease and type of HD Unit. Incident patients starting HD through an AVF had a significantly higher probability of receiving a KTx over time in comparison to patients who initiated HD through a catheter (hazard ratio 1.68 [95% confidence interval: 1.41-2.00], p < 0.001). In addition to some demographical and clinical characteristics of patients and type of HD Unit, KT activity can be a determining factor in AVF use in prevalent HD patients. Starting an HD programme through an AVF is independently associated with a greater probability of receiving a KTx as compared to starting HD through a catheter.

The Practiced Pattern of Vascular Access used in Hemodialysis

Background: The incidence of end-stage renal disease (ESRD) is increasing considerably worldwide; moreover, most of the patients start their therapy by hemodialysis (HD). Arteriovenous fistula (AVF) is the best type of vascular access for use in such therapy, due to its decreased rate of complications, followed by arteriovenous graft (AVG) and finally, central venous catheters, which are associated with, increased mortality and morbidity. In this study, we aim to find out the proportion of the current to initial vascular access used, the timing of creating permanent access, and any complications experienced. Patients and Methods: A cross-sectional study was conducted on two hundred eighteen patients currently on regular hemodialysis program. Their records were reviewed and the data was analyzed for vascular accesses type used at the start of hemodialysis and at the current time, the timing of the creation of permanent access, and the complications occurred. Data collected were statistically analyzed using IBM-SPSS statistics software Inc. Chicago, IL, USA. Results: Out-of-the 218 patients on hemodialysis, 193 patients (88.5%) started hemodialysis via Central venous catheters (CVC), 23 patients (10.5%) had an arterio-venous fistula (AVF), and only two patients (0.9%) used tunneled CVC, while no one has AV-graft. Currently, 82.1% of patients have AVF, 7.8% have chronic CVC, 5.9% have acute CVC and only 4.1% have AV-Graft, Many complications are noted in all types of access with different percentages of occurrence. Conclusion: We concluded that although a high percentage of patients have AVF, still pre-emptive AVF counts very low percentage, serious complications are still happening and we recommend the establishment of joined pre-dialysis clinic with surgeons and psychologists in each dialysis center.

Intraocular pressure, eye pain and hemodialysis

The review presents data on the effect of program hemodialysis on the state of intraocular pressure in patients with terminal chronic renal failure. Treatment with hemodialysis is accompanied by various effects: from intraocular pressure drop to the development of ophthalmic hypertension with pain syndrome. The state of the iris-corneal angle, neovascularization of the structures of the eye drainage system and the presence of glaucoma are significant, but not indisputable, risk factors for pain-related dialysis ophthalmic hypertension. Their combination with the effect on the osmolar balance of dialysis therapy increases the possibility of the formation of ocular hypertension syndrome formation. The need to eliminate dialysis eye pains and the chance of glaucoma progression due to dialysis-affected fluctuations of intraocular pressure remains relevant.

The impact of chronic kidney disease on muscle tissue metabolism in patients undergoing hemodialysis

Objective: to estimate the prevalence of sarcopenia and evaluate the contribution of myostatin and mTOR to the development of muscle mass loss and strength in patients with end-stage renal disease treated with program hemodialysis. Materials and methods: the study included 80 patients with CKD5D, the average age of study participants was 51.7±11.6 years. In all patients, anamnestic data were analyzed, the results of laboratory and instrumental examination were evaluated, the levels of myostatin and mTOR in the blood serum were determined, hand dynamometry, bioimpedancemetry, and a leg raising test were performed. Results: the average volume of muscle mass in the subgroup with sarcopenia was 20.5±0.7 kg and significantly differed from that in the subgroup without sarcopenia 25.23±0.8 kg (p &lt;0.05). The prevalence of sarcopenia in the general group was 38.75%. In men, decreased muscle mass was statistically significantly more common than among women (p &lt;0.05). The level of mTOR in the blood serum of patients with sarcopenia was significantly lower than that in the subgroup without sarcopenia (6.61±0.4 ng/ml and 9.4±0.3 ng/ml, respectively (p &lt;0.001)). The level of myostatin was significantly higher in the subgroup of patients with sarcopenia than without it (12.2±0.6 ng/ml vs. 8.1±0.3 ng/ml, respectively (p &lt;0.001)). The increase in myostatin was accompanied by a decrease in mTOR both in the general group (r=-0.57) and in the subgroup of patients with sarcopenia (r=-0.55). Conclusion: A high prevalence of sarcopenia was found in patients with CKD receiving renal replacement therapy. Myostatin and mTOR have demonstrated their diagnostic potential and can be used as promising markers for the verification of sarcopenia.

Risk factors associated with vascular access steal syndrome in renal replacement therapy patients with chronic kidney disease. A multicenter study

Introduction: Symptomatic decrease in perfusion distal to the vascular access is a severe complication in patients with chronic kidney disease (CKD) in hemodialysis programs. This study aimed to identify the risk factors associated with vascular access steal syndrome (VASS) in patients with CKD undergoing renal replacement therapy in hemodialysis units. Methods: This case-control study was carried out in Santo Domingo and Portoviejo (Ecuador) hemodialysis units from January to December 2015. Patients with CKD 5-d with arteriovenous fistulae, with VASS (Cases) and without VASS (controls). The variables were demographic, type of arteriovenous fistula, the severity of the steal syndrome, comorbidities, size of the anastomosis, place of implantation of the vascular access, and etiology of kidney disease. The sample was probabilistic of 42 patients in each group. The association with the Odds ratio and 95% confidence interval is presented. Results: The average age was 56 ±15 years. In patients with VASS 33 cases (78.57%) were in the elbow forearm, 6 cases (14.29%) were in the arm, and 3 cases (7.14%) were in the wrist. The severity of VASS was Grade I, 10 cases (23.81%); grade II, 19 cases (45.24%); grade III, 6 cases (14.29%); grade IV, 7 cases (16.67%). Overweight/obese had an OR 3.1 (95% CI 1.24-7.75) P=0.01. The implantation of the fistula was different from the wrist OR 11.81 (95% CI 1.24-7.75) P=0.01. Type 2 diabetes and high blood pressure were not factors associated with the presence of VASS. The anastomosis size &gt; 5 mm OR 0.20 (95% CI 0.07-0.52) was established as a protective factor. Conclusions: In the present study, overweight or obesity are established as risk factors for the presence of VASS at the implantation site other than the wrist.