Uremic Patients Research Articles

Evaluation of Psychological Intervention on Hemodialysis Nursing in Uremic Patients

Evaluation of Psychological Intervention on Hemodialysis Nursing in Uremic Patients

Study on Nursing Effect of Psychological Intervention on Uremic Hemodialysis Patients.

Aim Patients in the hemodialysis stage are prone to psychological pressure of depression and anxiety and have resistance, which affects the clinical treatment effect. Effective psychological intervention plays a very important role in improving patients' psychological pressure and patients' compliance. The aim of this study is to explore the nursing effect of psychological intervention on uremic hemodialysis patients. Methods There were 126 uremic hemodialysis patients admitted to the hospital from August 2020 to December 2021. The patients were randomly divided into the routine nursing care group (n = 63) and psychological intervention group (n = 63). The routine nursing care group received routine nursing care for uremia hemodialysis patients. The psychological intervention group implemented psychological intervention on uremia hemodialysis patients. The methods of psychological intervention mainly include establishing a good nurse-patient relationship, popularizing hemodialysis knowledge, timely psychological counseling for patients, and organizing patient communication meetings. The treatment compliance, Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) of the two groups were compared before and after nursing. SF-36 scale was used to evaluate the quality of life of patients. The incidence of complications and nursing satisfaction were compared between the two groups. Results The treatment compliance rate and nursing satisfaction of hemodialysis uremic patients in the psychological intervention group were significantly higher than the routine nursing care group. The SAS and SDS of hemodialysis uremia patients in the psychological intervention group were significantly lower than the routine nursing care group after psychological intervention, and SF-36 scale was significantly higher than the routine nursing group. The main complications of uremic hemodialysis patients are hypotension, hyperkalemia, internal fistula occlusion, and infection. Compared with the routine nursing care group, the incidence of complications in the psychological intervention group was significantly reduced. Conclusion The implementation of psychological nursing intervention for uremic hemodialysis patients have a very significant effect on reducing the incidence of complications and improving anxiety, depression, treatment compliance, and the quality of life and the nursing satisfaction.

Lipid Profile Is Negatively Associated with Uremic Toxins in Patients with Kidney Failure—A Tri-National Cohort

Patients with kidney failure (KF) have a high incidence of cardiovascular (CV) disease, partly driven by insufficient clearance of uremic toxins. Recent investigations have questioned the accepted effects of adverse lipid profile and CV risk in uremic patients. Therefore, we related a panel of uremic toxins previously associated with CV morbidity/mortality to a full lipid profile in a large, tri-national, cross-sectional cohort. Total, high-density lipoprotein (HDL), non-HDL, low-density lipoprotein (LDL), and remnant cholesterol, as well as triglyceride, levels were associated with five uremic toxins in a cohort of 611 adult KF patients with adjustment for clinically relevant covariates and other patient-level variables. Univariate analyses revealed negative correlations of total, non-HDL, and LDL cholesterol with all investigated uremic toxins. Multivariate linear regression analyses confirmed independent, negative associations of phenylacetylglutamine with total, non-HDL, and LDL cholesterol, while indole-3 acetic acid associated with non-HDL and LDL cholesterol. Furthermore, trimethylamine-N-Oxide was independently and negatively associated with non-HDL cholesterol. Sensitivity analyses largely confirmed findings in the entire cohort. In conclusion, significant inverse associations between lipid profile and distinct uremic toxins in KF highlight the complexity of the uremic milieu, suggesting that not all uremic toxin interactions with conventional CV risk markers may be pathogenic.

Pathological Analysis of Vascularization of the Arterialized Veins in Failed Arteriovenous Fistulae

PurposeTo assess venous wall vascularization and its correlation with neointimal hyperplasia (NIH) in failed arteriovenous fistulae (AVFs). Materials and MethodsA total of 43 uremic patients who underwent de novo AVF creation and 39 patients who underwent reconstruction of failed fistulae were enrolled in the study. A 5–10-mm vein segment adjacent to the future fistula creation or reconstruction site was surgically removed and assessed using histopathological analyses and stained by immunohistochemistry to quantify vasa vasorum density (VVD). ResultsBoth the intimal thickness (70.68 [28.81–99.54] vs 4.53 [2.69–7.30] μm, P < .001) and the intimal thickness-to-medial thickness ratio (2.20 [0.77–4.36] vs 0.15 [0.10–0.30], P < .001) were higher in failed AVFs than in preaccess veins. CD31- and factor VIII–marked VVDs in both the intima (6.31 [1.62–12.53] vs 0.0 [0.0–0.0], P < .001; 7.82 [3.33–11.61] vs 0.0 [0.0–0.0], P < .001) and media (10.0 [7.59–12.95] vs 3.71 [2.44–4.87], P < .001; 8.33 [5.55–13.0] vs 3.57 [2.53–4.82], P < .001) as well as the intimal VVD:medial VVD ratio (0.67 [0.19–1.08] vs 0.0 [0.0–0.0], P < .001; 0.71 [0.39–1.14] vs 0.0 [0.0–0.0], P < .001) were significantly higher in failed AVFs than in preaccess veins. Moreover, there was a positive relationship between the intimal VVD:medial VVD ratio and the intimal thickness:medial thickness ratio (P < .001). In addition, the vascular endothelial cell growth factor A expression was higher in failed AVFs than in preaccess veins. ConclusionsVascularization of the vessel wall was noticeably more developed in the arterialized veins, especially at the NIH regions in failed AVFs.

MO687: Positive Association of Serum Galectin-3 Level with the Peripheral Arterial Disease in Patients with Peritoneal Dialysis

Abstract BACKGROUND AND AIMS Galectin-3 expressed by epithelial cells, endothelial cells and macrophages, with multiple biological abilities, including cell proliferation, differentiation, growth and inflammation; it also participates in cardiovascular development. Peritoneal dialysis (PD) was an independent predictor for further mortality in uremic patients with subclinical peripheral arterial disease (PAD). The aim of this study was to evaluate the relationship between serum values of galectin-3 levels and ankle–brachial index (ABI) values in PD patients. METHOD Fasting blood samples were obtained from 92 PD patients. ABI values were measured using an ABI-form device. Serum galectin-3 concentrations were determined by commercially available enzyme-linked immunosorbent assays. Left or right ABI values &amp;lt;0.9 were included in the low ABI group. RESULTS A total of 19 PD patients (20.7%) were in the low ABI group. Compared with patients in the control group, patients in the low ABI group had higher prevalence of diabetes (P = 0.010), older age (P = 0.009), higher serum fasting glucose (P = 0.001), triglyceride (P = 0.021), C-reactive protein (P &amp;lt; 0.001), galectin-3 level (P &amp;lt; 0.001), while lower total clearance of creatinine (P = 0.028). Multivariable logistic regression analysis of the factors significantly associated with PAD revealed that serum galectin-3 level [odds ratio: 1.148, 95% confidence interval (CI): 1.032–1.227, P = 0.011] and C-reactive protein level (increase 0.1 mg/dL, odds ratio: 1.324, 95% CI: 1.101–1.592, P = 0.003) were the independent predictor of PAD in PD patients. The area under the curve plotted to estimate the optimal level of galectin-3 predicting PAD in PD patients by the receiver-operating characteristic curve analysis was 0.844 (95% CI: 0.753–0.911, P &amp;lt; 0.001). CONCLUSION High serum level of C-reactive protein and galectin-3 were found to be independent risk factors for predicting PAD in PD patients.

MO133: Multidisciplinary Regenerative Treatment for Rescuing a Severe Calciphylaxis Patient with Human Amnion-Derived Mesenchymal Stem Cells

Abstract BACKGROUND AND AIMS Calciphylaxis is a rare disease characterized histologically by microvessel calcification and microthrombosis, with high mortality and no proven therapy. Here, we reported multidisciplinary regenerative treatment for rescuing a severe uremic calciphylaxis patient with human amnion-derived mesenchymal stem cells (hAMSCs). METHOD A 34-year-old uremic woman presented progressive skin ischaemia, large areas of painful malodorous ulcers and mummified legs. The patient was diagnosed as calciphylaxis based on clinical manifestations, laboratory examinations and skin pathological features. Because of her refractory to conventional therapy, treatment with hAMSCs was approved. HAMSCs were administered intravenously to the patient at a dose of 1.0 × 106 cells per kilogram of body weight, local intramuscular injection along the wound edge (2.0 × 104 cells/cm2) and external application of the cell culture supernatant on wound surfaces. RESULTS Following up 15 months regularly after hAMSCs treatment, the patient's blood biochemical, inflammatory, mineral and bone metabolic indices improved significantly, with immunoregulation effects, regeneration of skin and soft tissue. Besides, wound healing (Figure 1), pain status and quality of life, evaluated by Pain Visual Analog Scale, Bates-Jensen Wound Assessment and the wound-quality of life questionnaire were also improved significantly (Figure 2). CONCLUSION This case represented the new method of hAMSC regeneration therapy for uremic calciphylaxis with safety and effectiveness, which deserved further investigation. Before hAMSC treatment, the patient had irregular ulcers on the buttocks and lower extremities, some of which were crusted on the surface or had purulent fishy discharge. Skin and soft tissue necrosis can be seen at the ulcerated area of the buttocks, localized deep to the fascia, with purulent secretions on the surface and brown pigmentation of the skin at the edge of the ulcer (Figure 1A and B). Because of her worsening symptoms and signs refractory to conventional therapy, the patient was given intravenous and local intramuscular injections of hAMSCs, supplemented by application of hAMSC culture supernatant to the wound. After 4 months of treatment, the sacrococcygeal wound has reduced size and become shallow with less exudate, some new granulation tissue was visible. The infection was controlled with pain significantly reduced (Figure 1C). After 12 months, most of the sacrococcygeal wound had healed with only a few erosions (Figure1D). Fifteen months later, her skin scarring of the wound was healed without pain (Figure 1E). The pain Visual Analogue Scale (Figure 2A) showed that the pain was unbearable before treatment (10 points) and disappeared after 15 months of hAMSC treatment (0 point). BWAT (Figure 2B) showed that all the 13 indexes got 5 points (worst) before hAMSC treatment, with a total score of 65 points. After 15 months of hAMSC treatment, each index got 1 point (best), and the total score was 13 points. The Wound-QoL questionnaire (Figure 2C) showed that the 17 items were quantified as 4 points (very serious) before treatment, with a total score of 68 points. After 15 months of hAMSC treatment, the score was 0 (none at all), and the total score was 0.

MO817: New Scenarios in Use of Calcimimetics: Could Etelcalcetide Improve Anaemia?

Abstract BACKGROUND AND AIMS Alterations of mineral metabolism in patients with chronic renal failure (MBD-CKD) are frequently found and appear in the earliest stages of the disease. If not accurately diagnosed and treated, they could lead to serious clinical complications. With the same safety and better tolerability compared with cinacalcet, etelcalcetide demonstrated greater efficacy in the control of parathyroid hormone (iPTH) with an improvement in patients' compliance. Several reports in the literature document the effect of elevated levels of iPTH on anaemia. In vitro experiments showed that elevated concentrations of PTH (comparable to those found in the blood of uraemic patients with secondary hyperparathyroidism) exert a significant inhibition on erythroid progenitors, decreasing the number of erythropoietin receptors on erythroid progenitors and making these cells insensitive to erythropoietin. High levels of iPTH could have, furthermore, a haemolytic effect on the peripheral RBCs causing disturbed calcium metabolism, increased cytosolic calcium and enhanced osmotic fragility of the cells. Aim of this study was to verify in a dialysis cohort if etelcalcetide could not only improve iPTH levels but also haemoglobin levels with a reduction in weekly doses of erythropoiesis-stimulating agents (ESA). METHOD We analysed data from 130 haemodialysis adult patients over 2 years from three different centres. A total of 24 patients treated with etelcalcetide (Image 1) were enrolled and followed at different time points (1–3–6–12–24 months). Patients were on stable doses of ferric carboxymaltose, active vitamin D analogues, phosphorus binders, supplement of oral calcium and calcium concentration in dialysate (1.25–1.50 mmol/L). RESULTS Data analysed after 24 months of treatment with etelcalcetide (Image 2) demonstrated not only a drastic improvement in iPTH values (772.53 ± 452.6 pg/mL versus 308.7 ± 207 pg/mL–60.05%) but also a statistically significant improvement of haemoglobin values ( 10.35 ± 1.45 g/dL versus 11.57 ± 0.97 g/dL; P &amp;lt; .05) in addition to a reduction in the weekly ESAs units required (193.39 ± 148 UI/kg/week versus 142.71 ± 118 UI/kg/week; P &amp;lt; .05). This effect was achieved by maintaining constant ferritin and TSAT levels and without substantial changes in iron carboxymaltose therapy. No side effects were recorded for the entire duration of the treatment. CONCLUSIONS Considering the well-known direct and indirect inhibition of parathyroid hormone on erythropoiesis, reduction of iPTH levels achieved with etelcalcetide could improve haemoglobin levels and reduce required weekly ESA units, with obvious clinical and economic advantages. Further studies, on large populations and over longer periods of time, are required.

Detecting Volemic, Cardiac, and Autonomic Responses From Hypervolemia to Normovolemia via Non-Invasive ClearSight Hemodynamic Monitoring During Hemodialysis: An Observational Investigation.

Background: Unstable hemodynamics are not uncommon during hemodialysis (HD), which involves a rapid volume depletion, taking the patient from hypervolemia toward euvolemia. Since uremic patients commonly have cardiovascular comorbidities, hemodynamic changes during HD may reflect interactions among the volemic, cardiac, and autonomic responses to gradual volume depletion during ultrafiltration. Accurate identification of inappropriate responses helps with precisely managing intradialytic hypotension. Recently, the non-invasive ClearSight was reported to be able to detect causes of intraoperative hypotension. In this prospective observational study, we aimed to determine whether ClearSight could be used to detect patterns in stroke volemic, cardiac, and vasoreactive responses during HD. Methods: ClearSight was used to monitor chronic stable patients receiving maintenance HD. Data of mean arterial blood pressure (MAP), heart rate (HR), stroke volume index (SVI), cardiac index (CI), and calculated systemic vascular resistance index (SVRI) were obtained and analyzed to examine patterns in volemic, cardiac, and vasoreactive changes from T0 (before HD) until T8 in 30-min intervals (total 4 h). Results: A total of 56 patients with a mean age of 60.5 years were recruited, of which 40 of them were men. The average ultrafiltration volume at T8 was 2.1 ± 0.8 L. The changes in MAP and HR from T0 to T8 were non-significant. SVI at T7 was significantly lower than that at T1, T2, and T3. CI at T4 to T8 was significantly lower than that at T0. SVRI was significantly higher at T3 to T8 than at T0. Pearson’s correlation coefficients between SVI and CI and between SVRI and MAP were positive at all time points. The correlation coefficients between SVRI and SVI and between CI and SVRI were significant and negative for all time points. Conclusion: ClearSight was able to detect patterns in hypervolemia during HD and was well tolerated for 4 h. CI decreased significantly after T4, with slightly decreased SVI. Ultrafiltration volume was not correlated with changes in SVI or CI. The vascular tone increased significantly, and this counteracted the reduced cardiac output after T4. With simultaneous monitoring on SVI, CI, and SVRI during HD, therefore, hypotension could be detected and managed by reducing the filtration rate or administering inotrope or vasopressors. Trial Registration: clinicaltrials.gov, ID: NCT03901794.

Time for Revival of Bone Biopsy with Histomorphometric Analysis in Chronic Kidney Disease (CKD): Moving from Skepticism to Pragmatism.

Bone Biopsy (BB) with histomorphometric analysis still represents the gold standard for the diagnosis and classification of different forms of renal osteodystrophy. Bone biopsy is the only technique able to provide comprehensive information on all bone parameters, measuring static and dynamic parameters of turnover, cortical and trabecular microarchitecture, and mineralization defects. In nephrological practice, bone biopsy yields relevant indications to support therapeutic choices in CKD, heavily impacting the management and prognosis of uremic patients. Unfortunately, the use of bone biopsy has decreased; a lack of expertise in performing and interpreting, perceived procedure invasiveness and pain, and reimbursement issues have all contributed to this decline. Nevertheless, both bone biomarkers and instrumental images cannot be considered reliable surrogates for histological findings, being insufficiently accurate to properly evaluate underlying mineral and bone disorders. This is a multidisciplinary position paper from the Nephrology and Osteoporosis Italian Scientific Societies with the purpose of restating the role of bone biopsy in CKD patient management and of providing strong solutions to allow diffusion of this technique in Italy, but potentially also in other countries. The Italian approach through the optimization and standardization of bone biopsy procedure, the construction of the Italian Hub and Spoke network, and a request for adjustment and national homogenization of reimbursement to the Italian Health Ministry has led the way to implement bone biopsy and to improve CKD patient management and prognosis.

A clinical randomized controlled trial: moxibustion at Laogong interval with Panax notoginseng promoted the maturation of arteriovenous fistulae

BackgroundWe aim to study the clinical effect of moxibustion at Laogong interval with Panax notoginseng on the short-term maturation and long-term patency of arteriovenous fistula.MethodsSeventy-four pre-dialysis uremic patients who received distal forearm radial-cephalic fistula creations were enrolled in this study and randomly assigned to the control group and experimental group. After arteriovenous fistula creations, the control group underwent handgrip exercise, and the experimental group received moxibustion at Laogong acupoint interval with Panax notoginseng. Both groups received a 12-week treatment and were followed up for 24 weeks in all at the following time points: before creations and 2, 4, 8, 12, 24 weeks after creations. The diameter of anastomosis, the diameter and outflow of draining-veins 5 cm above anastomosis, the diameter and outflow of brachial arteries evaluated the maturation and patency of arteriovenous fistula. Enzyme linked immunosorbent assay determined serum levels of endothelin and nitric oxide.ResultsThe maturity rate in the experimental group was significantly higher than that in the control group at 4 weeks after arteriovenous fistula creations (P = 0.048). The diameter of anastomosis, the diameter of draining veins, and the blood flow of draining veins increased in both groups during the whole 24 weeks. The diameter and blood flow of brachial arteries ascended in both groups during the previous 12 weeks. Compared with the control group, moxibustion at Laogong interval with Panax notoginseng significantly improved the value of the diameter of draining-veins (P = 0.016), the blood flow of draining-veins (P = 0.015), the diameter of brachial arteries (P < 0.001), and the blood flow of brachial arteries (P = 0. 012) at 2 weeks, and enhanced the blood flow of draining-veins (P = 0.029) and brachial arteries (P < 0.001) at 12 weeks. Serum levels of endothelin were significantly lower (P = 0.047), and serum levels of nitric oxide were markedly higher (P < 0.001) in the experimental group than that in the control group at 2 weeks after creations.ConclusionsMoxibustion at Laogong interval with Panax notoginseng was non-invasive and promoted the maturation of arteriovenous fistula at 4 weeks after creations. However, its long-term beneficial effect on patency at 24 weeks after creations was not significant.Trial registration Chinese Clinical Trial Registry, No. ChiCTR1900024042. Registered, http://www.chictr.org.cn/index.aspx

TO STUDY THE PREVALENCE OF ELECTROLYTE IMBALANCE IN PATIENTS WITH SEIZURES

Background: Seizure is dened as an episode of neurological dysfunction caused by abnormal neuronal activity that results in a sudden change in motor, behaviour and sensory perception1. Electrolytes seem to have a dominant role in the causation of seizures Electrolyte homeostasis in the central nervous system (CNS) is a characteristic essential feature behind brain functioning. “A number of clinical studies have also shown a relationship between electrolyte imbalance and seizures. OBJECTIVE: To Determine the Prevalence of electrolyte imbalance in patients with Seizures. RESEARCH DESIGN AND METHODS: A cross sectional study was conducted at , MLN Medical College associated SRN Hospital, Prayagraj. A total 100 patients were enrolled in the study. Patients with 18 years of age or older presented with seizure as the presenting complaint were included. Patients presenting with cerebrovascular accident ,subarachnoid hemorrhage, tuberculoma cavernous sinus thrombosis febrile seizures hypoglycemia alcohol withdrawal uremic encephalopathy and patients refusing to participate in the study. RESULT: Nearly two third (64%) patients had generalized tonic clonic seizures followed by focal seizures (27%) and status epilepticus (9%) respectively. Maximum electrolyte imbalance was seen for calcium (99%) followed by sodium (92%), potassium (63%) and magnesium (33%) respectively. A signicant association of serum sodium status was observed with type of seizures with hyponatremia being more common in GTCS and hypernatremia being more common in status epilepticus. Conclusion: In the present study, there was a high prevalence of hyponatremia (82%). Hyponatremia could be one of the most common factors leading to seizure activity. The ndings of the present study shows that both in adults as well as in children show that electrolyte imbalance is a frequent observation in seizure activity, primarily cation deciency is highly prevalent in seizure cases, however it is difcult to establish the role of a single electrolyte cation to be responsible for this activity

Unraveling Structural Rearrangements of the CFH Gene Cluster in Atypical Hemolytic Uremic Syndrome Patients Using Molecular Combing and Long-Fragment Targeted Sequencing

Complement factor H (CFH) and its related proteins have an essential role in regulating the alternative pathway of the complement system. Mutations and structural variants (SVs) of the CFH gene cluster, consisting of CFH and its five related genes (CFHR1-5), have been reported in renal pathologies as well as in complex immune diseases like age-related macular degeneration and systemic lupus erythematosus. SV analysis of this cluster is challenging because of its high degree of sequence homology. Following first-line next-generation sequencing gene panel sequencing, we applied Genomic Vision's Molecular Combing Technology to detect and visualize SVs within the CFH gene cluster and resolve its structural haplotypes completely. This approach was tested in three patients with atypical hemolytic uremic syndrome and known SVs and 18 patients with atypical hemolytic uremic syndrome or complement factor 3 glomerulopathy with unknown CFH gene cluster haplotypes. Three SVs, a CFH/CFHR1 hybrid gene in two patients and a rare heterozygous CFHR4/CFHR1 deletion in trans with the common CFHR3/CFHR1 deletion in a third patient, were newly identified. For the latter, the breakpoints were determined using a targeted enrichment approach for long DNA fragments (Samplix Xdrop) in combination with Oxford Nanopore sequencing. Molecular combing in addition to next-generation sequencing was able to improve the molecular genetic yield in this pilot study. This (cost-)effective approach warrants validation in larger cohorts with CFH/CFHR-associated disease.

Evaluation of the approach to hemodialysis vascular access during the pandemic period

Objective: During the pandemic, some surgeries were postponed due to the large number of patients admitted by hospitals. It was tried to shorten the hospitalization period of some patients. Hemodialysis patients who had to come to the hospital frequently were also affected by this situation. Physicians working during the pandemic period prefer to use less invasive techniques. In this study, it was aimed to investigate whether there is a change in the choice of vascular access used for hemodialysis in this period. Material and Method: In this study, 552 patients who were treated for hemodialysis vascular access in the cardiovascular surgery clinic of Kastamonu Training and Research Hospital between March 2019 and 2021 were retrospectively analyzed. The patients were divided into two groups as pre-pandemic (Group 1) and pandemic (Group 2). Patients in Group 1 and Group 2 needed high-flow vascular access to perform hemodialysis. For this purpose, 2 techniques are frequently used, the first being arteriovenous fistula(AVF) and the other permanent hemodialysis catheter insertion. The distribution of these techniques used in patients was examined. Results: In our study, we found that before the pandemic between March 2019-2020, 109 patients had AVF and 193 patients had a permanent tunneled catheter. Between March 2020- 2021, which started with the pandemic process, we found that AVF was opened in 74 patients and a permanent tunnel catheter was placed in 176 patients. Conclusion: Uremic patients who need hemodialysis should not be affected by the pandemic problem and the most permanent procedures should be applied for these patients. Like all vascular patients, dialysis patients should not become secondary afflictions of Covid-19

Impact of kidney size on the outcome of diabetic patients receiving hemodialysis.

IntroductionDiabetic patients normally have enlarged or normal-sized kidneys throughout their lifetime, but some diabetic uremic patients have small kidneys. It is uncertain if kidney size could have any negative impact on outcome in hemodialysis patients.MethodsThis longitudinal, observational cohort study recruited 301 diabetic hemodialysis patients in 2015, and followed until 2019. Patients were stratified into two subgroups according to their kidney sizes before dialysis, as small (n = 32) or enlarged or normal (n = 269). Baseline demographic, hematological, biochemical, nutritional, inflammatory and dialysis related data were collected for analysis.ResultsPatients with small kidney size were not only older (P<0.001) and had lower body mass index (P = 0.016), but had also higher blood uric acid concentration (P<0.001) compared with patients with enlarged or normal kidney size. All patients received adequate doses of hemodialysis since the Kt/V and urea reduction ratio was 1.7±0.3 and 0.7±0.1, respectively. Patients with small size kidneys received higher erythropoietin dose than patients with enlarged or normal kidney size (P = 0.031). At the end of analysis, 92 (30.6%) patients expired. Kaplan-Meier analysis revealed no survival difference between both groups (P = 0.753). In a multivariate logistic regression model, it was demonstrated that age (P<0.001), dialysis duration (P<0.001), as well as blood albumin (P = 0.012) and low-density lipoprotein (P = 0.009) concentrations were significantly correlated with mortality.ConclusionsSmall kidney size on starting hemodialysis was not related with an augmented risk for death in diabetic patients receiving hemodialysis. Further studies are necessary.

Integrated transcriptomic and proteomic analyses for the characterization of parathyroid oxyphil cells in uremic patients.

Chief cells are the predominant cells in parathyroid glands of healthy adults; however, parathyroid oxyphil cells, whose function is unknown, increase dramatically in patients with secondary hyperparathyroidism (SHPT). Calcitriol and calcimimetics are the most powerful treatments for SHPT, while the mechanisms leading to calcitriol or calcimimetic resistance in oxyphil cell-predominant SHPT are unknown. Here we used transcriptomic and proteomic techniques to characterize oxyphil cells by comparing the differences between chief and oxyphil cell nodules of parathyroid glands in uremic patients. Compared to chief cell nodules, the most marked expression increases in oxyphil cell nodules were for mitochondrion-associated proteins. The mitochondria number and mitochondrial DNA content were also significantly increased in oxyphil cell nodules. Moreover, oxyphil cell nodules expressed parathyroid-specific factors, and exhibited lower levels of proliferation-related proteins but higher synthesis and secretion level of parathyroid hormone (PTH). The protein expression of SHPT-regulating factors, including vitamin-D receptor, calcium-sensing receptor and Klotho, were significantly downregulated in oxyphil cell nodules. Therefore, oxyphil cells characterized by enrich mitochondria in uremic patients showed higher synthesis and secretion of PTH but lower expression of SHPT regulators than chief cells, which may contribute to the pathophysiology of SHPT and the treatment resistance to calcitriol and calcimimetics.

Incidence of Polyneuropathy among Uremic Patients Undergoing Hemodialysis: Cross-Sectional Study among Iraqis

Background: Peripheral neuropathy (PNP) is among the commonest neurological disorders. NP is a disorder of sensory or motor neurons. Peripheral NP impacts around 60-100% of cases admitted for dialysis units due to chronic kidney disease (CKD). In dialysis-dependent patients, a progressive uremic sensorimotor axonal NP is a well-known complication. Nevertheless, the precise polyneuropathy (PNP) among CKD patients has to be further investigated especially in our country. Objectives: This cross-sectional study aimed to evaluate the incidence of polyneuropathy among Iraqi uremic patients undergoing hemodialysis. Materials and Methods: This cross-sectional study was performed on patients 215 patients (99 women and 116 men). All participants were suffering from ESRD were assessed by expert specialists, aging 17-80 years, attending hemodialysis unit, receiving standardized maintenance hemodialysis. All patients had completed neurophysiological assessment in the same hospital, for sensory and motor nerves including median, ulnar, tibial, peroneal, and sural nerves, regardless of whether they had clinical findings of NP or not. SPSS (V-25) software was used for statistical analysis. A confidence level of 95% had considered significant. Results: Mean age and weight of patients was (48.16 ±13.4 years and 66.9 ± 12.9 kg), respectively, and the mean duration of dialysis was 4.7 ± 1.4 years. The majority of patients (85.1%) had a frequency of dialysis three times/week. The prevalence of UNP was 63.7% among the studied candidates. More than half of patients (51.8%) presented with moderate UPN, (29.2%) with mild UPN, and (19. 0%) with severe UPN (P&lt;0.05). There were significant differences between means of age and frequency of dialysis with the incidence of UPN. Conclusion: Polyneuropathy is a very common complication in patients with uremia undergoing dialysis. Polyneuropathy is not associated with the frequency of dialysis, but with a duration of uremia.

Uremic toxin indoxyl sulfate induces dysfunction of vascular smooth muscle cells via integrin-β1/ERK signaling pathway.

Protein-bound uremic toxins (PBUTs) are reported to be one of the major culprits in chronic kidney disease-cardiovascular disease (CKD-CVD) development, yet its mechanism is not fully clear. Our previous study confirmed elevated expression of integrin-β1 (ITGβ1) in vascular smooth muscle cells of uremic patients. Thus, this study aimed to explore the relationship between PBUTs and ITGβ1 in uremic vasculature injury. Human umbilical vein smooth muscle cells (HUVSMCs) and endothelial cells (HUVECs) were treated with two representative PUBTs, indoxyl sulfate (IS) and p-cresyl sulfate (PC). Both cells were measured for the expression of ITGβ1 and downstream signaling pathways and assayed for proliferation, migration, adhesion and apoptosis. The IS treatments were observed with significantly up-regulated ITGβ1 in HUVSMCs but not in HUVECs, while PC did not induce ITGβ1 alteration in either HUVSMCs or HUVECs. Furthermore, overexpression of ITGβ1 revealed activated downstream signal-regulated kinase (ERK) signaling pathway with promoted focal adhesion, migration, proliferation but no apoptosis in HUVSMCs by IS. These functional and pathway alterations could be significantly suppressed by RNA interference of ITGβ1. More importantly, the application of ERK1/2 inhibitor significantly suppressed the focal adhesion, migration and proliferation of HUVSMCs. We first demonstrated that ITGβ1/ERK signaling pathway mediated abnormal focal adhesion, migration and proliferation of vascular smooth muscle cells stimulated by IS. ITGβ1/ERK signaling may serve as a novel therapeutic target for CKD-CVD.

İnternal Jugüler Ven Kateterizasyonu Sonrası Brakiyal Pleksus Yaralanması

Central venous catheters are often used as a vascular access for uremic patients who need hemodialysis in both acute and chronic renal failure disease. Among different locations, the most preferable access for catheter is internal jugular vein (IJV) due to its less adverse effects. Herein, we present case of brachial plexus injuries (BPI) as a complication of percutaneous IJV catheterization. After the development of acute renal failure due to lupus nephritis in a 25-years-old pregnant woman; pregnancy was terminated and hemodialysis treatment administered since she has uremic symptoms. Brachial plexus injury occurred after the insertion of IJV catheter. IJV catheterization is safe procedure if the doctor has enough experience. If weakness develops in ipsilateral upper extremity movements after catheterization, doctors should be suspected of BPI.

Teaching NeuroImage: Reversible Symmetric Basal Ganglia Lesions in a Patient With Diabetes Undergoing Dialysis

A 50-year-old woman with diabetes and renal disease on hemodialysis presented with 1 month of involuntary movements, dysarthria, and gait disturbance. Examination revealed bradykinesia, dystonia, and choreoathetosis. Brain MRI showed symmetric basal ganglia lesions (Figure 1). Basic metabolic panel was stable from baseline with normal bicarbonate but elevated creatinine, blood urea nitrogen, and glucose. Serum and CSF testing was otherwise unremarkable. Repeat MRI 3 months later showed spontaneous lesion regression (Figure 2); however, her symptoms persisted. Findings were attributed to a well-described, but poorly understood, syndrome of basal ganglia injury in diabetic uremic patients due to metabolic and vascular dysregulation.1,2

Comparative Analysis of Efficacy and Prognosis of Hemodialysis and Peritoneal Dialysis for End-Stage Renal Disease: A Meta-analysis.

Objective This meta-analysis is aimed at systematically assessing the efficacy and prognosis of hemodialysis (HD) and peritoneal dialysis (PD) in the treatment of end-stage renal disease (ESRD). Methods China National Knowledge Infrastructure, VIP, SinoMed, Cochrane Library, PubMed, and Embase databases were searched for relevant studies to evaluate the two different dialysis methods for ESRD. The search time was set from 2010 to 2021. Meta-analysis was performed using Stata16.0. The treatment group received PD, while the control group was given HD. Results Out of 317 articles initially retrieved, 14 studies were finally included in our meta-analysis. The analysis results showed that there was no marked difference in the 1-year survival rate between the two groups (RR = 1.05; 95% CI: 1.00, 1.10; P > 0.05), but the incidence rate of adverse reactions in the treatment group was significantly lower than that in the control group (RR = 0.51; 95% CI: 0.37, 0.70; P < 0.05). In addition, PD and HD treatments caused significant decreases in serum creatinine levels (PD, SMD = −2.91; 95% CI: -3.79, -2.04; P < 0.05; HD, SMD = −3.09; 95% CI: -4.01, -2.16; P < 0.05) and blood urea nitrogen levels (PD, SMD = −2.54, 95% CI: -3.37, -1.72, P < 0.05; HD, SMD = −2.62, 95% CI: -3.47, -1.77, P < 0.05); however, there was no significant statistical difference in posttreatment levels of serum creatinine and blood urea nitrogen between the two groups. Compared with the control group, the hemoglobin (SMD = 0.56, 95% CI: 0.07, 1.06; P < 0.05) and serum albumin (SMD = 1.11, 95% CI: 0.46, 1.76, P < 0.05) levels were significantly increased in the treatment group after treatment. Conclusion In summary, both PD and HD can improve renal function in uremic patients, but PD is superior to HD in reducing the incidence of adverse reactions, improving the nutritional status, and therefore improving the quality of life of patients.