BACKGROUND:Depression is the most prevalent psychological condition among elderly patients on maintenance hemodialysis, significantly impairing quality of life and increasing readmission and mortality risks. METHODS:This study recruited 871 elderly patients undergoing hemodialysis from nine tertiary hospitals in China between November 2023 and February 2024. Depression symptoms were assessed using the Geriatric Depression Scale (GDS-15), with a score of ≥ 8 indicating clinically significant depressive symptoms. Participants were divided into depressed (n = 333) and nondepressed (n = 538) groups. Multivariable logistic regression analysis was used to identify independent risk factors and develop a risk prediction model presented as a nomogram, with internal validation performed. External validation was conducted in an independent cohort of 219 elderly patients undergoing maintenance hemodialysis recruited from three additional hospitals in Chengdu between March and April 2024. RESULTS:The prevalence of depressive symptoms among elderly maintenance hemodialysis patients was 38.2%. Logistic regression identified education level, vision impairment, frailty, cognitive impairment, malnutrition, low activities of daily living, and poor social support as independent risk factors (p < 0.05). Both internal and external validation of the model demonstrated a receiver operating characteristic (ROC) curve area under the curve (AUC) greater than 0.80, indicating good model discrimination, with calibration and clinical decision analyses confirming its clinical utility. CONCLUSIONS:The high prevalence of depressive symptoms in this population is linked to specific risk factors. The nomogram provides valuable support for identification of high-risk patients in clinical practice.
INTRODUCTION:Blood gas analysis is routinely performed in hemodialysis patients to monitor acid-base status and serum potassium. Despite frequent testing, longitudinal analyses of acid-base parameters over patients' lifetime are lacking. METHODS:We conducted a retrospective analysis of 45 chronic hemodialysis patients at a secondary dialysis center in Austria, including 7946 blood gas analyses. Acid-base disturbances and respiratory compensation to metabolic acidosis were evaluated. Longitudinal changes were assessed at three time points: START (4 weeks after dialysis initiation), MID (mid-survival), and EOL (last 4 weeks of dialysis). Four measurements per patient were included at each time point. Venous blood gas values were adjusted to arterial equivalents to improve comparability. Linear mixed-effects models were used for analysis. FINDINGS:Venous blood gas analysis systematically misclassified respiratory status; standard formulas for compensation (e.g., Winter's formula) were not applicable. Over the course of dialysis treatment, acid-base and electrolyte homeostasis changed significantly. Temporal patterns were largely comparable between expected and unexpected death, with the exception of lactate, which increased significantly in patients with unexpected death. DISCUSSION:This study provides a comprehensive longitudinal evaluation of acid-base parameters from dialysis initiation to death. Observed temporal patterns, particularly in patients with unexpected death, suggest distinct terminal metabolic trajectories. These findings warrant further investigation in larger cohorts, potentially supported by artificial intelligence-based analyses.
BACKGROUND:Uremic pruritus (UP) remains a common and distressing complication in patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis. The burden is particularly pronounced in low- and middle-income countries where twice-weekly hemodialysis is frequently practiced because of resource limitations. Gabapentin is widely used for the treatment of uremic pruritus; however, its use is often limited by central nervous system adverse effects and poor tolerability in older dialysis populations. Montelukast, a leukotriene receptor antagonist with anti-inflammatory properties, has been proposed as a potential alternative therapy. This study aimed to evaluate the comparative efficacy and safety of montelukast versus gabapentin for the treatment of uremic pruritus in patients receiving twice-weekly hemodialysis, with extended follow-up over 52 weeks. METHODS:This prospective, open-label, non-randomized comparative study enrolled 195 adult patients with refractory uremic pruritus receiving twice-weekly hemodialysis. Participants were allocated to receive either montelukast or gabapentin based on predefined clinical and demographic criteria, including physician discretion and patient-specific factors. Clinical follow-up was conducted at 2, 4, 8, 12, 24, and 52 weeks. Pruritus severity was assessed using the Visual Analogue Scale (VAS). The primary outcome was change in Visual Analogue Scale score from baseline. Secondary outcomes included adverse events, treatment tolerability, need for dose escalation, and treatment discontinuation. RESULTS:A total of 176 patients completed the 52-week follow-up (montelukast, n = 91; gabapentin, n = 85). Baseline pruritus severity was comparable between the montelukast and gabapentin groups (mean VAS score 7.26 ± 1.56 vs. 7.41 ± 1.67, p = 0.54). Both treatments produced significant reductions in Visual Analogue Scale scores from baseline throughout the 52-week follow-up (p < 0.001 for both groups). Dose escalation was required in 38 patients (44.7%) receiving gabapentin within the first 6 weeks of therapy. Adverse events occurred significantly more frequently in the gabapentin group than in the montelukast group; 6 histories of falls and 11 treatment discontinuations due to adverse effects. Frequent adverse events reported in the montelukast group were abdominal pain and headache (17 and 14 episodes, respectively); whereas in the gabapentin group the common side effects were somnolence (39 incidence), fatigue (n = 21), dizziness (n = 17), and cognitive slowing (n = 16). Although gabapentin achieved modestly greater reductions in Visual Analogue Scale scores at selected follow-up time points, the absolute between-group differences remained below the predefined minimum clinically important difference of 1.0 VAS point. CONCLUSIONS:Montelukast provided sustained clinically meaningful improvement in uremic pruritus with substantially fewer treatment-related adverse events and superior tolerability than gabapentin. Although gabapentin achieved slightly greater reductions in pruritus severity at selected time points, these differences did not exceed the predefined minimum clinically important difference of 1.0 VAS point. Montelukast represents a practical and well-tolerated therapeutic option for patients receiving twice-weekly hemodialysis, particularly in resource-limited settings.
BACKGROUND:In Erythropoiesis-Stimulating Agent (ESA)-hyporesponsive hemodialysis patients, hemoglobin (Hb) change from baseline may not fully capture durable treatment response. This secondary analysis evaluated sustained Hb ≥ 10 g/dL achievement and month-to-month Hb variability with roxadustat versus continued ESA therapy. METHODS:This multicenter retrospective secondary analysis included adult maintenance hemodialysis patients with ESA-hyporesponsive anemia and complete monthly Hb data from Months 1-6. Sustained target achievement was defined as Hb ≥ 10 g/dL in at least 3 of 6 months. Hb variability was assessed using within-patient Hb SD, coefficient of variation, range, mean absolute monthly change, and maximum absolute change. Predictors were evaluated using logistic and linear regression. RESULTS:Among 108 patients, 78 received roxadustat and 30 continued ESA therapy. Sustained Hb ≥ 10 g/dL achievement occurred in 52 patients. Roxadustat was associated with higher adjusted odds of sustained target achievement versus ESA therapy (adjusted OR: 4.44, 95% CI: 1.24-15.84; p = 0.022). Higher baseline Hb was also independently associated with sustained response (adjusted OR: 2.95 per 1 g/dL, 95% CI: 1.57-5.55; p < 0.001). By Month 6, Hb ≥ 10 g/dL was achieved by 50.0% of roxadustat-treated patients versus 33.3% of ESA-treated patients. Hb variability metrics were numerically lower with roxadustat but were not significantly different between groups. CONCLUSIONS:In ESA-hyporesponsive hemodialysis patients, roxadustat was associated with higher adjusted odds of sustained Hb ≥ 10 g/dL achievement but did not clearly reduce month-to-month Hb variability over 6 months. These retrospective findings support sustained target achievement as a clinically relevant response metric and warrant prospective validation.
OBJECTIVE:To investigate the efficacy of a traffic light diary in volume management for patients undergoing maintenance hemodialysis. METHODS:A total of 80 patients undergoing maintenance hemodialysis were enrolled and randomly assigned using a random number table to either an intervention group (n = 40) or a control group (n = 40) for a 12-week intervention period. The control group received routine hemodialysis treatment and health education on volume management in the hemodialysis unit. The intervention group additionally implemented volume management based on a traffic light diary. Comparisons were made between the two groups regarding before and after the intervention scores on the knowledge, attitude, and practice scales for volume management. The volume management compliance rate, interdialytic weight gain, ultrafiltration rate, and blood pressure levels were statistically analyzed. Acute dialysis complications during the intervention period were recorded and statistically evaluated for both groups. RESULTS:Before the intervention, there were no statistically significant differences between the two groups in terms of fluid management knowledge, attitude, and practice scores; fluid management compliance rate; or blood pressure levels (all p > 0.05). After the intervention, the intervention group scored significantly higher than the control group in knowledge (median [IQR]: 9 [8-10] vs. 7 [6-8]), attitudes (9.2 [8.5-10.0] vs. 7.0 [6.1-8.2]), and practice (22.9 ± 1.62 vs. 18.7 ± 1.01) (all p < 0.05). The fluid management compliance rate was 95% in the intervention group, which was significantly higher than the 75% in the control group (p < 0.05). Interdialytic weight gain and ultrafiltration rate decreased significantly in the intervention group compared with the control group (p < 0.05). Blood pressure control was also superior in the intervention group compared to the control group (p < 0.05). The incidence of acute intradialytic complications, namely hypotension and muscle cramps, was significantly lower in the intervention group than in the control group (p < 0.05). CONCLUSION:The implementation of fluid management based on a traffic light diary, which combines self-monitoring feedback with professional health education, is of significant importance for improving patients' knowledge, attitude, and practice regarding fluid management, enhancing fluid management efficacy, stabilizing blood pressure levels, and reducing the incidence of acute intradialytic complications.
BACKGROUND:The double plasma molecular adsorption system is an artificial-liver treatment model combining the use of ion exchange resins and neutral microporous resins to remove toxins such as inflammatory cytokines without consuming large amounts of plasma and albumin. Given the relatively expensive consumables needed for Bilirubin adsorption, extending treatment duration and maximizing adsorption column efficiency help save medical expenses and resources. CASE PRESENTATION:We report on a 51-year-old male hyperbilirubinemia patient of Chinese Han ethnicity, which was treated with prolonged double plasma molecular adsorption system sessions. The patient underwent two treatment sessions, each lasting over 6 h with a plasma adsorption volume greater than 10 L. total bilirubin clearance was 44.6% in the first session and 34.6% in the second. Dynamic monitoring of serum total bilirubin showed that clearance was maximized when plasma adsorption volume equaled the patient's plasma volume. When plasma adsorption volume reached 2 × plasma volume, total bilirubin decreased by less than 20%, indicating near-saturation of the column's bilirubin adsorption capacity. After plasma adsorption volume doubled in the first session, total bilirubin clearance dropped to nearly 20%, suggesting that the column still had some adsorption capacity. While the efficiency of bilirubin removal per unit of plasma volume decreased, continuing the treatment still allowed for the elimination of additional bilirubin. CONCLUSION:Total plasma adsorption volume in a single double plasma molecular adsorption system treatment session can serve as a reference for determining the therapeutic dose in future treatments. Furthermore, extending the treatment duration with a bilirubin adsorption column enhances bilirubin clearance.
INTRODUCTION:Timely adjustment of intervention strategies based on multidimensional hemodialysis data is essential for improving patients' quality of life, enhancing clinical outcomes, and reducing complications. However, conventional management (relying heavily on clinician experience and intermittent monitoring) often fails to provide personalized, real-time, and proactive care. Efficient, data-driven methods are therefore urgently needed. In recent years, artificial intelligence (AI) has shown increasing potential in hemodialysis management, yet comprehensive reviews in this area remain limited. DISCUSSION:This narrative review synthesizes recent advances in AI applications for hemodialysis, examining their potential, technical approaches, and practical effectiveness in addressing current management challenges. We focus on five representative domains: hemodynamic management, volume management, dialysis adequacy assessment, vascular access management, and renal anemia prediction. Furthermore, we discuss emerging opportunities from wearable devices and multimodal data integration, while also highlighting major barriers to translation, particularly the gap between retrospective predictive performance and proven improvement in hard clinical outcomes. By offering theoretical insights and practical directions, this review aims to support the transition from experience-based care toward an AI-driven, data-informed paradigm, facilitating the development of intelligent, closed-loop decision-support systems that cover the entire dialysis journey.
INTRODUCTION:Despite extensive investigation, the optimal method of assessing arteriovenous fistula (AV fistula) function remains elusive. Ultrasound is an important tool in the assessment of AV fistula, with a wide range of protocols and flow criteria used across the literature. However, the operator dependency of ultrasound has the potential to impact the quality of the acquired measurements, particularly volume flow, and has been poorly reported. Therefore, incorporating other measurements such as resistive indices may increase the robustness of the ultrasound findings. METHODS:This retrospective cohort study reviewed ultrasound and clinical data from two vascular ultrasound practices in Australia. All patients presenting with an upper limb AV fistula between January 2017 and October 2021 were included, stratified by indication for referral. The relationship between volume flow and resistive index was analyzed and predictive values were determined for two cutoff levels of resistive index (≤ 0.65 and ≤ 0.75) for a volume flow of ≥ 500 mL/min. FINDINGS:Eight types of AV fistula were noted in the 1988 ultrasound examinations conducted by 9 sonographers. Analysis was based on the three major AV fistula types: radio-cephalic (1267), brachiocephalic (491) and brachio-basilic (193). There were significant differences in the median values for both resistive index and volume flow between AV fistula type and indication for study. At an resistive index of ≤ 0.65 or 0.75, the positive predictive value in the group referred for surveillance was 96.8% and 95.4% respectively for a volume flow ≥ 500 mL/min, while in the group referred for problematic AV fistula it was 92.5% and 83.8%. CONCLUSION:The addition of resistive index values can support confidence in the technically difficult volume flow measures, especially for sonographers with non-specialized vascular skills.
OBJECTIVE:Complementary treatment methods support medical treatment in symptom control. The aim of this study was to investigate the effect of virtual museum visits on dialysis symptoms and anxiety in hemodialysis patients. METHOD:This randomized controlled trial included 60 participants (intervention group = 30, control group = 30). In the intervention group, a passive immersive virtual reality based virtual museum intervention was applied during hemodialysis sessions. Participants viewed pre-recorded museum environments through virtual reality glasses without interaction. The intervention was administered once weekly for five consecutive weeks (30 min per session). The control group received routine hemodialysis care only. Data were collected using a Patient Information Form, the Dialysis Symptom Index and the Beck Anxiety Inventory Outcomes were assessed at baseline and after completion of the intervention period. RESULTS:The mean Dialysis Symptom Index and Beck Anxiety Inventory scores decreased more in the intervention group compared with the control group (p < 0.001). In addition, improvements in symptoms such as feeling uncomfortable, irritability, fatigue/decreased energy, bone/joint pain, muscle pain, and nausea were greater in the intervention group (p < 0.05). Within-group analyses showed significant reductions in both Dialysis Symptom Index and Beck Anxiety Inventory scores in the intervention group, while no significant changes were observed in the control group. CONCLUSION:Virtual museum visits using VR technology may be a supportive intervention for reducing dialysis-related symptoms and anxiety levels in hemodialysis patients. Further studies with larger samples and more robust designs are recommended to confirm these findings.
BACKGROUND:To investigate the association between serum uric acid levels and the risks of all-cause and cardiovascular mortality in patients undergoing maintenance hemodialysis. METHODS:Patients receiving maintenance hemodialysis registered in 2014 in the Beijing Blood Purification Quality Control and Improvement Center database were included. Patients were stratified into low (≤ 344 μmol/L), intermediate (344-464 μmol/L), and high (> 464 μmol/L) serum uric acid groups. Propensity score matching (1:1:1) was performed using age, sex, diabetes, and dialysis vintage. Survival was analyzed using Kaplan-Meier curves and the log-rank test. Cox proportional hazards models and restricted cubic spline analyses were applied to evaluate the associations between serum uric acid levels and all-cause and cardiovascular death. RESULTS:We enrolled 2070 patients in three matched groups (n = 690 per group). The median follow-up was 64.0 (interquartile range, 31.1-72.0) months. All-cause death occurred in 292/690 (42.3%), 122/690 (17.7%), and 210/690 (30.4%) patients in the low-, intermediate-, and high-serum uric acid groups, respectively. After adjusting for multiple factors, the intermediate serum uric acid group had better survival than the low- (hazard ratio, 1.82; 95% confidence interval [95% CI], 1.41-2.34; p < 0.001) and high-serum uric acid groups (hazard ratio, 2.13; 95% CI, 1.64-2.76; p < 0.001). The pattern of cardiovascular death was consistent with that of all-cause mortality, showing higher risks in both the low- and high-serum uric acid groups compared with the intermediate-serum uric acid group. Further restricted cubic spline analyses suggested a U-shaped association between serum uric acid levels and the risks of all-cause and cardiovascular mortality, with the lowest mortality risk observed at serum uric acid levels of approximately 388-420 μmol/L. CONCLUSION:Serum uric acid exhibited a U-shaped association with the risks of all-cause and cardiovascular death in patients undergoing maintenance hemodialysis. Both excessively low and high serum uric acid levels were associated with increased mortality risk.
BACKGROUND:Shared hemodialysis care, or "shared care," empowers in-center hemodialysis patients to undertake some dialysis-related tasks. Although its benefits are increasingly recognized, data on shared care is not routinely reported, and its impact on patient experience is less studied. Shared decision-making-a key component of patient experience-is consistently rated poorly by renal patients. Using data from the UK Kidney Patient Reported Experience Measure survey, we examined the variation in shared care offered across 67 UK kidney centers and assessed its association with shared decision-making scores. METHODS:Shared care offer and acceptance was assessed by a single survey question. A measure of shared decision-making was derived from patient responses to three questions (scored between 1 = low and 7 = high). Associations between shared care and shared decision-making scores were analyzed at an individual level using linear mixed models. RESULTS:Analyzes included 6861 patients. 53% of respondents were offered shared care (47% in 2022), with rates from 13% to 93% between centers. Shared care was more likely to be offered to those aged 31-55 years, ethnic minorities and in satellite units. Those offered shared care gave higher scores for each question on shared decision-making, with a mean increase of 0.61 (95% CI 0.51-0.70, p < 0.0001) across all questions. CONCLUSIONS:Shared care participation in the UK is increasing but there remains considerable variation between centers with inequitable access to the opportunities it brings according to patient age, ethnicity and dialysis unit location. This study is the first to demonstrate a positive association between shared care and shared decision-making, suggesting that offering shared care can support shared decision-making and improve patient experience of care.
INTRODUCTION:Management of anemia in patients undergoing maintenance hemodialysis is primarily based on predialysis hemoglobin measurements. However, hemoglobin concentrations vary substantially across the hemodialysis cycle because of interdialytic fluid accumulation, ultrafiltration-induced hemoconcentration, and ongoing plasma refilling. Consequently, hemoglobin values obtained at different time points are not physiologically equivalent and may reflect distinct circulatory states. METHODS:This narrative review summarizes the physiological determinants of hemoglobin variation during the hemodialysis cycle and examines the clinical implications of different hemoglobin sampling strategies in patients undergoing maintenance hemodialysis. FINDINGS:Sampling practices differ across regions: in Japan, hemoglobin is commonly assessed during the first dialysis session of the week, whereas midweek predialysis sampling is frequently used in North America and Europe and is explicitly recommended by the 2025 UK Kidney Association guideline. Pre- and postdialysis hemoglobin measurements reflect different physiological conditions and may lead to different interpretations of anemia severity and hemoglobin variability. DISCUSSION:Greater attention to the timing and standardization of hemoglobin measurement may improve interpretation of anemia severity and hemoglobin variability and enhance the international comparability of clinical data in patients undergoing maintenance hemodialysis. Consideration of physiologically relevant sampling strategies may contribute to a more accurate assessment of anemia in routine dialysis practice.
BACKGROUND:Iron overload in chronic kidney disease contributes to oxidative injury. The role of iron chelators, standard in transfusion-related overload, remains unclear in chronic kidney disease. AIM:To evaluate the efficacy and safety of iron chelators in adults with chronic kidney disease. METHODS:A systematic review and meta-analysis followed PRISMA 2020 guidelines. Databases were searched for randomized controlled trials and observational studies reporting on iron indices, hematological parameters, and adverse events. RESULTS:Eleven studies (206 patients) were included. Iron chelation significantly reduced serum ferritin (weighted mean difference [WMD]: -1.48 μg/L; 95% CI: -2.09, -0.87), transferrin (WMD: -10.6 mg/dL; 95% CI: -15.6, -5.61), and serum iron (WMD: -24.2 μg/dL; 95% CI: -42.5, -5.9). Hemoglobin increased (WMD: 1.07 g/dL; 95% CI: 0.20, 1.94). Glucose levels decreased, but lipid parameters were unaffected. Evidence was limited by high heterogeneity and potential bias. Gastrointestinal adverse events were common; serious events were rare. CONCLUSION:Iron chelation effectively reduces iron stores and may improve anemia in chronic kidney disease patients. However, the evidence is limited by small sample sizes and heterogeneity. High-quality randomized controlled trials are needed to establish clinical utility and safety before routine use.
INTRODUCTION:End stage kidney disease (ESKD) is associated with a high prevalence of depression and anxiety, arising from both biological factors and the psychosocial burden of chronic dialysis care. Approximately 25%-30% of dialysis patients experience clinically significant depressive symptoms when assessed by structured clinical interview, though reported prevalence varies widely by assessment method. These disorders negatively impact adherence, hospitalization rates, and mortality, with diagnostic challenges arising from overlapping uremic symptoms and reliance on self-report tools. Biological contributors such as uremia, anemia, chronic inflammation, and polypharmacy, together with social stressors including unemployment, isolation, and financial hardship, exacerbate psychiatric vulnerability. DISCUSSION:Randomized trials demonstrate that cognitive behavioral therapy (CBT) reduces depressive symptoms, improves quality of life, and enhances treatment adherence, and lessons from oncology and primary care support collaborative care models. However, dialysis centers often lack resources and are constrained by reimbursement policy. This narrative review synthesizes evidence across epidemiology, biopsychosocial mechanisms, pharmacotherapy considerations specific to renal impairment, and non-pharmacologic interventions, and proposes a roadmap for integrated mental health care in dialysis that clearly distinguishes evidence-based recommendations from expert opinion. Integrated, multidisciplinary approaches hold promise for enhancing patient well-being and reducing the burden of mental illness in dialysis care.
BACKGROUND:Tenapanor is a mechanistically distinct treatment for hyperphosphatemia in hemodialysis and can reduce phosphate-binder pill burden in selected patients. However, its real-world value is constrained by bowel effects, particularly diarrhea, which commonly emerges early after initiation and may lead to treatment aversion or discontinuation. SUMMARY:In this review, treatment persistence refers to the ability to continue tenapanor through the early bowel-symptom period without permanent discontinuation due to gastrointestinal symptoms or treatment aversion, while maintaining clinically meaningful phosphate control. Current evidence indicates that tenapanor-associated bowel effects are clinically bidirectional. They may improve stool consistency and reduce laxative dependence in constipation-prone patients, whereas the same bowel shift may cause loose stools, urgency, discomfort, dialysis-session anxiety, and discontinuation in others. Longer-term studies suggest that patients who remain on therapy may maintain phosphate control with fewer concomitant phosphate-binder tablets, although early discontinuation and completer effects require cautious interpretation. A persistence-oriented approach includes baseline bowel-habit assessment, region-specific and label-consistent initiation and dose adjustment, individualized timing around dialysis sessions, review of concomitant bowel-active medications, anticipatory patient education, and monitoring for fluid and electrolyte consequences. CONCLUSIONS:Tenapanor-associated bowel effects are a central implementation barrier rather than a secondary tolerability issue. Persistence may be improved by matching treatment to baseline bowel phenotype and using a tolerability-first, safety-conscious continuation framework. Prospective studies should define predictors of persistence and validate supportive strategies.
AIM:This study evaluates the association between care dependency and self-efficacy in patients undergoing hemodialysis, representing one of the first domestic contributions to this area of research in Turkey. METHODS:This descriptive and correlational study was conducted in two dialysis centers in Mersin province, Turkey, between September 2025 and December 2025. The study included 143 hemodialysis outpatients who met the inclusion criteria. Care dependency and self-efficacy were assessed using the General Self-Efficacy Scale and the Care Dependency Scale. Statistical analyses were performed using SPSS version 25.0. RESULTS:Participants demonstrated moderate levels of care dependency and self-efficacy, with a mean Care Dependency Scale score of 55.6 ± 23.6 and a mean General Self-Efficacy Scale score of 27.8 ± 9.33. Self-efficacy was significantly associated with care dependency (β = 0.67, p < 0.001). The inclusion of self-efficacy in the regression model explained an additional 20.7% of the variance in care dependency (ΔR2 = 0.21). CONCLUSION:The findings suggest that self-efficacy is a key determinant of care dependency among hemodialysis patients. Care dependency appears to be closely related to patients' perceived self-efficacy, beyond sociodemographic characteristics. Interventions aimed at enhancing self-efficacy may therefore be beneficial in reducing care dependency and improving patient outcomes in clinical practice.
BACKGROUND:Guidelines recommend fluoroscopic guidance for tunneled hemodialysis catheter placement, but fluoroscopy is costly, not universally available, and increases patient radiation exposure. Ultrasound-guided bedside placement by nephrologists, using anatomical landmarks, may provide a safe and cost-effective alternative. To evaluate the immediate safety and outcomes of nonfluoroscopic right internal jugular vein tunneled catheter placement performed by nephrologists in a tertiary care center. METHODS:Conducted a retrospective analysis of all tunneled dialysis catheters placed bedside at our center between January 2021 and December 2022. Ultrasound was used for venous cannulation, anatomical landmarks for surface marking, and postprocedure chest radiography for tip confirmation. The primary outcome was procedure-related complications within 24 h. Access failure, defined as the inability to use the catheter for dialysis within 24 h, was the secondary outcome. RESULTS:Among 235 patients (77.4% male; mean age 55.8 years), 7 (2.9%) developed immediate complications. Minor exit-site bleeding occurred in four patients (1.7%), all managed conservatively; two received fresh frozen plasma. Catheter malposition occurred in two cases (0.85%); one required repositioning and the other replacement with a femoral catheter. One patient (0.4%) had a cardiac arrest attributed to acute coronary syndrome unrelated to the procedure. Access failure occurred in one case (0.4%). All remaining catheters functioned successfully for immediate dialysis. CONCLUSION:Ultrasound-guided, nonfluoroscopic bedside placement of right internal jugular vein tunneled catheters by nephrologists is feasible, safe, and cost-effective. This technique reduces radiation exposure and costs, supporting its role in resource-limited settings. Prospective multicenter studies are warranted to assess long-term patency, infection rates, and dialysis adequacy.
OBJECTIVES:Patients with end-stage kidney disease face an extremely high risk of major adverse cardiovascular and cerebrovascular events. This study investigated the role of microRNA-26a in patients with end-stage kidney disease who have been receiving long-term hemodialysis. METHODS:Blood samples were collected from patients with chronic kidney disease stages I-III and from those with end-stage kidney disease. Basic clinical information was recorded for all participants. Serum expression of microRNA-26a was measured using real-time quantitative polymerase chain reaction. Pearson correlation analysis was used to examine the relationships between microRNA-26a levels and clinical indicators, including serum albumin, estimated glomerular filtration rate, high-sensitivity C-reactive protein, serum creatinine, and blood urea nitrogen. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the association of microRNA-26a with disease progression and the occurrence of major adverse cardiovascular and cerebrovascular events. RESULTS:Serum microRNA-26a levels were significantly lower in patients with end-stage kidney disease compared with those with earlier-stage chronic kidney disease. MicroRNA-26a expression showed a positive correlation with serum albumin and estimated glomerular filtration rate, and negative correlations with high-sensitivity C-reactive protein, serum creatinine, and blood urea nitrogen. ROC curve analysis demonstrated that serum microRNA-26a levels had good diagnostic value for identifying end-stage kidney disease (area under the curve = 0.842). During follow-up, the cumulative incidence of major adverse cardiovascular and cerebrovascular events was 14% at 12 months, 22% at 24 months, and 34% at 36 months. MicroRNA-26a expression was significantly lower in patients who experienced these events. Both univariate and multivariate logistic regression analyses identified higher serum microRNA-26a levels as an independent protective factor against major adverse cardiovascular and cerebrovascular events in patients with end-stage kidney disease. CONCLUSION:In patients with end-stage kidney disease receiving long-term hemodialysis, microRNA-26a levels are associated with disease severity and the risk of major adverse cardiovascular and cerebrovascular events. Lower miR-26a expression may serve as a potential biomarker for disease monitoring and risk stratification.
OBJECTIVE:To conduct a meta-analysis of clinical randomized controlled studies related to vitamin D supplements for the treatment of anemia in patients with chronic kidney disease (CKD), to evaluate the clinical efficacy of vitamin D supplements for CKD patients complicated with anemia. METHODS:A literature review of the published literature in both English and Chinese was searched from the Cochrane Library, PubMed, Web of Science, CNKI and Wanfang Data that were published from the inception date to January 2018. Randomized controlled trials (RCTs) eligible for the inclusion and exclusion criteria were selected. The quality of eligible studies was assessed by the Cochrane Risk of Bias tool. Meta-analysis was performed by using Revman 5.3 software. RESULTS:A total of 12 RCTs comprising 779 patients were included in this meta-analysis, including 383 patients in the experimental group (with vitamin D supplementation) and 396 patients in the control group (without vitamin D supplementation). Meta-analysis showed that vitamin D supplements could significantly increase the hemoglobin (p < 0.01, SMD = 1.24, 95% CI: 1.02-1.45) and lower the dosage of erythropoietin required (p < 0.01, SMD = -0.76, 95% CI: -1.09 to -0.43). CONCLUSION:Use of vitamin D supplements can significantly elevate the hemoglobin concentration and reduce the dosage of erythropoietin. However, these findings remain to be validated by large-scale, multi-center, prospective RCTs.
