ABSTRACT Background Residual kidney function (RKF) is strongly associated with improved outcomes in patients receiving hemodialysis, and incremental hemodialysis—where dialysis dose and frequency are tailored to RKF—has gained increasing attention. However, the extent to which hemodialysis clinical practice guidelines (CPGs) provide actionable guidance for RKF‐based prescribing remains unclear. Methods We conducted a scoping review using Joanna Briggs Institute methodology and PRISMA ScR reporting. National and international adult hemodialysis CPGs were identified through database and organizational website searches (inception–December 2025). Guidelines were classified by depth of RKF integration into three tiers: Tier 3 (no RKF guidance), Tier 2 (conceptual acknowledgment without operational protocols), and Tier 1 (explicit, operational RKF‐based prescribing frameworks). Results Twelve guideline documents were included. Five were classified as Tier 3, providing no RKF guidance for chronic hemodialysis prescribing. Three were Tier 2 guidelines which acknowledged RKF and provided the concept of incremental hemodialysis but did not have standardized thresholds or implementation pathways. Four guidelines met Tier 1 criteria; among these, one provided a fully specified, mathematically integrated framework linking RKF measurement to adequacy targets, monitoring frequency, and eligibility for reduced‐frequency dialysis. Other Tier 1 guidelines endorsed incremental hemodialysis or RKF quantification but offered limited detail on measurement protocols, thresholds, or dose adjustment, resulting in substantial heterogeneity across approaches. Conclusions Despite growing interest in RKF‐informed hemodialysis, most CPGs offer limited operational guidance. Fully actionable frameworks are rare, underscoring the need for future guidelines to standardize RKF measurement, integration into adequacy targets, and monitoring strategies to support consistent clinical implementation.
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.
