Background: Chronic kidney disease (CKD) is frequently complicated by metabolic acidosis, which contributes to declining renal function, skeletal muscle protein degradation, and poor nutritional status. Objectives: This study evaluated whether correction of metabolic acidosis with oral sodium bicarbonate could influence changes in estimated glomerular filtration rate, serum albumin concentration, and muscle mass in predialysis patients with CKD. Methods: A prospective, randomized, open-label, parallel-group study was conducted at a tertiary care center. Ninety predialysis patients with CKD and serum bicarbonate levels of 10 - 20 mEq/L were randomized equally into two groups. Group 1 received oral sodium bicarbonate plus standard CKD care according to the Kidney Disease: Improving Global Outcomes (KDIGO) 2024 recommendations, whereas Group 2 received standard treatment alone. The sodium bicarbonate dose was titrated to maintain serum bicarbonate levels between 19 and 25 mEq/L. Estimated glomerular filtration rate, serum bicarbonate, serum albumin, and mid-arm muscle circumference were assessed at baseline and after 9 months. The primary treatment effect was assessed as the between-group difference in the change from baseline to 9 months. Results: At 9 months, patients receiving sodium bicarbonate showed a significant increase in serum bicarbonate and statistically significant preservation of renal function compared with the controls. The mean between-group difference in eGFR change was 2.98 mL/min/1.73 m2 (95% CI, 2.66 to 3.30; P < 0.001). Between-group differences in changes in serum bicarbonate, serum albumin, and mid-arm muscle circumference were also statistically significant. Conclusions: Correction of metabolic acidosis with sodium bicarbonate was associated with short-term preservation of renal function and improvements in serum albumin levels and muscle mass among predialysis patients with CKD.
Background: Tunneled cuffed catheters (TCCs) provide essential vascular access for patients with end-stage kidney disease undergoing maintenance hemodialysis; however, they remain highly susceptible to thrombotic occlusion and subsequent failure. Objectives: This investigation evaluated the clinical efficacy and safety of low-dose oral apixaban for the prophylaxis of TCC-associated thrombosis and flow dysfunction. Methods: A double-blind, randomized controlled trial was conducted involving 100 adult patients requiring newly inserted TCCs at Imam Khomeini Hospital in Urmia, Iran, between 2023 and 2024. Participants were allocated in a 1:1 ratio to receive either 2.5 mg of oral apixaban daily or standard care for 6 months. The primary endpoint was catheter dysfunction, defined as a blood flow rate below 300 mL/min. Secondary outcomes included bleeding events and catheter replacement interventions. Results: Baseline clinical characteristics were well balanced between the two arms. Apixaban administration was associated with a statistically significant reduction in the rate of TCC thrombosis (8% vs 28%; P = 0.0196) and a reduced requirement for catheter replacement (6% vs 20%; P = 0.0353). Bleeding events did not differ significantly between the groups (2% vs 6%; P = 0.6098), and no major bleeding episodes were recorded. Conclusions: Prophylactic low-dose oral apixaban significantly reduced TCC-related thrombotic dysfunction and decreased catheter exchange rates in patients receiving chronic hemodialysis, demonstrating a favorable short-term safety profile without excessive bleeding. However, given the limited sample size, these findings should be interpreted with caution. Large-scale, multicenter randomized trials are needed to confirm these preliminary results and establish long-term clinical safety before routine adoption.
Background: Acute kidney injury (AKI) is a serious complication in critically ill children admitted to pediatric intensive care units (PICUs) and is associated with increased morbidity and mortality. However, early identification of patients at risk for AKI remains a clinical challenge. Objectives: This study aimed to investigate the association between the age-adjusted shock index (SI) and the development of AKI in critically ill children admitted to the PICU. Methods: This prospective cohort study was conducted in the PICU at Amir Kabir Hospital, Arak, Iran, from February to July 2023. A total of 80 children aged 1 month to 18 years with a PICU stay ≥ 24 hours were enrolled. The shock index was calculated as heart rate divided by systolic blood pressure and categorized using age-adjusted thresholds. Acute kidney injury was diagnosed according to KDIGO criteria, based on changes in serum creatinine and urine output within 48 hours of admission. Independent t tests, Mann-Whitney U tests, chi-square tests, and logistic regression were used to analyze the data using STATA version 12. Results: The mean age of the participants was 7.21 ± 4.76 years, and 46.3% were male. The overall prevalence of AKI was 90% (n = 72; 95% CI, 81.0 - 95.0% using the Wilson method; 95% CI, 81.4 - 94.8% using the exact binomial method). Patients with elevated SI had significantly lower urine output (0.33 ± 0.11 vs 0.63 ± 0.04 mL/kg/h; P = 0.038) and a lower glomerular filtration rate (GFR) at 24 hours (62.86 ± 20.88 vs 88.29 ± 19.9 mL/min/1.73m2; P = 0.002) than those with normal SI. Elevated SI was present in 90.3% of patients with AKI versus 50% of patients without AKI. Logistic regression showed that patients with elevated SI had 9.28-fold higher odds of developing AKI (95% CI, 1.34 - 59.98; P = 0.001) and 8-fold higher odds of GFR reduction (95% CI, 1.18 - 50.47; P = 0.003). Conclusions: An elevated age-adjusted shock index was significantly associated with AKI development and reduced kidney function in critically ill children admitted to the PICU. Routine monitoring of this simple, noninvasive parameter may facilitate the early identification of high-risk patients and guide preventive interventions.
Background: Central venous stenosis or occlusion is an important vascular access-related complication in patients receiving maintenance hemodialysis. It can cause venous hypertension, upper limb symptoms, and arteriovenous access dysfunction. Objectives: This study aimed to describe the clinical and imaging characteristics and to evaluate immediate anatomical success, 1-month clinical outcomes, and early complications after endovascular treatment for central venous stenosis or occlusion. Methods: This retrospective observational analysis was conducted as part of a larger longitudinal project at Cho Ray Hospital, Vietnam. Patients who underwent endovascular intervention between January 2018 and December 2025 were reviewed. Anatomical success was assessed on completion angiography, and clinical outcomes were assessed within 1 month after the intervention. Data were analyzed descriptively, with exploratory univariable analyses of anatomical failure. Results: Of 106 patients screened, 101 were included in the final analysis. The mean age was 54.97 ± 14.59 years, and 56 patients (55.4%) were female. The most common symptoms were arm edema in 78 patients (77.2%) and arm pain in 68 patients (67.3%). On angiography, the brachiocephalic and subclavian veins were involved in 60 patients (59.4%) and 50 patients (49.5%), respectively. Balloon angioplasty alone was performed in 81 of 94 patients (86.2%). Anatomical success was achieved in 91 patients (90.1%). At 1 month, arm edema decreased in 68 of 78 patients (87.2%), arm pain decreased in 54 of 68 patients (79.4%), and collateral veins decreased in 16 of 26 patients (61.5%). Hemodialysis via the treated access was achieved in 74 patients (73.3%). No early complications were recorded in 92 patients (91.1%). In univariable analysis, longer lesion length was associated with anatomic failure. Conclusions: Endovascular treatment achieved immediate anatomical success in most patients and was followed by clinical improvement within 1 month in this selected cohort. Further follow-up is needed to evaluate restenosis, reintervention, and long-term patency.
Background: Previous studies have reported discordance in Gleason scores (GSs) between needle biopsy results and radical prostatectomy (RP) specimens. Objectives: To identify factors associated with International Society of Urological Pathology (ISUP) grade upgrading in patients who underwent radical prostatectomy (RP). Methods: In this retrospective cohort study, 110 patients with prostate cancer who underwent RP between 2019 and 2024 were evaluated. Demographic data, laboratory results, pathological characteristics, and MRI findings (Prostate Imaging-Reporting and Data System [PI-RADS], intraprostatic cancerous lesions, extracapsular extension, and seminal vesicle invasion) were extracted from patient records. Patients were classified into two groups according to the presence or absence of ISUP grade upgrading. Upgrading was defined as any increase in ISUP grade in the RP specimen compared with that in the needle biopsy. Univariate and multivariate logistic regression analyses were performed to evaluate predictive factors for upgrading. Results: Among the 110 patients (mean age, 62.97 years), 47 (42.7%) had ISUP upgrading on RP compared with biopsy. In univariable analysis, age, prostate-specific antigen (PSA), PSA density (PSAD), the time interval between biopsy and RP, and MRI parameters were not significantly associated with ISUP upgrading (P > 0.05). In multivariate logistic regression analysis, both a free/total PSA (f/tPSA) ratio ≤ 10% (OR = 0.27, 95% CI, 0.11 - 0.65, P = 0.004) and an ISUP grade of 1 on biopsy (OR = 0.25, 95% CI, 0.11 - 0.57, P = 0.001) were independently associated with the risk of upgrading. Conclusions: An f/tPSA ratio of ≤ 10% and an ISUP grade of 1 on biopsy were associated with pathological upgrading. Prospective studies are required to validate these findings.
