INTRODUCTION:Patients with end-stage renal disease (ESRD) undergoing chronic hemodialysis (HD) frequently report the sensation of prostration, tiredness, weakness, exhaustion, weariness, or fatigue after the hemodialysis treatment. This condition is defined as post-dialysis fatigue and significantly impairs patients' ability to perform routine daily activities. The present study aims to investigate whether territorial or environmental factors such as differences in geographic areas are associated with the prevalence and characteristics of post-dialysis fatigue and time to recovery after dialysis among chronic HD patients. METHODS:A total of 465 patients from six Italian HD units, located in both northern and central Italy, were enrolled between January and December 2024. Exclusion criteria included a dialysis duration of less than 1 year and a diagnosis of dementia, acute infectious disease, or active cancer. For each participant, demographic, clinical, and laboratory data were collected. FINDINGS:The results showed that 61.5% of the patients reported suffering from post-dialysis fatigue. The prevalence and characteristics of post-dialysis fatigue, as well as the length of time to recovery after dialysis, varied significantly among the six HD units. Multivariate analyses revealed that the hemodialysis unit itself was the main variable significantly and independently associated with both post-dialysis fatigue and time to recovery after dialysis. CONCLUSIONS:Our findings suggest that environmental factors such as differences in geographic areas are associated with the prevalence and characteristics of post-dialysis fatigue and time to recovery after dialysis among chronic HD patients.

Hypokalemic periodic paralysis (HypoPP) is a rare disease that consists of attacks of flaccid paralysis that often occur at night or early in the morning. Some patients with HypoPP may develop permanent muscle weakness and permanent myopathy. Four phenotypes of disease have been described: 1) no symptoms; 2) periodic paralysis and absence of permanent weakness; 3) periodic paralysis and permanent paralysis; 4) permanent weakness and absence of periodic paralysis. Vacuolar alterations are present in the muscles of all patients affected by HypoPP. In general, vacuoles are heterogeneous in size and content. Vacuoles are present in both fiber types and are not exclusive to any muscle fiber type, age, or phenotype. Generally, vacuoles contain glycogen but may also contain autophagosomes, fibrillar proteins, central nuclei, and myofiber invaginations. Magnetic resonance shows that fat accumulation of various extension is present in the muscle of patients with HypoPP. Water accumulation may also be present whereas atrophy is limited. Fat accumulation tends to increase with time together with a decrease of muscle strength. Permanent weakness and myopathy impairs significantly the quality of life. No treatment is currently available. The aim of this review is to define the characteristics and outcome of permanent weakness and myopathy in patients with HypoPP.

PURPOSE:To investigate the association between postdialysis fatigue (PDF) and physical and emotional symptoms in patients receiving maintenance hemodialysis. METHODS:All prevalent patients undergoing maintenance hemodialysis at our Hemodialysis Service between June 2022 and September 2024 were considered eligible. The Dialysis Symptom Index questionnaire was administered during dialysis sessions. PDF was assessed using the approach recommended by Sklar et al. Patients were classified as having PDF if they spontaneously reported feeling fatigued after dialysis in response to the question: "Do you feel fatigued after dialysis?" RESULTS:A total of 269 patients were studied: 220 with PDF and 49 without. Patients with PDF were significantly older and had a higher Charlson comorbidity index. The median [95% CI] number of symptoms was 13 [12-14] in patients with PDF versus 7 [6-8.8] in those without (p < 0.0001). In multivariable logistic regression, PDF was independently associated with the Charlson comorbidity index (odds ratio [95% CI]: 1.41 [1.08-1.85], p = 0.010) and the total number of symptoms (1.27 [1.16-1.40], p < 0.0001). The prevalence of 15 out of 29 symptoms was significantly higher in patients with PDF. After adjustment, PDF remained independently associated with swelling in the legs (OR [95% CI]: 12.8 [1.43-113.9], p = 0.022), restless legs (3.41 [0.98-11.8], p = 0.052), difficulty concentrating (8.24 [2.12-32.1], p = 0.002), difficulty becoming sexually aroused (6.00 [2.58-13.9], p < 0.0001), and feeling sad (6.06 [2.31-15.9], p = 0.0003). The severity of itching, bone or joint pain, worrying, feeling nervous, feeling anxious, and decreased interest in sex was also significantly greater in patients with PDF. CONCLUSION:PDF is independently associated with a higher burden of comorbidities and a greater number of physical and emotional symptoms. It is also specifically linked to the prevalence of leg swelling, restless legs, difficulty concentrating, difficulty becoming sexually aroused, and sadness.

Background: Interdialytic weight gain (IDWG), defined as the accumulation of salt and water intake between dialysis sessions, is a critical parameter of fluid management and a marker of adherence to dietary and fluid restrictions in hemodialysis patients. Excessive IDWG has been strongly associated with increased cardiovascular risk, including left ventricular hypertrophy, cardiac dysfunction, and cerebrovascular complications. Additionally, it necessitates more aggressive ultrafiltration, potentially compromising hemodynamic stability, impairing quality of life, and escalating healthcare costs. Despite international guidelines recommending an IDWG target of <4–4.5% of body weight, many patients struggle to achieve this due to barriers in adhering to dietary and fluid restrictions. This review explores the current state-of-the-art strategies to mitigate IDWG and evaluates emerging diagnostic and therapeutic perspectives to improve fluid management in dialysis patients. Methods: A literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science to identify studies on IDWG in hemodialysis. Keywords and MeSH terms were used to retrieve peer-reviewed articles, observational studies, RCTs, meta-analyses, and systematic reviews. Non-English articles, case reports, and conference abstracts were excluded. Study selection followed PRISMA guidelines, with independent screening of titles, abstracts, and full texts. Data extraction focused on IDWG definitions, risk factors, clinical outcomes, and management strategies. Due to study heterogeneity, a narrative synthesis was performed. Relevant data were synthesized thematically to evaluate both established strategies and emerging perspectives. Results: The current literature identifies three principal strategies for IDWG control: cognitive–behavioral interventions, dietary sodium restriction, and dialysis prescription adjustments. While educational programs and behavioral counseling improve adherence, their long-term effectiveness remains constrained by patient compliance and logistical challenges. Similarly, low-sodium diets, despite reducing thirst, face barriers to adherence and potential nutritional concerns. Adjustments in dialysate sodium concentration have yielded conflicting results, with concerns regarding hemodynamic instability and intradialytic hypotension. Given these limitations, alternative approaches are emerging. Thirst modulation strategies, including chewing gum to stimulate salivation and acupuncture for autonomic regulation, offer potential benefits in reducing excessive fluid intake. Additionally, technological innovations, such as mobile applications and telemonitoring, enhance self-management by providing real-time feedback on fluid intake. Biofeedback-driven dialysis systems enable dynamic ultrafiltration adjustments, improving fluid removal efficiency while minimizing hemodynamic instability. Artificial intelligence (AI) is advancing predictive analytics by integrating wearable bioimpedance sensors and dialysis data to anticipate fluid overload and refine individualized dialysis prescriptions, driving precision-based volume management. Finally, optimizing dialysis frequency and duration has shown promise in achieving better fluid balance and cardiovascular stability, suggesting that a personalized, multimodal approach is essential for effective IDWG management. Conclusions: Despite decades of research, IDWG remains a persistent challenge in hemodialysis, requiring a multifaceted, patient-centered approach. While traditional interventions provide partial solutions, integrating thirst modulation strategies, real-time monitoring, biofeedback dialysis adjustments, and AI-driven predictive tools represent the next frontier in fluid management. Future research should focus on long-term feasibility, patient adherence, and clinical efficacy, ensuring these innovations translate into tangible improvements in quality of life and cardiovascular health for dialysis patients.

BACKGROUND:Depression is common in patients with chronic kidney disease on maintenance hemodialysis. However, depression prevalence and associated variables have been less studied in maintenance hemodialysis patients older than 65 years old. OBJECTIVES:This study aimed to define the prevalence of depression and the associated variables in older patients on maintenance hemodialysis. DESIGN:This is a cross-sectional study. PARTICIPANTS:Participants included 197 older patients on maintenance hemodialysis (age range 65-80) recruited between September 2023 to September 2024 in Italy. MEASUREMENTS:Depression levels were measured with the Beck Depression Inventory II and perceived stress levels with the Perceived Stress Scale. We also collected clinical and laboratory variables. RESULTS:Of 197 patients, 130 patients (66%) had Beck Depression Inventory < 14 and 67 (34%) had Beck Depression Inventory ≥ 14. The two groups differed for age, sex, dialytic age, activity of daily living and instrumental activity of daily living scores, Body Mass Index, post-dialysis fatigue, dialysis recovery time, Perceived Stress Scale score, and serum creatinine. At the logistic regression analysis, the Beck Depression Inventory score was independently associated with female sex, post-dialysis fatigue, low IADL, and Perceived Stress Scale score. Post-dialysis fatigue intensity, duration, and frequency and the post-dialysis fatigue sum were significantly higher in patients with Beck Depression Inventory ≥ 14 than in those with Beck Depression Inventory < 14. The correlation between Beck Depression Inventory and Perceived Stress Scale was statistically significant. Then, we stratified patients according to the score of the Cohen's Perceived Stress Scale into three groups: low stress (0-13), moderate stress (14-26), and severe stress (27-40). Patients with Beck Depression Inventory≥ 14 had a higher frequency of severe perceived stress. CONCLUSIONS:Beck Depression Inventory score was independently associated with female sex, instrumental activity of daily living and Perceived Stress Scale score in older patients on maintenance hemodialysis.

Background/Objective: In recent years, three systematic reviews examining the relationship between frailty and mortality in chronic hemodialysis patients have been published; these reviews employed different inclusion criteria and methodologies, leading to conflicting results. The present study aimed to determine whether frailty is associated with an increased risk of all-cause mortality and hospitalization in patients on maintenance hemodialysis. Methods: The research was conducted in April 2024 using the following databases: MEDLINE via PubMed (1985 to present) and Web of Science Core Collection via Clarivate (1985 to present), with a combination of keywords to capture hemodialysis, frailty, and mortality. Results: We included 23 studies in the analysis, with a total of 10,333 patients (5592 frail and 4741 non-frail). The number of patients in each individual study ranged from 93 to 1652. Adjusted mortality data that accounted for patient characteristics and treatment variables was available from six studies (1034 patients) with a follow-up period of 12 months and revealed an increased all-cause mortality risk in frail patients in the random effects model (pooled OR, 3.28; 95% CI, 1.72–6.29). Moderate heterogeneity was observed in this analysis (Chi2 = 14.06, df = 5, (p = 0.02); I2 = 64%). Adjusted mortality data that accounted for patient characteristics and treatment variables was available from 21 studies (8757 patients) with any follow-up period and revealed an increased all-cause mortality risk in frail patients in the random effects model (pooled adjusted OR 2.47; 95% CI, 1.85–3.29). Moderate heterogeneity was observed in this analysis (Chi2 = 55.1, df = 20, (p < 0.0001); I2 = 64%). All-cause hospitalization data was available from 15 studies (6349 patients) with any follow-up period and revealed an increased all-cause hospitalization risk in frail patients in the random effects model (pooled adjusted OR 2.19; 95% CI, 1.72–2.78). Moderate heterogeneity was observed in this analysis (Chi2 = 40.9, df = 13; p < 0.0001; I2 = 68%). No obvious asymmetry, indicating no clear evidence of publication bias, was observed. Conclusions: Frailty is a significant risk factor for all-cause mortality and all-cause hospitalization in patients on maintenance hemodialysis and presents clinicians with important challenges in routine clinical practice.

ABSTRACT Introduction This study explored the relationship between post dialysis fatigue (PDF) and dialysis recovery time (DRT) with perceived stress and depression. Methods A cross‐sectional study was conducted on 223 patients on hemodialysis (HD). We collected demographic, laboratory and clinical variables [including depression and perceived stress levels measured with the Perceived Stress Scale (PSS) and Beck Depression Inventory (BDI‐II)] to explore their association with PDF and DRT. Findings Of the total, 120 patients suffered PDF and 103 did not. Groups differed in Charlson comorbidity index, dialysate sodium concentration, dialysate temperature, and BDI score, but had similar perceived stress levels. Logistic regression identified BDI and Charlson scores as independently associated with PDF. Of 130 patients, DRT was ≤ 120 min, and in 73, it was > 120 min, with higher BDI scores in the latter. Stratifying by perceived stress levels showed no significant differences in PDF or DRT. However, PDF and DRT were higher in patients with BDI > 17, and perceived stress levels strongly correlated with BDI. Conclusion While PDF and DRT are not significantly linked to perceived stress, they are strongly associated with depression levels in HD patients.

Background/Objectives: To measure the peri-dialytic serum lactate, sodium, potassium, calcium, and pH and base excess in chronic hemodialysis patients with and without post-dialysis fatigue (PDF). Methods: Patients were asked “Do you feel fatigued after dialysis?” Each patient was invited to rate the intensity, duration, and frequency of PDF from one to five. The recovery time after the hemodialysis session (TIRD) was calculated, and inviting patients were to answer the following single open-ended question: “How long does it take you to recover from a dialysis session?” Pre- and post-dialysis arterial blood was sampled, and pH, bicarbonates, base excess, sodium, calcium, potassium, and lactate were measured. Results: One hundred fifty-eight patients were included in the study. One hundred seventeen patients declared to suffer from PDF and forty-one did not. Median [range] PDF frequency, intensity, duration, and TIRD were 5 (1–5), 4 (1–5), 3 (1–5), and 12 h (1–48), respectively. Seventy patients had a TIRD ≤ 12 h and forty-seven had a TIRD > 12 h. Median post-dialysis and post-dialysis/pre-dialysis difference serum lactate levels (mmol/L) did not differ between patients with and without PDF (p = 0.111 and p = 0.395, respectively). In addition, the distribution of patients according to post-dialysis serum lactate levels was similar in the presence or absence of PDF. The median post-dialysis and post-dialysis/pre-dialysis difference serum lactate concentrations did not differ significantly according to the score of the PDF intensity and PDF duration (p = 0.928 and 0.935, p = 0.610 and 0.548, respectively). Finally, we stratified patients into two groups according to the length of TIRD: ≤12 h and >12 h. The median post-dialysis serum lactate concentrations did not differ significantly between the two groups (p = 0.862) as well as the median post-dialysis/pre-dialysis difference (p = 0.583). Also, the distribution of patients according to post-dialysis serum lactate levels was similar in the two groups. Conclusions: PDF and TIRD are not associated with peri-dialytic changes in serum lactate in patients on chronic hemodialysis.

Background/Objectives: Over the course of end-stage renal disease, patients undergoing hemodialysis (HD) often face significant psychological distress. Nonetheless, little is known about perceived stress levels and related factors in HD patients. This is a cross-sectional study that explores the prevalence of perceived stress levels and the associated variables in HD patients. Methods: Participants included 223 HD patients recruited in June 2024 in Italy. Perceived stress and depression levels were measured with the Perceived Stress Scale (PSS) and Beck Depression Inventory (BDI-II). We also collected clinical and laboratory variables to evaluate their association with PSS. Results: PSS score was moderate in 70.8% and high in 11.2% of the patients. The BDI score was significantly higher in patients with moderate or high perceived stress than in those with low perceived stress. The correlation between PSS and BDI scores was statistically highly significant, and in multivariate regression analysis, PSS score was independently associated with BDI, but not with age, sex, and serum creatinine. Patients with moderate or high perceived stress more frequently had a BDI ≥ 17. In women, with respect to men, the frequency of high and moderate perceived stress was higher. PSS does not correlate with some clinical characteristics such as functional disability (ADL and IADL scores), and the number of comorbidities (Charlson comorbidity Index). Also, we found that there was no correlation between PSS and post-dialysis fatigue prevalence/characteristics, nor between PSS and time of recovery after dialysis. Conclusions: These findings emphasize the critical need for targeted interventions addressing stress management in HD patients, especially with gender-specific approaches.

The present systematic review and meta-analysis aims to compare the effect of bicarbonate hemodialysis and HDF on quality of life (QoL), fatigue, and time to recovery in end-stage renal disease (ESRD) patients. Searches were run on January 2024 and updated on 3 March 2024 in the following databases: Ovid MEDLINE (1985 to present); Ovid EMBASE (1985 to present); Cochrane Library (Wiley); PubMed (1985 to present). Ten articles were fully assessed for eligibility and included in the investigation. Compared to HD, online HDF had a pooled MD of the mental component score (MCS) of the SF-36 of 0.98 (95

Objective: The use of selective serotonin reuptake inhibitors (SSRIs) is common among hemodialysis patients who receive treatment for depression. However, studies on the efficacy of SSRIs in patients on chronic hemodialysis are few and have led to conflicting results. The present systematic review aims to evaluate, in randomized, controlled studies (RCSs), the efficacy of SSRI administration in reducing symptoms of depression in patients on chronic hemodialysis when compared with placebo or psychological interventions. Method: Research was run on December 2023 in the following databases: Ovid MEDLINE (1985 to present); Ovid EMBASE (1985 to present); Cochrane Library (Wiley); and PubMed (1985 to present). The primary outcome was the frequency and severity of the symptoms of depression assessed through the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HAMD). The secondary outcome was the prevalence of adverse events. Results: Seven studies totaling 433 patients were included. The number of patients in each individual study ranged from 13 to 120. The length of studies ranged from 8 weeks to 6 months. Heterogeneous data precluded informative meta-analysis. Three studies compared sertraline with a placebo. Of these, two demonstrated that sertraline was better than the placebo in reducing the symptoms of depression while one showed no statistically significant differences between sertraline and the placebo. One study, comparing fluoxetine with a placebo showed that the symptoms of depression did not differ significantly at 8 weeks. In another study, escitalopram administration led to a significantly greater reduction in the Hamilton Depression Rating Scale score compared to a placebo, as well as in the Hamilton Anxiety Rating Scale score. In one study, citalopram and psychological interventions were both effective in reducing the symptoms of depression and anxiety and, in another study, sertraline was modestly more effective than CBT at 12 weeks in reducing the symptoms of depression. Conclusions: SSRIs may be effective in reducing the symptoms of depression in patients on chronic hemodialysis. SSRI administration, at the dosage used in the studies included in the present systematic review, seems safe in most hemodialysis patients. However, the paucity of studies and the limited number of patients included in the trials may suggest that further randomized, controlled studies are needed to determine if SSRIs may be used routinely in daily clinical practice in such a population.

Objectives: The aim of this study is to compare data from two cohorts separated by a 17-year interval. We assessed the prevalence and severity of symptoms with the “dialysis symptom index” in these two groups, recruited in 2007 and 2024, to determine how advancements in dialysis therapy have influenced the symptom burden’s prevalence and severity. Methods: End-stage renal diseases patients receiving maintenance hemodialysis three times a week in the hemodialysis unit of the university hospital were recruited between February and March 2007. In May 2024, in the same unit, another population sample was recruited and studied, as in 2007. The Dialysis Symptom Index (DSI) was administered to each patient, during the dialysis treatment. The DSI is made up of 30 questions, each of which addresses a specific physical or emotional symptom. The total symptom burden score, representing the total number of symptoms reported as being present, and the total symptom severity score, which represents the sum of individual severity scores, were generated for each patient. Results: We studied 71 patients in 2007 and 61 patients in 2024. The demographic, clinical and laboratory characteristics of the two study populations did not differ significantly. The total symptom burden score did not differ significantly between 2007 and 2024. The prevalence of most symptoms was similar in the two groups. The prevalence of constipation, decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. The total symptom severity was similar in the two periods. The severity of most symptoms was similar in the two groups. The severity of decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. Conclusions: The present study shows that, 17 years apart, the prevalence and severity of the symptom burden in patients on maintenance hemodialysis did not change significantly. These results suggest that studies investigating the causes and the pathogenesis of symptoms of patients on maintenance hemodialysis are urgently needed in the next future, as well as studies on therapeutic strategies.

Purpose The present systematic review and meta-analysis aimed at evaluating the effect of low dialysate sodium concentration on interdialytic weight gain (IDWG) in chronic hemodialysis patients. Methods Studies were eligible for inclusion if they were English language papers published in a peer-reviewed journal and met the following inclusion criteria: (1) studies in adult patients (over 18 years of age), (2) included patients on chronic hemodialysis since at least 6 months; (3) compared standard (138–140 mmol/l) or high (> 140 mmol/l) dialysate sodium concentration with low (< 138 mmol/l) dialysate sodium concentration; (4) Included one outcome of interest: interdialytic weight gain. Medline, PubMed, Web of Science, and the Cochrane Library were searched for the quality of reporting for each study was performed using the Quality Assessment Tool of Controlled Intervention Studies of the National Institutes of Health. The quality of reporting of each cross-over study was performed using the Revised Cochrane Risk of Bias (RoB) tool for cross-over trials as proposed by Ding et al. Results Nineteen studies (710 patients) were included in the analysis: 15 were cross-over and 4 parallel randomized controlled studies. In cross-over studies, pooled analysis revealed that dialysate sodium concentration reduced IDWG with a pooled MD of − 0.40 kg (95% CI − 0.50 to − 0.30; p < 0.001). The systematic review of four parallel, randomized, studies revealed that the use of a low dialysate sodium concentration was associated with a significant reduction of the IDWG in two studies, sustained and almost significant ( p = 0.05) reduction in one study, and not significant reduction in one study. Conclusion Low dialysate sodium concentration reduces the IDWG in prevalent patients on chronic hemodialysis.

Chronic kidney disease (CKD) patients have an increased risk for cognitive impairment compared to the general population. The risk is much higher in CKD patients who progress to end-stage kidney disease (ESKD) and require hemodialysis or peritoneal dialysis. Multiple factors may contribute to cognitive impairment in CKD patients and in patients on chronic dialysis. However, the observation that, after kidney transplantation, there is an improvement in several cognitive performance markers and that some structural and functional brain abnormalities may improve suggests that cognitive deficits in patients on dialysis may be at least partially reversible. Recent evidence supports the hypothesis that uremic toxins may disrupt the blood brain barrier and damage the brain cells. Such brain toxicity should prompt efforts to lower the burden of uremic toxins through dialytic and non-dialytic strategies.

Objectives: To define if the use of proton pump inhibitors (PPI) is associated with PDF prevalence and characteristics and with time of recovery after dialysis in patients on maintenance hemodialysis. Methods: Patients were defined as experiencing PDF if they spontaneously offered this complaint when asked the open-ended question: “Do you feel fatigued after dialysis?”. Time of recovery after dialysis (TIRD) was also assessed for each patient. Each patient was invited to rate the intensity, duration and frequency of PDF from 1 to 5. We defined if patients used PPI (no PPI use or PPI use), the type of used PPI, the dose of used PPI, and the duration of the use of PPI (<1 year or ≥1 year). Results: A total of 346 patients were studied: 259 used PPI (55 used omeprazole, 63 esomeprazole, 54 pantoprazole, 87 lansoprazole, and 7 rabeprazole) and 87 did not. Two hundred and thirty-two patients declared PDF and 114 did not. The median [min–max] TIRD was 210 min [0–1440]. The prevalence of PDF in PPI users and PPI non-users was 67% and 68%, respectively (p = 0.878). The median [min–max] TIRD did not differ significantly between PPI users and PPI non-users (180 [0–1440] and 240 [0–1440], respectively; p = 0.871). Median PDF intensity, duration, frequency, and severity did not differ significantly between PPI use and no use. The prevalence of PDF was similar among the different types of PPI use and did not differ with respect to PPI non-users. Duration of PPI exposure was <1 year in 40 patients and ≥1 year in 219 patients. The prevalence of PDF did not differ between the two exposures. The correlation matrix between PPI equivalent dose, PPI treatment duration and PDF frequency, PDF characteristics, and TIRD showed whether there was statistical significance. Conclusions: The use of PPI is not associated with PDF and time of recovery after dialysis in patients on maintenance hemodialysis.

BACKGROUND:. In the last decades some studies observed a moderate progressive decrease in short-term mortality in incident hemodialysis patients. The aim of the study is to analyse the mortality trends in patients starting hemodialysis using the Lazio Regional Dialysis and Transplant Registry. METHODS:. Patients who started chronic hemodialysis between 2008 and 2016 were included. Annual 1-year and 3-year Crude Mortality Rate*100 Person Years (CMR*100PY) overall, by gender and age classes were calculated. Cumulative survival estimates at 1 year and 3 years since the date of starting hemodialysis were presented as Kaplan-Meier curves for the three periods and compared using the log-rank test. The association between periods of incidence in hemodialysis and 1-year and 3-year mortality were investigated by means of unadjusted and adjusted Cox regression models. Potential determinants of both mortality outcomes were also investigated. RESULTS:. Among 6,997 hemodialysis patients (64.5% males, 66.1% over 65 years old) 923 died within 1 year and 2,253 within 3 years form incidence; CMR*100PY were 14.1 (95%CI: 13.2-15.0) and 13.7 (95%CI: 13.2-14.3), respectively; both remained unchanged over the years. Even after stratification by gender and age classes no significant changes emerged. Kaplan-Meier mortality curves did not show any statistically significant differences in survival at 1 year and 3 years from hemodialysis incidence across periods. No statistically significant associations were found between periods and 1-year and 3-year mortality. Factors associated with a greater increase in mortality are: being over 65 years, born in Italy, not being self-sufficient, having systemic versus undetermined nephropathy, having heart disease, peripheral vascular disease, cancer, liver disease, dementia and psychiatric illness, and receiving dialysis by catheter rather than fistula. CONCLUSIONS:. The study shows that the mortality rate in patients with end-stage renal disease starting hemodialysis in the Lazio region was stable over 9 years.

PURPOSE:Little is known about the relationships between apathy, depressive symptoms and interdialytic weight gain (IDWG) in patients on chronic hemodialysis. Aim of the present study is to investigate the association between IDWG and symptoms of depression and apathy in hemodialysis patients. METHODS:A total of 139 chronic patients of the HD units between January 2020 and December 2021 were included in the present cross-sectional study. IDWG was calculated as the difference between the pre-HD weight and the weight registered after the previous session; the average of the sessions in a month was registered. Apathy Evaluation Scale (AES) was adopted to evaluate apathy. Depression was assessed by Beck Depression Inventory (BDI). RESULTS:Ninety-three patients had IDWG% ≤ 4 and 46 had an IDWG% > 4. Correlation between IDWG% and BDI as well that between IDWG% and AES were not statistically significant. Median BDI and mean AES did not differ significantly between the groups. In addition, 104 patients had a BDI < 16 and 35 had a BDI ≥ 6. Seventy-five patients had an AES score ≤ 35 and 63 had a AES score > 35. The IDWG (kg) and the IDWG% did not differ significantly between the two groups. CONCLUSION:IDWG is not associated with symptoms of depression or apathy in hemodialysis patients. Thus, these results may question if the use of behavioral intervention aimed at improving motivation is warranted in the hemodialysis population to reduce the IDWG.

Introduction: The aim of this study was to determine if the Geriatric Depression Scale (GDS) was predictor of mortality in elderly patients on chronic hemodialysis (HD). Methods: A total of 140 HD patients >= 65 years were studied. Symptoms of depression were assessed through GDS and cognitive function through the Mini Mental State Examination (MMSE). GDS scores 0-9 are considered normal (Group 1); scores of 10-20 (Group 2) and 21-30 (Group 3) indicate mild and severe depression. Results: Median GDS was 13 (11-15): 54 patients in Group 1, 49 in Group 2, and 37 in Group 3. After a follow-up of 58.85 +/- 38.8 months, 94 patients died and 46 were alive. Kaplan-Meier survival was significantly lower in patients of Groups 2 and 3 than in Group 1 (log-rank chi(2): 101.9; DF: 2; p < 0.0001). According to Cox regression analysis, mortality was associated with age and GDS, and inversely associated with MMSE and Kt/V. Conclusion: GDS predicts mortality in elderly HD patients.

Fatigue surrounding hemodialysis treatments is a common and often debilitating symptom that impacts patients' quality of life. Intradialytic fatigue develops or worsens immediately before hemodialysis and persists through the dialysis treatment. Little is known about associated risk factors or pathophysiology, although it may relate to a classic conditioning response. Postdialysis fatigue (PDF) develops or worsens after hemodialysis and may persist for hours. There is no consensus on how to measure PDF. Estimates for the prevalence of PDF range from 20%-86%, likely due to variation in methods of ascertainment and participant characteristics. Several hypotheses seek to explain the pathophysiology of PDF, including inflammation, hypothalamic-pituitary-adrenal axis dysregulation, and osmotic and fluid shifts, but none is currently supported by compelling or consistent data. PDF is associated with several clinical factors, including cardiovascular and hemodynamic effects of the dialysis procedure, laboratory abnormalities, depression, and physical inactivity. Clinical trials have reported hypothesis-generating data about the utility of cold dialysate, frequent dialysis, clearance of large middle molecules, treatment of depression, and exercise as potential treatments. Existing studies are often limited by sample size, lack of a control group, observational design, or short intervention duration. Robust studies are needed to establish the pathophysiology and management of this important symptom.