Dialysis Adequacy: A Cross-Sectional Study to Assess the Reliability of the Online Clearance Monitor to Measure Dialysis Dose.

Background Frequent assessment of the dialysis dose delivered to hemodialysis patients might help improve morbidity and mortality. Daugirdas' second-generation formula is the recommended method for calculating dialysis doses. However, urea reduction ratios (URRs) and online clearance monitors (OCMs) are frequently used to assess dialysis adequacy due to their more straightforward concept and ease of use. This study was conducted to determine the most reliable method for measuring dialysis adequacy by comparing the correlation of urea reduction ratio and online clearance monitor measurements with the dialysis dose measured using the recommended Daugirdas' second-generation formula. Methods This study was an observational, cross-sectional, single-center study. The dialysis dose was measured as a urea reduction ratio and by an online clearance monitor simultaneously for 50 patients. It was compared to the dialysis dose measurements obtained using Daugirdas' second-generation formula. Results There was a statistically significant strong positive correlation (r = 0.929; p ≤ 0.001) of the urea reduction ratio and a poor concordance (ρC = 0.401; p ≤ 0.001) of online clearance monitor measurements with the dialysis dose measured using Daugirdas' second generation formula. Conclusion Our findings illustrate that the urea reduction ratio may be a more straightforward and reliable means for assessing the adequacy of intermittent hemodialysis with minimal errors in patients compared to online clearance monitors. Online clearance monitors offer easy estimation and practicality with minimal effort but are prone to multiple errors and may not be accurate in some settings.

Spinal Cord Stimulation for Parkinson's Disease: A Systematic Review and Meta-Analysis of Pain and Motor Outcomes.

BACKGROUND: Spinal cord stimulation (SCS) has been investigated as a potential therapeutic option for managing refractory symptoms in patients with Parkinson's disease (PD). OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the safety and efficacy of SCS in PD. METHOD: A comprehensive literature search was conducted on PubMed and Web of Science to identify SCS studies reporting Unified Parkinson Disease Rating Scale-III (UPDRS-III) or Visual Analogue Scale (VAS) score changes in PD cohorts with at least 3 patients and a follow-up period of at least 1 month. Treatment effect was measured as the mean change in outcome scores and analyzed using an inverse variance random-effects model. The risk of bias was assessed using the Newcastle-Ottawa Scale and funnel plots. RESULTS: A total of 11 studies comprising 76 patients were included. Nine studies involving 72 patients reported an estimated decrease of 4.43 points (95% confidence interval [CI]: 2.11; 6.75, p < 0.01) in UPDRS-III score, equivalent to a 14% reduction. The axial subscores in 48 patients decreased by 2.35 points (95% CI: 1.26; 3.45, p < 0.01, 20% reduction). The pooled effect size of five studies on back and leg pain VAS scores was calculated as 4.38 (95% CI: 2.67; 6.09, p < 0.001), equivalent to a 59% reduction. CONCLUSIONS: Our analysis suggests that SCS may provide significant motor and pain benefits for patients with PD, although the results should be interpreted with caution due to several potential limitations including study heterogeneity, open-label designs, small sample sizes, and the possibility of publication bias. Further research using larger sample sizes and placebo-/sham-controlled designs is needed to confirm effectiveness.

Oxalate Nephropathy: A Case Report of Acute Kidney Injury Due to Juice Diet.

Oxalate nephropathy occurs due to the deposition of calcium oxalate crystals in kidney tubules and/or the interstitium as a part of primary or secondary hyperoxaluria. Secondary oxalate nephropathy can occur even with moderately high doses of ascorbic acid intake under yet unidentified clinical circumstances. Vitamin C, although traditionally considered an antioxidant, leads to the formation of superoxide and subsequent generation of reactive oxidant species at pharmacologic concentrations. Ascorbic acid is partly converted to oxalic acid, which is responsible for deposition and renal tubular injury. We report a case of a diabetic patient with normal kidney function who was put on a juice diet for a week due to upper gastrointestinal bleeding. He developed acute kidney injury due to biopsy-proven oxalate nephropathy requiring dialysis. Though he was lost to follow-up after two weeks on dialysis, he was expected to have only a slow recovery or become dependent on dialysis given his age, comorbidities, and extent of tubular involvement. Hence, caution should be exercised before supplementing vitamin C either in its natural form or as a drug. Risk factors for secondary oxalate nephropathy due to excessive intake of oxalate or its precursor are likely to be age, diabetes, dehydration, and underlying chronic kidney disease. Most of the patients do not have a complete recovery of kidney function, and many become dependent on dialysis.

Uremic Optic Neuropathy: A Potentially Reversible Complication of Chronic Kidney Disease.

Uremic optic neuropathy (UON) is one of the rare causes of vision loss in chronic kidney disease patients. It is infrequently seen nowadays as most of the patients are dialyzed early owing to better availability of medical services. It is a clinical diagnosis, correlating loss of vision with optic disc edema in a patient with kidney failure which improves noticeably with hemodialysis and steroids. We describe a patient with UON with excellent improvement on timely institution of hemodialysis and steroid therapy.

Humoral response to viral vector COVID-19 vaccine in hemodialysis patients.

BACKGROUND: The coronavirus disease 2019 (COVID-19) vaccine is not readily available in many countries where dosing interval is spaced more than ideal. Patients with chronic kidney disease, especially those on maintenance hemodialysis, have a tendency for a reduced immune response. This study was undertaken to demonstrate the distinct humoral immune response to the viral vector COVID-19 vaccine in patients with kidney failure receiving maintenance hemodialysis. METHODS: The study was carried out with two cohorts: 1) patients receiving maintenance hemodialysis and 2) healthcare workers from the same dialysis center as controls, each group with 72 subjects. Participants received a dose of Covishield ChAdOx1 nCoV-19 coronavirus vaccine. The humoral immunological response was determined using electrochemiluminescence immunoassay which quantitatively measures antibodies to the severe acute respiratory syndrome coronavirus 2 spike protein receptor-binding domain. RESULTS: All study subjects in the control group developed a humoral response (antibody titer of ≥0.8 U/mL), while only 64 of 72 in the dialysis group (88.9%) were responders. Age (ρ = -0.234, p = 0.04) and sodium level (ρ = 0.237, p = 0.04) correlated with low antibody titer in bivariate analysis. In multivariate analysis, only age (odds ratio, 1.10; 95% confidence interval, 1.01-1.22; p = 0.045) was associated with nonresponders. CONCLUSION: Our study demonstrated a weak antibody response of hemodialysis patients to the viral vector COVID-19 vaccine. Older age was associated with nonresponders. Evaluation of both humoral and cellular immunity after the second vaccine dose and serial antibody titers can help determine the need for booster shots.