Caracterización de la situación problémica en un estudio psicosocial con pacientes con enfermedad renal crónica

Introducción: La enfermedad renal crónica es un problema de salud a nivel mundial, su manifestación más grave, la insuficiencia renal crónica, incide en el contexto cubano y determina el crecimiento de pacientes en hemodiálisis. El objetivo del texto es valorar los principales resultados del diagnóstico y caracterización de la situación problémica en un estudio de carácter psicosocial con pacientes con Insuficiencia Renal Crónica en la sala de Hemodiálisis del municipio Florida, de la provincia de Camagüey. Método: Es una investigación-acción participativa de corte experimental, que se desarrolla entre enero 2023 y diciembre del 2024 la cual constituye salida del proyecto de investigación Sistema de acciones psicosociales para el perfeccionamiento de la atención integral a los pacientes con enfermedades no transmisibles. El universo está constituido por 56 pacientes y la muestra por 22, que reciben tratamiento depurador y conservador, 22 familiares y 12 profesionales del servicio. El instrumento de investigación por excelencia fue la encuesta a participantes. Resultados: La edad de los pacientes no es definitiva de un grupo etario; predominan los hombres; se constata un elevado por ciento de pacientes con poca tolerancia a la adherencia al tratamiento e insuficiente desarrollo de las habilidades psicosociales y declaran la necesidad de poseer conocimientos para lograr estados de salud que conlleven a la sobrevida. Discusión: No existe coincidencia con lo constatado en la determinación de los grupos etarios de prevalencia para la enfermedad, pero los especialistas insisten en que la enfermedad no es privativa de un período de vida específico; reconocen la importancia del conocimiento de los factores de riesgo por el paciente para la prevención, promoción y educación en salud y resaltan la necesidad de la comunicación y la empatía entre el personal de salud y el paciente, para lograr resultados y estados emocionales favorables ante la enfermedad y el tratamiento.

Introduction: Chronic kidney disease is a global health problem. Its most serious manifestation, chronic kidney failure, affects the Cuban context and determines the growth of patients on hemodialysis. The objective of the text is to evaluate the main results of the diagnosis and characterization of the problematic situation in a psychosocial study with patients with Chronic Renal Failure in the Hemodialysis room of the Florida municipality, of the county of Camagüey. Method: It is an experimental participatory action research, which takes place between January 2023 and December 2024, which constitutes the output of the research project System of psychosocial actions for the improvement of comprehensive care for patients with non-communicable diseases. The universe is made up of 56 patients and the sample is made up of 22, who receive purifying and conservative treatment, 22 family members and 12 service professionals. The research instrument par excellence was the participant survey. Results: The age of the patients is not definitive of an age group; men predominate; A high percentage of patients are found to have low tolerance for adherence to treatment and insufficient development of psychosocial skills and declare the need to possess knowledge to achieve health states that lead to survival. Discussion: There is no coincidence with what was found in the determination of the prevalence age groups for the disease, but specialists insist that the disease is not exclusive to a specific period of life; recognize the importance of the patient's knowledge of risk factors for prevention, promotion and health education and highlight the need for communication and empathy between health personnel and the patient, to achieve favorable results and emotional states in the face of the disease and treatment.

Granulomatosis With Polyangiitis: Cardiac, Renal, and Respiratory Involvement.

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is an anti-neutrophilic cytoplasmic autoantibody (ANCA)-associated small-vessel vasculitis. Typically, it causes upper and lower respiratory tract necrotizing granulomatous inflammation and necrotizing glomerulonephritis. The diagnosis is made through clinical symptoms, positive antibody testing, imaging, and kidney biopsy. We describe the case of a man in his 60s who presented with multiple complications of GPA including rapidly progressive renal failure requiring dialysis, diffuse alveolar hemorrhage, acute respiratory distress syndrome (ARDS), circulatory shock, submassive pulmonary embolism, and biventricular and dilated cardiomyopathy.

Heart failure biomarkers in hemodialysis patients.

The diagnosis of end-stage renal disease (ESRD) is made when the estimated glomerular filtration rate is less than 15 mL/min/1.73 m2. Most patients with that stage of chronic kidney disease (CKD) are eligible for renal replacement treatment, which includes kidney transplantation, hemodialysis and peritoneal dialysis. It is well recognized that CKD raises the risk of cardiovascular disease and is linked to a higher cardiovascular death rate in this population. Additionally, the largest risk of cardiovascular events is seen in ESRD patients. Heart failure (HF) and dangerous arrhythmias, which are more common in the advanced stages of CKD, are two additional causes of cardiovascular death in addition to atherosclerosis-related complications such as myocardial infarction and stroke. In this review the significance of natriuretic peptides and other HF biomarkers in hemodialysis patients, as tools for cardiovascular risk assessment will be discussed.

Eradication Therapy for Helicobacter pylori Infection in Patients Receiving Hemodialysis: Review.

Patients receiving hemodialysis (HD) often develop gastrointestinal diseases. Recently, although in general population, clinical guidelines for Helicobacter pylori have strongly recommended its eradication in patients to prevent gastric cancer, optimal eradication regimen and optimal dosage of drugs for patients receiving HD have not been established, due to possible incidence of adverse events. Some antimicrobial agents used in eradication therapy, particularly amoxicillin, can exacerbate renal dysfunction. Given the delayed pharmacokinetics of drugs in patients receiving HD compared with those in healthy individuals, drug regimen and dosage should be considered to minimize adverse effects. Although previous studies have investigated the benefits of eradication therapy for patients receiving HD, because most studies were small in terms of the number of enrolled patients, it is hard to show evidence. The numbers of eradication in HD patients have recently increased, and it is important to provide an optimal regimen. The consideration of eradication in patients undergoing HD with a reduction in the drug dose by 1/2-1/3 may prevent adverse events. Additionally, another important consideration is whether adverse events can be prevented while maintaining a similar eradication rate with reduced drug dosages. Recent meta-analysis findings indicate comparable eradication rates in patients receiving HD and healthy individuals, both with the same dosage regimen and at a reduced dosage regimen, with no significant differences (relative risk [RR] for successful eradication: 0.85 [95% confidence interval (CI): 0.48-1.50]). Unlike with the same dosage regimen (RR for adverse events: 3.15 [95% CI: 1.93-5.13]), the adverse events in the dosage reduction regimen were similar to those in healthy individuals (RR: 1.26 [95% CI: 0.23-6.99]). From a pharmacological perspective, the eradication regimen in patients receiving HD should consider the dosage (1/2-1/3 dosage), dosing number (bid), dosing timing of drugs (after HD), and susceptibility to antimicrobial agents.

Inadvertent Intoxication with Salbutamol, Treated with Hemodialysis: A Case Report and Brief Review of the Literature.

Introduction: Salbutamol is a moderately selective beta-2-adrenergic agonist. Various side effects can occur because of beta-1 and beta-2 receptor activation. Due to the large volume of distribution, it is not considered dialyzable. Case Presentation: A patient with salbutamol intoxication, which developed as a result of a medical error in a patient with sepsis, Down syndrome, and liver cirrhosis, is presented. Initial treatment was partially successful and antibiotic adjustments were made. After his respiratory failure worsened, the patient needed non-invasive ventilation, and previously undiagnosed chronic obstructive pulmonary disease was suspected. He was prescribed intravenous methylprednisolone but accidently received 5 mg of salbutamol (albuterol), which led to immediate severe arrhythmic tachycardia with hemodynamic collapse. After unsuccessful cardioversion and treatment with landiolol infusion, salvage hemodialysis was commenced to decrease suspectedly highly elevated serum salbutamol levels. After 30 min, sinus rhythm with normocardia was observed. After the hemodialysis termination, no rebound tachycardia was noted, but due to severe septic shock, the hypotension was ongoing and vasoactive medications were adjusted. However, the measured levels of plasma salbutamol and data from literature do not support the view that hemodialysis was the cause of the described improvement: the total amount of the drug cleared was very small (2.8% of total dose). Conclusion: Our results confirm a large volume of salbutamol distribution; the measured levels are within observed therapeutic levels; and the measured half-life time during hemodialysis (3.1 h) is comparable to observed half-life times in therapeutic settings. The observed favorable clinical benefit associated with dialysis may be fortuitous, highlighting potential bias toward positive clinical outcomes and unproven ("salvage") therapies.

Intervention control of aerobic exercise in maintaining quality of life and pulmonary hypertension in hemodialysis patients.

BACKGROUND: Pulmonary hypertension is a serious complication in the treatment of maintenance hemodialysis patients, which seriously affects the quality of life of patients and threatens their life safety. Prevention, treatment and improvement of pulmonary hypertension are of great significance to improve the quality of life of patients. AIM: To investigate the intervention and control of pedal-powered bicycle in maintaining quality of life and pulmonary hypertension in hemodialysis patients. METHODS: 73 patients with maintenance hemadialysis combined with pulmonary arterial hypertension at a hemodialysis center in a certain hospital from May 2021 to May 2022 are selected. Patients are divided into two groups, 37 cases in the control group (group C) and 36 cases in the intervention group (group I). Patients are divided into two groups, group C is treated with oral administration of betaglandin sodium combined with routine nursing care. Based on group C, group I conducts power cycling exercises. RESULTS: After treatment, group I patients had higher muscle strength, 36-Item Short Form Health Survey scores, and Kidney Disease Targets Areas scores; The 6-minute walk distance test index level was higher and the Borg score was lower; The group I had lower systolic blood pressure, greater vital capacity, higher positive emotion, lower systolic pulmonary artery pressure index level, higher arterial partial oxygen pressure level, lower pulmonary vascular resistance index level, and higher blood oxygen saturation level [158.91 ± 11.89 vs 152.56 ± 12.81, 1795.01 ± 603.18 vs 1907.20 ± 574.15, 24.00 (22.00, 29.00) vs 24.00 (22.00, 28.00), P < 0.001]. CONCLUSION: Aerobic exercise combined with Western medicine treatment can effectively improve patients' pulmonary hypertension, alleviate their negative emotions, and enable them to achieve a higher level of quality of life.

The Time to Negative Conversion among Adult COVID-19 Patients on Chronic Hemodialysis Admitted at the Philippine General Hospital - A Retrospective Cohort Study.

Objectives: In the Philippines, patients on chronic hemodialysis with COVID-19 remain admitted in hospitals despite clinical recovery because most free-standing dialysis units require proof of negative conversion via Reverse Transcriptase - Polymerase Chain Reaction (RT-PCR). This study aims to determine the time to negative conversion of COVID-19 RT-PCR testing among adult patients on chronic hemodialysis with COVID-19 admitted at the Philippine General Hospital (PGH) and bring insight in using the symptom or time-based procedure as recommended by local guideline, and ultimately, to ensure delivery of adequate hemodialysis despite being infected with COVID-19, shorten isolation period, and conserve resources especially in resource-limited settings. Methods: This is a retrospective cohort study on all adult patients on chronic hemodialysis who were admitted in PGH after the diagnosis of COVID-19 by RT-PCR between March 2020 and February 2021. Descriptive statistics was used in summarizing the data. Results: A total of 90 patients on chronic hemodialysis who tested positive for COVID-19 via RT-PCR admitted at PGH were included in the study. Most of these patients had moderate COVID-19 at 53.3%. The median number of days from onset of symptoms to clinical recovery was 14.5 days. The median time to first negative conversion was 18 days. Most of these patients had negative conversion at the second week. The correlation coefficient between time to clinical recovery and negative conversion was 0.214. Conclusion: Among adult patients on chronic hemodialysis who were admitted in PGH after the diagnosis of COVID-19, the time to negative conversion was longer compared to the time to clinical recovery with a very weak correlation between the two.

Association Between Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score and Arteriovenous Fistula Failure in Patients on Maintenance Hemodialysis.

BACKGROUND: Arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis in end-stage renal disease (ESRD) patients but has a significant failure rate. Atherosclerotic cardiovascular disease (ASCVD) is a major cause of mortality in ESRD patients. Atherosclerosis of the peripheral vessels may contribute to poor maturation of AVF leading to the exploration of the ASCVD score as a prognostic tool for AVF failure. METHODS: This study included 110 hemodialysis patients with AVFs and aimed to examine the association between ASCVD score and AVF failure. Participants were categorized into the presence of vascular access failure (N=12) and absence of vascular access failure (N=98), and demographic and clinical data were collected.  Results: The study comprised predominantly male patients (63.6%), with a notable prevalence of hypertension and diabetes. Twelve patients experienced AVF failure, with pseudoaneurysms and thrombosis being the predominant causes. The ASCVD risk group at intermediate and high stages exhibited a statistically significant risk (relative risk (RR)=1.403; 95% CI, 1.041-1.904) of AVF failure in comparison to the low and borderline ASCVD risk groups. There was no association of age, gender (male and female), body mass index (BMI), serum calcium, serum phosphorus, intact parathyroid hormone (iPTH), and serum albumin with AVF failure. CONCLUSION: The ASCVD score emerges as a potential prognostic tool to identify dialysis patients at high risk of AVF failure, suggesting avenues for targeted interventions and improved patient care. However, limitations of the ASCVD risk estimator and study limitations, such as small sample size and absence of mortality data, warrant cautious interpretation and necessitate further exploration in larger patient populations.

Evaluation of Clinical Characteristics of Critically Ill COVID-19 Patients With Renal Failure.

INTRODUCTION: This study aimed to investigate the clinical characteristics and prognostic factors of critically ill COVID-19 patients with renal failure admitted to the ICU. METHODS: We analyzed 300 adult patients with SARS-CoV-2 infection admitted to the ICU between November 1, 2020, and June 1, 2022. Demographic data, renal function parameters, and outcomes were collected and analyzed. RESULTS: The median age was 72 years, and 54.3% were men. Mechanical ventilation was required for 86.3% of patients, with 71.0% needing invasive ventilation. Renal failure was present in 43.3% of patients at ICU admission, significantly associated with older age, higher mechanical and invasive ventilation needs, and increased ICU mortality (76.9% vs. 51.8%, p<0.001). Patients with renal failure had elevated levels of urea, creatinine, C-reactive protein (CRP), D-dimer, white blood cell (WBC), neutrophil (Neu), and procalcitonin (PCT) (p<0.001 for all). Among patients with acute kidney injury (AKI), those with AKI had significantly higher median age (75 vs. 66 years, p<0.001), mechanical ventilation requirement (93.6% vs. 74.3%, p<0.001) and ICU mortality (79.1% vs. 35.4%, p<0.001). Elevated levels of urea (76 vs. 44 mg/dL, p<0.001) and creatinine (1.4 vs. 0.8 mg/dL, p<0.001), as well as inflammatory markers CRP and D-dimer (p=0.001), were observed in AKI patients. Survivors had lower median age (66.0 vs. 74.0 years, p<0.001) and lower prevalence of chronic kidney disease (CKD) (4.5% vs. 12.8, p=0.019) and AKI (34.8% vs. 78.7%, p<0.001). Non-survivors exhibited higher levels of urea, creatinine, lactate dehydrogenase (LDH), CRP, ferritin, and D-dimer (p<0.001 for all). CONCLUSION: Renal failure and AKI are prevalent in critically ill COVID-19 patients and are associated with worse outcomes. Elevated creatinine and urea levels at ICU admission are significant predictors of ICU mortality, underscoring the importance of early recognition and management of renal impairment in these patients.

Effects of Dietary Fiber Intake and the Prevalence of Constipation Among Patients With End-Stage Renal Disease (ESRD) in Jeddah, Saudi Arabia: A Cross-Sectional Observational Study.

RATIONALE/BACKGROUND: Hemodialysis (HD) patients with end-stage renal disease (ESRD) are particularly prone to constipation, which has become a growing public health issue. Nutritional therapy, such as fiber intake, significantly influences the management of constipation. In Saudi Arabia, there is limited data on fiber consumption and its correlation with constipation management in HD patients. AIMS: The study aimed to investigate the correlation between dietary fiber intake and its effect on the prevalence of constipation in HD patients. MATERIALS AND METHODS: This cross-sectional observational study of 77 ESRD patients on HD aged 18+ was conducted in a single dialysis center over six months. A questionnaire was employed to diagnose constipation (as defined by the Rome IV criteria of constipation), and seven-day food records were used to evaluate dietary fiber intake. RESULTS: A study found a high prevalence of constipation (53%) among participants, with a lower daily fiber intake than recommended. However, a significant relationship was found between fiber intake and constipation (p < 0.05) with lower fiber intake in constipated patients compared to non-constipated (p = 0.001). CONCLUSION: The study highlights a significant link between fiber intake and constipation in HD patients, suggesting adequate daily intake of fiber was effective in preventing constipation and that nutritional counseling should include adequate daily fiber intake in medical therapy management.

Percutaneous Endovascular Creation of a Neo-arteriovenous Fistula in Dysfunctional Hemodialysis Fistulas.

PURPOSE: Arteriovenous fistulas (AVF) is the preferred type of hemodialysis access, but when an arteriovenous anastomosis (AVA) calcifies, surgical revision of the AVF may be required. We report a technique to create percutaneous artery-to-vein intervascular neo-fistulas for re-anastomosis of AVA and evaluate its safety and efficacy. MATERIALS AND METHODS: 9 patients who failed either guidewire navigation or conventional balloon dilation for calcified AVA stenosis/occlusion underwent a salvage procedure of their dialysis shunt by the percutaneous creation of a new arteriovenous fistula. Needle puncture of the adjacent supplying artery and outflow vein under ultrasonographic and/or fluoroscopic guidance was performed and followed by balloon dilation, with or without stent graft placement. The detailed techniques, technical success, primary neo-fistula patency, primary and secondary access patency rates were reported herein. RESULTS: Technical success was achieved in 100% of the 9 patients treated (7 neo-fistulas with stents and 2 neo-fistulas without stent placement). The median primary neo-fistula and access patencies were 15 and 5 months, respectively. The primary neo-fistula patency rates at 6, 12, and 18 months were 72.9%, 54.7% and 27.9%, respectively, with secondary neo-fistula and access patency rates of 72.9%, 72.9% and 72.9%, respectively. One delayed complication of pseudoaneurysm formation occurred, which was managed by the successful endovascular deployment of a stent graft on an out-patient basis. CONCLUSION: Percutaneous artery-to-vein intervascular neo-fistula creation is feasible for re-anastomosing calcified AVA, with low adverse effects and acceptable primary neo-fistula and secondary access patency.

The Role of Genedrive in Point of Care Method For Hepatitis C Elimination in Hemodialysis Center.

BACKGROUND: Point of care is laboratory testing conducted close to the site of the patient. Point of care assessment is essential to detect and treat the hepatitis C virus in a single visit. The potential use of Genedrive extends to remote areas and key populations Therefore, there is a need for a simple, and cost-effective examination of methods, such as Genedrive. Genedrive is a rapid and low-cost diagnostic tool for the identification and treatment selection of infectious diseases. The World Health Organization targets to eliminate hepatitis by 2030, which decreases infections by 90%, and decreases deaths by 65%. Point of care could play a significant role in contributing to the elimination of hepatitis C. Chronic kidney disease (CKD) patients on hemodialysis are among the population at risk of hepatitis C due to nosocomial transmission. This study aimed to assess the role of Genedrive in measuring hepatitis C in chronic hepatitis C patients with chronic kidney disease on hemodialysis. METHODS: This study used a cross-sectional design. There were 64 CKD on Hd patients in Cipto Mangunkusumo Hospital tested by Genedrive. ROC analysis was conducted to assess significant hepatitis C among chronic kidney disease on hemodialysis. RESULTS: The calculated detection limit of Genedrive was 3.1x103 IU/mL. Genedrive HCV assay showed 90.6% sensitivity, 96.8% specificity, 92% negative predictive value, and 97% positive predictive value to detect HCV, 10.36 positive likelihood ratio, and 0.09 negative likelihood ratio. CONCLUSION: Genedrive could be a simple and reliable point of care method to detect hepatitis C with chronic kidney disease on hemodialysis.

The Severity, Quality of Life, and Correlated Factors of Chronic Kidney Disease-associated Pruritus between Hemodialysis and Kidney Transplant Patients: A Cross-sectional Study.

BACKGROUND: Chronic kidney disease-associated pruritus (CKD-aP) mainly occurs in hemodialysis (HD) patients and could persist in kidney transplant (KT) recipients. This study aims to compare the severity, correlation of various biochemical factors, and quality of life (QoL) concerning pruritus in CKD. METHODS: A cross-sectional study was conducted on HD and KT recipients with chronic pruritus, where the 5-Dimensional (5-D) Itch Scale and Dermatology Life Quality Index (DLQI) were used to evaluate pruritus severity and QoL. Results: Among the 60 subjects, 76.7% of HD patients had moderate-to-severe pruritus, whereas in the KT group, 83.3% experienced mild pruritus (p < 0.001). The median DLQI score was 5 (3-6) and 3 (2-4), respectively (p < 0.001). There was a correlation between hs-CRP and the 5-D itch score in the HD group (r = 0.443; p < 0.05), whereas e-GFR was correlated with the 5-D itch score in the KT group (r = -0.424; p < 0.05). CONCLUSION: Moderate-to-severe pruritus was more common in HD patients. While pruritus in KT recipients had a mild effect on QoL, pruritus in the HD group had a mild-moderate impact on QoL. There was a correlation between hs-CRP and e-GFR and the severity of pruritus in HD and KT recipients, respectively.

Effects of active vitamin D analogs and calcimimetic agents on PTH and bone mineral biomarkers in hemodialysis patients with SHPT: a network meta-analysis.

OBJECTIVE: Active vitamin D analogs and calcimimetic agents are primary drugs for patients with secondary hyperparathyroidism. Due to the different pharmacological mechanisms, they have different effects on the level of parathyroid hormone, serum calcium, phosphorus, and bone turnover biomarkers. This study aimed to evaluate the active vitamin D analogs and calcimimetic agents in hemodialysis patients with secondary hyperparathyroidism. METHODS: We included randomized clinical trials of hemodialysis patients with secondary hyperparathyroidism, comparing active vitamin D analogs to calcimimetic agents or placebo/control. The primary outcome was the change of PTH level from baseline to end-up. The secondary outcome was the change in serum calcium, phosphorus, calcium-phosphorus product, and bone turnover biomarkers. A network meta-analysis method was applied to complete this study. The forest plots reflected statistical differences in the outcomes between active vitamin D analogs and calcimimetic agents. The SUCRA result presented the ranking of impact on the outcomes. RESULTS: Twenty-one randomized clinical trials with 4653 patients were included in this network meta-analysis. Global and splitting-node inconsistencies provided no evidence of inconsistency in this study. There was no statistical difference between two active vitamin D analogs and three calcimimetic agents in the PTH, and phosphorus levels changed. Considering serum calcium level, compared with placebo, calcitriol (9.73, 3.09 to 16.38) and paricalcitol (9.74, 3.87 to 15.60) increase serum calcium. However, cinacalcet (- 1.94, - 3.72 to - 0.15) and etelcalcetide (- 7.80, - 11.80 to - 3.80) reduced the serum calcium, even a joint use of cinacalcet with active vitamin D analogs (- 5.83, - 9.73 to - 1.93). Three calcimimetic agents decreased calcium levels much more than calcitriol and paricalcitol. The same type of drugs was not distinct, with each one affecting the change in calcium level. Cinacalcet reduced calcium-phosphorus product much more than paricalcitol (- 3.66, - 6.72 to - 0.60). Evocalcet decreased calcium-phosphorus product more than cinacalcet (- 5.64, - 8.91 to - 2.37), calcitriol (- 9.36, - 14.81 to - 3.92), and paricalcitol (- 9.30, - 13.78 to - 4.82). Compared with paricalcitol, cinacalcet significantly increases the level of ALP (24.50, 23.05 to 25.95) and bALP (0.67, 0.03 to 1.31). The incidence of gastrointestinal disorders in cinacacet (29.35, 1.71 to 504.98) and etelcalcetide (20.92, 1.20 to 365.68) was notably higher than in paricalcitol. Etelcalcetide (0.71, 0.53 to 0.96) and evocalcet (0.46, 0.33 to 0.64) presented a lower rate of gastrointestinal disorders than cinacalcet. Cinacalcet ranked first in adverse gastrointestinal, nervous, and respiratory reactions. CONCLUSION: The same kinds of agents perform similar efficacy on the level of PTH, serum calcium, phosphorus, and calcium-phosphorus product. Paricalcitol did not lead to more hypercalcemia than calcitriol. The calcium decrease induced by cinacalcet was not settled even by associating it with active vitamin D analogs. Cinacalcet and evocalcet were superior to calcitriol and paricacitol in reducing calcium-phosphorus product. Calcimimetics induced more gastrointestinal disorders than active vitamin D analogs, especially cinacalcet.

Hemodialysis patients have signs of a chronic thrombotic burden.

BACKGROUND: Cardiovascular diseases are the dominant cause of morbidity in hemodialysis (HD) patients. Unless sufficient anticoagulation is used during HD, clotting may appear. The objective was to investigate if levels of fibrin degradation products (D-dimer) were increased before and during HD. METHODS: The combined observational study included 20 patients performing a total of 60 hemodialysis divided into three sessions of low-flux dialysis. None of the patients suffered from any clinically evident thromboembolic event before or during the study. Median bolus anticoagulation (mainly tinzaparin) doses were 84 Units/kg bow. Blood samples were drawn before HD (predialysis), and at 30min and 180min during HD with focus on analyzing D-dimer levels and its relation to interdialytic weight gain (IDWG) and speed of fluid elimination by HD (UF-rate). RESULTS: Predialysis, D-dimer levels (mean 0.767 ±0.821, min 0.136mg/L) were above the upper reference value in 95% of the sessions. D-dimer levels were lowered at 30min (p<0.001) and returned to predialysis levels at 180min. Predialysis D-dimer correlated with NT-pro-BNP, Troponin T, IDWG and UF-rate. Multiple regression analysis revealed that the D-dimer levels were significantly related to IDWG and the UF-rate. CONCLUSIONS: D-dimer levels were elevated in a high proportion predialysis and during HD and related to the IDWG and the UF-rate. Awareness of D-dimer levels and future studies will help clarify if optimization of those variables, besides anticoagulation and biocompatibility measures, will eradicate the repeated subclinical thromboembolic events related to each HD; one reason that may explain organ damage and shortened life span of these patients.

Uremic Pericarditis and Cardiac Tamponade Resolving With Intensive Hemodialysis.

We present an interesting and complex case of cardiac tamponade due to uremic pericarditis (UP), resolving with intensive hemodialysis (HD). HD should be considered as first line management for patients with UP and pericardial effusion. Intensification of HD should be considered based on clinical presentation and severity of presentation.

Association between magnesium, erythropoietin resistance and mortality: the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS).

Background: Limited data are now available to evaluate the relationship between serum magnesium level, anemia and mortality in the dialysis population. Methods: Using data from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS) phases 5 and 6, we analyzed the association between serum magnesium (s-Mg) levels and the erythropoiesis-stimulating agents resistance index (ERI) as the primary outcome. To estimate the longitudinal relationship, a mixed-effect model was used with ERI at each 4-month period as the dependent variable and quintiles of s-Mg at the previous 4-month period as the independent variable. We also examined incidence of infectious events, and the all-cause and cardiovascular disease (CVD)-related deaths as secondary outcomes by Cox regression with quintiles of s-Mg at baseline. Results: Of the 4776 participants in J-DOPPS, 1650 were included in the analysis. The median of s-Mg at baseline was 2.5 mg/dL. A significant linear association of s-Mg with ERI (P for trend <.001) was revealed. Low and high s-Mg levels were not associated with the clinical outcomes of interest, except for the highest quintile of s-Mg being significantly associated with lower incidence of all-cause mortality and CVD-related deaths compared with the middle (reference) quintile. Conclusions: We observed that lower s-Mg levels subsequently induced higher ERI and that mild higher s-Mg levels were possibly associated with good rather than poor outcomes in Japanese hemodialysis patients. Adjustment of s-Mg levels may be proposed as a new strategy at a low cost and risk to reduce the risk of premature mortality.

Initial experience of enfortumab vedotin in a patient with metastatic urothelial carcinoma on hemodialysis: Two case reports.

Introduction: Few studies have reported on administering enfortumab vedotin to patients with metastatic urothelial carcinoma and end-stage renal disease requiring hemodialysis. Case presentation: Case 1: An 85-year-old man underwent hemodialysis for progressive renal failure 4 months after right laparoscopic radical nephroureterectomy. Case 2: A 73-year-old man underwent hemodialysis after two laparoscopic radical nephroureterectomies for recurrent urothelial carcinoma. In both cases, enfortumab vedotin was administered due to postoperative recurrence and progression despite platinum-based chemotherapy and pembrolizumab. Partial response and disease progression were observed in cases 1 and 2, respectively. Adverse events included a mild skin rash in both patients and neutropenia in Case 1, both of which resolved with symptomatic treatment. Conclusion: The efficacy and safety of enfortumab vedotin in patients with metastatic urothelial carcinoma, and end-stage renal disease undergoing hemodialysis, were confirmed.

Treatment Options for Hemodialysis-related Central Vein Occlusive Disease: Case Series and Review of Literature.

Central venous occlusive disease is commonly seen in patients undergoing hemodialysis and can threaten the viability of the arteriovenous access. Majority of cases are related to central venous catheter placement. This paper reports on three patients on chronic hemodialysis who presented with signs and symptoms of upper extremity venous hypertension and underwent three different therapeutic modalities, all with successful relief of symptoms. A review of the existing literature on past and current treatment options is done.

Personalized prediction of intradialytic hypotension in clinical practice: Development and evaluation of a novel AI dashboard incorporating risk factors from previous and current dialysis sessions.

BACKGROUND: Intradialytic hypotension (IDH) is one of the most common and critical complications of hemodialysis. Despite many proven factors associated with IDH, accurately predicting it before it occurs for individual patients during dialysis sessions remains a challenge. PURPOSE: To establish artificial intelligence (AI) predictive models for IDH, which consider risk factors from previous and ongoing dialysis to optimize model performance. We then implement a novel digital dashboard with the best model for continuous monitoring of patients' status undergoing hemodialysis. The AI dashboard can display the real-time probability of IDH for each patient in the hemodialysis center providing an objective reference for care members for monitoring IDH and treating it in advance. METHODS: Eight machine learning (ML) algorithms, including Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM), K Nearest Neighbor (KNN), Light Gradient Boosting Machine (LightGBM), Multilayer Perception (MLP), eXtreme Gradient Boosting (XGBoost), and NaiveBayes, were used to establish the predictive model of IDH to determine if the patient will acquire IDH within 60 min. In addition to real-time features, we incorporated several features sourced from previous dialysis sessions to improve the model's performance. The electronic medical records of patients who had undergone hemodialysis at Chi Mei Medical Center between September 1, 2020 and December 31, 2020 were included in this research. Impact evaluation of AI assistance was conducted by IDH rate. RESULTS: The results showed that the XGBoost model had the best performance (accuracy: 0.858, sensitivity: 0.858, specificity: 0.858, area under the curve: 0.936) and was chosen for AI dashboard implementation. The care members were delighted with the dashboard providing real-time scientific probabilities for IDH risk and historic predictive records in a graphic style. Other valuable functions were appended in the dashboard as well. Impact evaluation indicated a significant decrease in IDH rate after the application of AI assistance. CONCLUSION: This AI dashboard provides high-quality results in IDH risk prediction during hemodialysis. High-risk patients for IDH will be recognized 60 min earlier, promoting individualized preventive interventions as part of the treatment plan. Our approachis believed to promise an excellent way for IDH management.