Patient satisfaction with coronary CT angiography versus invasive coronary angiography: results of a single-center randomized trial.

OBJECTIVE: Because there is evidence for a clinical benefit of using coronary computed tomography (CT) angiography instead of invasive coronary angiography (ICA) in patients with suspected coronary artery disease (CAD), we ascertained if patient satisfaction could represent an important barrier to implementation of coronary CT in clinical practice. MATERIALS AND METHODS: A total of 329 patients with suspected CAD and clinical indication for ICA were randomly assigned to undergo either CT or ICA for guiding treatment. Satisfaction for both groups was assessed by patient questionnaire completed twice, ≥24 h after CT or ICA, and at follow-up after a median of 3.7 years. Assessment included preparation, concern, comfort, helplessness, pain, willingness to undergo tests again, overall satisfaction, and preference. Pearson's chi-square test and Wilcoxon rank-sum test were used. RESULTS: Overall, 91% of patients undergoing CT (152/167) and 86% undergoing ICA completed assessment (140/162, p = 0.19). Patients reported being significantly better prepared for CT, less concerned about the test, and felt less helpless than during ICA (all: p < 0.001). Subjective pain (horizontal nonmarked visual analogue scale) was significantly lower for CT (6.9 ± 14.7) than for ICA (17.1 ± 22.7; p < 0.001). At follow-up, significantly more patients in the CT group reported very good satisfaction with communication of findings compared with the ICA group (p < 0.001) and 92% would recommend the institution to someone referred for the same examination. CONCLUSIONS: Results from our single-center randomized study show very good satisfaction with coronary CT compared to ICA. Thus, superior acceptance of CT should be considered in shared decision-making. CLINICAL RELEVANCE STATEMENT: This evaluation of patient satisfaction in a randomized study shows that patients' preference is in line with the clinical benefit provided by CT and also suggests to prefer a CT-first strategy in suspected coronary artery disease. KEY POINTS: • Subjective pain was significantly lower for coronary CT angiography than for invasive coronary angiography and patients felt better prepared and less concerned about CT. • Patients were overall more satisfied with coronary CT angiography than invasive coronary angiography in a randomized controlled trial. • After a median follow-up of 3.7 years, more patients in the CT group indicated very good satisfaction with the communication of findings and with the examination itself.

Outcomes of Remote Patient Monitoring in Peritoneal Dialysis: A Meta-Analysis and Review of Practical Implications for COVID-19 Epidemics.

The present study seeks to determine clinical outcomes associated with remote patient monitoring of peritoneal dialysis (RPM-PD), with potential implications during COVID-19 outbreaks. We performed a systematic review in the PubMed, Embase, and Cochrane databases. We combined all study-specific estimates using the inverse-variant weighted averages of logarithmic relative risk (RR) in the random-effects models. Confidence interval (CI) including the value of 1 was used as evidence to produce a statistically significant estimate. Twenty-two studies were included in our meta-analysis. Quantitative analysis demonstrated that RPM-PD patients had lower rates of technique failure (log RR = -0.32; 95% CI, -0.59 to -0.04), lower hospitalization rates (standardized mean difference = -0.84; 95% CI, -1.24 to -0.45), and lower mortality rates (log RR = -0.26; 95% CI, -0.44 to -0.08) compared with traditional PD monitoring. RPM-PD has better outcomes in multiple spheres of outcomes when compared with conventional monitoring and likely increases system resilience during disruptions of healthcare operations.

Pyridinium-Inspired Organocatalysts for Carbon Dioxide Fixation: A Density Functional Theory Inspection.

The current project aims to apply the virtues of minimalism to examine the catalytic ability of commercially organic compounds of small chemical structures to catalyze the coupling reaction between carbon dioxide and propylene oxide (PO) under mild conditions. The proposed catalysts are pyridinium iodide (A), 2-hydroxypyridinium iodide (B), and piperidinium iodide (C), where their structure is based on cooperative acidic and nucleophilic motifs. The quantum chemistry model, M062X-D3/def2-TZVP//M062X-D3/def2-SVPP, was used to understand the reaction mechanism and the catalytic performance. Since the coupling reaction was performed under excess PO, we proposed that PO serves as a reactant and solvent. Therefore, calculations were performed in gas and liquid phases for comparison. The findings indicated that the rate-determining step depends on the chemical structure of the catalyst and whether the phase is a gas or liquid phase. In general, modeling in the liquid phase produces potential energy surfaces of lower energy barriers. The noncovalent interactions reflect the role of hydrogen bonding in controlling the kinetic behavior of the coupling reaction. Based on the finding, catalyst A is the best candidate for transforming CO2 into cyclic carbonates.

A Case of Postcoronavirus Disease 2019 Antineutrophil Cytoplasmic Antibody-associated Vasculitis Successfully Treated with Rituximab.

We report a case of a 69-year-old Caucasian male with a history of hypertension, Type 2 diabetes, and Stage IIIa chronic kidney disease (CKD), who presented to the emergency department with positional dizziness, generalized weakness, weight loss, and suppressed appetite. Two months earlier, the patient was diagnosed with coronavirus disease 2019 (COVID-19). The patient had non-oliguric acute kidney injury alongside preexisting CKD. The urinalysis showed hematuria and significant non-nephrotic proteinuria. His serological markers were positive for antineutrophil cytoplasmic antibodies with high titers. A kidney biopsy showed focal crescentic glomerulonephritis of the pauci-immune type. Initially, treatment with immunosuppressive medication was deferred because the biopsy findings suggested a poor renal outcome, as the cortical sample showed tubular atrophy and interstitial fibrosis of more than 50%. The patient was discharged but was later readmitted with worsening renal function, deep venous thrombosis in the lower extremities, and patchy lung consolidation suggesting possible pneumonia, which was ruled out. He required dialysis and brief empiric antibiotics for pneumonia, and anticoagulation for deep venous thrombosis, and was treated with intravenous (IV) pulsed steroids, followed by gradually tapering oral steroids and rituximab induction therapy. He continued dialysis three times a week. Three months after discharge, his renal function improved to near-baseline level, and he no longer required hemodialysis. He continues to be on maintenance IV rituximab therapy and low-dose oral steroids and is followed closely by a rheumatologist. Our case reflects the evolving state of understanding how COVID-19 impacts the immune system, its varying manifestations, and its management.

Cefotaxime removal enhancement via bio-nanophotocatalyst α-Fe2O3 using photocatalytic degradation technique and its echo-biomedical applications.

The present paper evaluates the photocatalytic degradation (PCD) performance of the biofabricated hematite nanoparticles (α-HNPs) for the degradation approach of the Cefotaxime (Cfm). The optimum pH of the solution to achieve the best PCD was found to be 10.5. The kinetics study for the PCD of the Cfm via α-HNPs has been investigated and the reaction was found to be fellow pseudo-first-order at R2 = 0.992. The mass loading impact of α-HNPs was investigated and estimated for the maximum degradation of Cfm 0.4 mg/mL. UV-Vis confirmed that α-HNPs had a direct transition bandgap at 3.78 eV at a maximum absorption wavelength of 362 nm with suspension stability for 7 days. The probable mechanism of the Cfm PCD via α-HNPs and the degradation pathway was conducted. The validation of the suspension stability of the α-HNPs (-68.6 ± 11.8 mV) was determined using the zeta potential investigation test. XRD investigation was conducted after Cfm PCD showing an average crystallite size of 27.0 nm. XRD, TEM, SEM, EDX, and FT-IR analyses have been conducted for the α-HNPs before and after Cfm PCD confirming the high efficiency for the reusability of the current biocatalyst α-HNPs for further use. TEM results of the particle sizes of α-HNPs were found at 19.2 ± 4.4 and 20.6 ± 7.4 nm respectively before and after Cfm PCD. The efficiency of the Cfm PCD was found to be 99.1% after 6 h. High potent as an antibacterial agent of α-HNPs was investigated either α-HNPs alone or after its PCD activity against Cfm. The antibacterial activity revealed high sensitivity, especially toward Gram-positive species indicating its promising ability against pathogenic issues. Interestingly, Cfm@α-HNPs showed superior anti-proliferative activity as tested by MTT assay and were able to induce apoptosis in MCF7 and HepG2 cell lines using the flow cytometry technique at 20.7% and 17% respectively. Also, The IC50 of hydrogen peroxide scavenging was estimated and it was manifested that 635.8 and 665.6 µg/mL of α-HNPs before and after the PCD process of Cfm respectively.

Environmentally azithromycin pharmaceutical wastewater management and synergetic biocompatible approaches of loaded azithromycin@hematite nanoparticles.

Pharmaceutical wastewater contamination via azithromycin antibiotic and the continuous emergence of some strains of bacteria, cancer, and the Covid-19 virus. Azithromycin wastewater treatment using the biosynthesized Hematite nanoparticles (α-HNPs) and the biocompatible activities of the resulted nanosystem were reported. Biofabrication of α-HNPs using Echinacea purpurea liquid extract as a previously reported approach was implemented. An evaluation of the adsorption technique via the biofabricated α-HNPs for the removal of the Azr drug contaminant from the pharmaceutical wastewater was conducted. Adsorption isotherm, kinetics, and thermodynamic parameters of the Azr on the α-HNPs surface have been investigated as a batch mode of equilibrium experiments. Antibacterial, anticancer, and antiviral activities were conducted as Azr@α-HNPs. The optimum conditions for the adsorption study were conducted as solution pH = 10, 150 mg dose of α-HNPs, and Azr concentration 400 mg/L at 293 K. The most fitted isothermal model was described according to the Langmuir model at adsorption capacity 114.05 mg/g in a pseudo-second-order kinetic mechanistic at R2 0.9999. Thermodynamic study manifested that the adsorption behavior is a spontaneous endothermic chemisorption process. Subsequently, studying the biocompatible applications of the Azr@α-HNPs. Azr@α-HNPs antibacterial activity revealed a synergistic effect in the case of Gram-positive more than Gram-negative bacteria. IC50 of Azr@α-HNPs cytotoxicity against MCF7, HepG2, and HCT116 cell lines was investigated and it was found to be 78.1, 81.7, and 93.4 µg/mL respectively. As the first investigation of the antiviral use of Azr@α-HNPs against SARS-CoV-2, it was achieved a safety therapeutic index equal to 25.4 revealing a promising antiviral activity. An admirable impact of the use of the biosynthesized α-HNPs and its removal nanosystem product Azr@α-HNPs was manifested and it may be used soon as a platform of the drug delivery nanosystem for the biomedical applications.

The anti-corrosive behavior of benzo-fused N-heterocycles: an in silico study toward developing organic corrosion inhibitors.

The work provides a computational protocol to predict the anti-corrosive performance of organic molecules through three successive phases of calculations; electron propagator theory (EPT), Monte Carlo (MC) simulations, and the density functional based tight-binding (DFTB) method. The protocol was applied to investigate the influence of two structural factors on the anti-corrosive performance of benzo fused-N-heterocycles (BFNHs) against the Fe(110) surface in an acidic medium; positional isomerism and the gradual insertion of nitrogen atoms in the heterocycle ring. The choice of BFNHs is attributed to their anti-corrosion activity and their use as building blocks in the molecular structure of many organic inhibitors. The findings indicate that EPT is a safe method for calculating the quantum chemical descriptors of the isolated molecules. Besides, the current work recommends using MC simulations and the DFTB method to describe the physical and chemical adsorption, respectively. Unexpected results were observed, as the gradual insertion of nitrogen atoms is not a specific factor for improving the inhibition efficiency of BFNHs. The findings were crystallized in equations linking the physical and chemical adsorption energies with the quantum chemical descriptors with a correlation exceeding 0.75. Besides, the peri steric hindrance plays an influential role in chemical adsorption. Intriguingly, the continuous introduction of nitrogen atoms does not increase the efficiency of the inhibitor along the way. For example, phthalazine exhibited better efficiency than benzotetrazine. In light of the above, the present protocol helps understand the anti-corrosive behavior of organic inhibitors and provides a feasible method to develop novel corrosion inhibitors.

A DFT-design of single component bifunctional organocatalysts for the carbon dioxide/propylene oxide coupling reaction.

The aim of this work is to develop single-component bifunctional organic catalysts capable of effective coupling reactions between CO2 and propylene epoxide (PO) under mild conditions using density functional theory (DFT) calculations. The dual functionalities of the target catalysts come from their inclusion of a hydroxyl-containing electrophile and the nucleophilicity of iodide ion. In this respect, a series of hydroxyl-functionalized quaternary onium-based ionic liquids were studied using M062X-D3/def2-TZVP//M062X-D3/def2-SVPP model chemistry. The design of catalysts was based on tailoring two structural factors; the first one is the onium center of pnictogens (N, P, As, Sb and Bi), and the second one is the number of hydrogen bond donor groups (n = 1-3). The proposed catalysts were examined by investigation of their catalytic mechanisms to afford the cyclic carbonate. Additionally, the highest active transition state, along with the potential energy difference, was examined using non-covalent interaction (NCI) analysis. Also, the activation strain model (ASM) was used to explain the kinetic behavior of PO activation. The findings showed that the ring-opening step of PO is always the critical step of the reaction. Among the suggested catalysts, the results indicated that the dihydroxyl ammonium-based catalyst (2OH-NI) is a good choice for this catalysis under mild and solvent-free conditions.

Diaryl Sulfide Derivatives as Potential Iron Corrosion Inhibitors: A Computational Study.

The present work aimed to assess six diaryl sulfide derivatives as potential corrosion inhibitors. These derivatives were compared with dapsone (4,4'-diaminodiphenyl sulfone), a common leprosy antibiotic that has been shown to resist the corrosion of mild steel in acidic media with a corrosion efficiency exceeding 90%. Since all the studied compounds possess a common molecular backbone (diphenyl sulfide), dapsone was taken as the reference compound to evaluate the efficiency of the remainder. In this respect, two structural factors were examined, namely, (i) the effect of replacement of the S-atom of diaryl sulfide by SO or SO2 group, (ii) the effect of the introduction of an electron-withdrawing or an electron-donating group in the aryl moiety. Two computational chemical approaches were used to achieve the objectives: the density functional theory (DFT) and the Monto Carlo (MC) simulation. First, B3LYP/6-311+G(d,p) model chemistry was employed to calculate quantum chemical descriptors of the studied molecules and their geometric and electronic structures. Additionally, the mode of adsorption of the tested molecules was investigated using MC simulation. In general, the adsorption process was favorable for molecules with a lower dipole moment. Based on the adsorption energy results, five diaryl sulfide derivatives are expected to act as better corrosion inhibitors than dapsone.

Impact of kidney transplantation on functional status.

BACKGROUND AND AIMS: Functional capacity (FC) is known to affect morbidity and mortality in kidney transplantation. Despite this important role, little is known about the variables influencing post-transplant FC. Our study aims at identifying these crucial associations. METHOD: Our study included 16,684 renal transplant recipients (RTR). Patients had transplant between 1 September 2018 and 1 September 2019. Mild functional impairment was defined as those with a KPSS score > or = 80; moderate functional impairment was defined as those with a KPSS score between 50 and 70 and severe functional impairment was defined as those with a KPSS score < or =40. The outcome measured was FC at follow-up one-year post-transplant. Abnormal FC at follow-up was defined as those with KPSS score less than 80%. Normal FC at follow-up was defined as those with KPSS score equal or above 80%. Multivariate logistic regression was used to assess with the relationship between patient characteristics and abnormal functional status post-transplant. RESULTS: Three groups were identified; those with none-to-mild functional impairment at time of transplant (Group A; n = 8388), those who had moderate impairment at time of transplant (Group B; n = 7694) and those who had severe impairment at time of transplant (Group C; n = 602). Abnormal FC at one-year post transplant was present in 7.69%, 28.89%, 49.49% of patients in group A, B and C, respectively. Glucocorticoid withdrawal was associated with lower risk of developing abnormal FC post-transplant (OR = 0.75, p value = .02, 95% confidence intervals: 0.64 to 0.97), while recipient diabetes was associated with higher risk of abnormal FC (OR = 1.44, p value <.01, 95% confidence intervals: 1.20 to 1.74) in adjusted model. CONCLUSION: Kidney transplantation is associated with substantial improvement in all stages of FC in KTRs. Glucocorticoid withdrawal and diabetes mellitus are potentially modifiable factors of FC and merit further considerations during pre-transplant workup and post-transplant immunosuppressive therapeutic planning.Key messagesKidney transplantation is associated with substantial improvement in all stages of FC in KTRs.Glucocorticoid withdrawal and diabetes mellitus are potentially modifiable factors of FC and merit further considerations during pre-transplant workup and post-transplant immunosuppressive therapeutic planning.

Hypertension and obesity in living kidney donors.

Over the past few decades, the shortage in the kidney donor pool as compared to the increasing number of candidates on the kidney transplant waitlist led to loosening of kidney donors' acceptance criteria. Hypertension and obesity represent risk factors for chronic kidney disease, both in native kidneys and those in kidney transplant recipients. While great progress has been made in kidney transplantation from living donors to benefit the recipient survival and quality of life, progress has been slow to fully risk-characterize the donors. This review critically reassesses the current state of understanding regarding the risk of end-stage kidney disease in those donors with obesity, hypertension or both. Accurate risk assessment tools need to be developed urgently to fully understand the risk glomerular filtration rate compensation failure in the remaining kidney of the donors.

Pharm.D.s and M.D.s in the Transplant World - Friends, Foes, Competitors or All are in Evolution?

Mutual trust, efforts, and commitment between patients and providers are essential for a successful, long-lasting renal transplant. From the renal transplant recipient's side, non-adherence to the medication has gained recognition as a predominant cause of late antibody-mediated rejection. Since the early 1970s, pharmacists have been involved in the care of transplant recipients and the incorporation of transplant pharmacists has improved the outcomes in solid organ transplantation. Such involvement of clinical pharmacists extends beyond improving graft outcomes: various studies demonstrated benefits in the care of diabetes, hypertension, and hyperlipidemia, with commensurate reduction of cardiovascular risk. From a unique perspective, this overview aimed to discuss the emerging role of Pharm. D.s and clinical pharmacists in general as it relates to team care, education of patients and healthcare providers and the sometimes conflicting relationship between physicians and pharmacists. Additional clinically relevant studies from culturally diverse settings are needed to explore the responsibilities of clinical team members to ensure optimized teamwork efforts without overlapping and duplication of efforts.

Leukemic Stem Cell (CD34+/CD38-/TIM3+) Frequency in Patients with Acute Myeloid Leukemia: Clinical Implications.

This study aimed to address the prognostic relevance of CD34+/CD38-/TIM3+ leukemic stem cell (LSC) frequency in patients with acute myeloid leukemia (AML) and its impact on patient outcome. We analyzed the expression of LSC markers (CD34+/CD38-/TIM3+) using flow cytometry in bone marrow samples of 53 AML cases before and after induction chemotherapy. The LSC frequency at diagnosis was significantly higher compared with that postinduction (P < .001). Patients were categorized into high LSC expressers (≥ median) and low expressers (< median). Patients with AML with high number of LSCs at diagnosis had significantly lower induction of remission response (P = .0104), shorter disease-free survival, and shorter overall survival (P < .001 for both) compared with those with lower LSC count. Cox regression analysis revealed that LSC frequency at diagnosis is an independent prognostic factor in AML. Assessment of LSCs (CD34+/CD38-/TIM3+) at diagnosis is recommended for refining of AML risk stratification.

Outcomes of Interleukin-2 Receptor Antagonist Induction Therapy in Standard-Risk Renal Transplant Recipients Maintained on Tacrolimus: A Systematic Review and Meta-Analysis.

INTRODUCTION: The additive benefit of interleukin-2 receptor antagonist (IL2-RA) induction in standard-risk kidney transplant recipients, while maintained on tacrolimus-based immunosuppressive therapy, is uncertain. METHODS: We divided the studies included in this meta-analysis into 2 groups: group A (included studies that used same dose of tacrolimus in both arms of each study) and group B (included studies that compared patients who received induction therapy and low-dose tacrolimus vs. those who received no-induction therapy and high dose of tacrolimus). RESULTS: In group A, 11 studies were included (n = 2,886). IL2-RA induction therapy was not associated with significant differences in comparison to no-induction therapy in terms of acute rejection rates at 6 months post-transplant (risk ratio = 1.12 and 95% confidence interval [CI] range: 0.94-1.35) or graft survival at 1 year post-transplant (risk ratio = 0.78 and 95% CI range: 0.45-1.36). In group B, 2 studies were included (n = 669). There was no difference between both arms in terms of acute rejection rates (risk ratio = 0.62, with 95% CI range: 0.33-1.14) or graft survival (risk ratio = 1 and 95% CI range: 0.57-1.74). CONCLUSION: IL2-RA induction therapy does not improve outcomes in patients maintained on tacrolimus-based immunotherapy in standard-risk population.

Effects of hemodialysis access surveillance on reducing risk of hemodialysis access thrombosis: A meta-analysis of randomized studies.

INTRODUCTION: Vascular access thrombosis remains the Achilles Heel for many a hemodialysis patient. We performed a systematic review and meta-analysis to assess the impact of monitoring vascular access blood flow on prediction and prevention of vascular access thrombosis. We hypothesized that monitoring vascular access blood flow has a pivotal role in lowering the risk of thrombosis and subsequent access failure. METHODOLOGY: We conducted a systematic review in PubMed and EMBASE databases to identify randomized studies that have assessed the effect of hemodialysis access surveillance on the risk of thrombosis. A random-effects model was used for the meta-analysis. Subgroup analysis was performed among patients with arterio-venous fistula (AV-fistulas) and those with arterio-venous graft (AV-grafts). RESULTS: Ten randomized studies were included in the meta-analysis. The total number of patients included in the analysis was 1430. On performing the random-effects model among the included studies, hemodialysis access surveillance was associated with better outcomes (risk ratio = 0.73, 95% confidence interval ranges from 0.55 to 0.98). The analysis of the AV-fistula group showed an estimated overall risk ratio of 0.55 (95% confidence interval ranges from 0.33 to 0.89) favoring access surveillance. However, in the AV-grafts group, the estimated overall risk ratio was 0.92 (95% confidence interval ranges from 0.65 to 1.29) showing no additional benefit for access surveillance. CONCLUSION: Hemodialysis access surveillance using access blood flow monitoring can reduce the risk of access thrombosis for patients with AV-fistulas, but this is not the case with AV-grafts.

Targeting host cell proteases as a potential treatment strategy to limit the spread of SARS-CoV-2 in the respiratory tract.

As the death toll of Coronavirus disease 19 (COVID-19) continues to rise worldwide, it is imperative to explore novel molecular mechanisms for targeting SARS-CoV-2. Rather than looking for drugs that directly interact with key viral proteins inhibiting its replication, an alternative and possibly add-on approach is to dismantle the host cell machinery that enables the virus to infect the host cell and spread from one cell to another. Excellent examples of such machinery are host cell proteases whose role in viral pathogenesis has been demonstrated in numerous coronaviruses. In this review, we propose two therapeutic modalities to tackle SARS-CoV-2 infections; the first is to transcriptionally modulate the expression of cellular proteases and their endogenous inhibitors and the second is to directly inhibit their enzymatic activity. We present a nonexhaustive collection of clinically investigated drugs that act by one of these mechanisms and thus represent promising candidates for preclinical in vitro testing and hopefully clinical testing in COVID-19 patients.

The effects of dialysis modality choice on cognitive functions in patients with end-stage renal failure: a systematic review and meta-analysis.

INTRODUCTION: Cognitive dysfunction is a major consequence of end-stage renal disease (ESRD) and has further detrimental effects on both functionality and the quality of life for patients. While peritoneal dialysis is generally advocated in ESRD, there is a substantial knowledge gap about the differential effects of chronic dialysis modalities on cognitive dysfunction and decline. The aim of this meta-analysis is to evaluate cognitive function in peritoneal dialysis versus hemodialysis patients. METHODS: We performed a systematic review in different databases to identify studies that assessed the effect of different dialysis modalities on cognitive functions. Inclusion criteria for our meta-analysis were all studies that compared the effects of peritoneal dialysis on cognitive functions compared to intermittent hemodialysis. The data collected were the name of the first author, journal title, year of publication, country where the study was conducted, number of patients in the peritoneal dialysis and hemodialysis arms and methods of assessment of cognitive functions. RESULTS: Out of 2769 abstracts reviewed in different databases, 11 papers were included in our meta-analysis. Altogether, 195,774 patients were included in the final analysis. The forest plot analysis of the rate of cognitive impairment in different dialysis modalities showed decreased risk of cognitive impairment in the peritoneal dialysis population compared to hemodialysis patients (relative risk = 0.634, confidence interval ranges from 0.508 to 0.790). There was evidence of significant heterogeneity among studies with p < 0.0001 and I2 = 85.5%. The sensitivity analysis limited to studies on patients younger than 65 years of age showed similar results (relative risk = 0.516; 95% confidence intervals: 0.379-0.704). CONCLUSION: Patients on peritoneal dialysis demonstrated a lower odd of cognitive dysfunction compared to those on hemodialysis. Future prospective studies should assess cognitive decline as a meaningful outcome in dialysis patients.