Rachid Daoui, Joseph Saccucci, Diane Fountain, Loay Salman
Background
In previous work, we demonstrated that using the B. Braun hemodialysis (HD) machine for home HD typically delivers higher single treatment Kt/V (spKt/V), weekly standard Kt/V, and urea reduction ratio (URR) compared to the NxStage home HD machine.
Methods
We reviewed the technical requirements and home modifications necessary to implement the B. Braun HD machine for home HD based on our 5 years of experience with 40 patients.
Results
Successful home use of the B. Braun machine at home required a larger dedicated space, installation of a dedicated reverse osmosis water treatment system, specialized plumbing and electrical connections, and tailored machine-specific patient training.
Conclusions
Despite these home requirements, most of our patients found these modifications manageable and the machine easy and intuitive to operate. Our experience supports the B. Braun machine as another practical option for home HD, including nocturnal HD treatments.
{"title":"The Use of B. Braun Machines to Provide Home Hemodialysis: Technical Aspects","authors":"Rachid Daoui, Joseph Saccucci, Diane Fountain, Loay Salman","doi":"10.1111/hdi.70025","DOIUrl":"10.1111/hdi.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In previous work, we demonstrated that using the B. Braun hemodialysis (HD) machine for home HD typically delivers higher single treatment Kt/V (spKt/V), weekly standard Kt/V, and urea reduction ratio (URR) compared to the NxStage home HD machine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed the technical requirements and home modifications necessary to implement the B. Braun HD machine for home HD based on our 5 years of experience with 40 patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Successful home use of the B. Braun machine at home required a larger dedicated space, installation of a dedicated reverse osmosis water treatment system, specialized plumbing and electrical connections, and tailored machine-specific patient training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite these home requirements, most of our patients found these modifications manageable and the machine easy and intuitive to operate. Our experience supports the B. Braun machine as another practical option for home HD, including nocturnal HD treatments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"4-9"},"PeriodicalIF":1.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christine L. Meyer-Olesen, Merete B. Christensen, Dea H. Kofod, Mads Hornum, Kirsten Nørgaard, Tobias Bomholt
Introduction
Diabetes management in hemodialysis patients is complicated by limited treatment options and challenges in glycemic monitoring. Continuous glucose monitoring (CGM) provides detailed glucose profiles, enabling tailored glucose-lowering therapy.
Methods
This case series presents three insulin-treated hemodialysis patients with type 1 or type 2 diabetes.
Findings
Each case reveals significant glycemic abnormalities, including excessive hyperglycemia with nocturnal glucose drops, unrecognized hypoglycemia, and extreme glucose variability. We propose specific personalized insulin adjustments based on CGM readings to optimize treatment across these different clinical scenarios.
Conclusions
The case series highlights the potential to rethink glucose monitoring in hemodialysis patients with diabetes and underlines the need for future studies evaluating CGM use in this population.
{"title":"Practical Use of Continuous Glucose Monitoring to Adjust Glucose-Lowering Therapy in Hemodialysis Patients: A Case Series","authors":"Christine L. Meyer-Olesen, Merete B. Christensen, Dea H. Kofod, Mads Hornum, Kirsten Nørgaard, Tobias Bomholt","doi":"10.1111/hdi.70024","DOIUrl":"10.1111/hdi.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Diabetes management in hemodialysis patients is complicated by limited treatment options and challenges in glycemic monitoring. Continuous glucose monitoring (CGM) provides detailed glucose profiles, enabling tailored glucose-lowering therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This case series presents three insulin-treated hemodialysis patients with type 1 or type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Each case reveals significant glycemic abnormalities, including excessive hyperglycemia with nocturnal glucose drops, unrecognized hypoglycemia, and extreme glucose variability. We propose specific personalized insulin adjustments based on CGM readings to optimize treatment across these different clinical scenarios.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The case series highlights the potential to rethink glucose monitoring in hemodialysis patients with diabetes and underlines the need for future studies evaluating CGM use in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"296-301"},"PeriodicalIF":1.2,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vikram Mitra, Victoria Jackson, John Woods, Sandip Mitra, Kunaal Kharbanda
Background
The majority of growth in the rising dialysis population remains within in-center hemodialysis, stretching capacity. Despite national strategies promoting home hemodialysis, uptake remains low. Assisted home hemodialysis may overcome challenges by supporting patients who wish to dialyse at home but require assistance. This study aimed to evaluate the feasibility, interest, and operational implications of assisted home HD through multi-modal data collection amongst prevalent in-center HD patients and staff members.
Methods
A feasibility study incorporating patient surveys, focus groups, and care model development was conducted recruiting from three renal centers in the United Kingdom. Outcomes measured utilized structured patient questionnaires to assess patient perspectives, interest in assisted home HD, and assistance needs. Focus groups explored barriers and concerns regarding delivery. Hypothetical cost modeling was estimated.
Findings
Four hundred and sixty-five in-center hemodialysis patients from three UK centers participated, with a median age of 66 years. 34% of patients, a significantly younger (p < 0.01) group with higher disability (p < 0.05), answered “yes” when asked if they would consider a switch to assisted home HD, compared with 44% who answered “no”, and 22% were unsure. Patients expressed varying degrees of assistance needs across dialysis tasks, with cannulation (65%), machine connection (51%), and set-up (38%). Patients voiced concerns about safety during home treatment and missing social aspects of in-center care, though many also expressed a desire for greater autonomy. Five key themes emerged around staffing practices in implementing assisted home HD, which included (i) boundaries of care, (ii) staff training and supervision, (iii) staff responsibility, (iv) back-up and support requirements, and (v) implementation strategies.
Conclusions
Assisted home HD demonstrates a feasible and desirable option for in-center dialysis patients. Assisted home HD presents as a potential model for overcoming barriers to home HD adoption by prevalent HD patients. Assisted home HD care models should explore varying levels of assistance at home. The findings of this study merit further exploration through implementation pilots and outcomes-based studies.
{"title":"In-Center Dialysis Patients' and Staff Perspectives of Assisted Home Hemodialysis: A Three-Phase Feasibility Study","authors":"Vikram Mitra, Victoria Jackson, John Woods, Sandip Mitra, Kunaal Kharbanda","doi":"10.1111/hdi.70027","DOIUrl":"10.1111/hdi.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The majority of growth in the rising dialysis population remains within in-center hemodialysis, stretching capacity. Despite national strategies promoting home hemodialysis, uptake remains low. Assisted home hemodialysis may overcome challenges by supporting patients who wish to dialyse at home but require assistance. This study aimed to evaluate the feasibility, interest, and operational implications of assisted home HD through multi-modal data collection amongst prevalent in-center HD patients and staff members.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A feasibility study incorporating patient surveys, focus groups, and care model development was conducted recruiting from three renal centers in the United Kingdom. Outcomes measured utilized structured patient questionnaires to assess patient perspectives, interest in assisted home HD, and assistance needs. Focus groups explored barriers and concerns regarding delivery. Hypothetical cost modeling was estimated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Four hundred and sixty-five in-center hemodialysis patients from three UK centers participated, with a median age of 66 years. 34% of patients, a significantly younger (<i>p</i> < 0.01) group with higher disability (<i>p</i> < 0.05), answered “yes” when asked if they would consider a switch to assisted home HD, compared with 44% who answered “no”, and 22% were unsure. Patients expressed varying degrees of assistance needs across dialysis tasks, with cannulation (65%), machine connection (51%), and set-up (38%). Patients voiced concerns about safety during home treatment and missing social aspects of in-center care, though many also expressed a desire for greater autonomy. Five key themes emerged around staffing practices in implementing assisted home HD, which included (i) boundaries of care, (ii) staff training and supervision, (iii) staff responsibility, (iv) back-up and support requirements, and (v) implementation strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Assisted home HD demonstrates a feasible and desirable option for in-center dialysis patients. Assisted home HD presents as a potential model for overcoming barriers to home HD adoption by prevalent HD patients. Assisted home HD care models should explore varying levels of assistance at home. The findings of this study merit further exploration through implementation pilots and outcomes-based studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"30-36"},"PeriodicalIF":1.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Double-filtration plasmapheresis is an advanced extracorporeal blood purification technique that selectively removes pathogenic macromolecules based on molecular weight. Unlike conventional plasma exchange, double-filtration plasmapheresis uses a two-step filtration process to retain beneficial plasma components such as albumin, while eliminating harmful substances, thereby reducing the need for exogenous plasma replacement. Over the last few decades, double-filtration plasmapheresis has gained prominence in the management of refractory autoimmune, neurological, metabolic, and renal diseases. This review systematically examines the therapeutic mechanisms, recent clinical advances, safety, limitations, and prospects of double-filtration plasmapheresis.
{"title":"Recent Progress in Double Filtration Plasmapheresis","authors":"Dan Li, Xiaoqiang Liu, Yuhan Wang, Wenxuan Ji","doi":"10.1111/hdi.70026","DOIUrl":"10.1111/hdi.70026","url":null,"abstract":"<p>Double-filtration plasmapheresis is an advanced extracorporeal blood purification technique that selectively removes pathogenic macromolecules based on molecular weight. Unlike conventional plasma exchange, double-filtration plasmapheresis uses a two-step filtration process to retain beneficial plasma components such as albumin, while eliminating harmful substances, thereby reducing the need for exogenous plasma replacement. Over the last few decades, double-filtration plasmapheresis has gained prominence in the management of refractory autoimmune, neurological, metabolic, and renal diseases. This review systematically examines the therapeutic mechanisms, recent clinical advances, safety, limitations, and prospects of double-filtration plasmapheresis.</p>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"18-25"},"PeriodicalIF":1.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A serum transferrin (transferrin) level below 200 mg/dL has been suggested as an indicator of malnutrition in hemodialysis (HD) patients. We investigated the relationships among transferrin levels, various markers of malnutrition, and 1-year mortality in this patient population.
Methods
We assessed transferrin, ferritin, and transferrin saturation (TSAT) five times over 1 year. We also measured baseline serum albumin, C-reactive protein (CRP), geriatric nutritional risk index (GNRI), Kt/Vurea, post-dialysis body composition (using bioimpedance analysis), and 1-year mortality.
Findings
Our study included 431 HD patients (mean age: 67 ± 11 years; median dialysis duration: 67 [35–138] months; diabetes prevalence: 45%). Patients with baseline transferrin ≥ 200 mg/dL had consistently and significantly higher transferrin concentrations throughout the study (p < 0.001). Compared to patients with baseline transferrin < 200 mg/dL (n = 285), those with baseline transferrin ≥ 200 mg/dL (n = 146) showed significantly higher serum albumin (3.7 [3.4–3.9] vs. 3.4 [3.1–3.7] g/dL), GNRI (95 [90–98] vs. 90 [85–95]), and lean tissue index (11.2 [9.5–13.3] vs. 10.3 [9.0–12.1] kg/m2). Conversely, they had significantly lower TSAT (22% ± 12% vs. 27% ± 14%), ferritin (74 ± 79 vs. 172 ± 148 ng/mL), and CRP (p < 0.01 for all). Baseline serum albumin, Kt/Vurea, and the presence of diabetes were significant determinants of having a baseline transferrin level ≥ 200 mg/dL (p < 0.05). Over the 1-year period, 45 all-cause deaths occurred among the 431 patients. Patients with baseline transferrin ≥ 200 mg/dL had a significantly higher cumulative 1-year survival rate (p < 0.05). Furthermore, baseline transferrin was a significant predictor of 1-year all-cause mortality in HD patients (hazard ratio: 0.99; p < 0.05).
Discussion
Our findings indicate that HD patients with baseline transferrin ≥ 200 mg/dL exhibit a better nutritional status than those with transferrin < 200 mg/dL. Moreover, baseline transferrin serves as a significant predictor for 1-year mortality in HD patients.
{"title":"Associations Among Serum Transferrin Levels, Markers of Malnutrition, and Mortality in Hemodialysis Patients","authors":"Sonoo Mizuiri, Yoshiko Nishizawa, Toshiki Doi, Aiko Okubo, Kenichi Morii, Kenichiro Shigemoto, Kazuomi Yamashita, Tetsuji Arakawa, Takao Masaki","doi":"10.1111/hdi.70018","DOIUrl":"10.1111/hdi.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>A serum transferrin (transferrin) level below 200 mg/dL has been suggested as an indicator of malnutrition in hemodialysis (HD) patients. We investigated the relationships among transferrin levels, various markers of malnutrition, and 1-year mortality in this patient population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We assessed transferrin, ferritin, and transferrin saturation (TSAT) five times over 1 year. We also measured baseline serum albumin, C-reactive protein (CRP), geriatric nutritional risk index (GNRI), Kt/Vurea, post-dialysis body composition (using bioimpedance analysis), and 1-year mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Our study included 431 HD patients (mean age: 67 ± 11 years; median dialysis duration: 67 [35–138] months; diabetes prevalence: 45%). Patients with baseline transferrin ≥ 200 mg/dL had consistently and significantly higher transferrin concentrations throughout the study (<i>p</i> < 0.001). Compared to patients with baseline transferrin < 200 mg/dL (<i>n</i> = 285), those with baseline transferrin ≥ 200 mg/dL (<i>n</i> = 146) showed significantly higher serum albumin (3.7 [3.4–3.9] vs. 3.4 [3.1–3.7] g/dL), GNRI (95 [90–98] vs. 90 [85–95]), and lean tissue index (11.2 [9.5–13.3] vs. 10.3 [9.0–12.1] kg/m<sup>2</sup>). Conversely, they had significantly lower TSAT (22% ± 12% vs. 27% ± 14%), ferritin (74 ± 79 vs. 172 ± 148 ng/mL), and CRP (<i>p</i> < 0.01 for all). Baseline serum albumin, Kt/Vurea, and the presence of diabetes were significant determinants of having a baseline transferrin level ≥ 200 mg/dL (<i>p</i> < 0.05). Over the 1-year period, 45 all-cause deaths occurred among the 431 patients. Patients with baseline transferrin ≥ 200 mg/dL had a significantly higher cumulative 1-year survival rate (<i>p</i> < 0.05). Furthermore, baseline transferrin was a significant predictor of 1-year all-cause mortality in HD patients (hazard ratio: 0.99; <i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our findings indicate that HD patients with baseline transferrin ≥ 200 mg/dL exhibit a better nutritional status than those with transferrin < 200 mg/dL. Moreover, baseline transferrin serves as a significant predictor for 1-year mortality in HD patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"207-214"},"PeriodicalIF":1.2,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmad Mahdi Ahmad, Mona Mohammed Ghareeb, Ahmed Ezzat Mansour, Heba Ahmed Mousa
Introduction
Functional capacity deteriorates over time in patients on hemodialysis, which is associated with increased mortality risk. This study aimed to assess the effects of two low-frequency (i.e., twice weekly) intradialytic cycling exercise training programs—low- to moderate-intensity continuous training (L-MICT) versus moderate- to high-intensity interval training (M-HIIT) — on functional capacity in patients undergoing hemodialysis.
Methods
Sixty-seven out of sixty-nine patients undergoing hemodialysis of both sexes (44 men and 23 women), aged 35–55 years, completed this study. Patients were randomly assigned to three groups: L-MICT group (n = 23), M-HIIT group (n = 21), and nonexercise control group (n = 23). Patients in the L-MICT group performed intradialytic cycling exercise continuously at a low-to moderate-intensity for 20–30 min. Patients in the M-HIIT group performed 3 × 3-min moderate- to high-intensity cycling exercise, separated by 4-min low-intensity active breaks. The intradialytic cycling programs were scheduled twice a week for 8 weeks. The outcome measure was the functional capacity assessed by the 6-min walk test (6MWT).
Findings
The 6-min walk distance (6MWD) increased significantly in the L-MICT group [p = 0.004, the change score (Δ) = 18.2 meters (m)], in the M-HIIT group (p = 0.001, Δ = 17.6 m), and in the control group (p = 0.014, Δ = 11.4 m) compared to baseline. However, no significant differences were found between groups.
Discussion
Low-frequency intradialytic cycling training programs, either L-MICT or M-HIIT, twice a week for 8 weeks, could similarly induce statistically significant improvements in the 6MWD in people receiving hemodialysis. Nevertheless, the 6MWD changes did not exceed the minimally detectable change previously reported in this population.
{"title":"Effects of Two Low-Frequency Intradialytic Cycling Training Programs on Functional Capacity in Subjects Undergoing Hemodialysis: A Randomized Controlled Trial","authors":"Ahmad Mahdi Ahmad, Mona Mohammed Ghareeb, Ahmed Ezzat Mansour, Heba Ahmed Mousa","doi":"10.1111/hdi.70017","DOIUrl":"10.1111/hdi.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Functional capacity deteriorates over time in patients on hemodialysis, which is associated with increased mortality risk. This study aimed to assess the effects of two low-frequency (i.e., twice weekly) intradialytic cycling exercise training programs—low- to moderate-intensity continuous training (L-MICT) versus moderate- to high-intensity interval training (M-HIIT) — on functional capacity in patients undergoing hemodialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty-seven out of sixty-nine patients undergoing hemodialysis of both sexes (44 men and 23 women), aged 35–55 years, completed this study. Patients were randomly assigned to three groups: L-MICT group (<i>n</i> = 23), M-HIIT group (<i>n</i> = 21), and nonexercise control group (<i>n</i> = 23). Patients in the L-MICT group performed intradialytic cycling exercise continuously at a low-to moderate-intensity for 20–30 min. Patients in the M-HIIT group performed 3 × 3-min moderate- to high-intensity cycling exercise, separated by 4-min low-intensity active breaks. The intradialytic cycling programs were scheduled twice a week for 8 weeks. The outcome measure was the functional capacity assessed by the 6-min walk test (6MWT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The 6-min walk distance (6MWD) increased significantly in the L-MICT group [<i>p</i> = 0.004, the change score (Δ) = 18.2 meters (m)], in the M-HIIT group (<i>p</i> = 0.001, Δ = 17.6 m), and in the control group (<i>p</i> = 0.014, Δ = 11.4 m) compared to baseline. However, no significant differences were found between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Low-frequency intradialytic cycling training programs, either L-MICT or M-HIIT, twice a week for 8 weeks, could similarly induce statistically significant improvements in the 6MWD in people receiving hemodialysis. Nevertheless, the 6MWD changes did not exceed the minimally detectable change previously reported in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"251-257"},"PeriodicalIF":1.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiaoqi Wang, Dan Yuan, Feng Shao, Conghui Liu, Xiao Zhang, Zhongxin Li
Background
Cardiac valve calcification is a serious complication in patients with cardiovascular disease. This study investigated the relationship between visfatin levels and cardiac valve calcification in individuals undergoing hemodialysis.
Methods
We conducted a cross-sectional study at Beijing Luhe Hospital of Capital Medical University, enrolling 339 maintenance hemodialysis patients between June 2023 and May 2024. We collected baseline data including sex, age, underlying diseases, electrolyte levels, and parathyroid hormone levels. Patients were categorized into cardiac valve calcification and non-cardiac valve calcification groups based on echocardiogram findings; we analyzed associations between valve calcification and clinical data.
Results
Of the 339 hemodialysis patients, 186 (55.8%) were male, with an average age of 66.1 ± 12.5 years and a mean dialysis duration of 58.7 ± 45.3 months. Cardiac valve calcification was present in 36.7% of patients. Compared to the non-cardiac valve calcification group, patients with cardiac valve calcification were significantly older, had longer dialysis durations, a higher prevalence of coronary heart disease, longer histories of hypertension, elevated intact parathyroid hormone levels, and increased visfatin levels (p < 0.05). Logistic regression analysis identified advanced age, prolonged dialysis duration, an extended hypertension history, and elevated serum visfatin as factors associated with valve calcification.
Conclusion
Our findings indicate that cardiac valve calcification is significantly linked to advanced age and higher visfatin concentrations in hemodialysis patients. Calcium and phosphate levels did not show significant group differences in this study.
{"title":"Serum Visfatin Level and Cardiac Valve Calcifcation in Hemodialysis Patients","authors":"Xiaoqi Wang, Dan Yuan, Feng Shao, Conghui Liu, Xiao Zhang, Zhongxin Li","doi":"10.1111/hdi.70019","DOIUrl":"10.1111/hdi.70019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac valve calcification is a serious complication in patients with cardiovascular disease. This study investigated the relationship between visfatin levels and cardiac valve calcification in individuals undergoing hemodialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study at Beijing Luhe Hospital of Capital Medical University, enrolling 339 maintenance hemodialysis patients between June 2023 and May 2024. We collected baseline data including sex, age, underlying diseases, electrolyte levels, and parathyroid hormone levels. Patients were categorized into cardiac valve calcification and non-cardiac valve calcification groups based on echocardiogram findings; we analyzed associations between valve calcification and clinical data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 339 hemodialysis patients, 186 (55.8%) were male, with an average age of 66.1 ± 12.5 years and a mean dialysis duration of 58.7 ± 45.3 months. Cardiac valve calcification was present in 36.7% of patients. Compared to the non-cardiac valve calcification group, patients with cardiac valve calcification were significantly older, had longer dialysis durations, a higher prevalence of coronary heart disease, longer histories of hypertension, elevated intact parathyroid hormone levels, and increased visfatin levels (<i>p</i> < 0.05). Logistic regression analysis identified advanced age, prolonged dialysis duration, an extended hypertension history, and elevated serum visfatin as factors associated with valve calcification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings indicate that cardiac valve calcification is significantly linked to advanced age and higher visfatin concentrations in hemodialysis patients. Calcium and phosphate levels did not show significant group differences in this study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"101-109"},"PeriodicalIF":1.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hesham Kamal Habeeb Keryakos, Christina Rafat Kamal, Aliaa Mohamed Monir Higazi
Introduction
Catheter-related bloodstream infections (CRBSI) represent a major cause of morbidity and mortality in hemodialysis (HD) patients. Current diagnostic reliance on blood cultures leads to delays in treatment initiation, underscoring the need for rapid biomarkers. Emerging evidence suggests that CD4+CD25+CD39+ regulatory T cells (Tregs) may serve as indicators of immune dysregulation during CRBSI. This study aimed to: (1) evaluate CD4+CD25+CD39+ Tregs as diagnostic biomarkers for CRBSI in HD patients, (2) compare the reliability of dialysis bloodline cultures versus peripheral venipuncture cultures, and (3) determine optimal fever thresholds for CRBSI prediction.
Methods
In this prospective cohort study, we enrolled 87 HD patients with suspected CRBSI (42 confirmed CRBSI, 45 non-CRBSI controls). Treg frequencies were quantified using flow cytometry. Paired blood cultures were obtained simultaneously from dialysis bloodlines and peripheral veins. CRBSI was confirmed using CDC criteria (≥ 3-fold higher colony count or ≥ 2-h earlier positivity in catheter-derived cultures).
Findings
CRBSI patients showed markedly elevated Treg frequencies (14.1% ± 4.5% vs. 3.3% ± 2.8%, p < 0.001) with outstanding diagnostic accuracy (AUC 0.974, 98.3% sensitivity, 96.3% specificity). Dialysis bloodline cultures demonstrated excellent concordance with peripheral cultures (92% agreement, κ = 0.88). Fever > 38.0°C strongly predicted CRBSI (OR 18.67, p < 0.001; 85% specificity). The diagnostic triad of Tregs > 10%, CRP > 50 mg/L, and fever > 38.0°C achieved exceptional discrimination (AUC 0.93).
Discussion
CD4+CD25+CD39+ Tregs represent a novel, high-performance biomarker for CRBSI. Combined with validated dialysis line cultures and fever thresholds, they enable rapid diagnosis and early intervention, offering a practical alternative to current culture-dependent approaches in hemodialysis patients.
导述：导管相关性血流感染（CRBSI）是血液透析（HD）患者发病和死亡的主要原因。目前对血液培养的诊断依赖导致了治疗开始的延迟，强调了对快速生物标志物的需求。新出现的证据表明，CD4+CD25+CD39+调节性T细胞（Tregs）可能是CRBSI期间免疫失调的指标。本研究旨在：(1)评估CD4+CD25+CD39+ Tregs作为HD患者CRBSI的诊断生物标志物，(2)比较透析血培养与外周静脉穿刺培养的可靠性，以及(3)确定预测CRBSI的最佳发热阈值。方法：在这项前瞻性队列研究中，我们招募了87例疑似CRBSI的HD患者（42例确诊CRBSI， 45例非CRBSI对照）。流式细胞术定量Treg频率。同时从透析血液系和外周静脉获得配对血培养。CRBSI采用CDC标准确诊（集落计数≥3倍或导管培养≥2小时早期阳性）。结果：CRBSI患者Treg频率明显升高（14.1%±4.5% vs. 3.3%±2.8%），p 38.0°C强烈预测CRBSI (OR 18.67, p 10%), CRP > 50 mg/L，发热> 38.0°C具有特殊区别（AUC 0.93）。讨论：CD4+CD25+CD39+ treg代表了一种新的、高性能的CRBSI生物标志物。与有效的透析培养和发热阈值相结合，它们能够快速诊断和早期干预，为血液透析患者提供了一种替代目前依赖培养方法的实用方法。
{"title":"CD4+CD25+CD39+ Regulatory T Cells as Novel Diagnostic Biomarkers for Catheter-Related Bloodstream Infections in Hemodialysis Patients","authors":"Hesham Kamal Habeeb Keryakos, Christina Rafat Kamal, Aliaa Mohamed Monir Higazi","doi":"10.1111/hdi.70021","DOIUrl":"10.1111/hdi.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Catheter-related bloodstream infections (CRBSI) represent a major cause of morbidity and mortality in hemodialysis (HD) patients. Current diagnostic reliance on blood cultures leads to delays in treatment initiation, underscoring the need for rapid biomarkers. Emerging evidence suggests that CD4<sup>+</sup>CD25<sup>+</sup>CD39<sup>+</sup> regulatory T cells (Tregs) may serve as indicators of immune dysregulation during CRBSI. This study aimed to: (1) evaluate CD4<sup>+</sup>CD25<sup>+</sup>CD39<sup>+</sup> Tregs as diagnostic biomarkers for CRBSI in HD patients, (2) compare the reliability of dialysis bloodline cultures versus peripheral venipuncture cultures, and (3) determine optimal fever thresholds for CRBSI prediction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective cohort study, we enrolled 87 HD patients with suspected CRBSI (42 confirmed CRBSI, 45 non-CRBSI controls). Treg frequencies were quantified using flow cytometry. Paired blood cultures were obtained simultaneously from dialysis bloodlines and peripheral veins. CRBSI was confirmed using CDC criteria (≥ 3-fold higher colony count or ≥ 2-h earlier positivity in catheter-derived cultures).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>CRBSI patients showed markedly elevated Treg frequencies (14.1% ± 4.5% vs. 3.3% ± 2.8%, <i>p</i> < 0.001) with outstanding diagnostic accuracy (AUC 0.974, 98.3% sensitivity, 96.3% specificity). Dialysis bloodline cultures demonstrated excellent concordance with peripheral cultures (92% agreement, κ = 0.88). Fever > 38.0°C strongly predicted CRBSI (OR 18.67, <i>p</i> < 0.001; 85% specificity). The diagnostic triad of Tregs > 10%, CRP > 50 mg/L, and fever > 38.0°C achieved exceptional discrimination (AUC 0.93).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>CD4<sup>+</sup>CD25<sup>+</sup>CD39<sup>+</sup> Tregs represent a novel, high-performance biomarker for CRBSI. Combined with validated dialysis line cultures and fever thresholds, they enable rapid diagnosis and early intervention, offering a practical alternative to current culture-dependent approaches in hemodialysis patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"138-148"},"PeriodicalIF":1.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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