Hemodialysis International最新文献

We describe a case of severe symptomatic tumoral calcinosis in a young man with end stage kidney disease secondary to antineutrophil cytoplasmic antibodies-associated vasculitis with longstanding hyperphosphatemia and secondary hyperparathyroidism while on several years of peritoneal dialysis. The use of intravenous sodium thiosulfate, optimization of clearance with five times weekly hemodialysis, and intradialytic nutrition were used to treat his inoperable tumoral calcinosis. Over 3 months, he had a remarkable reduction in the size of his calcified masses and associated improvement in pain. He subsequently received a living donor kidney transplant.

Psoriasis is an immune-mediated chronic inflammatory skin disease and chronic kidney disease is one of the common comorbidities of psoriasis. Ixekizumab, a humanized IgG4 monoclonal antibody, has been approved for the treatment of moderate-to-severe plaque psoriasis in recent years. However, ixekizumab has not been studied in a population of patients with renal insufficiency. We report two cases of plaque psoriasis patients with renal dysfunction successfully treated with ixekizumab without dose reduction，which experience no side effects and does not cause further kidney injury.

End stage kidney disease (ESKD) patients in the developing countries often present late for dialysis initiation with advanced uremia and life-threatening complications. Urgent start dialysis in such emergent situations exposes the patient to risk of uremia related complications as well as iatrogenic insults. We report the case of a middle-aged man with ESKD who presented late with acute pulmonary edema and hyperkalemia and developed osmotic demyelination syndrome following urgent start hemodialysis. Osmotic demyelination syndrome in this patient is noteworthy since there was no accompanying hyponatremia, the most commonly recognized antecedent. We propose that rapid lowering of serum osmolality by aggressive hemodialysis is sufficient to incite osmotic demyelination syndrome in patients who have long-standing uremia and high blood urea level. Malnutrition resulting from uremia might be a compounding factor in this scenario. Our patient had a characteristic initial presentation of osmotic demyelination syndrome with locked-in-state which later progressed to respiratory failure and death.

This commentary delves into the complexities surrounding chronic kidney disease management in Pakistan, specifically examining the critical role played by renal satellite units in providing accessible dialysis services. Chronic kidney disease in Pakistan accounts for 3.9% of total deaths, warranting a focused exploration of challenges and potential solutions. RSUs, smaller entities affiliated with main renal units, emerge as key players in addressing issues of geographic accessibility and diminishing travel burdens for chronic kidney disease patients. Challenges such as financial constraints, limited resources, and staff shortages, particularly in rural settings, pose significant hurdles to the effective functioning of RSUs. This commentary emphasizes the importance of clear eligibility criteria, robust vascular access support, regular physician engagement, and the strategic integration of telemedicine. It explores diverse funding models, including government allocations, community contributions, and philanthropic partnerships, as potential solutions to alleviate cost-related concerns. The commentary advocates for a holistic, cost-effective approach to chronic kidney disease care, highlighting the transformative potential of renal satellite units in improving health outcomes across varied settings.

We present a 60-year-old maintenance hemodialysis patient who initially presented with neck swelling, which was diagnosed as a thyroid issue. Following a hemodialysis session, the swelling in the neck progressively enlarged, leading to respiratory distress and eventual cardiac arrest. During a life-saving tracheotomy, dark red blood was observed, and endotracheal intubation was urgently performed. Subsequent computed tomography examination identified multiple areas of slight high-density images in the nasopharyngeal cavity, oropharyngeal cavity, and esophagus. As time passed, the patient's hematoma underwent spontaneous absorption, but signs of recovery were absent. We discuss the rarity, etiology, diagnosis, and management of spontaneous neck hematoma in maintenance hemodialysis patients.

Unfractionated heparin is the most used anticoagulative agent for extracorporeal settings in children, including acute hemodialysis modalities. In certain situations, such as heparin-induced thrombocytopenia, alternatives must be applied. The direct thrombin inhibitor bivalirudin has come forth as an attractive substitute. Bivalirudin is currently only approved for adult use in specific percutaneous coronary intervention settings. However, it has a growing off-label popularity in different contexts for both adult and pediatric patients. Experience with bivalirudin in children is mainly limited to extracorporeal membrane oxygenation, ventricular assist devices and during cardiopulmonary bypass surgery. Literature about its use as anticoagulation strategy for pediatric hemodialysis is very scarce. Here, we present two pediatric cases where bivalirudin was used during acute hemodialysis, followed by a short summary of recent literature.