Seminars in Dialysis最新文献

Acute kidney injury (AKI) is a heterogeneous syndrome with multiple etiologies. It occurs frequently in the neurocritical intensive care unit and is associated with greater morbidity and mortality. In this scenario, AKI alters the kidney-brain axis, exposing patients who receive habitual dialytic management to greater injury. Various therapies have been designed to mitigate this risk. Priority has been placed by KDIGO guidelines on the use of continuous over intermittent acute kidney replacement therapies (AKRT). On this background, continuous therapies have a pathophysiological rationale in patients with acute brain injury. A low-efficiency therapy such as PD and CRRT could achieve optimal clearance control and potentially reduce the risk of secondary brain injury. Therefore, this work will review the evidence on peritoneal dialysis as a continuous AKRT in neurocritical patients, describing its benefits and risks so it may be considered as an option when deciding among available therapeutic options.

Vascular access (VA) for hemodialysis (HD) continues to be the keystone of the technique's success. The first option should be an arteriovenous fistula (AVF) or arteriovenous graft (AVG), although in some scenarios the only possibility available is a central venous catheter, which could lead to an increase in vascular complications such as thoracic central vein occlusion (TCVO), becoming a challenge for physicians. If conventional therapies cannot be performed, a new device called the Surfacer® Inside-Out® Access Catheter System (IOA) (Bluegrass Vascular Technologies, San Antonio, TX, USA) arises as a promising alternative. Here we describe the case of a patient in which we performed a combination of two techniques: sharp recanalization plus Surfacer® Inside-Out® Access Catheter System.

Introduction: The purity of water and dialysis fluids is of utmost importance in ensuring the safe and effective administration of hemodialysis treatment to patients with chronic kidney disease. It is crucial to enforce compliance with international standards for dialysis water and fluids, as this is mandatory in reducing chemical hazards, mitigating the adverse effects of bioincompatibility resulting from contaminated water and ultimately enhancing long-term patient outcomes.

Standards and risks: Within this comprehensive review, we highlight the presence of water contaminants and thoroughly assess the existing international standards for dialysis water and fluids, spanning from pure to ultrapure. Additionally, we delve into the fundamental components of water purification and present a comprehensive range of water treatment options, encompassing pre-treatment, primary treatment (reverse osmosis), and tertiary water treatment. Furthermore, we outline recommended monitoring and maintenance procedures, ensuring the consistent delivery of high-quality water and dialysis fluids at the point of care. WATER PURIFICATION AND MONITORING SUSTAINABILITY AND FUTURE CHALLENGES: Importantly, we raise concerns regarding the sustainability and conservation of water resources in hemodialysis treatment. It is imperative that these concerns be addressed in the future to avert the potential shortage of this essential resource.

Conclusion: In conclusion, the contemporary landscape of hemodialysis conditions has engendered an urgent necessity for advanced water treatment systems and optimized delivery of dialysis fluids. This review serves as a comprehensive update on the latest technological advancements aimed at meeting these critical demands. Dialysis water and fluids must adhere to increasingly stringent purity constraints, encompassing both biochemical and microbiological perspectives.

Background: In the United Kingdom, over 80% of end-stage kidney disease patients receive in-center hemodialysis. We conducted a survey of UK renal healthcare workers on their preferred dialysis modality if they needed dialysis themselves.

Methods: An anonymized online survey was disseminated to all renal healthcare workers in the United Kingdom. We asked "Assume you are an otherwise well 40-year-old (and, separately, 75-year-old) person approaching end stage kidney disease, you have no living kidney donor options at present. There are no contraindications to any dialysis options. Which dialysis therapy would you choose?" We also asked about factors influencing their choice.

Results: 858 individuals with a median age of 44.3 years responded. 70.2% were female, 37.4% doctors, and 31.1% were senior nurses. There was a preference for peritoneal dialysis over in-center hemodialysis (50.47% v. 6.18%; p < 0.001 for 40-year-old and 49.18% v. 17.83%; p < 0.001 for 75-year-old assumption) and home hemodialysis (50.47% v. 39.28%; p < 0.001 for 40-year-old and 49.18% v. 18.41% for 75-year-old assumption). There was a preference for home hemodialysis over in-center hemodialysis for 40-year-old (39.28% v. 6.18%; p < 0.001) but not for 75-year-old. On logistic regression, senior doctors were more likely to opt for PD when compared to nurses. Nurses, allied healthcare professionals, and those of Asian/British Asian ethnicity were more likely to choose in-center hemodialysis.

Conclusions: Most healthcare workers in renal medicine would choose home-based treatment for themselves although the majority of end-stage kidney disease patients receive in-center hemodialysis in the United Kingdom; the reasons for the discrepancy need to be explored.

Introduction: Sarcopenia is associated with significant cardiovascular risk, and death in patients undergoing peritoneal dialysis (PD). Three tools are used for diagnosing sarcopenia. The evaluation of muscle mass requires dual energy X-ray absorptiometry (DXA) or computed tomography (CT), which is labor-intensive and relatively expensive. This study aimed to use simple clinical information to develop a machine learning (ML)-based prediction model of PD sarcopenia.

Methods: According to the newly revised Asian Working Group for Sarcopenia (AWGS2019), patients were subjected to complete sarcopenia screening, including appendicular skeletal muscle mass, grip strength, and five-time chair stand time test. Simple clinical information such as general information, dialysis-related indices, irisin and other laboratory indices, and bioelectrical impedance analysis (BIA) data were collected. All data were randomly split into training (70%) and testing (30%) sets. Difference, correlation, univariate, and multivariate analyses were used to identify core features significantly associated with PD sarcopenia.

Result: 12 core features (C), namely, grip strength, body mass index (BMI), total body water value, irisin, extracellular water/total body water, fat-free mass index, phase angle, albumin/globulin, blood phosphorus, total cholesterol, triglyceride, and prealbumin were excavated for model construction. Two ML models, the neural network (NN), and support vector machine (SVM) were selected with tenfold cross-validation to determine the optimal parameter. The C-SVM model showed a higher area under the curve (AUC) of 0.82 (95% confidence interval [CI]: 0.67-1.00), with a highest specificity of 0.96, sensitivity of 0.91, positive predictive value (PPV) of 0.96, and negative predictive value (NPV) of 0.91.

Conclusion: The ML model effectively predicted PD sarcopenia and has clinical potential to be used as a convenient sarcopenia screening tool.

Introduction: Caffeine overdose, while uncommon, can be life threatening with hemodynamic and neurological complications and often requires intensive monitoring and critical management.

Case report: We report a case of a 23-year-old male who ingested approximately 24 g of caffeine in a suicidal attempt and developed cardiopulmonary complications. He was resuscitated, and hemodialysis was performed with successful recovery.

Conclusion: Hemodialysis appears to effectively remove caffeine from the blood system and can be lifesaving in severe caffeine overdose.

Introduction: Physical inactivity is a strong predictor of mortality in hemodialysis patients. Although regular physical activity reduces mortality, patients remain inactive. Comparing the cognition of exercise in hemodialysis patients with different physical activity status could highlight domains where inactive people experience heightened barriers to physical activity. We therefore assessed patients' perceived benefits and barriers to exercise using a standardized way, thereby informing future exercise interventions to address these barriers experienced by inactive patients.

Methods: ESRD patients undergoing hemodialysis were recruited and asked to complete a human activity profile, wear a pedometer for seven consecutive days, and complete the Dialysis Patient-perceived Exercise Benefits and Barriers Scale (DPEBBS). Binominal Logistic regression analysis was conducted to determine which benefits and barriers are associated with physical activity. This cross-sectional observational study was registered as NCT05189795.

Results: A total of 505 patients completed the survey, most of whom were male (67.1%), with an average age of 49.69 ± 13.96 years. And 52.67-76.63% patients on HAP questionnaire were inactive. The co-benefits in active patients were improving mood and prevention of muscle wasting but did not reach significance in physical activity level. Tiredness, muscle fatigue, and lack of knowledge of exercise were common barriers to patients, and all have a significant impact on a patient's physical activity level.

Conclusions: For inactive patients, exercise during hemodialysis can not only improve physical activity but also reduce family burden. And improving physical activity is a long-term project that cannot be separated from the support of hemodialysis medical staff.

Background: COVID-19 vaccinations have a central role in decreasing severe SARS-CoV-2 disease complications. This study investigated the long-term humoral immune response to BNT162b2 vaccine among hemodialysis (HD) versus peritoneal dialysis (PD) patients, and their relative risk for COVID-19 infection.

Methods: This prospective, observational study included maintenance HD and PD patients who had received at least two BNT162b2 vaccine doses. Levels of antibodies targeting SARS-CoV-2 spike protein were measured 6 and 12 months after the first vaccine dose, and 2-3 weeks after the third and fourth vaccine doses. Patients were divided according to dialysis modality (HD or PD). Humoral response was evaluated at different time points among different vaccine regimens (two vs. three vs. four doses of vaccine). An adjusted multivariate model was used to assess cumulative risk for SARS-CoV-2 infection.

Results: Eighty-seven HD and 36 PD patients were included. Among them, 106 (86%) received at least three vaccine doses. Both HD and PD patients demonstrated marked increases in humoral response 2-3 weeks after the third dose (mean anti-S antibody increased from 452 ± 501 AU/mL to 19,556 ± 14,949 AU/mL, p < 0.001). By 6 months after the third dose, antibody titers had declined significantly (mean anti-S antibody 9841 ± 10,493 AU/mL, p < 0.001). HD patients had higher risk for SARS-CoV-2 infection than PD patients (OR 4.4 [95% CI 1.4-13.6], p = 0.006). In multivariate analysis, the most important predictor for SARS-CoV-2 infection was dialysis modality.

Conclusion: This study found a high antibody response rate after the third and fourth doses of BNT162b2 vaccine among dialysis patients. Hemodialysis as dialysis modality is an important predictor of COVID-19 infection, despite similar humoral responses to vaccine in peritoneal dialysis.

We comment on the recently published to investigate hemodynamic changes in central venous stenosis patients before and after stent placement. Through the evidence, we believe that the boundary conditions in computational models and simulations of this study are incorrect in three points.

Laparoscopic implantation of a catheter through rectus sheath tunnel minimizes the risks of catheter failure and reduces some complications like catheter migration, hernias, and leaks. We described a novel method for laparoscopic catheter rectus sheath tunneling using an aspiration tube and a silk tie (Lin's tube). This material is easily available and yields a small fascial defect with an equivalent cannula size to minimize tissue disruption. The technique is feasible, reproducible and it may reduce the risks of postoperative leakage and hemorrhage.