Hemodialysis international. International Symposium on Home Hemodialysis最新文献

Introduction: Autogenous arteriovenous fistulas are the preferred vascular access for hemodialysis due to superior patency and lower infection rates compared with grafts or catheters. The brachiobasilic AV fistula provides a valuable option for patients with unsuitable veins, though it remains underutilized due to technical challenges and wound morbidity. This study aimed to evaluate the clinical outcomes, patency, and complications of brachiobasilic-AV fistula creation over a 10-year period at a tertiary vascular center.

Methods: A retrospective descriptive analysis was conducted of all patients who underwent brachiobasilic AV fistula creation between January 2014 and December 2024 at the Manmohan Cardiothoracic Vascular and Transplant Center. Demographics, comorbidities, operative details, and outcomes were obtained from hospital records and follow-up interviews. Preoperative vessel diameters were assessed using Doppler ultrasonography. Brachiobasilic AV fistulas were created using either single-stage (82.6%) or two-stage (17.4%) techniques. Statistical analysis was performed to assess maturation, patency, and complication rates (p < 0.05 considered significant).

Results: A total of 167 brachiobasilic AV fistulas were created in 158 patients (62 males, 96 females; mean age 55.6 ± 15.8 years). The most common comorbidities were hypertension (91.1%) and diabetes (49.4%). The mean basilic vein and brachial artery diameters were 3.46 ± 1.6 mm and 3.23 ± 0.8 mm, respectively. Successful maturation occurred in 141 cases (84.4%) within 6 weeks, while 21 (12.6%) experienced early failure. Primary patency was 22 ± 5 months, and secondary patency was 6 ± 2.1 months. Kaplan-Meier analysis demonstrated primary patency rates of 98%, 65%, and 28% at 1, 3, and 5 years, respectively. The most frequent complications included bleeding (40.7%), infection (12.6%), and pseudoaneurysm (11.4%).

Conclusion: For the patients with exhausted autogenous vascular access, brachiobasilic AV fistula is a viable procedure in our setting with acceptable complication and patency outcomes comparable to international standards. Outcome and postoperative complication can be reduced by adoption of newer techniques which need further evaluation considering cost and benefit issue.

Introduction: Exercise has been increasingly recognized as a safe and effective adjunct therapy for improving physiological and biochemical outcomes in dialysis patients. However, its specific impact on parathyroid hormone (PTH) regulation remains uncertain. This systematic review and meta-analysis aimed to determine the effect of exercise interventions on PTH levels in adults undergoing dialysis.

Methods: A systematic search of PubMed, Scopus, Embase, Web of Science, and Google Scholar databases was conducted up to October 31, 2025, without language or date restrictions. Eligible interventional studies compared exercise-based programs with standard dialysis care and reported quantitative PTH outcomes. Methodological quality was assessed using RoB 2.0 for randomized controlled trials and ROBINS-I for non-randomized trials. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated using a random-effects model, with subgroup, sensitivity, and publication bias analyses performed to assess the robustness of results.

Results: Nine eligible studies involving 438 dialysis patients were analyzed. Pooled results showed a significant reduction in PTH levels in the exercise groups compared with controls (SMD = -0.70; 95% CI: -1.00 to -0.40; p < 0.001). This effect remained consistent across study designs, randomized controlled trials (SMD = -0.68) and non-randomized trials (SMD = -0.72), and across both short-term (≤ 12 weeks; SMD = -0.71; 95% CI: -0.99 to -0.42) and long-term (> 12 weeks; SMD = -0.81; 95% CI: -1.37 to -0.25) interventions, with no significant subgroup difference. Sensitivity analysis confirmed that no single study significantly altered the pooled effect size, and funnel plot assessment with Egger's test indicated no publication bias (p = 0.181). Several individual trials also reported concurrent improvements in serum calcium and phosphate balance following exercise.

Conclusion: Exercise interventions significantly lower PTH levels in dialysis patients and may be integrated as a non-pharmacological adjunct to conventional secondary hyperparathyroidism management. Implementing structured physical activity during dialysis sessions can help improve mineral balance and endocrine stability. Further large-scale, multicenter randomized controlled trials with standardized protocols and longer follow-up periods are warranted to establish optimal exercise regimens for this population.

Background: Central venous catheter is indispensable to urgent start and unplanned hemodialysis. Central venous catheters are prone to infectious complications like catheter related blood stream infection (CRBSI) and malfunction. Catheter-related septic thrombophlebitis is a serious, yet underrecognized complication of CRBSI. It often presents as persistent or recurrent bacteremia and septic pulmonary embolism.

Case report: In this case report, we describe the case of an elderly woman on hemodialysis who presented with recurrent CRBSI and septic pulmonary embolism due to a right internal jugular vein non-cuffed central venous catheter-related septic thrombophlebitis. She required surgical thrombectomy since standard source control strategies like catheter removal and antibiotic therapy failed.

Conclusion: We describe the surgical approach used in this patient and highlight the importance of prompt recognition and timely surgical intervention in catheter-related septic thrombophlebitis.

Background: Patients on hemodialysis have comorbidities and malnutrition and are subject to polypharmacy, which contributes to disability and sarcopenia. These conditions increase the risk of falls and are associated with fractures, morbidities, substantial costs, nursing home admissions, hospitalization, and mortality.

Objective: This prospective study evaluated the association of physical function, postural balance, frailty, fear of falling, and quality of life with the occurrence and number of falls within a 12-month interval in patients on hemodialysis.

Methods: Patients were assessed for physical function (gait speed over 15 ft., timed up and go [TUG] test, 5-repetition sit-to-stand [5-STS] test, and handgrip strength), postural balance (Mini-Balance Evaluation Systems Test [Mini-BESTest]), frailty, fear of falling (Falls Efficacy Scale-International [FES-I]), and quality of life (36-Item Short Form Health Survey [SF-36]). Interviews were conducted for 12 months to monitor falls.

Results: One hundred twelve patients were included and the incidence rate was 1.62 falls/person-years. The occurrence of falls was associated with the TUG (OR: 1.24; 95% CI: 1.01-1.53) and 5-STS (OR: 1.11, 95% CI: 1.02-1.21) performance and frailty (OR: 7.22, 95% CI: 1.71-30.50). The number of falls was associated with the gait speed (OR: 0.22; 95% CI: 0.06-0.77), TUG test results (OR: 1.37; 95% CI: 1.16-1.62), handgrip strength (OR: 0.95; 95% CI: 0.91-0.99), Mini-BESTest (OR: 0.87; 95% CI: 0.78-0.96), frailty (OR: 4.43; 95% CI: 1.87-10.51), FES-I score (OR: 1.11; 95% CI: 1.06-1.17), and SF-36 scores in the physical functioning (OR: 0.98; 95% CI: 0.96-0.99), physical role (OR: 0.99; 95% CI: 0.98-0.99), and physical component summary (OR: 0.96; 95% CI: 0.92-0.99) domains.

Conclusions: Patients undergoing hemodialysis have a higher incidence of falls. Falls are associated with physical function, postural balance, frailty, and quality of life.

Pregnancy in women with end-stage kidney disease (ESKD) requiring dialysis remains high risk, with significant maternal and fetal complications. While fertility rates are markedly reduced in this population, advances in dialysis care and obstetric management have led to increasing reports of successful pregnancies. Important maternal adverse outcomes include early pregnancy loss, preeclampsia, polyhydramnios, and cesarean delivery, while common adverse fetal outcomes are preterm birth, low birth weight, and high neonatal intensive care utilization. Evidence consistently demonstrates that dialysis intensification-achieving longer treatment hours or targeting lower maternal blood urea nitrogen levels-correlates with improved gestational age and birth weight, thereby enhancing live birth rates. Optimizing therapy further requires individualized dialysis prescriptions, careful volume and blood pressure management, and timely adjustment of dialysate composition. A multidisciplinary approach involving nephrology, maternal-fetal medicine, obstetrics, gynecology, and neonatology is critical for care coordination. Despite these advances, significant disparities persist, particularly in access to intensive dialysis and specialized care worldwide. Future directions include strengthening obstetric nephrology training, expanding research in peritoneal and home hemodialysis during pregnancy, and establishing integrated care models. With careful planning and optimization of renal replacement therapy, maternal and fetal outcomes in this high-risk population can continue to improve. This review aims to synthesize current evidence on fertility, dialysis strategies, and maternal-fetal outcomes in pregnant women with ESKD on dialysis, while highlighting practical considerations for dialysis optimization and multidisciplinary care, thereby addressing gaps in consolidated guidance for clinicians managing this increasingly encountered high-risk population.

Introduction: Late arteriovenous fistula (AV fistula) occlusion is a major cause of morbidity in hemodialysis patients. The Systemic Immune-Inflammation Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), and Geriatric Nutritional Risk Index (GNRI) have emerged as candidate prognostic biomarkers. This study aimed to compare their predictive accuracy, evaluate their independent prognostic value, and develop a combined risk score.

Methods: This retrospective cohort study included 750 hemodialysis patients undergoing primary AV fistula creation. Baseline Systemic Immune-Inflammation Index, Neutrophil-to-Lymphocyte Ratio, and Geriatric Nutritional Risk Index were collected preoperatively. The primary outcome was late AV fistula occlusion (> 90 days). Predictive performance was assessed using ROC analysis and Cox proportional hazards regression.

Findings: Over a median follow-up of 48 months, 38.0% of patients developed late AV fistula occlusion. Systemic Immune-Inflammation Index demonstrated the highest predictive accuracy (AUC: 0.79), significantly outperforming Geriatric Nutritional Risk Index (p < 0.001). In multivariate analysis, Systemic Immune-Inflammation Index > 850 (Hazard ratios 3.15, 95% CI: 2.28-4.35), Neutrophil-to-Lymphocyte Ratio > 4.5 (Hazard ratios 2.78, 95% CI: 2.02-3.82), and Geriatric Nutritional Risk Index < 92 (Hazard ratios 1.92, 95% CI: 1.41-2.62) were independent predictors. A combined risk score integrating these biomarkers achieved superior discrimination (AUC: 0.83). Baseline vascular diameters were not independently associated with occlusion risk in this cohort.

Discussion: The synergistic interaction between inflammation and malnutrition identifies a distinct high-risk phenotype. The combined risk score is a readily implementable tool that may support personalized surveillance strategies to improve long-term AV fistula outcomes in hemodialysis patients.

Introduction: The relationship between serum calcium levels at the initiation of hemodialysis and coronary artery calcium score (CACS) remains unclear. This study examined whether albumin-corrected calcium (correctedCa; Payne's formula) and ionized calcium (ionizedCa) measured at dialysis initiation are associated with CACS assessed by screening coronary computed tomography.

Methods: This single-center cross-sectional study included 176 adults who initiated hemodialysis between 2015 and 2023 and underwent coronary computed tomography with CACS measurement within ±30 days. Restricted cubic spline (RCS) logistic regression was used to evaluate the associations of correctedCa and ionizedCa with CACS ≥ 400, adjusting for clinical covariates. Subgroup analyses were performed according to the median serum albumin level. For models in which nonlinearity was not significant, logistic models treating the variable as a linear term were fitted to calculate odds ratios (OR) per 1-standard deviation (SD) increase.

Findings: The mean age was 70.9 years, 32.9% were women, 54.3% had diabetes, and the mean eGFR was 5.45 mL/min/1.73 m². Higher calcium levels were associated with higher CACS. ionizedCa showed a linear association with CACS ≥ 400 (OR per 1-SD, 1.51; 95% CI, 1.08-2.11). correctedCa also showed a statistically linear association (OR per 1-SD, 1.53; 95% CI, 1.09-2.13), although the RCS curve visually plateaued at higher correctedCa levels. Subgroup analyses revealed that this convex pattern was driven by the low-albumin group.

Discussion: Higher calcium at hemodialysis initiation was associated with increased coronary calcification. ionizedCa tended to show a more stable linear relationship with CACS than correctedCa, as correctedCa may overestimate ionizedCa in patients with low albumin. Measurement of ionizedCa at dialysis initiation may help refine vascular calcification risk stratification as patients enter the dialysis period.

Introduction: Patients with end-stage renal disease (ESRD) undergoing chronic hemodialysis (HD) frequently report the sensation of prostration, tiredness, weakness, exhaustion, weariness, or fatigue after the hemodialysis treatment. This condition is defined as post-dialysis fatigue and significantly impairs patients' ability to perform routine daily activities. The present study aims to investigate whether territorial or environmental factors such as differences in geographic areas are associated with the prevalence and characteristics of post-dialysis fatigue and time to recovery after dialysis among chronic HD patients.

Methods: A total of 465 patients from six Italian HD units, located in both northern and central Italy, were enrolled between January and December 2024. Exclusion criteria included a dialysis duration of less than 1 year and a diagnosis of dementia, acute infectious disease, or active cancer. For each participant, demographic, clinical, and laboratory data were collected.

Findings: The results showed that 61.5% of the patients reported suffering from post-dialysis fatigue. The prevalence and characteristics of post-dialysis fatigue, as well as the length of time to recovery after dialysis, varied significantly among the six HD units. Multivariate analyses revealed that the hemodialysis unit itself was the main variable significantly and independently associated with both post-dialysis fatigue and time to recovery after dialysis.

Conclusions: Our findings suggest that environmental factors such as differences in geographic areas are associated with the prevalence and characteristics of post-dialysis fatigue and time to recovery after dialysis among chronic HD patients.

Background: Hemodiafiltration has demonstrated improved outcomes in end-stage kidney disease, particularly with higher convection volumes than conventional hemodialysis. However, data on multiethnic Asian populations remain limited. This study evaluated the feasibility of achieving relatively high targeted convection volumes in hemodiafiltration in patients with end-stage kidney disease in Singapore.

Methods: This retrospective cohort analysis included 1404 patients undergoing hemodiafiltration between 2019 and 2023 at Fresenius Kidney Care clinics in Singapore using data obtained from the EuCliD database. Patients aged ≥ 18 years and on hemodiafiltration for > 3 months were included. Multivariate regression models were used to assess the factors associated with the attainment of convection volume.

Results: Over 291,000 hemodiafiltration sessions were analyzed. The mean convection volumes achieved were 21.8 L in post-dilution and 40.8 L in pre-dilution mode. Higher blood flow rates and treatment durations were significantly associated with relatively high targeted convection volume (p < 0.001). The distribution of convection volume was similar among Chinese, Indian, and Malay patients. Ethnicity, age, and vascular access were not significant predictors. Approximately 29% of the variation in achieved convection volume was attributable to center-related factors.

Conclusion: Relatively high targeted convection volume in hemodiafiltration was consistently achieved across a multiethnic cohort in Singapore. These findings support the feasibility of delivering high-volume hemodiafiltration to diverse real-world settings.

Purpose: To investigate the association between postdialysis fatigue (PDF) and physical and emotional symptoms in patients receiving maintenance hemodialysis.

Methods: All prevalent patients undergoing maintenance hemodialysis at our Hemodialysis Service between June 2022 and September 2024 were considered eligible. The Dialysis Symptom Index questionnaire was administered during dialysis sessions. PDF was assessed using the approach recommended by Sklar et al. Patients were classified as having PDF if they spontaneously reported feeling fatigued after dialysis in response to the question: "Do you feel fatigued after dialysis?"

Results: A total of 269 patients were studied: 220 with PDF and 49 without. Patients with PDF were significantly older and had a higher Charlson comorbidity index. The median [95% CI] number of symptoms was 13 [12-14] in patients with PDF versus 7 [6-8.8] in those without (p < 0.0001). In multivariable logistic regression, PDF was independently associated with the Charlson comorbidity index (odds ratio [95% CI]: 1.41 [1.08-1.85], p = 0.010) and the total number of symptoms (1.27 [1.16-1.40], p < 0.0001). The prevalence of 15 out of 29 symptoms was significantly higher in patients with PDF. After adjustment, PDF remained independently associated with swelling in the legs (OR [95% CI]: 12.8 [1.43-113.9], p = 0.022), restless legs (3.41 [0.98-11.8], p = 0.052), difficulty concentrating (8.24 [2.12-32.1], p = 0.002), difficulty becoming sexually aroused (6.00 [2.58-13.9], p < 0.0001), and feeling sad (6.06 [2.31-15.9], p = 0.0003). The severity of itching, bone or joint pain, worrying, feeling nervous, feeling anxious, and decreased interest in sex was also significantly greater in patients with PDF.

Conclusion: PDF is independently associated with a higher burden of comorbidities and a greater number of physical and emotional symptoms. It is also specifically linked to the prevalence of leg swelling, restless legs, difficulty concentrating, difficulty becoming sexually aroused, and sadness.