Hemodialysis international. International Symposium on Home Hemodialysis最新文献

Calciphylaxis is a rare and serious disorder characterized by vascular calcification and occlusion of the microvessels in the dermis, subcutaneous adipose tissue, visceral organs, and musculature. Studies have suggested that the major risk factors for developing calciphylaxis are chronic kidney disease and secondary hyperparathyroidism. Its diagnosis is clinical, and the treatment includes a multidisciplinary approach, although there are no clinical protocols based on randomized clinical trials. Therefore, the management and treatment are informed by specialist opinion. Sodium thiosulfate is frequently utilized for its vasodilatory and antioxidant properties, as well as its ability to chelate calcium. However, there are no guidelines regarding the duration of its use. The present report describes a chronic kidney disease patient on hemodialysis with calciphylaxis, who underwent sodium thiosulfate treatment for 2 years associated with debridement and reconstructive plastic surgery with a good response and control of the disease.

Objectives: To assess the efficacy and safety of locally manufactured generic sofosbuvir-based direct-acting antivirals in the treatment of Hepatitis C virus (HCV) infected patients on maintenance hemodialysis.

Patients and methods: We have conducted a retrospective multicenter study including patients on maintenance hemodialysis, treated with sofosbuvir-based regimens between 01/01/2017 and 09/30/2021. Patients were treated for 12 or 24 weeks, with sofosbuvir 400 mg + ledipasvir 90 mg 3 times/week, or sofosbuvir 3 times/week + daclatasvir 60 mg/d, or sofosbuvir + daclatasvir in coformulation, 3 times/week. Sustained virological response was defined as a negative HCV RNA test 12 weeks after treatment. The occurrence of serious adverse events during treatment defines intolerance to treatment. Statistical analysis was performed using SPSS software (version 25).

Results: A total of 120 patients were treated; the mean age was 50 ± 14.17 years [18-78], 50% were men. Twenty-two patients (n = 22; 18.3%) were previously treated with pegylated Interferon. Genotype 1 was predominant (n = 68; 82%). Most of the patients (n = 53; 44.2%) had no significant fibrosis, and 24 (20%) had cirrhosis. The SVR rate was 93.3% (CI 95% [88.8; 97.8]) (n = 112), the serious adverse events rate was 10.8% (CI 95% [0.054-0.166]) (n = 13), including 2 deaths unrelated to direct-acting antivirals. Early treatment discontinuation occurred in 5.8% (n = 7), and a relapse in 0.8% (n = 1). On multivariate analysis, risk factors for serious adverse events included advanced liver fibrosis, thrombocytopenia, hypoalbuminemia, high bilirubin level, and pre-treatment status.

Conclusion: Locally manufactured generic sofosbuvir-based regimens are safe and effective in maintenance hemodialysis patients. However, they should be closely monitored to manage comorbidities and complications during treatment.

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.

The most common cause of rhabdomyolysis is trauma. In the presence of rhabdomyolysis attacks triggered by heavy exercise and fever, hereditary causes should be investigated. In our study, a case was presented that developed rhabdomyolysis and acute kidney injury due to carnitine palmitoyltransferase 2 (CPT2) deficiency and then required hemodialysis treatment. We wanted to draw attention to hereditary rhabdomyolysis in this case. A 25-year-old male patient was hospitalized with pneumonia and acute kidney injury. On examination, muscle enzymes, creatinine, and potassium levels were high. The patient, who was evaluated as having rhabdomyolysis and acute kidney injury, underwent three sessions of hemodialysis treatment due to the indication for renal replacement therapy. He had a history of rhabdomyolysis and acute kidney injury 5 years ago. The only trigger for both attacks was febrile infection. There was a history of acute kidney injury in two of his siblings in family history. In the gene analysis requested due to suspicion of hereditary causes, homozygous mutation was detected in CPT2 whole gene sequence analysis. Medium-chain triglycerides, low-fat diet, and L-carnitine capsules were given for treatment. Carnitine palmitoyltransferase 2 deficiency is the most common form of muscle fatty acid metabolism disorder. The phenotype of the patients can vary from severe infantile form to milder muscle form characterized by rhabdomyolysis. Cases requiring hemodialysis are very rare, so we wanted to present this case. Detection of hereditary rhabdomyolysis is important for preventing new attacks and preventive treatments.

Introduction: Arteriovenous fistulas (AVFs) and grafts are essential for long-term hemodialysis access in patients with end-stage renal disease. However, complications and access failure often necessitate re-intervention. In this study, we aim to delineate the factors associated with earlier failure of permanent hemodialysis access warranting revision procedures.

Methods: This retrospective study aimed to identify factors associated with increased revision rates in AVFs and arteriovenous grafts, using multivariate survival analysis. A cohort of 136 patients who underwent initial arteriovenous access creation between 2005 and 2022 was analyzed. Patient characteristics, including age, comorbidities, access type, and vascular anatomy, were extracted, and hazard ratios (HR) were calculated to identify independent predictors of needing revision.

Findings: A total of 119 patients were included in the final cohort, with a mean age of 55.2 years. Over 40% of patients had a previous central venous catheter placement, while 15% had a previous AVF. The majority of procedures were performed on the left side (74%), and brachiocephalic fistulas were most commonly created (41%). Univariate and multivariate Cox regression revealed that age (adjusted HR = 1.02, p = 0.01) and prior central venous catheter placement (adjusted HR = 1.77, p = 0.01) were independent predictors of earlier revision, while other variables such as sex, hypertension, and diabetes did not show significant associations. Patients with prior central venous catheter placement had a 77% increased risk of revision, even when adjusted for confounders.

Discussion: Understanding predictors of successful long-term access outcomes can guide decision-making regarding access type and alternative strategies. In our cohort, increased age and prior central venous catheter placement are associated with a shorter time to failure of permanent hemodialysis access and an increased risk of needing revision.

Introduction: The study aimed to investigate the impact of the using local skin cooling on arteriovenous fistula cannulation pain and the comfort levels of hemodialysis patients.

Methods: The single-blind randomized controlled trial was formed with 50 patients between June 20, 2023, and July 31, 2023, in the hemodialysis units of two state hospitals in Turkey. Patients were randomly assigned to either the experimental group (n = 25) or the control group (n = 25) using the block randomization method. This data were collected through the use of the CoolSense device, the "Patient Information Form," the "Verbal Category Scale," and the "General Comfort Scale." Patients in the experimental group received the local skin cooling for five seconds during arteriovenous fistula cannulation, while the control group followed the standard hospital protocol. The study was registered on Clinical Trials (NCT06144801).

Findings: The study revealed that the application of the local skin cooling during arteriovenous fistula cannulation significantly reduced pain and increased patients' comfort levels, demonstrating an anesthetic effect (p < 0.001). Furthermore, it was observed that as pain levels decreased, patient comfort levels increased (p < 0.001).

Discussion: It is concluded that the using lokal skin cooling is an effective tool for reducing pain and enhancing comfort during arteriovenous fistula cannulation in hemodialysis patients.

Introduction: Arteriovenous fistula (AVF) maturation failure remains common despite preoperative ultrasound mapping. Identifying predictive biomarkers can help anticipate primary failure and reducing invasive procedures. Our study aimed to identify clinical and analytical risk factors for primary AVF failure or delay.

Methods: A prospective study (October 2022-March 2023) included adult patients scheduled for AVF creation. In all patients, a preoperative ultrasound mapping was conducted and AVF maturation assessed at least 6 weeks post-surgery. Clinical, analytical, and demographic data were collected.

Findings: Eighty patients were included, 62.5% male, and mean age 66.3 years. For distal anastomosis, preoperative vein (3.8 ± 1.2 vs. 2.8 ± 0.6 mm; p 0.002) and supply artery (2.5 ± 0.4 vs. 2.0 ± 0.3 mm; p 0.001) diameters were significant factors impacting primary failure. Also, for proximal anastomosis, the artery diameter (2.4 ± 0.4 vs. 2.0 ± 0.4 mm; p 0.01) had an impact on AVF maturation. ROC curves established for distal AVF a vein diameter cutoff of 3.25 mm (AUC 77.2%) and artery cut-off of 2.35 mm (AUC 74.6%) and for proximal AVF an artery cutoff of 2.25 mm (AUC 76.5%). Distal AVF creation correlated with higher primary failure risk (p < 0.001). No correlation was found between the primary failure rate and the presence of central venous catheter or serum results. In a sub analysis, we found that patients with central venous catheter had higher levels of inflammatory markers.

Discussion: Our study highlights the importance of preoperative evaluation, ultrasound mapping, and careful AVF site selection. Recognizing vein and artery diameter thresholds for optimal outcomes is crucial. Avoiding central venous catheters in suitable patients can positively impact AVF results.

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.

Introduction: Hemodialysis is frequently used as a primary treatment for individuals with end-stage kidney disease (ESKD), and it significantly impacts the quality of life in adolescents undergoing this procedure. Providing a hemodialysis education to these patients is a valuable strategy for enhancing their well-being. The aim of the study is to assess the effect of the video-assisted educational program on the quality of life among adolescents undergoing hemodialysis in Palestine.

Methods: This study employed a quasi-experimental design, a pre-test-post-test interventional study, involving a sample of 68 adolescent patients between the ages of 13 and 18 diagnosed with ESKD. The quality of life level was assessed in both groups using an Arabic version of the Pediatric Quality of Life Inventory™ version 3.0 ESKD Module survey. The study was conducted at the dialysis units in four hospitals associated with Augusta Victoria Hospital, An-Najah University Hospital, Palestine Medical Complex/Ramallah, and Beit Jala (Al Housain) Hospital. The study involved providing tailored face-to-face educational sessions with video assistance to the experimental group, while the control group received regular face-to-face education.

Findings: The Generalized Estimating Equation analysis revealed no significant differences in quality of life between the experimental and control groups over time, across pre-test, post-test, and follow-up periods (p ≥ 0.05). However, within the experimental group, there was a significant improvement in total quality of life scores between the pre-test, post-test, and post-test follow-up (p ≤ 0.001), although the difference between the pre-test and follow-up approached significance but was not statistically significant (p = 0.056). In contrast, the control group showed significant differences in quality of life across the pre-test, post-test, and follow-up time points (p ≤ 0.05).

Discussion: Implementing suitable interventions can potentially enhance the quality of life for individuals undergoing hemodialysis. Consequently, we suggest using video-based education as a cost-effective, uncomplicated, and engaging approach for educating hemodialysis patients.

Dialysis Jeopardy! was a fun and innovative dialysis quiz for conference attendees at the Annual Dialysis Conference 2024 held in San Diego. The event saw active participation from nephrology fellows, faculty, and allied health care professionals. The event provided an excellent opportunity for nephrology fellows to interact with faculty in a nonformal setting.