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Background: Ascertaining the total body water (V), usually obtained by the Watson formula or bioimpedance spectroscopy (BIS), is crucial for the calculation of Kt/V in patients with peritoneal dialysis (PD). The aim of our study was to compare two different methods of determining V and explore which one is suitable for clinical application. Methods: This was a retrospective observational study. V was determined using the Watson formula (Vwat) and BIS (Vbis). The differences between Vbis and Vwat and between Kt/Vbis and Kt/Vwat were assessed. The patients were allocated to different groups according to the Kt/Vwat and Kt/Vbis values. Clinical parameters were compared between these groups to investigate which method of obtaining the Kt/V value was more suitable. Results: 150 patients on PD were included. Vwat was significantly higher than Vbis, apart from in female patients with volume overload. Consequently, weekly Kt/Vwat was lower than Kt/Vbis in these patients. A significant negative correlation between mean Vwat-Vbis and overhydration values was also found. Moreover, through uniform manifold approximation and projection analysis, a clustering tendency between patients in the adequate group with both Kt/Vwat and Kt/Vbis > =1.7 and patients in the inconsistent group with Kt/Vwat <1.7 and Kt/Vbis > =1.7 was identified, suggesting that their clinical features were similar. There were significant differences between Vwat and Vbis and between Kt/Vwat and Kt/Vbis. Kt/Vwat may underestimate small-solute dialysis adequacy in most cases. Kt/Vbis instead of Kt/Vwat could be accounted for in creating individualized dialysis prescriptions if the patient has no obvious clinical symptoms. [ABSTRACT FROM AUTHOR]

Abstract Background In Japan dialyzers are classified as type I, II, III, IV, or V on the basis of the β 2-microglobulin clearance. In 2023, Type V dialyzers were defined as super high-flux membrane dialyzers. Herein, we investigate the association between dialyzer type and mortality. Methods A cohort study was conducted using the Japanese Society for Dialysis Therapy Renal Data Registry database from 31 December 2017, to 31 December 2019. We enrolled 181,879 patients on hemodialysis who were divided into type I–V groups per the Japanese classification. We assessed the associations of each group with 2-year all-cause mortality using Cox proportional hazard models. Furthermore, propensity score matching analysis was performed. Results By the end of 2019, 34,196 patients (18.8%) had died. The hazard ratio (95% confidence interval) was significantly higher in the type I (1.25 [1.12–1.39]), type II (1.21 [1.13–1.31]), and type III (1.07 [1.02–1.13]) groups and significantly lower in the type V group (0.86 [0.80–0.92] P

Background: adequacy of dialysis is very important and has a major impact on morbidity as well as mortality among hemodialysis (HD) children. Many researchers have reported that high flux membrane (HFM) enhances the medium-sized molecules removal while other reports revealed no remarkable effect on them. This study aimed to compare the efficacy of high-flux hemodialysis (HFHD) versus low-flux hemodialysis (LFHD) in HD children. Patients and methods: In the period from June to December 2023,50 caseson regular HD for end-stage renal disease included in this retrospective cohort study at the Pediatric nephrology unit, Zagazig University Children's Hospital. Blood samples were collected pre- and post-dialysis and forwarded to the lab for analysis. To evaluate dialysis effectiveness, we employed KT/V, blood urea nitrogen (BUN), as well as urea reduction ratio (URR) parameters. Results: Post dialysis, a significant difference between the groups concerning the adequacy of HD was found according to URR and KT/V(p<0.001, p=0.008 respectively). According to having URR (≥65%), 56% within HF group versus 24% had adequate HD. While according to KT/V (≥1.2), 72% versus 20% within HFHD and LFHD groups respectively had adequate HD. There was a notable variation between the tested groups in terms of HD sufficiency according to URR and KT/V (p=0.041, p<0.001 respectively). Conclusion: High-flux hemodialysis demonstrates more successful efficacy in improving biochemical parameters, including URR and KT/V, compared to low-flux hemodialysis in pediatric patients. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Dialysis adequacy is traditionally calculated from pre‐ and post‐hemodialysis session serum urea concentrations and expressed as the urea reduction ratio, or Kt/Vurea. However, with increasing hemodiafiltration usage, we wished to determine whether there were any differences between standard Kt/Vurea equations and directly measured spent dialysate urea clearance.Urea clearance was measured from collected effluent dialysate and compared with various other methods of Kt/Vurea calculation, including change in total body urea from measuring pre‐ and post‐total body water with bioimpedance and the Watson equation, by standard Kt/V equations, and online clearance measurements using effective ionic dialysance (OLC).We compared urea clearance in 41 patients, 56.1% male, mean age 69.3 ± 12.6 years with 87.8% treated by hemodiafiltration. Reduction in total body urea was greater when estimating changes in total body urea, compared to measured dialysate losses of 58.4% (48.5–67.6) vs 71.6% (62.1–78), p < 0.01. Sessional urea clearance (Kt/Vurea) was greater using the online Solute‐Solver program compared to OLC, median 1.45(1.13–1.75) vs 1.2 (0.93–1.4), and 2nd generation Kt/V equations 1.3 (1.02–1.66), p < 0.01, but not different from estimated total body urea clearance 1.36 (1.15–1.73) and dialysate clearance 1.36 (1.07–1.76). The mean bias compared to the Solute‐Solver program was greatest with OLC (−0.25), compared to second‐generation equations (−0.02), estimated total body clearance (−0.02) and measured dialysate clearance (−0.01).This study demonstrated that the result from equations estimating urea clearance indirectly from pre‐ and postblood samples from hemo‐ and hemodiafiltration treatments was highly correlated with direct measurements of dialysate urea clearance. [ABSTRACT FROM AUTHOR]

Background Green nephrology encompasses all initiatives in kidney care that have a positive impact on climate and environment. To prepare the dialysate, at least 120 L of water are needed for one 4-h session with a dialysate flow (Qd) set at 500 mL/min. A lower dialysate flow rate is associated with a significant reduction in the amount of water used. The aim of this study was to check whether change of Qd from 500 mL/min to 300 mL/min has a significant impact on dialysis adequacy. Methods The study was a retrospective analysis. Due to administrative issues, a satellite dialysis center reduced their dialysate flow to 300 mL/min for a month. The center then increased Qd to 500 mL/min again. We analyzed laboratory data from 3 months before dialysate flow reduction, in the month with Qd reduced to 300 mL/min, and from 3 months thereafter with Qd set at 500 mL/min. Results Twenty-four people were included in the final analysis. There were no significant changes in urea reduction ratio caused by lower rate of Qd [64.50 (61.75–71.00) vs 67.00 (63.00–72.25) vs 69.00 (63.75–72.25), analysis of variance F(2,46) = 0.71, P = .50]. Similarly, hemodialysis adequacy expressed by Kt/V did not differ at any Qd [1.23 (1.12–1.41) vs 1.25 (1.18–1.40) vs 1.35 (1.19–1.48), ANOVA F(2,46) = 2.51, P = .09]. There was a small but statistically significant increase in mean predialysis potassium with lower Qd [potassium = 5.18 (95% confidence interval, 95% CI, 4.96–5.44) vs 5.46 (95% CI 5.23–5.69) vs 5.23 (95% CI 4.99–5.47) mmol/L at Qd = 500, 300 and 500 mL/min, respectively, P = .039]. Conclusion Reduction in dialysate flow rate to 300 mL/min seems safe and does not cause any short-term negative effects in this small study. Thus, we might be able to achieve a similar therapeutic effect while saving water consumption. Larger, long-term studies incorporating patient-reported outcome measures are needed to confirm the efficacy of this approach. [ABSTRACT FROM AUTHOR]

Background Patients with kidney failure treated with maintenance haemodialysis (HD) require appropriate small molecule clearance. Historically, a component of measuring 'dialysis adequacy' has been quantified using urea kinetic modelling that is dependent on the HD prescription. However, the impact of dialysate flow rate on urea clearance remains poorly described in vivo and its influence on other patient-important outcomes of adequacy is uncertain. Methods We searched Embase, MEDLINE and the Cochrane Library from inception until April 2022 for randomized controlled trials and observational trials comparing a higher dialysate flow rate (800 ml/min) and lower dialysate flow rate (300 ml/min) with a standard dialysis flow rate (500 ml/min) in adults (age ≥18 years) treated with maintenance HD (>90 consecutive days). We conducted a random effects meta-analysis to estimate the pooled mean difference in dialysis adequacy as measured by Kt/V or urea reduction ratio (URR). Results A total of 3118 studies were identified. Of those, nine met eligibility criteria and four were included in the meta-analysis. A higher dialysate flow rate (800 ml/min) increased single-pool Kt/V by 0.08 [95% confidence interval (CI) 0.05–0.10, P  < .00001] and URR by 3.38 (95% CI 1.97–4.78, P  < .00001) compared with a dialysate flow rate of 500 ml/min. Clinically relevant outcomes including symptoms, cognition, physical function and mortality were lacking and studies were generally at a moderate risk of bias due to issues with randomization sequence generation, allocation concealment and blinding. Conclusion A higher dialysate flow increased urea-based markers of dialysis adequacy. Additional high-quality research is needed to determine the clinical, economic and environmental impacts of higher dialysate flow rates. [ABSTRACT FROM AUTHOR]

Background Adequate delivery of hemodialysis (HD), measured by the spKt/V derived from urea reduction, is an important determinant of clinical outcomes in chronic hemodialysis patients. However, the need for pre- and postdialysis blood samples prevented the assessment of spKt/V in every session.Methods This retrospective single-center study was performed on end-stage renal disease (ESKD) patients aged ≥ 18 years who received standard thrice-weekly chronic HD therapy. Eighty-seven variables, including general, intradialytic, and laboratory variables, were collected from the medical records for analysis. Five steps of preprocessing procedure were deployed to select only the most relevant variables. Six binary classification models were developed to predict whether spKt/V was higher than 1.4.Results A total of 1869 HD sessions from 373 ESKD patients were included in this study. The Random Forest model showed the best prediction for dialysis adequacy, with AUROC scores of 0.860 in the validation dataset and 0.873 in the testing dataset. Notably, an accessible model that solely relied on noninvasively collected general and dialysis-related variables maintained high prediction accuracy, with AUROC scores of 0.854 and 0.868 in the validation and testing datasets, respectively. The five most significant predictive variables were vascular access, gender, body mass index, ultrafiltration volume, and dialysis duration.Conclusion The study results suggest that the development of ML models for accurately predicting dialysis adequacy based on general and intradialytic variables is feasible. These models have the potential to be utilized for noninvasive clinical assessments of dialysis adequacy.

Background Ascertaining the total body water (V), usually obtained by the Watson formula or bioimpedance spectroscopy (BIS), is crucial for the calculation of Kt/V in patients with peritoneal dialysis (PD). The aim of our study was to compare two different methods of determining V and explore which one is suitable for clinical application.Methods This was a retrospective observational study. V was determined using the Watson formula (Vwat) and BIS (Vbis). The differences between Vbis and Vwat and between Kt/Vbis and Kt/Vwat were assessed. The patients were allocated to different groups according to the Kt/Vwat and Kt/Vbis values. Clinical parameters were compared between these groups to investigate which method of obtaining the Kt/V value was more suitable.Results 150 patients on PD were included. Vwat was significantly higher than Vbis, apart from in female patients with volume overload. Consequently, weekly Kt/Vwat was lower than Kt/Vbis in these patients. A significant negative correlation between mean Vwat-Vbis and overhydration values was also found. Moreover, through uniform manifold approximation and projection analysis, a clustering tendency between patients in the adequate group with both Kt/Vwat and Kt/Vbis > =1.7 and patients in the inconsistent group with Kt/Vwat =1.7 was identified, suggesting that their clinical features were similar.Conclusion There were significant differences between Vwat and Vbis and between Kt/Vwat and Kt/Vbis. Kt/Vwat may underestimate small-solute dialysis adequacy in most cases. Kt/Vbis instead of Kt/Vwat could be accounted for in creating individualized dialysis prescriptions if the patient has no obvious clinical symptoms.

Background The guidelines recommended target and minimum single-pool Kt / V urea are 1.4 and 1.2, respectively, in hemodialysis patients. However, the optimal hemodialysis dose remains controversial. We investigated the effects of Kt / V urea on patient outcomes according to age, with a focus on older patients. Methods This study used the hemodialysis quality assessment program and claims datasets. Patients were divided into four subgroups according to age (<65, 65–74, 75–84, and ≥85 years). Each group was divided into three subgroups according to Kt / V urea : reference (ref) (1.2 ≤  Kt / V urea ≤ 1.4), low (< 1.2), and high (> 1.4). Results The low, ref, and high Kt / V urea groups included 1668, 8156, and 16   546 (< 65 years); 474, 3058, and 7646 (65–74 years); 225, 1362, and 4194 (75–84 years); and 14, 126, and 455 (≥85 years) patients, respectively. The low Kt / V urea group had higher mortality rates than the ref Kt / V urea group irrespective of age [adjusted hazard ratio (aHR), 95% confidence interval (CI): 1.23, 1.11–1.36; 1.14, 1.00–1.30; 1.28, 1.09–1.52; and 2.10, 1.16–3.98, in patients aged <65, 65–74, 75–84, and ≥85 years, respectively]. The high Kt / V urea group had lower mortality rates than the ref Kt / V urea group in patients aged <65 and 65–74 years (aHR, 95% Cl: 0.87, 0.82–0.92 and 0.93, 0.87–0.99 in patients aged <65 and 65–74 years, respectively). Conclusions These results support the current recommendations of a minimum Kt / V urea of 1.2 even in patients age ≥85 years. In young patients, Kt / V urea above the recommended threshold can be beneficial for survival. [ABSTRACT FROM AUTHOR]

IntroductionPrevious studies on hemodialysis adequacy primarily focused on the association between Kt/V and survival, and low Kt/V is associated with increased mortality. There is a paucity of research on the correlation between Kt/V and chronic kidney disease (CKD) complications.MethodsThe retrospective study was conducted in the blood purification center of a tertiary hospital in China from July 2020 to September 2022. It aimed to analyze the association between latent Kt/V trajectory categories and CKD complications (hypertension, anemia, mineral and bone disorder) and inflammatory markers. The latent class trajectory model was established to describe the different patterns of Kt/V changes over the observation period.ResultsDuring the 2-year study period, 93 patients on thrice-weekly hemodialysis with residual kidney function 1.6 to

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Background: Erythropoietin (EPO)-deficient anemia occurs in patients with chronic kidney disease (CKD). Erythropoietin-stimulating agents (ESAs) are the standard treatment for CKD anemia, but patient responses vary. Hemodialysis patients are often anemic due to hypo erythropoiesis and their chronic inflammatory state. Inadequate dialysis is considered one of the factors that are linked to ESA hypo responsiveness. Dialysis patients may experience many symptoms that lower their quality of life. End stage renal disease (ESRD) symptoms are assessed using Dialysis Symptom Index (DSI). Objective: The current study was designed to measure the association between physical, and emotional symptoms and ESA responsiveness. Also, to determine how dialysis adequacy affects response level. Materials and Methods: The current study included 150 CKD anemic patients in a multicenter dialysis units. patients were examined for the response to Epoetin alfa (Eprex) after 12 weeks in this cross-sectional study. Clinical, demographic, and laboratory data were collected. The erythropoietin resistance index (ERI) evaluated the effect of erythropoietin dosage on hemoglobin levels. Dialysis adequacy (Kt/V) measured the efficacy of dialysis. The severity of symptoms was evaluated using the 30-question Dialysis Symptom Index (DSI). Results: 150 patients in all were enrolled, with a mean age of 51.6 ± 14.9 for the male patients. There was a significant difference in kt/v among study groups, mainly between hypo response and resistance groups (P-value < 0.01). However, there was no statistically significant difference in the DSI mean (P = 0.4). kt/v was positively correlated with the duration of dialysis and parathyroid hormone (PTH) (R = 0.27, P-value < 0.001), (R = 0.19, P-value = 0.01). additionally, The DSI was strongly connected with the age of the patients (R = 0.18, P-value = 0.02). Conclusion: One of the main causes of Eprex resistance in this study was insufficient dialysis. Patients who received longer hemodialysis sessions exhibited higher hemodialysis sufficiency. However, there was no significant association between DSI and degree of response across research groups, and older hemodialysis patients experienced higher dialysis-related symptoms.

Background The urea clearance index (Kt/V) is an important index for predicting the clinical outcome of peritoneal dialysis (PD) patients, but it changes with time depending on the clinical condition. This study aimed to investigate the association between the Kt/V reach rate (defined as the percentage of Kt/V measurements that reached ≥ 1.70) and clinical outcome in incident PD patients.Methods In this retrospective cohort study, 210 patients were enrolled from the First Affiliated Hospital of Zhengzhou University from 1 January 2013 to 31 October 2019. The target Kt/V reach rate in the first year was applied as the predictor variable. Kaplan-Meier survival curves were drawn to evaluate differences in prognosis. The association between Kt/V reach rate and the composite clinical outcome (death or transfer to hemodialysis) was tested by Cox regression analysis.Results The dialysis adequacy group (Kt/V reach rate 3/3 times) and the dialysis intermittent adequacy group (1/3 or 2/3 times) had significantly better clinical outcomes than the dialysis inadequacy group (0/3 times). There was no difference in clinical outcome between the lower-rate group (reach rate 1/3 times) and the higher-rate group (2/3 times). Compared with the dialysis inadequacy group, the dialysis intermittent adequacy group and dialysis adequacy group had significantly lower risks of the composite outcome (HR 0.487, 95% CI 0.244–0.971, p = 0.041; HR 0.150, 95% CI 0.043–0.520, p = 0.003) in the fully adjusted analysis.Conclusion Higher Kt/V reach rates are associated with a better prognosis in incident PD patients.

Introduction: Most hemodialysis machines deliver a fixed bicarbonate concentration. Higher concentrations may improve acidosis, but risk post‐hemodialysis alkalosis, whereas lower concentrations potentially increase acidosis but reduce alkalosis. We reviewed the effects of lowering dialysate bicarbonate. Methods: We reviewed peri‐dialysis chemistries in patients switching to a lower bicarbonate dialysate at 4 time points over 19 months. Results: We studied 126 patients, mean age 63.7 ± 16.3 years, 57.9% males. Post‐hemodialysis alkalosis fell from 1.6 to 0.3% sessions, but pre‐hemodialysis acidosis increased from 11.9 to 23.8% sessions (p = 0.005) reducing dialysate bicarbonate from 32 to 28 mmol/L. After 3 months, pre‐hemodialysis serum bicarbonate fell (21.1 ± 2.3 to 19.8 ± 2.2 mmol/L), and post‐hemodialysis (24.9 ± 2.1 to 22.5 ± 2.0 mmol/L, p < 0.001) with a fall in pre‐hemodialysis weight from 74.6 ± 20.7 to 71.7 ± 18.2 kg, normalized protein nitrogen accumulation rate 0.8 ± 0.28 to 0.77 ± 0.2 g/kg/day, p < 0.05, and serum albumin 39.7 ± 4.2 to 37.7 ± 4.9 g/L, p < 0.001. Thereafter, apart from pre‐ and post‐hemodialysis serum bicarbonate, weight and normalized protein nitrogen accumulation stabilized, although albumin remained lower (37.6 ± 4.0 g/L, p < 0.001). On multivariate logistic analysis, serum bicarbonate increased more with lower pre‐hemodialysis bicarbonate standardized coefficient β 0.5 (95% confidence interval −0.6 to −0.42), increased normalized protein nitrogen accumulation β 0.2 (0.96 to 2.38), p < 0.001, and session time β 0.09, (0.47 to 5.98), p < 0.022, and less with lower dialysate bicarbonate 0.0–0.23 (−1.54 to −0.74), p < 0.001. Conclusion: Increases in SE‐Bic with hemodialysis, depend on the bicarbonate gradient, session time and nPNA. Lower D‐Bic reduces post‐hemodialysis alkalosis but increases pre‐hemodialysis acidosis and may initially have adverse effects on weight and normalized protein nitrogen accumulation. [ABSTRACT FROM AUTHOR]

The urea clearance index (Kt/V) is an important index for predicting the clinical outcome of peritoneal dialysis (PD) patients, but it changes with time depending on the clinical condition. This study aimed to investigate the association between the Kt/V reach rate (defined as the percentage of Kt/V measurements that reached ≥ 1.70) and clinical outcome in incident PD patients. In this retrospective cohort study, 210 patients were enrolled from the First Affiliated Hospital of Zhengzhou University from 1 January 2013 to 31 October 2019. The target Kt/V reach rate in the first year was applied as the predictor variable. Kaplan-Meier survival curves were drawn to evaluate differences in prognosis. The association between Kt/V reach rate and the composite clinical outcome (death or transfer to hemodialysis) was tested by Cox regression analysis. The dialysis adequacy group (Kt/V reach rate 3/3 times) and the dialysis intermittent adequacy group (1/3 or 2/3 times) had significantly better clinical outcomes than the dialysis inadequacy group (0/3 times). There was no difference in clinical outcome between the lower-rate group (reach rate 1/3 times) and the higher-rate group (2/3 times). Compared with the dialysis inadequacy group, the dialysis intermittent adequacy group and dialysis adequacy group had significantly lower risks of the composite outcome (HR 0.487, 95% CI 0.244–0.971, p = 0.041; HR 0.150, 95% CI 0.043–0.520, p = 0.003) in the fully adjusted analysis. Higher Kt/V reach rates are associated with a better prognosis in incident PD patients. [ABSTRACT FROM AUTHOR]

Introduction: Growth retardation is a common problem in pediatric patients with chronic kidney disease. It is unknown if the growth of children on peritoneal dialysis (PD) can be augmented by more dialysis. Methods: We studied the effect of various peritoneal adequacy parameters on delta height standard deviation scores (SDSs) and growth velocity z-scores in 53 children (27 males) on PD, who underwent 2 longitudinal adequacy tests at 9-month intervals. None of the patients were on growth hormone. Intraperitoneal pressure and standard KDOQI guidelines were compared to the outcome measures delta height SDS and height velocity z-scores, using univariate and multivariate tests. Results: At the time of the second PD adequacy test, their mean age was 9.2 ± 5.3 years; mean fill volume was 961 ± 254 mL/m2; and median total infused dialysate volume was 5.26 L/m2/day (range 2.03–15.32 L). The median total weekly Kt/V was 3.79 (range 0.9–9.5), and the median total creatinine clearance was 56.6 (range 7.6–133.48) L/week, higher than previous pediatric studies. The delta height SDS was a median of −0.12 (range −2 to +3.95)/year. The mean height velocity z-score was −1.6 ± 4.0. The only relationships discovered were between the delta height SDS and age, bicarbonate, and intraperitoneal pressure, but not for Kt/V or creatinine clearance. Conclusion: Our findings highlight the importance of normalization of bicarbonate concentrations to improve height z-score. [ABSTRACT FROM AUTHOR]

Abstract Background The Japanese Society for Dialysis Therapy (JSDT) published in 2013 inaugural hemodialysis (HD) guidelines. Specific targets include 1.4 for single-pool Kt/V (spKt/V) with a minimum dose of 1.2, minimum dialysis session length of 4 hours, minimum blood flow rate (BFR) of 200 mL/min, fluid removal rate no more than 15 mL/kg/hr, and hemodiafiltration (HDF) therapy for certain identified symptoms. We evaluated the effect of these guidelines on actual practice in the years spanning 2005 – 2018. Methods Analyses were carried out to describe trends in the above HD prescription practices from December 2005 to April 2013 (before guideline publication) to August 2018 based on prevalent patient cross-sections from approximately 60 randomly selected HD facilities participating in the Japan Dialysis Outcomes and Practice Patterns Study. Results From April 2006 to August 2017 continual rises occurred in mean spKt/V (from 1.35 to 1.49), and percent of patients having spKt/V>1.2 (71% to 85%). Mean BFR increased with time from 198.3 mL/min (April 2006) to 218.4 mL/min (August 2017) , along with percent of patients with BFR >200 ml/min (65% to 85%). HDF use increased slightly from 6% (April 2006 and August 2009) to 8% by April 2013, but increased greatly thereafter to 23% by August 2017. In contrast, mean HD treatment time showed little change from 2006-2017, whereas mean UFR declined from 11.3 in 2006 to 8.4 mL/Kg/hour in 2017. Conclusions From 2006 – 2018 Japanese HD patients experienced marked improvement in reaching the spKt/V target specified by the 2013 JSDT guidelines. This may have been due to moderate increase in mean BFR even though mean HD session length did not change much. In addition, HDF use increased dramatically in this time period. Other HD delivery changes during this time, such as increased use of super high flux dialyzers, also merit study. While we cannot definitively conclude a causal relationship between the publication of the guidelines and the subsequent practice changes in Japan, those changes moved practice closer to the recommendations of the guidelines.

Background: Chronic hemodialysis (HD) patients are at high risk of severe COVID-19 with a high risk of death. The organization of dialysis units to treat chronic HD patients with COVID-19 is demanding to prevent virus transmission both in COVID-free patients and the staff. These constraints may have an impact on the dialysis delivery to COVID-free HD patients. We report our experience in French NephroCare (NC) centers. Methods: We report retrospectively dialysis and nutritional indicators among COVID-free prevalent chronic HD patients' cohort treated in French NC units from February 2020 to April 2020. The COVID-free HD patients were split into 2 subgroups for the analysis, Paris region and other regions because the incidence of COVID-19 was different according to the French regions. Results: The Paris region was the most impacted by COVID-19 with 73% of all the contaminations that occurred in French NC units (n = 118). The dialysis frequency was not reduced all over the NC regions. 2,110 COVID-free HD patients were split into 2 subgroups including Paris region (748 patients) and other regions (1,362 patients). The weekly treatment time decreased significantly in Paris region from February to April (723–696 min [p < 0.00001]) but remained stable in the other regions. The processed blood volume, KT/V, and convective volume declined significantly in the Paris region subgroup but not in other regions. The 3-month weight loss significantly increased in the whole group of patients whatever the region from 0.0 to 0.2% between February 2020 and April 2020 (p < 0.00001). Ultrafiltration rate (UFR) and the normalized proteic catabolic rate remained stable all along the period. The stepwise regression analysis identified February serum albumin level and April UFR as negatively associated with 3-month weight loss. Conclusion: HD delivery to COVID-free HD patients was negatively impacted in the Paris region because of the strong constraints on units' organization related to the treatment of COVID-19+ HD patients and with a higher proportion of limited care/self-care units with less staff resources. The 3-month weight loss increase may be related to the suppression of intradialytic snack that impacted mostly the more malnourished patients or patients with lower interdialytic weight gain. These consequences of the COVID-19 crisis on COVID-free HD patients must be recognized and corrected to prevent further deleterious effects on patients' outcomes. [ABSTRACT FROM AUTHOR]

Introduction: In low-flow home daily dialysis (HDD), the dialysis dose is evaluated from the total body water (TBW). TBW can be estimated by anthropometric methods or bioimpedance spectroscopy. Methods: A multicentric cross-sectional study of patients in HDD for >3 months was conducted to assess the correlation and the difference between the anthropometric estimate of TBW (Watson-TBW) and the bioimpedance estimate (BIS-TBW) and to analyse the impact on the dialysate volume prescribed. Results: Forty patients from 10 centres were included. The median BIS-TBW and Watson-TBW were 35.1 (29.1–41.4 L) and 36.9 (32–42.4 L), respectively. The 2 methods had a good correlation (r = 0.87, p < 0.05). However, Bland-Altman analysis showed an overestimation of TBW with Watson's formula, with a bias of 2.77 L. For 4, 5, or 6 sessions per week, the use of Watson-TBW increases the dialysate prescription per week by 100 L, 45 L, or 10 L, respectively, over our entire cohort. There is no increase in the volume of dialysate prescribed with the 7 sessions per week schedule. Conclusion: BIS-TBW and Watson-TBW estimation have a good correlation; however, Watson's equation overestimates TBW. This overestimation is negligible for a prescription frequency of >5 sessions per week. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is the leading cause of death in peritoneal dialysis (PD) patients. But the relationship between regular PD and the risk of major adverse cardiovascular events (MACE) remains controversial. The possible risk factors are not fully elucidated. This study aims to investigate the possible factors affecting the risk of MACE estimated by high ankle-brachial index (ABI) in PD patients. A total of 243 patients were enrolled and divided into chronic kidney diseases (CKD) stage 1, non-dialyzed CKD stages 2–5, and PD groups. The prevalence of high ABI, indicating increased MACE, was elevated with CKD progression but not further increased in PD patients. Systolic blood pressure was closely correlated with high ABI in non-dialyzed CKD patients (β = 0.059, P = 0.001). But in PD patients, serum calcium had a crucial effect on high ABI (β = −9.853, P < 0.001). Additionally, PD patients with high ABI tended to dialyze inadequately (Kt/V

ABSTRACT BACKGROUND: The high number of patients with end-stage kidney disease (ESRD) on hemodialysis makes it necessary to conduct studies aimed at improving their quality of life. OBJECTIVES: To evaluate brain compliance, using the Brain4care method for intracranial pressure (ICP) monitoring, among patients with ESRD before and at the end of the hemodialysis session, and to correlate ICP with the dialysis quality index (Kt/V). DESIGN AND SETTING: Cross-sectional study conducted at a renal replacement therapy center in Brazil. METHODS: Sixty volunteers who were undergoing hemodialysis three times a week were included in this study. Brain compliance was assessed before and after hemodialysis using the noninvasive Brain4care method and intracranial pressure wave morphology was analyzed. RESULTS: Among these 60 ESRD volunteers, 17 (28%) presented altered brain compliance before hemodialysis. After hemodialysis, 12 (20%) exhibited normalization of brain compliance. Moreover, 10 (83%) of the 12 patients whose post-dialysis brain compliance became normalized were seen to present good-quality dialysis, as confirmed by Kt/V > 1.2. CONCLUSIONS: It can be suggested that changes to cerebral compliance in individuals with ESRD occur frequently and that a good-quality hemodialysis session (Kt/V > 1.2) may be effective for normalizing the patient’s cerebral compliance.

Our objective is to evaluate the impact of individualization of the dialysis dose on the quality of dialysis and the quality of life of our peritoneal dialysis patients. Quality of life was assessed at least 3 months after individualization of the dialysis dose, by self-questionnaires using the SF-36 (short form) version of the KDQOL (Kidney Disease Quality Of Life) scale. The results of the KDQOL-SF36 are used as quantitative variables related to the achievement of a Kt/V>1.7. Dialysis dose was calculated from dialysate and 24-hour urine, blood samples from patients encoded in the French Language Peritoneal Dialysis Registry (RDPLF). https://www.rdplf-db.org. Pearson's significance test is used to look for a correlation between the SF-36 subscores of the KDQOL scale and Kt/V. Fifteen patients (eight men, seven women) with a mean age of 65.93 years were eligible for the study. Our results did not show a direct relationship between Kt/V and quality of life. There was an existing but weak correlation between the sub-scores "physical functioning" and Kt/V as well as between "role limitation due to physical problems" and Kt/V. These correlations do not appear to be significant according to Pearson's significance test. The individualization of the treatment does not seem to have a negative impact on the Kt/V and certain dimensions of the KDQOL SF36 score seem to be less altered (social interactions, social support, life in relation with others). Further studies taking into account the limitations of our study are necessary to generalize such a therapeutic approach.

Objectives: To compare different methods of calculating adequacy of hemodialysis in terms of Kt/V. Methods: This was an observational, quantitative study undertaken after the approval of Internal Review Board at the Hemodialysis Unit of Nephrology department, Mayo Hospital, Lahore from 1st December 2018 to 30th June 2019. Sixty hemodynamically stable patients of end stage renal disease undergoing hemodialysis for more than three months with age 18 to 70 years were included in the study by convenience non probability sampling. Critically ill patients with multiple co-morbidities like sepsis (i.e. total leukocyte count >11000 or <4000 x 109/L), ischemic heart disease, pace- makers, malignancies, cirrhosis etc were excluded. Patients who were not adherent to dialysis prescription or hemodynamically unstable were also excluded. One way ANOVA and Pearson's correlation were used to find correlation between three methods of measuring Kt/V. Results: Mean ultrafiltration was 2.1+ 0.76 liter/session. Pre dialysis weight was 64.7 +14.7 kgs, mean post dialysis weight was 62.5 + 14.7 kgs. For every patient blood flow rate was 300 ml/m and dialysis flow rate was 500 ml/min. The mean values of Kt/V measured by Daugirdas formula was 1.35 ± 0.33, mean online clearance monitoring (OCM) value was 1.17 ± 0.29 and by normogram was 1.36 ± 0.33. There was positive significant correlation between values of Daugirdas formula, Normogram and online clearance monitoring (OCM) i.e. r = 0.897 (p-value < 0.001) measured by Pearson's correlation and one way-ANOVA. Conclusion: Online clearance monitoring can be used for measuring adequacy of hemodialysis, but OCM slightly underestimates Kt/V as compared to Daugirdas formula and Normogram. [ABSTRACT FROM AUTHOR]

Abstract Background Haemodiafilteration (HDF) is a promising new modality of renal replacement therapy (RRT). It is an improvement in the quality of hemodialysis (HD) and thus in the quality of patients’lives. The main obstacle to using HDF is the cost, especially in developing countries. The purpose of this study was to evaluate the benefits of incorporating HDF with different regimens in the treatment of children with end stage renal disease (ESRD). Methods Thirty-four children with ESRD on regular HD in Pediatric Dialysis Unit, Children’s Hospital, Ain Shams University were followed up in 2 phases: initial phase (all patients: HD thrice weekly for 3 months) and second phase, patients were randomized into 2 groups, HDF group and HD group, the former was subdivided into once and twice weekly HDF subgroups. Evaluation using history, clinical and laboratory parameters at 0, 3, 9 and 18 months was carried out. Results On short term, we found that the HDF group was significantly superior to HD group regarding all clinical and laboratory parameters. Also, twice HDF subgroup was significantly superior to once HDF subgroup. This was confirmed on long term follow up, but the once HDF proved comparable to twice subgroup. Conclusions Incorporating online hemodiafilteration (OL-HDF) in the RRT of children was beneficial in most of the clinical and laboratory parameters measured. It’s not all or non; OL-HDF, even once a week, can improve outcomes of HD without significantly affecting the cost.

Abstract Background Vascular calcification (VC) is a risk factor for cardiovascular disease in end-stage renal disease (ESRD) patients undergoing maintenance haemodialysis (MHD). However, evidence is still insufficient about the association between dialysis parameters and VC. Thus, this study was to evaluate association of dialysis parameters with VC. Methods We enrolled 297 ESRD patients undergoing MHD at six distinct centers in Korea. Study participants were categorized into 3 groups by the scoring system of abdominal aortic calcification based on lateral lumbar radiography (no VC group: 0, mild VC group: 1–7 and advanced VC group: 8–24). We compared the features of dialysis parameters according to the severity of VC. Multivariate logistic regression analysis was used to calculate adjusted odd ratios (ORs) and 95% confidence interval (CI) for mild and advanced VC in each haemodialysis parameter (adjusted OR [95% CI]). Results Pooled Kt/V (spKt/V), equilibrated Kt/V (eKt/V), standard Kt/V (stdKt/V) and the proportion of haemodiafiltration were increased along with the severity of VC. Multivariate regression analysis indicated that advanced VC was positively associated with spKt/V (5.27 [1.51–18.41]), eKt/V (6.16 [1.45–26.10]), stdKt/V (10.67 [1.74–65.52]) and haemodiafiltration (3.27 [1.74 to 6.16]). Conclusion High dose dialysis and haemodiafiltration were significantly associated with advanced VC.

Studies assessing peritoneal thickness by CT in peritoneal dialysis (PD) patients are lacking. In this study, we aimed to investigate the association between peritoneal thickness as measured by CT and dialysis adequacy with peritoneal membrane characteristics in PD patients. Ninety-four PD patients were enrolled. Peritoneal thickness was measured by CT. Patients with and without a decrease in Kt/V of at least 0.3 over time were classified as Group 1 and Group 2, respectively. An increase of 0.1 unit of dialysate/plasma (D/P) creatinine over time were considered significant. The relationship between peritoneal membrane thickness, change in Kt/V, and peritoneal membrane characteristics were investigated. There were 31 (33.0%) patients in Group 1. The duration of PD (86.0 ± 64.1 vs. 59.6 ± 45.2 months, p: 0.023), peritoneal thickness (1.02 ± 0.37 vs. 0.87 ± 0.21 mm, p: 0.015), peritoneal calcification (7 [22.6%] vs. 3 [4.8%] patients, p: 0.013], increased D/P creatinine ratio (14 [45.2%] vs. 14 [22.2%] patients, p: 0.031) and CRP (13.9 ± 11.2 vs. 7.1 ± 4.8 mg/L, p: 0.045) were significantly higher in Group 1, whereas albumin (3.6 ± 0.5 vs. 3.8 ± 0.6 g/dL, p: 0.047) and parathyroid hormone (355.2 ± 260.2 vs. 532.1 ± 332.9 ng/L, p: 0.015) levels were significantly lower. Peritoneal thickness was significantly correlated with duration of PD (r: 0.775, p < 0.001) and CRP (r: 0.282, p: 0.006). Regression analysis showed that peritoneal thickness (Exp (B) [95% CI]: 0.029 [0.003-0.253], p: 0.001) was independent predictor of decreased Kt/V in PD patients. In conclusion, prolonged PD duration and increased peritoneal thickness are associated with a decrease in Kt/V over time. CT may be an alternative and noninvasive method instead of peritoneal biopsy for determining the structural changes of the peritoneal membrane. [ABSTRACT FROM AUTHOR]

The search for the 'perfect' renal replacement therapy has been paralleled by the search for the perfect biomarkers for assessing dialysis adequacy. Three main families of markers have been assessed: small molecules (prototype: urea); middle molecules (prototype β2-microglobulin); comprehensive and nutritional markers (prototype of the simplified assessment, albumin levels; composite indexes as malnutrition-inflammation score). After an era of standardization of dialysis treatment, personalized dialysis schedules are increasingly proposed, challenging the dogma of thrice-weekly hemodialysis. In this review, we describe the advantages and limitations of the approaches mentioned above, focusing on the open questions regarding personalized schedules and incremental hemodialysis. In the era of personalized dialysis, the assessment of dialysis adequacy should be likewise personalized, due to the limits of 'one size fits all' approaches. We have tried to summarize some of the relevant issues regarding the determination of dialysis adequacy, attempting to adapt them to an elderly, highly comorbidity population, which would probably benefit from tailor-made dialysis prescriptions. While no single biomarker allows precisely tailoring the dialysis dose, we suggest using a combination of clinical and biological markers to prescribe dialysis according to comorbidity, life expectancy, residual kidney function, and small and medium-size molecule depuration. [ABSTRACT FROM AUTHOR]

Background: The Japanese Society for Dialysis Therapy (JSDT) published in 2013 inaugural hemodialysis (HD) guidelines. Specific targets include 1.4 for single-pool Kt/V (spKt/V) with a minimum dose of 1.2, minimum dialysis session length of 4 hours, minimum blood flow rate (BFR) of 200 mL/min, fluid removal rate no more than 15 mL/kg/hr, and hemodiafiltration (HDF) therapy for certain identified symptoms. We evaluated the effect of these guidelines on actual practice in the years spanning 2005 - 2018.Methods: Analyses were carried out to describe trends in the above HD prescription practices from December 2005 to April 2013 (before guideline publication) to August 2018 based on prevalent patient cross-sections from approximately 60 randomly selected HD facilities participating in the Japan Dialysis Outcomes and Practice Patterns Study.Results: From April 2006 to August 2017 continual rises occurred in mean spKt/V (from 1.35 to 1.49), and percent of patients having spKt/V>1.2 (71% to 85%). Mean BFR increased with time from 198.3 mL/min (April 2006) to 218.4 mL/min (August 2017) , along with percent of patients with BFR >200 ml/min (65% to 85%). HDF use increased slightly from 6% (April 2006 and August 2009) to 8% by April 2013, but increased greatly thereafter to 23% by August 2017. In contrast, mean HD treatment time showed little change from 2006-2017, whereas mean UFR declined from 11.3 in 2006 to 8.4 mL/Kg/hour in 2017.Conclusions: From 2006 - 2018 Japanese HD patients experienced marked improvement in reaching the spKt/V target specified by the 2013 JSDT guidelines. This may have been due to moderate increase in mean BFR even though mean HD session length did not change much. In addition, HDF use increased dramatically in this time period. Other HD delivery changes during this time, such as increased use of super high flux dialyzers, also merit study. While we cannot definitively conclude a causal relationship between the publication of the guidelines and the subsequent practice changes in Japan, those changes moved practice closer to the recommendations of the guidelines. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis (HD) dose targets and ultrafiltration rate (UFR) limits for pediatric patients on chronic HD are not known and are derived from adults (spKt/V>1.4 and <13 ml/kg/h). We aimed to characterize how delivered HD dose and UFR are associated with survival in a large cohort of patients who started HD in childhood. Methods: Retrospective analysis on a cohort of patients <30 years, on chronic HD since childhood (<19 years), having received thrice-weekly HD 2004–2016 in outpatient DaVita centers. Outcome: Survival while remaining on HD. Predictors: (I) primary analysis: mean delivered dialysis dose stratified as spKt/V ≤1.4/1.4–1.6/>1.6 (Kaplan–Meier analysis), (II) secondary analyses: UFR and alternative dialysis adequacy measures [eKt/V, body-surface normalized Kt/BSA] on continuous scale (Weibull regression model). Results: A total of 1780 patients were included (age at the start of HD: 0–12y: n=321, >12–18y: n=1459; median spKt/V=1.55, eKt/V=1.31, Kt/BSA=31.2 L/m2, UFR=10.6 mL/kg/h). (I) spKt/V<1.4 was associated with lower survival compared to spKt/V>1.4–1.6 (P<0.001, log-rank test), and spKt/V>1.6 (P<0.001), with 10-year survival of 69.3% (59.4–80.9%) versus 83.0% (76.8–89.8%) and 84.0% (79.6–88.5%), respectively. (II) Kt/BSA was a better predictor of survival than spKt/V or eKt/V. UFR was additionally associated with survival (P<0.001), with increased mortality <10/>18 mL/kg/h. Associations did not alter significantly following adjustment for demographic characteristics (age, etiology of kidney disease, and ethnicity). Conclusions: Our results suggest usefulness of targeting Kt/BSA>30 L/m2 for best long-term outcomes, corresponding to spKt/V>1.4 (>12 years) and >1.6 (<12 years). In contrast to adults, higher UFR of 10–18 ml/kg/h was not associated with greater mortality in this population. [ABSTRACT FROM AUTHOR]

Objective: Ventricular repolarization (VR) markers may predict ventricular arrhythmias and cardiac arrest. The aim of this study was to investigate the acute effects of a hemodialysis (HD) session and HD adequacy on VR markers in HD patients. Methods: This cross-sectional study was conducted at 2 university hospitals with 83 patients and VR markers were measured before and after an HD session: QT, QTc, QT minimum, QT maximum, dispersion of QT (QTd), T-peak to T-end (Tp-e) interval, and Tp-e/QT. Kt/V measurements calculated using the second generation Daugirdas formula were used to indicate dialysis adequacy. The patients were divided into 2 groups according to the Kt/V value. Group 1 patients had a Kt/V of ≤1.6 with a standard dialysis dose, and Group 2 comprised those with a measurement of >1.6 with a high dialysis dose. Results: There were 36 patients in Group 1 and 47 patients in Group 2. There were statistically significantly more female patients in Group 2 (p=0.016). After an HD session, heart rate increased, blood pressure decreased, and the QT, QTc, QT maximum, QTd, Tp-e interval, and Tp-e/QT were prolonged (p

زمینه وهدف :تهوع یکی از عوارض شایع همودیالیز است تهوع، اثرات نامطلوبی بر سطح کفایت همودیالیز که شاخص مهم مرگ ومیر در این بیماران به شمار میرود، دارد. در بیماران همودیالیزی یکی از عللی که بیماران دیالیزی تهوع را تجربه می کنند سطح کفایت دیالیز انجام شده برای آنان است. لذا این مطالعه با هدف بررسی تأثیر تکنیک آرام سازی عضلانی بر تهوع و کفایت دیالیز بیماران تحت درمان با همودیالیز انجام شد.روش: این مطالعه یک مطالعه تجربی که45 بیمار همودیالیزی درگروه کنترل و 44 بیمار درگروه مداخله از بیمارستان های گناباد و زاهدان در سال های 94-1393درآن شرکت داشتند. نمونه ها به صورت تخصیص تصادفی در دو گروه کنترل و مداخله قرار گرفتند.تکنیک آرام سازی عضلانی به گروه آزمون آموزش داده واجرا شد. نتایج حاصل با نرم افزار SPSS نسخه 21 و با استفاده از آزمون های آماری کای اسکوئر، تی مستقل و من ویتنی در سطح معنی داری کمتر از 05/0 مورد تجزیه و تحلیل قرار گرفت.یافته ها: اختلاف میانگین بین کفایت دیالیز بعداز مداخله در گروه آزمون،با توجه به آزمون آماری تی زوجی معناداربود(009/0=p).:سطح کفایت دیالیز در گروه آزمون قبل مداخله 39/0±35/1 و بعدمداخله0 و 43/0±50/1 بود. وامانتیجه آزمون آماری ویلکاکسون درخصوص مقایسه شدت تهوع قبل(04/1±22/0)و بعد از مداخله در گروه آزمون تفاوت)15/0±02/( آماری معناداری نشان نداد (65/0=p)، نتیجه گیری: با توجه به نتایج این مطالعه، میتوان بیان کرد که آموزش و اجرای تکنیک آرامسازی عضلانی بنسون باعث کاهش میزان تهوع و افزایش کفایت دیالیز بیماران تحت درمان با همودیالیز میشود.

Abstract Background Assessment of adequacy of intermittent hemodialysis (IHD) is conventionally based upon urea kinetic models for calculation of single pool Kt/Vurea (Kt/V), with 1.2 accepted as minimum adequate clearance for thrice weekly IHD. In the Acute Renal Failure Trial Network (ATN) Study, adequacy of IHD in patients with acute kidney injury (AKI) was assessed using Kt/V. However, equations for Kt/V require volume of distribution of urea, which is highly variable in AKI. Therefore, simpler methods are needed to assess adequacy of IHD in AKI. We assessed correlation of urea reduction ratio (URR) with Kt/V and determined URR thresholds corresponding to Kt/V values to determine if URR could be a simpler means to assess the delivered dose of IHD. Methods Using patients who received IHD for 2.5–6 h and with pre-dialysis BUN ≥20 mg/dL, we plotted URR against Kt/V. We determined URR thresholds (0.60 to 0.75) corresponding to Kt/V ≥ 1.2, 1.3, and 1.4. We generated receiver operating characteristic (ROC) curves for increasing URR values for each level of Kt/V to identify the corresponding thresholds of URR. Results There was strong correlation between URR and Kt/V. ROC curves comparing URR with Kt/V ≥ 1.2, 1.3, and 1.4 had area under the curves (AUC) of 0.99. Sensitivity and specificity of URR ≥0.67 for corresponding values of Kt/V ≥ 1.2 were 0.769 (95% CI: 0.745 to 0.793) and 0.999 (95% CI: 0.997 to 1.000), respectively and the sensitivity and specificity of URR ≥0.67 for corresponding values of Kt/V ≥ 1.4 were 0.998 (95% CI: 0.995 to 1.000) and 0.791 (95% CI: 0.771 to 0.811), respectively. Conclusions Targeting a URR ≥0.67 provides a simplified means of assessing adequacy of IHD in patients with AKI. Use of URR will enhance ability to assess delivery of small solute clearance and improve adherence with clinical practice guidelines in AKI.

Abstract Background In patients undergoing home dialysis, conventionally, Kt/V has been regarded as an index of the removal efficiency per dialysis session. However, more recently, it has been considered that the hemodialysis product (HDP), rather than the Kt/V, is better associated with the clinical symptoms and outcomes in patients undergoing short daily dialysis or nocturnal dialysis. Nevertheless, the HDP lacks a theoretical background, and it does not take into consideration the dialyzer clearance or patient’s body size. The aims of the present study were to clarify the theoretical validity of HDP focusing on its association with solute concentration by computer simulation and to propose a new index of hemodialysis adequacy. Methods We used compartment models and calculated the time course of urea and β2 microglobulin (β2MG) concentrations to determine the peak concentrations and time-averaged concentrations at varying dialysis frequencies (n = 2–7 sessions/week) and durations of dialysis per session (t = 1 to 8 h dialysis sessions). Results It was found that the peak concentrations of urea and β2MG were significantly correlated with the HDP. Based on this, we theoretically extracted the factor related to the peak concentration and defined the squared frequency-Kt/V (sf-Kt/V), as a new index for determining hemodialysis adequacy (sf-Kt/V = n 2 Kt/V; K, clearance; V, solute distribution volume; n, frequency; t, dialysis time); this index was well correlated with the peak concentrations of urea and β2MG, even when the values of K and V were changed. Conclusions Since the sf-Kt/V is an index that reflects peak concentrations of urea and β2MG, which takes into account the dialysis frequency, session duration, dialyzer clearance, and the body weight of the patient, it will be a very useful tool for determining appropriate dialysis schedules and dialysis conditions for individual patients.

The determination of Kt/V by ionic dialysance is a technique that has extended its use in hemodialysis clinics. The clinical guidelines have reflected the need to validate this method as a determinant of the dose of dialysis. Determine in daily practice, the influence of hemodialysis characteristics and medication on Kt/V results by ionic dialysance (Kt/V OCM) and compare them with Kt/V measures by serum urea (Kt/V Daugirdas). Cross-sectional and observational study. Participants: 127 patients on chronic hemodialysis. Measurements: Descriptive variables, study variables (Kt/VOCM, Kt/VDaugidas), and the variables that modified the effect (patient temperature, serum sodium, vascular access, recirculation, blood flow, hemodialysis technique, dialyzer, acid concentrate, conductivity, dialyzate flow). The mean of Kt/V Daugirdas was 1.84 and the Kt/VOCM mean 1.65; Pearson's was CC r = 0.54; P < 0.001 and Lin CCC = 0.48. In the linear regression, the variables related to hemodialysis technique showed no statistical association with the measurement obtained by Kt/VOCM. Monosodium phosphate and 20% sodium chloride dispensing were associated with a higher Kt/VOCM. The different technical aspects noted during HD sessions do not influence Kt/V OCM outcomes. Kt/V determined by ionic dialysance isn't similar to that determined by serum urea. When assessing dialysis doses measured by dialysance, consider that it is not the same as determined with serum urea, but it provides an approximation to estimate dialysis doses in real time. It is necessary to consider if drugs or supplements have been administered that can modify it when interpreting the results. [ABSTRACT FROM AUTHOR]

For three‐weekly hemodialysis, a single‐pool Kt/V target of at least 1.4 together with a minimal dialysis dose Kt at 45 L for men and 40 L for women per each session is currently recommended. Fully automatic online calculation of Kt and Kt/V from conductivity or UV‐absorbance measurements in the dialysate is standardly implemented on some hemodialysis monitors and makes it possible to estimate the dialysis dose without the need for blood or dialysate samples. Monitoring the UV‐absorbance of the spent dialysate is the most direct method for estimating Kt/V as it does not require an estimate of V. Calculation of ionic dialysance from conductivity measurements is the most direct method for estimating Kt and BSA‐scaled dialysis dose. Both ionic dialysance monitoring and UV‐absorbance monitoring may help detect a change in urea clearance occurring during the session, but this change must be interpreted differently depending on the monitoring being considered. An abrupt decrease in urea clearance results in a decrease in ionic dialysance but, paradoxically, a sudden increase in estimated urea clearance provided by dialysate UV‐absorbance monitoring. Healthcare teams who monitor both ionic dialysance and UV‐absorbance in their hemodialysis units must be clearly informed of this difficulty. [ABSTRACT FROM AUTHOR]

In advanced Chronic Kidney Disease, patients require renal replacement therapy (dialysis or transplantation) for clearance of toxins, electrolyte and acid-base balance and removal of excess fluid. Dialysis adequacy should be taken into consideration in the adjustment of the dialysis prescription. Kt/Vurea is one method of measuring dialysis adequacy that is commonly used in clinical practice. Different formulae for calculating Kt/V are available. The appropriate Kt/V formula to be used depends on the clinical scenario, as well as parameters such as gender and size of patient, frequency of dialysis, mode of dialysis (ie hemodialysis vs, peritoneal dialysis), inter-dialysis weight gain, clinical symptoms, complications (fluid overload, hyperkalemia, intolerance to dialysis, etc), and residual kidney function. Nutrition parameters including serum protein and albumin levels, vitamin B12 and β2-microglobulin levels should be factored into the assessment of dialysis adequacy. In this review, we have described how Kt/Vurea is calculated in hemodialysis and peritoneal dialysis with examples. We reviewed the available literature by searching for papers related to calculating Kt/Vurea, single pool Kt/V, double pool Kt/V, weekly Kt/V, standard Kt/V, surface area normalized Kt/V, and various equations commonly practiced in clinical practice. We found several original articles, some review articles along with detailed information from manufacturers of different dialyzers published on their websites or as package inserts. Understanding the different equations available for calculating Kt/Vurea and the application of these results in the clinical setting is important for refining patient care and for designing clinical studies. [ABSTRACT FROM AUTHOR]

Background Dialysis adequacy, as measured by single pool Kt/V , is an important parameter for assessing hemodialysis (HD) patients' health. Guidelines have recommended Kt/V of 1.2 as the minimum dose for thrice-weekly HD. We describe Kt/V achievement, its predictors and its relationship with mortality in the Gulf Cooperation Council (GCC) (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates). Methods We analyzed data (2012–18) from the prospective cohort Dialysis Outcomes and Practice Patterns Study for 1544 GCC patients ≥18 years old and on dialysis >180 days. Results Thirty-four percent of GCC HD patients had low Kt/V (<1.2) versus 5%–17% in Canada, Europe, Japan and the USA. Across the GCC countries, low Kt/V prevalence ranged from 10% to 54%. In multivariable logistic regression, low Kt/V was more common (P < 0.05) with larger body weight and height, being male, shorter treatment time (TT), lower blood flow rate (BFR), greater comorbidity burden and using HD versus hemodiafiltration. In adjusted Cox models, low Kt/V was strongly related to higher mortality in women [hazard ratio (HR) = 1.91, 95% confidence interval (CI) 1.09–3.34] but not in men (HR = 1.16, 95% CI 0.70–1.92). Low BFR (<350 mL/min) and TT (<4 h) were common; 41% of low Kt/V cases were attributable to low BFR or TT (52% for women and 36% for men). Conclusion Relatively large proportions of GCC HD patients have low Kt/V. Increasing BFR to ≥350 mL/min and TT to ≥4 h thrice weekly will reduce low Kt/V prevalence and may improve survival in GCC HD patients—particularly among women. [ABSTRACT FROM AUTHOR]

مقدمه: همودیالیز به‌عنوان بهبوددهنده‌ی کیفیت زندگی و کاهنده عوارض نارسایی کلیه، شایع‌ترین روش درمانی در بیماران کلیوی می‌باشد. عدم‌کفایت دیالیز نیز از مهم‌ترین علل تعیین‌کننده ناتوانی و مرگ‌ومیر در بیماران دیالیزی بوده و به علت نبود تـصویر روشنی از سطح کفایت دیالیز، مطالعـه حاضر با هدف تعیین کفایت دیالیز در بیماران تحت کفایت همودیالیز در بیمارستان شهید بهشتی قروه انجام گردید.مواد و روش‌ها: این پژوهش از نوع توصیفی_تحلیلی و به‌صورت مقطعی در سال 1398 انجام شد. تعداد نمونه‌ها، 41 بیمـار تحـت همودیـالیز که بیش از سه ماه از شروع دیالیز آن‌ها گذشته و به‌روش سرشـماری انتخـاب شـد. جمع‌آوری داده‌ها از طریق پرسشنامه دموگرافیک محقق ساخته انجام شد. کفایت دیالیز از طریق پارامترهای Kt/v و URR محاسبه گردید. درنهایت داده‌ها با استفاده از آزمون‌های آماری توصیفی و استنباطی در نرم‌افزار SPSS 22 مورد تجزیه‌وتحلیل قرار گرفت.یافته‌ها: نتایج نشان داد که حداقل و حداکثر شاخص KT/V به ترتیب 24/0 و 12/3، میانگین کل آن در بیماران 43/0±28/1 بود.میانگین URR کل بیماران 23/14±83/66، و کمترین درصد URR،60/12 و بیشترین آن 30/94 درصد بود. میانگین نیتروژن اوره خون قبل از دیالیز 23/0±63/273 و بعد از دیالیز 23/5±17/63 گزارش شد.بحث و نتیجه‌گیری: مطالعه حاضر نشان داد که بیش از نیمی از بیماران تحت همودیالیز دارای کفایت دیالیز مطلوب بوده؛ اما در 36 درصد بیماران کفایت دیالیز از کارآیی مناسب برخوردار نمی‌باشند؛ لذا اجرای مداخلاتی در جهت اصلاح مدت‌زمان دیالیز و جریان خون، نوع صافی و ...به‌عنوان عوامل عمده تأثیرگذار ضرورت دارد.

Abstract Background Choice of dialysis is context sensitive, explored for PD and extracorporeal dialysis, but less studied for haemodialysis (HD) and hemodiafiltration (HDF), both widely employed in Italy and France; reasons of choice and differences in prescriptions may impact on dialysis-related variables, particularly relevant in elderly, high-comorbidity patients. Methods The study involved two high-comorbidity in-hospital cohorts, treated in Centers with similar characteristics, in Italy (Cagliari) and France (Le Mans). All patients (204) agreed to participate. Stable cases on thrice-weekly dialysis, with at least 2 months follow-up were selected (180 patients, Males 59.4%, median age 71 years, vintage 4.3 years, Charlson index 9). Univariate and multivariate correlations between baseline data, HD-HDF, dialysis efficiency and nutritional markers were assessed. Results In Le Mans HDF was mainly chosen to increase efficiency (large surface dialysers, high convective volume; 76.3% of the patients), in Cagliari to improve tolerance (smaller surfaces, lower convective volume; 59% of patients). Kt/V was similar in HD and HDF, and in both settings(median Kt/V Daugirdas 2: 1.6); in the setting of high efficiency no correlation was found between Kt/V, BMI, urea, creatinine, n-PCR and phosphate. The relationship between Kt/V and albumin was divergent: a weak consensual increase was present in Cagliari, a decrease in Le Mans, suggesting a role of albumin losses with high convective volumes. In the multivariate analysis, after adjustment for other covariates (including comorbidity and type of treatment) low albumin level = 7 (OR: 3.153 (1.311–7.582)), MIS index> = 7 (OR: 5.916 (2.457–14.241)). Conclusions The different prescriptions of HD and HDF may have similar effects on dialysis efficiency, but diverging effects on crucial nutritional markers, such as albumin levels, probably more evident in high-comorbidity populations.

Background: Haemodiafilteration (HDF) is a promising new modality of renal replacement therapy (RRT). It is an improvement in the quality of hemodialysis (HD) and thus in the quality of patients'lives. The main obstacle to using HDF is the cost, especially in developing countries. The purpose of this study was to evaluate the benefits of incorporating HDF with different regimens in the treatment of children with end stage renal disease (ESRD).Methods: Thirty-four children with ESRD on regular HD in Pediatric Dialysis Unit, Children's Hospital, Ain Shams University were followed up in 2 phases: initial phase (all patients: HD thrice weekly for 3 months) and second phase, patients were randomized into 2 groups, HDF group and HD group, the former was subdivided into once and twice weekly HDF subgroups. Evaluation using history, clinical and laboratory parameters at 0, 3, 9 and 18 months was carried out.Results: On short term, we found that the HDF group was significantly superior to HD group regarding all clinical and laboratory parameters. Also, twice HDF subgroup was significantly superior to once HDF subgroup. This was confirmed on long term follow up, but the once HDF proved comparable to twice subgroup.Conclusions: Incorporating online hemodiafilteration (OL-HDF) in the RRT of children was beneficial in most of the clinical and laboratory parameters measured. It's not all or non; OL-HDF, even once a week, can improve outcomes of HD without significantly affecting the cost. [ABSTRACT FROM AUTHOR]

Background: Vascular calcification (VC) is a risk factor for cardiovascular disease in end-stage renal disease (ESRD) patients undergoing maintenance haemodialysis (MHD). However, evidence is still insufficient about the association between dialysis parameters and VC. Thus, this study was to evaluate association of dialysis parameters with VC.Methods: We enrolled 297 ESRD patients undergoing MHD at six distinct centers in Korea. Study participants were categorized into 3 groups by the scoring system of abdominal aortic calcification based on lateral lumbar radiography (no VC group: 0, mild VC group: 1-7 and advanced VC group: 8-24). We compared the features of dialysis parameters according to the severity of VC. Multivariate logistic regression analysis was used to calculate adjusted odd ratios (ORs) and 95% confidence interval (CI) for mild and advanced VC in each haemodialysis parameter (adjusted OR [95% CI]).Results: Pooled Kt/V (spKt/V), equilibrated Kt/V (eKt/V), standard Kt/V (stdKt/V) and the proportion of haemodiafiltration were increased along with the severity of VC. Multivariate regression analysis indicated that advanced VC was positively associated with spKt/V (5.27 [1.51-18.41]), eKt/V (6.16 [1.45-26.10]), stdKt/V (10.67 [1.74-65.52]) and haemodiafiltration (3.27 [1.74 to 6.16]).Conclusion: High dose dialysis and haemodiafiltration were significantly associated with advanced VC. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis has been taken a major role in prolonging survive of patient with end stage renal disease (ESRD) patient. The efficacy of hemodialysis may be improved by using the difference flux dialysis membranes and blood flow rates by considering their difference complications. This study aimed to know the assess dialysis adequacy in difference blood flow rates and low and high flux membranes. Subject and materials: The research method adopted for the study was a quasi-experimental design. The researchers selected 96 hemodialysis sessions from different patients. Two difference filters were used, and BFRs have been arranged from 200ml/min, 250ml/min, and 300ml/min. The clinical signs of the patient status were assessed and monitored during dialysis. Dialysis adequacy for difference flow rates were measured based on normalized treatment ratio (Kt/V) and urea reduction rate (URR). Results: Over 58 of participants were male, with the overall mean age was (51.40±13.64). Mean Kt/V (1.31±0.43) and URR (55.09±11.68) were significantly high among female, the statistical value (P. value=0.026). The high Kt/v was seen in blood flow rate 300ml/min in low flux and high flux dialysis membranes, means was 1.33±0.35, and 1.54±0.47. Similarly, high URR was seen 300ml/min blood flow rates in high flux dialysis membrane, 64.57±6.82. Statistical difference was (p. value=0.000). The high significant Kt/V and URR were seen in dry weight patient (P. value= 0.016 and 0.021 respectively). Over (33%) of patient was developed complication during dialysis, the most frequent complications were hypotension (10%) and weakness (9%). Conclusion: dialysis adequacy is most associated with high blood flow rate with using high flux dialysis membrane. Less percentage complications have seen among dialysis patients in this study. [ABSTRACT FROM AUTHOR]