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Introduction. A single pass albumin dialysis (SPAD) is a form of extracorporeal liver support system for removing albumin-bound toxins and water-soluble substances that accumulate in liver failure (LF). Case report. We presented three patients hospitalized for LF and treated using the SPAD at the University Clinical Center of Vojvodina, Serbia, from 2018 to 2019. Two of the patients presented with acute LF and one with acute-on-chronic LF. A total of 6 SPAD sessions were performed on each patient, resulting in decreased serum bilirubin and bile acid levels and hepatic encephalopathy grade. On discharge from the hospital, the liver function was improved in all the patients. Conclusion. SPAD removes the hepatotoxic substances without improvement of synthetic liver function. It represents a supportive treatment for LF patients who do not respond to the standard of care, offering a longer time for bridging to organ transplantation or spontaneous recovery of the liver function.

Uraemic pruritus is a common and burdensome symptom in patients undergoing haemodialysis. Though a significant negative impact of chronic itch on patient's quality of life is proved, this problem is still often underestimated in clinical practice. Various instruments describing itch are in use, however only recently a specific instrument for uraemic itch - Uraemic Pruritus in Dialysis Patient (UP-Dial) - questionnaire has been created.To translate and to validate the Polish version of the UP-Dial questionnaire.Forward and backward translations were conducted according to international standards. The validation was performed on a group of 30 patients undergoing haemodialysis and suffering from uraemic itch. Respondents completed the questionnaire twice with a 3-7 days' interval. Moreover, for convergent validity, the subjects were asked to assess their itch with the Numerical Rating Scale (NRS), 4-Item Itch Questionnaire (4IIQ) as well as ItchyQoL questionnaire.The Polish version of the UP-Dial questionnaire showed very good internal consistency - Cronbach α coefficient was 0.90 for total score. The reproducibility assessed with the intraclass correlation coefficient (ICC) was also very good - 0.9. Furthermore, UP-Dial correlated strongly with NRS (The Polish version of the UP-Dial questionnaire showed high internal reliability, validity and reproducibility and can be widely used both in research and in daily clinical practice.

Innovative, patient-centered, and pragmatic dialysis technologies are urgently needed to accommodate the growing national interest in home dialysis use. To help achieve this goal, the US Centers for Medicare & Medicaid Services (CMS) are expanding reimbursement for eligible home dialysis machines through an existing payment mechanism, the transitional add-on payment for new and innovative equipment and supplies (TPNIES). This mechanism incentivizes the early adoption of innovative equipment into practice by reimbursing dialysis providers up to 26% of the total cost of approved home dialysis machines. Machines are evaluated for TPNIES eligibility using prespecified substantial clinical improvement (SCI) criteria that are derived from the Inpatient Prospective Payment System (for non-nephrology technologies). Although the SCI criteria may be suitable for some non-nephrology technologies, they have not been adapted to consider the unique and complex care inherent in home dialysis. Thus, many of the SCI criteria appear unsuitable for home dialysis machines. To better incentivize innovation, CMS should develop nephrology-specific transparent and pragmatic criteria for TPNIES. In this perspective, we provide an overview of the TPNIES payment mechanism, highlight areas of concern within the policy, and offer solutions for improving TPNIES that could better promote the adoption of new home dialysis machines.

Dialytic clearance of p-cresyl sulfate (pCS) and other protein-bound toxins is limited by diffusive and convective therapies, and only a few studies have examined how to improve their removal by adsorptive membranes. This study tested the hypothesis that high-flux polymethylmethacrylate (PMMA) dialysis membranes with adsorptive capacity increase pCS removal compared to polysulfone membranes, in a postdilution on-line hemodiafiltration (OL-HDF) session. Thirty-five stable hemodialysis patients randomly completed a single study of 4 h OL-HDF with PMMA (BG2.1U, Toray®, Tokyo, Japan) and polysulfone (TS2.1, Toray®) membranes. The primary endpoint was serum pCS reduction ratios (RRs) obtained with each dialyzer. Secondary outcomes included RRs of other solutes such as β2-microglobulin, the convective volume obtained after each dialysis session, and the dialysis dose estimated by ionic dialysance (Kt) and urea kinetics (Kt/V). The RRs for pCS were higher with the PMMA membrane than those obtained with polysulfone membrane (88.9% vs. 58.9%, p &lt, 0.001), whereas the β2-microglobulin RRs (67.5% vs. 81.0%, 0.001), Kt (60.2 ± 8.7 vs. 65.5 ± 9.4 L, p = 0.01), Kt/V (1.9 ± 0.4 vs. 2.0 ± 0.5, p = 0.03), and the convection volume (18.8 ± 2.8 vs. 30.3 ± 7.8 L/session, 0.001) were significantly higher with polysulfone membrane. In conclusion, pCS removal by OL-HDF was superior with high-flux PMMA membranes, appearing to be a good dialysis strategy for improving dialytic clearance of pCS, enabling an acceptable clearance of β2-microglobulin and small solutes.

Three-dimensional aggregate-suspension culture is a potential biomanufacturing method to produce a large number of human induced pluripotent stem cells (hiPSCs); however, the use of expensive growth factors and method-induced mechanical stress potentially result in inefficient production costs and difficulties in preserving pluripotency, respectively. Here, we developed a simple, miniaturized, dual-compartment dialysis-culture device based on a conventional membrane-culture insert with deep well plates. The device improved cell expansion up to approximately ~3.2 to 4×107 cells/mL. The high-density expansion was supported by reduction of excessive shear stress and agglomeration mediated by the addition of the functional polymer FP003. The results revealed accumulation of several growth factors, including fibroblast growth factor 2 and insulin, along with endogenous Nodal, which acts as a substitute for depleted transforming growth factor-β1 in maintaining pluripotency. Because we used the same growth-factor formulation per volume in the upper culture compartment, the cost reduced in inverse proportional manner with the cell density. We showed that growth-factor-accumulation dynamics in a low-shear-stress environment successfully improved hiPSC proliferation, pluripotency, and differentiation potential. This miniaturised dialysis-culture system demonstrated the feasibility of cost-effective mass production of hiPSCs in high-density culture., Although human pluripotent stem cell culture is routine, daily media changes, high cost of growth factors required in pluripotent cell media, and reproducibility of differentiation are an obstacle for the mass production of hPSCs. Here, Torizal et al. describe a cost-effective dialysis-culture system for human pluripotent stem cells (hPSCs) at a high density.

BACKGROUND Hemodialysis corrects metabolic acidosis by transferring bicarbonate or bicarbonate equivalents across the dialysis membrane from the dialysis fluid to the plasma. With the conventional three-stream bicarbonate-based dialysis fluid delivery system, a change in the bicarbonate concentration results in changes in the other electrolytes. In practice, the dialysis machine draws either a little less or more from the bicarbonate concentrate and a little more or less from the acid concentrate, respectively in a three-stream delivery system. The result not only changes the bicarbonate concentration of the final dialysis fluid but also causes a minor change in the other ingredients. METHODS We propose a four-stream bicarbonate-based dialysis fluid delivery system consisting of an acid concentrate, a base concentrate, a product water, and a new sodium chloride concentrate. RESULTS By adjusting the flow rate ratio between the sodium chloride and sodium bicarbonate concentrates, one can achieve the desired bicarbonate concentration in the dialysis fluid without changing the concentration of sodium or ingredients in the acid concentrate. The chloride concentration mirrors the change in bicarbonate but in the opposite direction. CONCLUSION A four-stream, bicarbonate-based dialysis fluid delivery system allows the bicarbonate concentration to be changed without changing the other constituents of the final dialysis fluid.

Background Free-living amoeba (FLA), including Acanthamoeba, Naegleria, Balamuthia and Vermamoeba, have been isolated from water, sand, soil, dust and air. Numerous studies considered that FLA are a significant cause of neurological and ocular complications in high-risk groups, including immunocompromised individuals. The present study aimed to identify morphological and molecular characteristics of FLA isolates in dialysis fluid samples of hydraulic systems in hemodialysis units in Iran. Methods A total of 328 dialysis fluid samples were collected from 16 dialysis machines, including 164 samples before hemodialysis sessions (after cleaning) and 164 samples after hemodialysis sessions (before cleaning). Filtration and cultivation were performed on non-nutrient agar medium. Also, PCR and sequencing were applied by using the genus-specific primers along with a common primer set on positive samples. Results Both morphology and molecular investigations showed that 22.5% (74/328) of dialysis fluid samples were positive for FLA. There was a positive relationship between the high frequency of FLA after hemodialysis sessions (before cleaning) compared with before hemodialysis sessions (after cleaning) (OR=2.86; 95% CI 1.5 to 5.45). Considering the PCR assay, 16.46% (54/328) samples were identified as Acanthamoeba spp. (belonging to T3 and T4 genotypes), 5.18% (17/328) as Vermamoeba vermiformis and 0.91% (3/328) as Vahlkampfiidae family (Naegleria australiensis, Naegleria pagei and Allovahlkampfia). Conclusion The present results support a need to improve filtration and purification methods for dialysis fluid of hydraulic systems in hemodialysis units. They also highlight the relevance of periodic screenings for FLA-related diseases in hemodialysis patients.

Prevalence of Hepatitis C (HCV) is quite high in Pakistan and in particular among maintenance hemodialysis (MHD) patients. HCV is associated with increasing morbidity and mortality among MHD patients. The current availability of direct acting antiviral therapy has changed the canvas for HCV prevalence in many countries. Aim of our study was to evaluate the status of HCV prevalence and its management at our center. Methods: This descriptive study was conducted at Nawaz Sharif Kidney Hospital Swat, Pakistan to evaluate the seroprevalence of HCV among MHD patients. Data regarding HCV status, PCR positivity and number of patietns on active treatment were evaluated. Results: A total of 109 patients were undergoing MHD in this study. The prevalence of patient who had HCV was 40 (36.6%). All patietns had PCR done and out of them PCR was positive in 28 Patients. All except 4 of the 28 patients had been started on HCV treatment with direct antiviral therapy for HCV. Conclusion: almost all of HCV PCR positive patients were being treated with DAA in our dialysis unit.

International audience; Introduction: 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.Areas covered: 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.Expert opinion: 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.

Polymeric nanoparticles (NPs) are typically designed to enhance the efficiency of drug delivery by controlling the drug release rate. Hence, it is critical to obtain an accurate drug release profile. This study presents the first application of asymmetric flow field-flow fractionation (AF4) with fluorescence detection (FLD) to quantify release profiles of fluorescent drugs from polymeric NPs, specifically poly(lactic-co-glycolic acid) NPs loaded with enrofloxacin (PLGA-Enro NPs). In contrast to conventional measurements requiring separation of the NPs and dissolved drugs (typically by dialysis) prior to quantification, AF4 provides in situ removal of unincorporated drugs, while the judicious combination of online FLD and UV detection selectively provides the entrapped drug and PLGA NP concentrations, respectively, and hence the drug loading. NP size and shape factors are simultaneously obtained by online dynamic and multi-angle light scattering (DLS, MALS) detectors. The AF4 and dialysis approaches were compared to evaluate drug release from PLGA-Enro NPs containing a high proportion (≈ 94%) of unincorporated (burst release) drug at three temperatures spanning the glass transition temperature (Tg ≈ 33 °C) of the NPs. The AF4 method clearly captured the temperature dependence of the drug release relative to Tg (from no release at 20 °C to rapid release at 37 °C). In contrast, dialysis was not able to distinguish differences in the extent or rate of release of the entrapped drug because of interferences from the burst release, as well as the dialysis lag time, as supported through a diffusion model and validation experiments on purified NPs with low burst release. Finally, the multi-detector AF4 analysis yielded unique size-dependent release profiles across the entire NP size distribution, with smaller NPs showing faster release consistent with radial diffusion from the NPs. Overall, this study demonstrates the novel application and advantages of multi-detector AF4 methods, particularly AF4-FLD, to obtain direct, size-resolved release profiles of fluorescent drugs from polymeric NPs.

We propose a novel osmotic soft valve consisting of an osmosis membrane and hydrogel films. In our osmotic valve system, material selectivity is determined by the osmosis membrane, and the hydrogel film, which deforms depending on the ion concentration of the surrounding solution, controls the passage area of the membrane. Independently controlling the material selectivity and permeability allowed us to design an osmotic soft valve with an osmotic flow rate that increases with osmotic pressure at low pressures but decreases with osmotic pressure at high pressures. We demonstrate a representative application of our hydrogel valve system in a portable power generator utilizing reverse electrodialysis (RED). As the permeability varied with concentration, the hydrogel valve was able to maintain the electric power of the RED for 30 min with only an ∼10% change. Our study provides techniques to build osmotic soft valves that can serve as gating membranes in various osmosis and dialysis systems.

Background: To analysis survival in onset uremic patients who initiating HD or PD dialysis in our dialysis center. Methods: Between Jan. 2015 and June. 2018, patients with onset uremia and initiating planned-start dialysis were retrospectively enrolled in this study and followed up to January, 2019. The relationships between the types of dialysis modality and patient prognosis were assessed. Results: A total of 460 patients were included in the final analysis. Of which, 213 patient (46.30%) undergoing PD and 247 patients (53.70%) undergoing HD with arteriovenous fistula. The average follow-up time was 27.9 months. Eighty-seven (18.91%) patients died during the study period. The all-cause mortality was 127 per 1000 person-year. It was 102 per 1000 person-year in the HD group and 171 per 1000 person-year in the PD group ( p Conclusions: Though dialysis modality was not an independent factor for overall survival, HD therapy seemed to be more suitable for patients without DN.

Purpose of review Improvement in hemodialysis treatment and membrane technology are focused on two aims: the first one is to achieve a better control of circulating uremic solutes by enhancing removal capacity and by broadening molecular weight spectrum of solutes cleared; the second one is to prevent inflammation by improving hemocompatibility of the global dialysis system. Recent findings Despite impressive progresses in polymers chemistry few hazards are still remaining associated with leaching or sensitization to polymer additives. Research has focused on developing more stable polymers by means of additives or processes aiming to minimize such risks. Membrane engineering manufacturing with support of nanocontrolled spinning technology has opened up membrane to middle and large molecular weight substances, while preserving albumin losses. Combination of diffusive and enhanced convective fluxes in the same hemodialyzer module, namely hemodiafiltration, provides today the highest solute removal capacity over a broad spectrum of solutes. Summary Dialysis membrane is a crucial component of the hemodialysis system to optimize solute removal efficacy and to minimize blood membrane biological reactions. Hemodialyzer is much more than a membrane. Dialysis membrane and hemodialyzer choice are parts of a treatment chain that should be operated in optimized conditions and adjusted to patient needs and tolerance, to improve patient outcomes.

Summary Objectives Filters used in continuous renal replacement therapy (CRRT) induce elimination by filtration, dialysis, and adsorption. The worldwide used ST150® filter adsorbs cytokines. However, adsorption is a non-specific process which might alter the pharmacokinetics of drugs. Pharmacodynamic/pharmacokinetic relationship of aminoglycosides evidences the importance of the peak concentration at the first dose. We hypothesize an in vitro study may clarify the routes of elimination of aminoglycosides using the ST150® filter. Methods Prismaflex® and the STX150® filter, Baxter-Gambro were used. The diafiltration mode combined flowrates of dialysis and filtration at 2.5/1.5 L/h, respectively, over 6 h. One ionic solute was used in the different compartments. Pharmacokinetic analyses were performed using the NeckEpur® software. Results Percentages of gentamicin, tobramycin, and amikacin eliminated from the central compartment were 97 ± 1, 95 ± 3, and 94 ± 6, %, respectively. The clearances were 8.4 ± 2.3, 5.4 ± 5, and 4.2 ± 0.4 L/h, respectively. The contributions of dialysis, filtration, and adsorption for gentamicin, tobramycin, and amikacin were 34.3 ± 2.1, 0 ± 0, and 67.7 ± 2.1; 51.1 ± 1.6, 6.3 ± 3.1, and 46.3 ± 2.0, and 37.8 ± 6.3, 46.3 ± 2.0, and 16.0 ± 5.7%, respectively. Among physico-chemical properties, the rate of adsorption linearly and inversely correlated with the polar surface area of aminoglycosides (Y = −0.44 X + 161.7; R2 = 0.9993). Discussion Using the ST150® filter, dialysis, filtration, and adsorption play a role depending on the chemical structure of aminoglycosides. In the diafiltration mode, elimination of gentamicin and tobramycin by filtration is not detected or weak, respectively. Adsorption should be considered as a potential adverse effect of CRRT. Polar surface area of drugs is a physico-chemical parameter which should be considered regarding adsorption of drugs in filters. The risk needs to be systematically assessed.

Intradialytic hypotension (IDH) occurs in 20% of haemodialysis treatments, leading to end-organ ischaemia, increased morbidity and mortality; and contributing to poor quality of life for patients. Treatment of IDH is reactive since brachial blood pressure (BP) is recorded only intermittently during haemodialysis, making early detection and prediction of hypotension impossible. Noninvasive continuous BP monitoring would allow earlier detection of IDH and thus support the development of methods for its prediction and consequently prevention.Noninvasive continuous BP monitoring is not yet part of routine practice in renal dialysis units, with a small number of devices (e.g. finger cuffs) having occasionally been used in research settings. In use, patients frequently report pain or discomfort at measurement sites. Additionally, these devices can be unreliable in patients with reduced blood flow to the digits, often manifest in dialysis patients. All existing methods are sensitive to patient movement.A new method for continuously estimating BP has been developed by monitoring arterial pressure near the arteriovenous fistula which can be achieved without any extraneous monitoring equipment attached to the patient. Additionally, artificial intelligence-based methods for real-time prediction of IDH are currently emerging.Key monitoring technologies and computational methods are emerging to support the development of real-time IDH prediction.

The principal possibility for preparing tritiated hyaluronic acid by the thermal activation method is demonstrated. The influence exerted by the conditions of preparing substances and the conduction of the isotope exchange reaction on the specific activity of the labeled product and the uniformity of tritium distribution among the molecules with different molecular weights is determined. It is shown that under mild experimental conditions and double dialysis purification of the samples (before and after the introduction of tritium), tritium-labeled hyaluronic acid with a specific activity of 26–52 GBq/g can be obtained without significant changes in the molecular weight distribution.

A 65-year-old Japanese male presented with a substantial amount of bright red and burgundy rectal bleeding. A colonoscopy confirmed the presence of fresh blood and coagulation in the orifice of the appendix. A suitable position was found using an endoscopic hood to visualize the exposed vessel clearly. We placed two hemo-clips on the appendix orifice at opposite sides of the exposed vessel and then stirred them with an endoscopic hood to visualize the exposed vessel clearly. Finally, we placed other two hemo-clips near the exposed vessels and carried out a complete hemostasis with vessel thrombosis.

BACKGROUND. The survival of dialysis patients remains unsatisfactory. A number of observational studies have shown that the conditions of initiation of dialysis can influence long-term outcomes, including mortality.THE AIM. To compare the mortality of patients under predefined conditions of optimal (planned) and suboptimal (unplanned) dialysis initiation.METHODS. Using the MEDLINE and EMBASE databases from inception to June 2020, we conducted a systematic search for studies that examined the overall mortality of patients who met or did not meet the predefined conditions for an “optimal” start of renal replacement therapy (RRT): planned vs. unplanned onset; initiation of substitution therapy on permanent access vs. temporary; with priorobservation of the nephrologist vs. without it. As a result of a systematic search, subsequent analysis and selection of publica tions, 8 studies were included in the meta-analysis (total number of incident patients was 22755; 13680 patients met the conditions of the optimal dialysis start).RESULTS. All-cause mortality among patients with the conditions of suboptimal dialysis start was higher than in those with the optimal start (34.4 % vs. 46.6 %, pCONCLUSION. The meta-analysis demonstrated the relationship between the urgent initiation of RRT, the use of temporary access for dialysis, and the lack of timely prior follow-up by a nephrologist with an increase in mortality. Prevention of dialysis initiation in these suboptimal conditions in real-world clinical practice can be an effective tool for improving patient-centered outcomes.

Background: Chronic kidney disease (CKD) is a public health problem over all the world. CKD may also be defined by the presence of kidney damage or a reduced glomerular filtration rate (GFR), which is the best overall indicator or index of kidney function. CKD patients are usually treated using kidney dialysis (hemodialysis) that uses a blood filtration mechanism (HD). Several metabolic parameters, such as blood urea, sodium, potassium, and glucose levels, can alter during HD. Osmotic alterations in blood, aqueous and vitreous humor, and other extracellular fluids arise from these fluctuations. That also can affect visual acuity, intraocular pressure (IOP), and retinal thickness. Aim of the Study: To evaluate some of the ocular findings undergoing HD to keep prevent the loss of patient vision such as visual acuity (VA), intraocular pressure (IOP), central corneal thickness (CCT), central Foveal Thickness (CFT), retinal nerve fiber layer (RNFL). Patient& Methods: This is a cohort (prospective) design study. This study including Seventy nine patients divided into two groups the first group from one week to six month (9 femal & 18 males) another group over than six month (36 female & 16 male) the average age between (12 to 70 years). This research performed in the three places department of the eye in Al-Hussein hospital in Samawah city, Al-Haboby hospital, Al-Hussein hospital in Dhi Qar city finally in Al-Shaheed Gazy hospital and Baghdad teaching hospital in Baghdad. Examining Visual Acuity by Snellen chart & auto refractometer, IOP& CCT by (CT.1 Computerized Tonometer TOPCON), RNLF and Central Foveal Thickness by OCT (Carl ZEISS, TOPCON). The inclusion criteria were as follows: all the patients undergoing dialysis from one week to over six months. Exclusion criteria were as follows: the patients have diabetic, any patients have a hereditary disease or glaucoma history or laser therapy, or intraocular injection in the eye before dialysis, the patients have a problem in the eye before dialysis such as cataracts or opacity leads to does surgery, the patients who have a refractive error or wear glass had been also excluded. Result: Includes the results of seventy-nine patients (45 females and 34 males) with chronic kidney disease examined ocular findings before a session of dialysis divided into two groups based on their duration of dialysis. Group one with twenty-seven patients (9 female & 18 male) under dialysis from one week to six months with mean & standard deviation (3.2037, ± 1.89259), group tow with fifty tow patients (36 female & 16 male) under dialysis from the duration over than six months with mean & standard deviation (44.2308, ± 26.24367) respectively. Patients aged (12 to 70 years) had mean age & ± standard deviation (35.1481, ± 12.88918), (44.4038, ± 15.42249) for two groups respectively. Patients in two groups had IOP (Right eye), its mean & standard deviation (15, ± 2.34), (15.69, ± 2.56) for group one & group tow respectively. Also, patients had CCT (Right eye) with mean & standard deviation (5.3467E2, ± 39.00296), (5.2312E2, ± 30.44162) for group one & group tow respectively. Patients had CCT (Left) with mean & standard deviation (5.2878E2, ± 37.55748), (5.2179E2, ± 29.58957) for group one & group tow respectively. Patients in two groups had average thickness RNFL (Right eye) with mean & standard deviation (1.0604E2, ± 25.17551), (95.6154, ± 21.27150) for group one & group tow respectively. Also, patients had average thickness RNFL (left eye) with mean & standard deviation (1.0930E2, ±23.80177), (98.7500, ± 23.77334) for group one & group tow respectively. Conclusions: This study found CCT effective with dialysis tend to be thin (53 patient,18 patient in group one &35 in group two) and that will be had a threefold higher risk of developing glaucoma when compared with thick average because of the IOP value affected by it. Refractive error effective with dialysis & become was more prominent that can be shown in the group two have (40 patient from 52) while (15 patient from27) in the group one although a lot of them corrected to the BCVA. In conclusion high value of the C/D ratio formed about (45.57%, 53.16%) to the right &left eye respectively this value will be form important sign of risk factor to progressive of glaucomatous need to be alert in the future. Also our research reveals CFT effective undergoing dialysis the thick value was (56 in the right eye, 55 in the left eye) high compared with the thin (9 in the right&9 in the left eye) & normal (14 in the right eye, 15 in the left eye). All the two groups of patients will be effected by the duration of dialysis with a time.

Bacteremia in dialysis patients is a major risk factor of mortality. The aim of this study was to assess the effectiveness of dialysis with high-flux versus low-flux dialyzer regarding risk of bacteremia in dialysis patients. This was a retrospective cohort study that included dialysis patients who underwent dialysis therapy at old dialysis center where old low-flux dialyzers were used and the new dialysis center where high-flux dialyzers were used. The rate of positive culture was more in high-flux group (37.0%) compared to low-flux group (24.5%), although the difference was not statistically significant (P = 0.13). The vascular access was mostly permanent catheter in high-flux group compared to low-flux group (48.9% vs. 28.6%, respectively; P = 0.06), while arteriovenous (AV) fistula was more prominent in low-flux group compared to high-flux group (65.3% vs. 47.8%, respectively; P = 0.06). This was reflected in the type of bacteria, which was mostly from Gram-positive family (Staphylococcus). The results showed higher risk of bacteremia in high-flux group as compared to low-flux group; however, permanent catheters were more prominent in high-flux group.

Background: Most pre-dialysis patients are medically eligible for home dialysis, and home dialysis has several advantages over incentre dialysis. However, accurately selecting patients for home dialysis appears to be difficult, since uptake of home dialysis remains low. The aim of this study was to investigate which medical or psychosocial elements contribute most to the selection of patients eligible for home dialysis. Methods: All patients from a Dutch teaching hospital, who received treatment modality education and subsequently started dialysis treatment, were included. The pre-dialysis programme consisted of questionnaires for the patient, nephrologist and social worker, followed by an assessment of eligibility for home dialysis by a multidisciplinary team. Clinimetric assessment and logistic regression were used to identify domains and questions associated with home dialysis treatment. Results: A total of 135 patients were included, of whom 40 were treated with home dialysis and 95 with incentre haemodialysis. The key elements associated with long-term home dialysis treatment were part of the domains ‘suitability of the housing’, ‘self-care’, ‘social support’ and ‘patient capacity’, with adjusted odds ratios ranging from 0.13 for negative to 18.3 for positive associations. Conclusion: The assessment of contraindications by a nephrologist followed by the assessment of possibilities by a social worker or dialysis nurse who investigates four key elements, ideally during a home visit, and subsequent detailed education offered by specialized nurses is an optimal way to select patients for home dialysis.

Dialysis access-related distal ischaemia is a rare yet potentially rather risky complication of haemodialysis angioaccess. Timely diagnosis is crucial to target both the goals of the access team: first of all to preserve the function of the hand ideally along with angioaccess patency. Unfortunately for some patients, urgent access ligation and central vein catheter insertion would be needed to save the hand. After a first clinical examination to determine the diagnostic suspicion, the ultrasound evaluation would provide nearly all the needed information to confirm the diagnosis and to determine the most appropriate procedure to rescue the patient from distal ischaemia. In some cases, photoplethysmography would help in the differential diagnosis of other non-ischaemic causes of similar signs and symptoms. Angiography would complete the preoperative evaluation for some. Dialysis access-related distal ischaemia would be briefly reviewed, and a deep description of the ultrasound examination tools and findings would be provided for a tailored therapeutic approach.

Purpose According to the principle of equivalence of care, health care in prison has to be of the same standard and quality as in the general population. This study aims to determine the geographic accessibility of dialysis services for older prisoners and the older general population in Switzerland and whether accessibility and availability of dialysis care are equivalent. Design/methodology/approach Spatial accessibility analysis incorporated four different data types: population data, administrative data, street network data and addresses of prisons and hemodialysis services. Findings Analysis revealed that the average travel time to the nearest dialysis service was better for prisoners (11.5 min) than for the general population (14.8 min). However, dialysis service for prisoners is hampered by the necessary lead-time in correctional settings, which, ultimately, leads to longer overall access times (36.5 min). Accordingly, the equivalence of dialysis care for older Swiss prisoners is not entirely respected for availability and accessibility. Originality/value The strength of the study lies in the combination of ethical principles and the highly tangible results of a spatial accessibility analysis. The ethics-driven empirical analysis provides arguments for policy-makers to review the current practices.

In this work, two types of silica functionalized monosodium glutamate (GMSG and VMSG)/poly(vinyl alcohol) (PVA) were cross-linked by sol–gel process to prepare novel hybrid cation exchange membranes. The prepared membranes were systematically characterized by FTIR spectroscopy, SEM analysis, ion exchange capacity (IEC), TGA, water uptake, water swelling, mechanical strength and diffusion dialysis performance for alkali separation using NaOH/Na2WO4 solution. The FTIR peaks around 1260–1350 cm− 1 confirmed the secondary C–N linkages. The cross-linking between GMSG/VMSG and PVA was verified by the presence of stretching peaks of Si–O–C, Si–O–Si, C–O–C and –C(=O)–O–C groups between 1080 and 1120 cm− 1. SEM analysis confirmed dense structure and uniform distribution of silica particles in the membrane. TGA results indicated that GMSG membranes showed relatively high thermal stability as compared to VMSG membranes. Water uptake and degree of swelling decreased while IEC values increased with the increase of GMSG/VMSG content in membrane matrix. The mechanical properties of the membranes improved up to 40% GMSG/VMSG content. The NaOH dialysis coefficient (UOH) values improved while values of separation factor (S) declined with the increase of GMSG/VMSG content. Finally, the effect of temperature was studied and it was found that increase in temperature from 25 to 45 °C resulted in increase of diffusion coefficient and decrease of separation factor for both GMSG/VMSG crossed-linked with PVA membranes.

The worldwide biomedical polymeric waste (BPW) production from dialysis treatment is estimated to be reached about 1.6 million tons/year by 2025, dramatically raising financial, environmental, and ...

Introduction: Echocardiography is a simple and established method of evaluating cardiac functions, assessing left ventricle geometry, and systolic and diastolic functions. Patients with chronic kidney disease have a tremendous burden of cardiovascular disease (CVD), and patients with end-stage renal disease (ESRD) are at a greater risk of CVD and deaths.Materials and Methods: In this study, 245 incident dialysis patients were included, and none of the patient was on erythropoietin. All the patients were aged >18 years. Patients with ESRD, already on maintenance dialysis, were not included in this study. Patient’s data such as demographic details, comorbidities, laboratory values, echocardiographic changes, management, and outcome were recorded.Results: Out of 245 patients, 165 (67.3%) were males and 80 (32.6%) females. The mean age of the patients was 49.7 years. Left ventricular hypertrophy (LVH) was observed in 188 (76.7%), mild left ventricular dysfunction (LVD) in 25.7%, moderate LVD in 23.67%, severe LVD in 8.5%, global hypokinesia in 33.8%, valvular heart disease in 26.5%, regional wall motion abnormality in 4.4%, and pericardial effusion in 1.6% patients. Echocardiographic changes, such as LVD, LVH, and global hypokinesia, were observed in greater number in hypertensive group com-pared to normotensive group (P < 0.05). On regression analysis adjusted for age and gender, we found that hypertension and anemia (

Accidental extrusion of tunneled hemodialysis (HD) catheter leaves the dialysis patient without a vascular access and creates an emergency. The common practice is to insert a new catheter via a new venotomy site and a new tunnel. We highlight a lesser-known intervention technique that helps preserve the limited central venous vascular access sites needed to provide dialysis. A 42-year-old man with end stage kidney disease on HD through a right internal jugular vein (RIJV) tunneled hemodialysis catheter (TDC) was referred 1-day after he accidently pulled his catheter following the removal of butterfly wing sutures. The TDC had been in place for 2 months. On examination, the catheter exit site was not infected. After sterile skin preparation the exit site and the tunnel were cleaned with betadine impregnated Q-tips. An 0.035″ hydrophilic guidewire was advanced through the existing venotomy site over a 5F directional catheter under fluoroscopic guidance. The catheter over the guidewire was advanced through the tunnel towards the previous venotomy site in the RIJV. The exact position of the guidewire and catheter was confirmed by injecting contrast. The angled catheter was then maneuvered inferiorly towards the superior vena cava and the wire was placed in the inferior vena cava. A new TDC was advanced over the guidewire through the existing tunnel and the catheter tip was positioned into the mid-right atrium. The procedure was uneventful and TDC was functioning well at 1-month follow-up review. In conclusion, the case highlights the safety of an underutilized practical approach to achieving safe and quick access for dialysis in patients with accidental loss of TDC. The technique described herein, avoids the need to select a new venotomy site, improves patient satisfaction by minimizing procedure related discomfort due to alleviating the need to create a new tunnel, and optimizes resources used for the procedure.

Background and objectives: Survival of peritoneal dialysis (PD) patients in Japan is high, but few reports exist on cause-specific mortality, transfer to haemodialysis (HD) or hybrid dialysis and hospitalisation risks. We aimed to identify reasons for transfer to HD, hybrid dialysis and hospitalisation in the Japan Peritoneal Dialysis and Outcomes Practice Patterns Study. Methods: This observational study included 808 adult PD patients across 31 facilities in Japan in 2014–2017. Information on all-cause and cause-specific mortality and hospitalisation and permanent transfer to HD and PD/HD hybrid therapy were prospectively collected and rates calculated. Results: Median follow-up time was 1.66 years where 162 patients transferred to HD, 79 transferred to hybrid dialysis and 74 patients died. All-cause and cardiovascular disease (CVD)-related mortality rates were 5.1 and 1.7 deaths/100 patient-years, respectively. Rates of transfer to HD and hybrid therapy were 11.2 and 5.5 transfers/100 patient-years, respectively. Among HD transfers, 40% were due to infection (including peritonitis), while 20% were due to inadequate solute/water clearance. Eighty-one percent of hybrid dialysis transfers were due to inadequate solute/water clearance. All--cause, peritonitis-related and CVD-related hospitalisation rates were 120.4, 21.1 and 15.6/100 patient-years, respectively. Median hospital length of stay was 19 days. Conclusions: Mortality, hospitalisation and transfer to HD/hybrid dialysis rates are relatively low in Japan compared to many other countries with hybrid transfers, accounting for one-third of dialysis transfers from PD. Further study is needed to explain the high inter-facility variation in hospitalisation rates and how to further reduce hospitalisation rates for Japanese PD patients.

Background: Catheter-associated bacteremia (CAB) often leads to removal of tunneled dialysis catheters with delayed insertion (RDI). Exchange over a guidewire (ExW) can be considered for access site preservation. Fibrin sheath disruption (FSD) during exchange is not standard practice for infected catheters. Here we present the first analysis of outcomes after such exchanges (ExW-FSD). Methods: Retrospective analysis of catheter exchanges and removals performed by interventional nephrology for bacteremia in 2008–2011 observed for 20.5 months. Charts were reviewed for recurrent or new bacteremia and death at 3 months, and for occurrence of thrombosis or stenosis along the catheter site. Catheter exchange with central venogram and fibrin sheath disruption was our standard of care in all patients presenting for CAB. RDI was performed either for tunnel infection, non-clearing of infection or at the request of referring physicians. Results: Over 4 years, 66 patients were treated for CAB. Forty-two patients underwent ExW-FSD, which was performed even for Staph. aureus, gram negative bacteremia or candidemia. RDI was performed in 24 cases. Bacteremia recurred in 3 (7%) patients after ExW-FSD, and in 7 (30%) cases after RDI ( p = 0.02). There was no significant difference in new infections: 5 (12%) after ExW-FSD and 2 (8%) after RDI. There was no death within 3 months after ExW-FSD and 4 (27%) ( p = 0.005) deaths in the RDI group. There was one new central venous stenosis in the ExW-FSD group (2%) with no loss of access site, and 8 (33%) patients developed thrombosis/stenosis along the prior catheter track after RDI (33%) ( p = 0.006) with loss of access site in (21%). Conclusions: In this retrospective analysis of treatment of CAB, ExW-FSD was associated with lower recurrence of bacteremia, lower death rate and a lower incidence of access site loss compared to RDI. These data support ExW-FSD use in patients with CAB.

Coronavirus disease (COVID-19) is highly contagious and is now a tragic pandemic. Maintenance hemodialysis (MHD) patients are susceptible to COVID-19 and more prone to develop into severe cases because of the older age, heavy comorbidities, and impaired immunity. Patients who receive in-center dialysis have to travel to and from dialysis centers; patients have to share the dialysis hall with others during dialysis, making the prevention and control of COVID-19 in dialysis centers different from that in community and more difficult. This article provides key points in coping with COVID-19 in dialysis centers during this pandemic based on experience: (1) enforcing infection control management of dialysis centers, (2) training of hemodialysis patients and medical staffs, (3) screening for COVID-19 among patients and medical staffs, and (4) providing graded isolated dialysis to close contacts, suspected cases, and confirmed cases of COVID-19. We hope our single-center experience can be referenced by other dialysis centers around the world in coping with the COVID-19 pandemic.

Micelle dispersions purification is made available via inline flow dialysis in which micelles are separated from the organic solvent used to dissolve the block copolymers in the micelle formation step. Purification was performed using simple and cost-effective dialysis units employing cellulose membranes. The proposed setup allows us to remove THF from a micelle dispersion within a few hours almost entirely in a looped flow system, without significantly changing the micelle size. Purification is found to be independent of the exact flow rates and only on the circulation time through the dialysis units. The system is not only able to reduce the concentration of the organic solvent, but also water-soluble monomers can be removed. Further, the integration of the method into a full synthesis line to produce encapsulated micelles directly from block copolymer solutions is demonstrated with a throughput of 1.2 g of micelles per hour.

International audience; Since the first attempt at extracorporeal renal replacement therapy, renal replacement therapy has been constantly improved. In the field of hemodialysis, substantial efforts have been made to improve toxin removal and biocompatibility. The advent of hemodiafiltration (HDF) and, more recently, of mid cut-off membranes have contributed to management of patients with end-stage renal disease (ESRD). Although several uremic toxins have been discovered, we know little about the clinical impact of their clearance in hemodialysis patients. In addition, a great deal of progress has been made in the areas of filtration and diffusion, but the adsorptive properties of hemodialysis membranes remain under-studied. The mechanism of action of adsorption is based on the attraction between the polymer of the dialysis membrane and the solutes, through hydrophobic interactions, ionic or electrostatic forces, hydrogen bonds or van der Waals forces. Adsorption on the dialysis membrane depends on the membrane surface, pore size, structure and electric load. Its involvement in toxin removal and biocompatibility is significant, and is not just an epiphenomenon. Diffusive and convective properties cannot be improved indefinitely and high permeability membranes, despite their high performance in the clearance of many toxins, have several limitations for long-term use in hemodialysis. This review will discuss why adsorption should be reconsidered and better characterized to improve efficiency and adequacy of dialysis.

There has been a resurgence in home haemodialysis over the last decade and interest in its implementation in gaining momentum with advances in technology and healthcare policy initiatives. Both increasing haemodialysis frequency and treatment time have several potential benefits in improving dialysis efficiency and are ideally placed in the home setting. The paper describes the rationale, current status, controversies, challenges and future avenues for home haemodialysis.

The presence of gas in the cranial cavity is called “pneumocephalus”, and is usually seen after invasive surgical procedures. Although symptoms are non-specific, such as headache, it can cause neurological distortion, coma, and death. Oxygen therapy is the most effective way to treat pneumocephalus and accelerates the reabsorption of the air. Hyperbaric oxygen treatment (HBOT), with its direct high pressure effect, causes the air mass to shrink. In the case reported in this paper, the pneumocephalus manifested with the symptom of sudden loss of consciousness and the etiology was an invasive intervention of dialysis catheter placement while the patient was in a sitting position. HBOT was applied as an emergency treatment, after which a dramatic radiological improvement was detected with computed tomography. Although this patient needed consecutive HBOT sessions for the best result, only a single session of HBOT could be applied because she was under the observation in the intensive care unit of another hospital due to the lack of space in the intensive care unit of our hospital. One of the main points is that the clinicians should not decide to cease HBOT only after the first session. Consecutive HBOT sessions can dramatically improve the radiological and clinical findings in these case, İntrakranial kavitedeki gaz varlığı “pnömosefali” olarak adlandırılır ve genellikle invaziv cerrahi işlemlerden sonra görülür. Baş ağrısı gibi spesifik olmayan semptomlar görülse de nörolojik bozulma, koma ve ölüme neden olabilir. Oksijen tedavisi, pnömosefaliyi tedavi etmenin en etkili yoludur ve havanın rezolüsyonunu hızlandırır. Hiperbarik oksijen tedavisi (HBOT), doğrudan yüksek basınç etkisiyle hava kütlesinin küçülmesine neden olur. Bu yazıda bildirilen olguda pnömosefali ani bilinç kaybı semptomu ile kendini göstermiş ve etiyolojisinde; hastanın oturur pozisyonda iken diyaliz katateri yerleştirilmesine yönelik invaziv bir girişim yer almaktadır. Acil tedavi olarak HBOT uygulanan vakada, tedavi sonrası bilgisayarlı tomografi ile dramatik radyolojik düzelme saptandı. Bu hastada en iyi sonucun alınabilmesi için ardışık HBOT seanslarına ihtiyaç duyulmasına rağmen hastanemizin yoğun bakım ünitesinde yer olmaması nedeniyle başka bir hastanenin yoğun bakım ünitesinde müşahede altında olduğu için sadece tek seans HBOT uygulanabildi. Ana noktalardan biri, klinisyenlerin HBOT’ni sadece ilk seanstan sonra bırakma kararı vermemeleri gerektiğidir. Bu vakalarda ardışık HBOT seansları radyolojik ve klinik bulguları önemli ölçüde iyileştirebilir.

International audience; Red blood cells (RBCs) can act as carriers for therapeutic agents and can substantially improve the safety, pharmacokinetics, and pharmacodynamics of many drugs. Maintaining RBCs integrity and lifespan is important for the efficacy of RBCs as drug carrier. We investigated the impact of drug encapsulation by hypotonic dialysis on RBCs physiology and integrity. Several parameters were compared between processed RBCs loaded with l-asparaginase (“eryaspase”), processed RBCs without drug and non-processed RBCs. Processed RBCs were less hydrated and displayed a reduction of intracellular content. We observed a change in the metabolomic but not in the proteomic profile of processed RBCs. Encapsulation process caused moderate morphological changes and was accompanied by an increase of RBCs-derived Extracellular Vesicles release. Despite a decrease in deformability, processed RBCs were not mechanically retained in a spleen-mimicking device and had increased surface-to-volume ratio and osmotic resistance. Processed RBCs half-life was not significantly affected in a mouse model and our previous phase 1 clinical study showed that encapsulation of asparaginase in RBCs prolonged its in vivo half-life compared to free forms. Our study demonstrated that encapsulation by hypotonic dialysis may affect certain characteristics of RBCs but does not significantly affect the in vivo longevity of RBCs or their drug carrier function.

In this report, we describe the fluorescent labeling of bacterial polysaccharides (Escherichia coli O86:B7, Escherichia coli O19ab, Pseudomonas aeruginosa O10a10b, and Shigella flexneri 2b) at the “natural” amino group of their phosphoethanolamine moiety. Two protocols for labeling are compared: 1) on a scale of a few mg of the polysaccharide, with a dialysis procedure for purification from excessive reagents; and 2) on a scale of 0.1 mg of the polysaccharide, with a simple precipitation procedure instead of dialysis. The microscale version is sufficient for comfortable cytofluorometric analysis. The resulting probes were found to specifically bind to human dendritic cells in a dose-dependent manner. The used limited set of polysaccharides did not allow us even to get close to understanding which dendritic cell-associated lectins and which cognate polysaccharide epitopes are involved in recognition, but the proposed microscale protocol allows to generate a library of fluorescent probes for further mapping of the polysaccharide specificity of the dendritic cells.

Background: Peritoneal dialysis (PD) management is a fundamental nephrology skill, especially with the recent emphasis on home dialysis. We report a prospective multicentre cohort study of a formative objective structured clinical examination (OSCE) assessing competence in managing PD-associated bacterial peritonitis, using the unified model of construct validity. Methods: The OSCE was developed by the principal investigators and reviewed by two subject matter experts. The test committee (eight nephrologists and one PD nurse) assessed test item difficulty/relevance and determined passing score. There were 22 test items (7 evidence-based/standard-of-care questions). Passing score was 16/22 (73%). No item had median relevance less than ‘important’, and all were easy to medium difficulty. Content validity index was 0.91. Preliminary validation (16 board-certified volunteers): mean score was 19 ± 2, with 94% (15/16) passing. Kappa = 0.85 [95% confidence interval (CI) 0.77–0.94]. Cronbach’s α = 0.70. Results: Eighty-seven fellows (16 programmes) were tested; 67% passed. Fellows scored significantly less than validators: 17 ± 3 versus 19 ± 2, p < 0.001 [95% CI 1.2–3.6]. Eighty-six per cent of evidence-based/standard-of-care questions were answered correctly by validators versus 54% by fellows; p < 0.001. Ninety-three per cent of fellows recognized that sufficient criteria were present to diagnose peritonitis, but only 17% correctly indicated all three. Seventy-seven per cent recognized peritonitis-associated ultrafiltration failure, but only 17% prescribed 21 days of antibiotic treatment for gram-negative peritonitis. Eighty-five per cent of fellows surveyed agreed/strongly agreed that the OSCE was useful in self-assessing proficiency. Second-year in-training examination and OSCE scores were positively correlated (Pearson’s r = 0.57, p < 0.00). Conclusions: The OSCE may be used to formatively assess fellow proficiency in managing PD-associated peritonitis.

Background: Citrate is instilled into the dialysis catheter to prevent clotting and to maintain patency between dialysis sessions. A significant amount of citrate leaks from the catheter at the injection time, which decreases the blood ionized calcium concentration (Ca2+) due to chelation. We aimed to evaluate the local impact of concentrated (i.e. 30%) citrate spilling on Ca2+ at the catheter tip in real-time pediatric conditions. Methods: An in-vitro model was constructed, involving an ion-selective electrode (Ca-ISE). A pre-curved catheter and the Ca-ISE were submerged in a glass vessel with the tips positioned adjacent to each other. The vessel was filled with 30 and 80 ml of normal saline with added calcium to simulate normal right atrium size in children and adults, respectively, and normal blood Ca2+. The amount of instilled citrate matched the filling volume of the catheter. Measurements were performed with 4% and 30% citrate solutions. Results: The mean Ca2+ measured at the tip of the catheter was 0.457 and 0.058 mmol/l when using 4% and 30% citrate, respectively ( p 2+ recorded in 30 and 80 ml after instilling 30 % citrate was 0.058 and 0.055 mmol/l, respectively ( p = 0.878). Conclusions: The spilling of 30% citrate caused a strikingly greater decrease of Ca2+ at the catheter tip than the standard 4% citrate. The atrial volume did not influence the test results implying similar safety concerns for pediatric and adult patients. The used static experimental setting might have overestimated the spilling effect.

Background and Objectives: Water quality is important for preparation of dialysis solution due to its direct relationship with blood of patients with renal failure. The aim of this study was to evaluate the chemical and microbial quality of inlet and outlet water of dialysis devices in hospitals of East Azerbaijan province. Material and Methods: This study was a descriptive-analytical study in which the water of dialysis ward of three hospitals affiliated to East Azerbaijan University of Medical Sciences was investigated. The results of physicochemical (45 cases) and microbial (163 cases) of dialysis water were extracted from the relevant archives in two stages before and after reverse osmosis treatment during 2014-2016. Independent t-test and one-way ANOVA were used for statistical analysis while extracting descriptive statistical parameters. Data analysis was done using Excel and SPSS 23 software. Results: Evaluation of the efficiency of reverse osmosis system showed that there was a significant difference between water quality, before and after the system. Except for calcium, magnesium, fluoride and nitrate, the concentrations of other cations and anions in 100% of samples were lower than the European Pharmacopoeia standard. Incoming water samples to dialysis machine in 4.9% of cases had total coliform contamination and there was no fecal coliform in any of the samples. The frequency and frequency of tests in hospitals are not observed and despite the risk of heavy metals, heavy metals tests are not performed on dialysis water for the health of dialysis patients. Conclusion: The need to develop a national standard for controlling dialysis water, testing all quality parameters of dialysis water according to standards in regular times and timeframes, informing hospital managers and environmental health experts about the importance of dialysis water quality in health and increasing life expectancy of dialysis patients is felt.

Background: Advances in medical imaging and interventional procedures have been associated with increased exposure to ionizing radiation. Thus, the International Commission on Radiological Protection (ICRP) established uniform safety standards to protect the general public against the dangers arising from ionizing radiations. In Europe, the ICRP standards are listed in the European Directive 2013/59/EURATOM, which should be transposed into national legislation by member states. They require that the administered dose must be part of the radiological report and identify the practitioners’ responsibilities in justifying and optimizing the dose and correctly informing the patient. Despite these indications, the literature lacks information about the dose from fluoroscopically inserted dialysis tunneled central venous catheters (td-CVC). This study aimed to quantify the effective dose and organ dose to relevant organs in td-CVC to comply with the EU statements. Methods: We revised fluoroscopically-guided procedures of td-CVC insertion, considering dose per area product, fluoroscopic time, effective dose, organ dose, and anatomical district. We also compared these parameters with those of fluoroscopically inserted oncological central venous devices (Port-a-cath). Results: The dose-area product, fluoroscopic time, and organ dose for td-CVC were 13 ± 22.2 Gy*cm2, 81 ± 129 s, and 1.9 ± 3.3 mSv. The radiological parameters for the left internal jugular, subclavian and femoral veins were similar but higher than for the right internal jugular vein. The radiological parameters were significantly higher for td-CVC than for Port-a-cath. Conclusions: Fluoroscopically inserted td-CVC are associated with a relatively low dose of ionizing radiation, with considerable variability due to the anatomical puncture site and previous accesses’ history. In light of the European Directive, it is a concern for nephrologists to be aware of the administered ionizing dose to comply with their legal responsibilities.