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Context: Chronic renal failure leads to end-stage renal disease (ESRD), where patients rely on hemodialysis (HD). ESRD affects multiple organ systems, including the eyes, there is limited data on ocular complications among HD patients in India. Aims: The aim of the study was to analyze the clinical spectrum of ocular manifestations in ESRD patients on HD and investigate the relationship between the duration of dialysis and ocular complications. Settings and Design: A hospital-based cross-sectional study was conducted at a tertiary care center involving 75 ESRD patients. Methodology: Participants underwent comprehensive ophthalmic examinations, including tonometry and fundus examination. The study excluded patients with corneal dystrophy, renal transplant history, ocular trauma, or malignancy. Data on dialysis duration, frequency, and ESRD etiology were collected. Statistical Analysis Used: Nonparametric Mann–Whitney U test assessed the relationship between dialysis duration and ocular complications, with significance set at P < 0.05. Results: Among 150 eyes, 83.33% exhibited ocular abnormalities, with cataracts (50%) and conjunctival calcification (16%) being the most common findings. Significant correlations were found between dialysis duration and diabetic retinopathy (P = 0.01), hypertensive retinopathy (P = 0.005), and conjunctival calcification (P = 0.012). Conclusions: Ocular abnormalities are prevalent in ESRD patients undergoing HD, with dialysis duration significantly associated with specific conditions. Regular ophthalmologic evaluations are essential for managing ocular health in this population. [ABSTRACT FROM AUTHOR]

Background: Kidney transplantation (KT) leads to body composition change, particularly increasing the fat mass. However, limited researches have focused on the long-term follow-up of these changes and factors influencing body composition after KT. Methods: This study evaluated body composition in 31 adult KT recipients, measuring body mass index (BMI), the psoas muscle mass index (PMI) representing muscle mass, visceral and subcutaneous adipose tissue (VAT and SAT) representing fat mass, and skeletal muscle radiodensity (SMR) representing muscle quality before KT and at 2, 4, and 6 years posttransplantation using computed tomography. Linear mixed models (LMM) analyzed temporal changes and contributing factors, while growth curve models assessed influence of these factors on body composition changes posttransplantation. Results: Following KT, BMI, and PMI remained stable, while SAT increased significantly, revealing a 1.30-fold increase from baseline 2 years after transplantation. Similarly, a substantial increase in VAT was observed, with a 1.47-fold increase from baseline 2 years after transplantation with a further 1.75-fold increase 6 years after transplantation. In contrast, SMR decreased with a 0.86-fold decrease from baseline after 2 years. VAT increase was significantly influenced by the interaction between posttransplantation and dialysis duration. Growth curve models confirmed this interaction effect persistently influenced VAT increase posttransplantation. Conclusions: The study revealed that KT promoted significant alterations in body composition characterized by increase in the VAT and SAT and a decline in SMR. Notably, dialysis duration and its interaction with posttransplantation duration emerged as significant factors influencing VAT increase. [ABSTRACT FROM AUTHOR]

Peritoneal dialysis (PD)-associated peritonitis is a serious complication observed in peritoneal dialysis patients. Herein, we investigated the clinical characteristics and treatment outcomes of PD peritonitis in patients with different PD durations. All peritonitis episodes from January 2007 to December 2020 at Peking University People's hospital PD center were retrospectively analyzed and divided into the long-dialysis duration (≥60 months, LDD) and short-dialysis duration (<60 months, SDD) groups. Clinical characteristics and outcomes were compared between these groups. The risk factors for treatment failure were analyzed using a logistic regression model. During 14 years, 156 patients had 267 peritonitis episodes. There were 83 (31.1%) peritonitis episodes in the LDD group and 184 (68.9%) in the SDD group. No statistical difference was noted in peritonitis causes and the composition of causative pathogens between the two groups. The hospitalization, treatment failure, and transfer-to-hemodialysis rates, and peritonitis-related mortality were significantly higher in the LDD group than in the SDD group (all p <.05). Logistic regression analysis revealed that PD duration was an independent risk factor for PD-associated hospitalization, treatment failure and peritonitis-related death (p <.05). The receiver operating characteristic curve analysis results showed that when the cutoff value of PD duration was 5.5 years, the sensitivity of predicting PD peritonitis treatment failure was 51.1%, specificity was 78.8%, and the area under the curve was 0.679 (95% confidence interval: 0.594–0.765, p <.001). PD duration is an independent risk factor for poor prognosis in PD peritonitis. Careful and active attention should be paid to the prevention of peritonitis in PD patients with long PD duration. [ABSTRACT FROM AUTHOR]

Longer pre-transplant dialysis duration is known to be associated with worse post-transplant outcomes. Our study aimed to cluster kidney transplant recipients with prolonged dialysis duration before transplant using an unsupervised machine learning approach to better assess heterogeneity within this cohort. We performed consensus cluster analysis based on recipient-, donor-, and transplant-related characteristics in 5092 kidney transplant recipients who had been on dialysis ≥ 10 years prior to transplant in the OPTN/UNOS database from 2010 to 2019. We characterized each assigned cluster and compared the posttransplant outcomes. Overall, the majority of patients with ≥10 years of dialysis duration were black (52%) or Hispanic (25%), with only a small number (17.6%) being moderately sensitized. Within this cohort, three clinically distinct clusters were identified. Cluster 1 patients were younger, non-diabetic and non-sensitized, had a lower body mass index (BMI) and received a kidney transplant from younger donors. Cluster 2 recipients were older, unsensitized and had a higher BMI; they received kidney transplant from older donors. Cluster 3 recipients were more likely to be female with a higher PRA. Compared to cluster 1, cluster 2 had lower 5-year death-censored graft (HR 1.40; 95% CI 1.16–1.71) and patient survival (HR 2.98; 95% CI 2.43–3.68). Clusters 1 and 3 had comparable death-censored graft and patient survival. Unsupervised machine learning was used to characterize kidney transplant recipients with prolonged pre-transplant dialysis into three clinically distinct clusters with variable but good post-transplant outcomes. Despite a dialysis duration ≥ 10 years, excellent outcomes were observed in most recipients, including those with moderate sensitization. A disproportionate number of minority recipients were observed within this cohort, suggesting multifactorial delays in accessing kidney transplantation. [ABSTRACT FROM AUTHOR]

Aim: The influence of dialysis modality and duration on outcomes following simultaneous pancreas‐kidney transplantation (SPKT) remains uncertain. Methods: We performed a single‐center retrospective review in 255 SPKT recipients according to dialysis modality (55 preemptive/no dialysis‐ND, 70 peritoneal dialysis–PD, 130 hemodialysis–HD) and duration (55 none, 137 < 2 years, 41 2‐4 years, 22 > 4 years). Results: Mean follow‐up was 9.4 years (median 9.2 years). Early (3‐month) relaparotomy rate (20% ND vs. 36% PD/HD, p =.03) was lower in ND patients. There were no differences in early graft loss, patient survival, overall or death‐censored kidney or pancreas graft survival rates (GSR) at 1 or 10 years follow‐up. When analyzing dialysis duration, there were no differences in rates of pancreas thrombosis or early pancreas graft loss. Kidney delayed graft function (DGF) was lower in the ND/short dialysis groups combined (1.0%), compared to the intermediate/long dialysis groups combined (9.5%, p =.003). Early relaparotomy rates were higher with longer duration of dialysis (p =.045 between ND and >4 years of dialysis). Patient survival in the long dialysis group was 50% compared to 69.5% in the other three groups combined (p =.09). However, both overall and death‐censored kidney and pancreas GSR were comparable. Conclusions: Preemptively transplanted patients had a lower incidence of kidney DGF and relaparotomy whereas patient survival was slightly lower with longer dialysis vintage prior to SPKT. Dialysis modality and duration did not influence either overall or death‐censored pancreas or kidney GSR in patients with short waiting times, low KDPI donor organs, and dialysis duration up to 4 years. [ABSTRACT FROM AUTHOR]

Background: Broad organ acceptance can increase early kidney transplantation (KTX) within <1‐year of dialysis initiation while improving access inequity. Methods: Single‐center data of adult isolated deceased‐donor KTX recipients between 2013 and 2020 were stratified into three 2.5‐year periods before‐, early after‐, and late after our center's deceased‐donor organ acceptance practice change, excluding a 6‐month implementation period. Outcomes were assessed within five recipient subgroups based on demographic and clinical characteristics. Results: Of 704 recipients, the frequency of early KTX was 22% pre‐change, 36% early post‐change, and 34% late post‐change. Given similar post‐change frequencies of early KTX, post‐change eras were combined to improve analytic power of subgroup analyses. After the organ acceptance practice change (vs. pre‐change), the likelihood of early KTX increased variably within historically underserved groups, including recipients who were older (37%–39%, p =.859), Black (10%–21%, p =.136), female (21%–37%, p =.034), diabetic (13%–32%, p =.010), and BMI≥35 kg/m2 (20%–34%, p =.007). Despite the practice change, Black recipients continued to experience less early KTX compared to non‐Black recipients. The likelihood of delayed graft function was significantly increased (p <.001), and 1‐year creatinine was significantly higher (p <.001) post‐practice change, but between‐era risk‐adjusted death‐censored graft survival was similar. Conclusions: Transition to broader donor acceptance was associated with more early KTXs among historically underserved patient subgroups. However, the effect was non‐significant among Black recipients, suggesting the need for additional strategies to impact early transplant access for this population. Studies of broad organ acceptance are needed to examine both access and outcomes. [ABSTRACT FROM AUTHOR]

Abstract Kidney transplantation is the most promising treatment to improve mortality and life quality in end‐stage kidney disease; however, cancer remains a leading cause of death. Several factors including immunosuppressants might be associated with a gradual increase in cumulative cancer incidence after kidney transplantation. Risk factors for cancer and overall and cancer‐specific survival were analyzed in 1973 kidney transplant recipients from three study institutions in Japan. The 5‐, 10‐, 20‐, and 30‐year overall and cancer‐specific survival rates were 93.3%, 88.4%, 78.0%, and 63.6% and 99.4%, 98.0%, 95.3%, and 91.7%, respectively. The overall survival rate was significantly higher and the graft survival rate was significantly lower in recipients without cancer than in those with cancer. Older recipient age, longer dialysis duration before kidney transplantation, and history of transfusion were significant predictors of cancer. Dialysis duration before kidney transplantation was a prognostic factor of overall survival rate. Regarding cancer‐specific survival rates, older recipient age and dialysis duration before kidney transplantation were prognostic factors of worse cancer‐specific survival rates. The type of immunosuppressant was not associated with an increased cancer rate. Aggressiveness of immunosuppressant regimens or potent immunosuppressants might improve graft survival rate while inducing de novo cancer after kidney transplantation. Older age and longer dialysis duration before kidney transplantation were risk factors of cancer‐specific survival rate.

Rationale & Objective: Taiwan implemented national pay-for-performance programs for chronic kidney disease (CKD) care in 2006 and 2011; however, it is unknown whether this affected trends in maintenance dialysis. This study assessed the temporal trends in the incidence, prevalence, and mortality of individuals treated with maintenance dialysis from 2002-2016 in Taiwan. Study Design: Follow-up study using Taiwan Renal Disease System Databases. Setting & Participants: Participants who received dialysis for ≥90 days. Predictors: Age, sex, and calendar year. Outcomes: Incidence, prevalence of maintenance dialysis, or death, ascertained using the National Death Registry database. Analytical Approach: The estimated annual percentage change was assessed by a generalized linear model, and the association of the programs with changes in the incidence of maintenance dialysis was evaluated using an age-period-cohort model. Results: A total of 144,258 incident cases with a follow-up of 346 million person-years were analyzed during the observed periods. The estimated annual percentage change of the expected crude incidence rate was slightly reduced by 0.41% (95% CI, −1.06 to 0.24) and was more obvious in women and patients aged greater than 70 years; whereas, it was significantly increased in those aged greater than 75 years. After disentangling age and cohort effects, the implementation of the care programs was associated with an overall net drift of −1.09% (95% CI, −1.65 to −0.52) per year and a significant linear reduction in the period rate ratio from 1.06 (95% CI, 1.02-1.09) in the years 2002-2006 to 0.95 (95% CI, 0.92-0.98) in 2012-2016, using years 2007-2011 as reference. Limitations: The findings of the study may have limited inferences to other countries with different health care systems. Conclusions: The implementation of universal CKD care programs in Taiwan has significantly reduced the long-term trends in the incidence of maintenance dialysis; hence, devoting governmental resources to CKD care and prevention is advocated.

The association between pre‐transplant dialysis duration and post‐transplant outcomes may vary by the population and endpoints studied. We conducted a population‐based cohort study using linked healthcare databases from Ontario, Canada including kidney transplant recipients (n = 4461) from 2004 to 2014. Our primary outcome was total graft failure (i.e., death, return to dialysis, or pre‐emptive re‐transplant). Secondary outcomes included death‐censored graft failure, death with graft function, mortality, hospitalization for cardiovascular events, hospitalization for infection, and hospital readmission. We presented results by pre‐transplant dialysis duration (pre‐emptive transplant, and.01–1.43, 1.44–2.64, 2.65–4.25, 4.26–6.45, and 6.46–36.5 years, for quintiles 1–5). After adjusting for clinical characteristics, pre‐emptive transplantation was associated with a lower rate of total graft failure (adjusted hazard ratio [aHR].68, 95% CI:.46,.99), while quintile 4 was associated with a higher rate (aHR 1.31, 95% CI: 1.01, 1.71), when compared to quintile 1. There was no significant relationship between dialysis duration and death‐censored graft failure, cardiovascular events, or hospital readmission. For death with graft function and mortality, quintiles 3–5 had a significantly higher aHR compared to quintile 1, while for infection, quintiles 2–5 had a higher aHR. Longer time on dialysis was associated with an increased rate of several adverse post‐transplant outcomes. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to determine the prevalence of malnutrition and its associated risk factors among patients undergoing hemodialysis in a tertiary hospital in Mauritius., Methods: We enrolled 250 participants in this cross-sectional single-center study. A modified Malnutrition-Inflammation Score (MIS) questionnaire was used. We collected and analyzed data pertaining to patients' medical and hemodialysis details., Results: Among the 250 enrolled participants, 136 (54.4%) were male patients. Participants had been undergoing hemodialysis for a mean duration of 5.67 ± 4.66 years. Malnutrition was present in 108 (43.2%) participants, and 176 patients (70.4%) had diabetes mellitus, which was found to be a significant predictor of malnutrition. There was a significant correlation between malnutrition and the number of years a participant had been under hemodialysis, as well as female sex. A significant variation in MIS values was found among different age groups. Participants with malnutrition had lower body mass index and hyponatremia., Conclusions: Malnutrition is an important issue, particularly among women, patients who have been on hemodialysis for an extended period, those with older age, and patients with diabetes mellitus., Competing Interests: Declaration of conflicting interestThe authors declare that there is no conflict of interest.

Introduction. The correlation between quantitative C-reactive protein (CRP) and dialysis duration in twice-aweek hemodialysis patients has not been examined extensively. This study aimed to examine the relationship between quantitative CRP and dialysis duration in twice-a-week hemodialysis patients. Methods. It involved cross-sectional observation of 62 hemodialysis patients at H. Adam Malik General Hospital, Medan, Indonesia, between March and October 2019. Interviews, clinical examinations, and a review of medical records were used for data collection. Hematology analyzer was used to measure the Blood Urea Nitrogen (BUN), Hemoglobin, creatinine, and differential leucocyte counts, while colored latex immunofiltration assays (IFAs) was used to analyze the qualitative CRP. The correlation between quantitative CRP and dialysis duration and hemoglobin assessed using the Spearman's correlation test. Results. The result did not show any correlation between quantitative CRP and dialysis duration (r = 0.091; p = 0.240), but there was a significant inverse correlation between dialysis duration and hemoglobin (r = -0.234; p = 0.033) and a significant inverse correlation between quantitative CRP and hemoglobin (r = -0.144; p = 0.032). Conclusion. This study revealed that there was no significant correlation between quantitative CRP and dialysis duration, but it was correlated with low hemoglobin twice-a-week in hemodialysis patients. The findings of the report provide the basis for further study. [ABSTRACT FROM AUTHOR]

Kidney transplantation is the most promising treatment to improve mortality and life quality in end‐stage kidney disease; however, cancer remains a leading cause of death. Several factors including immunosuppressants might be associated with a gradual increase in cumulative cancer incidence after kidney transplantation. Risk factors for cancer and overall and cancer‐specific survival were analyzed in 1973 kidney transplant recipients from three study institutions in Japan. The 5‐, 10‐, 20‐, and 30‐year overall and cancer‐specific survival rates were 93.3%, 88.4%, 78.0%, and 63.6% and 99.4%, 98.0%, 95.3%, and 91.7%, respectively. The overall survival rate was significantly higher and the graft survival rate was significantly lower in recipients without cancer than in those with cancer. Older recipient age, longer dialysis duration before kidney transplantation, and history of transfusion were significant predictors of cancer. Dialysis duration before kidney transplantation was a prognostic factor of overall survival rate. Regarding cancer‐specific survival rates, older recipient age and dialysis duration before kidney transplantation were prognostic factors of worse cancer‐specific survival rates. The type of immunosuppressant was not associated with an increased cancer rate. Aggressiveness of immunosuppressant regimens or potent immunosuppressants might improve graft survival rate while inducing de novo cancer after kidney transplantation. Older age and longer dialysis duration before kidney transplantation were risk factors of cancer‐specific survival rate. [ABSTRACT FROM AUTHOR]

Dialysis session in less duration - either to give a better quality of life for the patient or to optimize the organization the dialysis institution - may have bad repercussions on the quality of the treatment and therefore the quality of life of the patient. According to the result of the publications listed in this work, we conclude that it is necessary to perform either longer sessions or more frequent treatments to limit the interval time between two sessions. As this is difficult to perform by the providers, we recommend to develop home dialysis to obtain the best result.

Aim: Haemodialysis treatment prescription varies widely internationally. This study explored patient‐ and centre‐level characteristics associated with weekly haemodialysis hours. Methods: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data were analysed. Characteristics associated with weekly duration were evaluated using mixed‐effects linear regression models with patient‐ and centre‐level covariates as fixed effects, and dialysis centre and state as random effects using the 2017 prevalent in‐centre haemodialysis (ICHD) and home haemodialysis (HHD) cohorts. Evaluation of patterns of weekly duration over time analysed the 2000 to 2017 incident ICHD and HHD cohorts. Results: Overall, 12 494 ICHD and 1493 HHD prevalent patients in 2017 were included. Median weekly treatment duration was 13.5 (interquartile range [IQR] 12‐15) hours for ICHD and 16 (IQR 15‐20) hours for HHD. Male sex, younger age, higher body mass index, arteriovenous fistula/graft use, Aboriginal and Torres Strait Islander ethnicity and longer dialysis vintage were associated with longer weekly duration for both ICHD and HHD. No centre characteristics were associated with duration. Variability in duration across centres was very limited in ICHD compared with HHD, with variation in HHD being associated with state. Duration did not vary significantly over time for ICHD, whereas longer weekly HHD treatments were reported between 2006 and 2012 compared with before and after this period. Conclusion: This study in the Australian and New Zealand haemodialysis population showed that weekly duration was primarily associated with patient characteristics. No centre effect was demonstrated. Practice patterns seemed to differ across states/countries, with more variability in HHD than ICHD. SUMMARY AT A GLANCE: Patient‐level characteristics such as age, sex, BMI, dialysis vintage, ethnicity rather than centre‐level ones were associated with weekly duration of haemodialysis, with more variability among home‐ than in‐centre haemodialysis patients in the Australian and New Zealand population. [ABSTRACT FROM AUTHOR]

Noncompliance with fluid restriction is a problem in patients undergoing hemodialysis. The impact suchs pulmonary edema increases the risk of cardiovascular disorders, and hypertension. This study aims to determine the relationship of family support and the length of dialysis with adherence to fluid restriction in patients with Chronic Renal Failure (CRF) in the RST. Reksodiwiryo Padang. This type of analytic descriptive research with cross-sectional design. Data collection was conducted in August 2018 in the RST hemodialysis unit room Dr. Reksowidiryo Padang. The population was all patients with CRF who underwent hemodialysis therapy with an average visit of 42 patients. Sampling by means of the total population. Data were collected using questionnaires and documentation studies, processed computerically. Univariate analysis with frequency distribution and bivariate with chi-square test significance of 0.05. The results showed that 76.2% were not adherent to limiting fluid, 52.4% did not get family support, 66.7% were in the old category of running dialysis. There was a significant relationship between family support (p = 0.030) and dialysis time (p = 0.001) with fluid restriction compliance. It was concluded that there was a relationship between family support and the length of dialysis with fluid restriction compliance. It is suggested to officers to include, educate, and motivate patients with their families regarding fluid restrictions, describe the impact, and give enthusiasm in carrying out dialysis therapy and provide alternatives that can be done for fluid replacement in controlling thirst.

Abstract: Introduction: High ultrafiltration (UF) rates can result in intradialytic hypotension and are associated with increased mortality. The effects of a weight‐based UF rate limit on intradialytic hypotension and the potential for unwanted fluid weight gain and hospitalizations for volume overload are unknown. Methods: This retrospective cohort study examined 123 in‐center hemodialysis patients at one facility who transitioned to 13 mL/kg/h maximum UF rates. Patients were studied for an 8 week UF rate limit exposure period and compared to the 8‐week period immediately prior, during which the cohort served as its own historical control. The primary outcomes were frequency of intradialytic hypotension events and percentage of treatments with a hypotension event. Findings: The delivered UF rate was lower during the exposure compared to the baseline period (mean UF rate 7.90 ± 4.45 mL/kg/h vs. 8.92 ± 5.64 mL/kg/h; P = 0.0005). The risk of intradialytic hypotension was decreased during the exposure compared to baseline period (event rate per treatment 0.0569 vs. 0.0719, OR 0.78 [95% CI 0.62–1.00]; P = 0.0474), as was the risk of having a treatment with a hypotension event (percentage of treatments with event 5.2% vs. 6.8%, OR 0.75 [95% CI 0.58–0.96]; P = 0.0217). Subgroup analyses demonstrated that these findings were attributable to patients with high baseline UF rates. Statistically significant differences in all‐cause or volume overload‐related hospitalization were not observed during the exposure period. Discussion: A weight‐based UF rate limit of 13 mL/kg/h was associated with a decrease in the rate of intradialytic hypotension events among in‐center hemodialysis patients. [ABSTRACT FROM AUTHOR]

Cerebral venous oxygen saturation (SvO) is an important indicator of brain function. There was debate about lower cerebral oxygen metabolism in hemodialysis patients and there were no reports about the changes of deep regional cerebral SvO in hemodialysis patients. In this study, we aim to explore the deep regional cerebral SvO from straight sinus using quantitative susceptibility mapping (QSM) and the correlation with clinical risk factors and neuropsychiatric testing 52 hemodialysis patients and 54 age-and gender-matched healthy controls were enrolled. QSM reconstructed from original phase data of 3.0 T susceptibility-weighted imaging was used to measure the susceptibility of straight sinus. The susceptibility was used to calculate the deep regional cerebral SvO and compare with healthy individuals. Correlation analysis was performed to investigate the correlation between deep regional cerebral SvO, clinical risk factors and neuropsychiatric testing. The deep regional cerebral SvO of hemodialysis patients (72.5 ± 3.7%) was significantly lower than healthy controls (76.0 ± 2.1%) ( P < 0.001). There was no significant difference in the measured volume of interests of straight sinus between hemodialysis patients (250.92 ± 46.65) and healthy controls (249.68 ± 49.68) ( P = 0.859). There were no significant correlations between the measured susceptibility and volume of interests in hemodialysis patients ( P = 0.204) and healthy controls ( P = 0.562), respectively. Hematocrit ( r = 0.480, P < 0.001, FDR corrected), hemoglobin ( r = 0.440, P < 0.001, FDR corrected), red blood cell ( r = 0.446, P = 0.003, FDR corrected), dialysis duration ( r = 0.505, P = 0.002, FDR corrected) and parathyroid hormone ( r = −0.451, P = 0.007, FDR corrected) were risk factors for decreased deep regional cerebral SvO in patients. The Mini-Mental State Examination (MMSE) scores of hemodialysis patients were significantly lower than healthy controls ( P < 0.001). However, the deep regional cerebral SvO did not correlate with MMSE scores ( P = 0.630). In summary, the decreased deep regional cerebral SvO occurred in hemodialysis patients and dialysis duration, parathyroid hormone, hematocrit, hemoglobin and red blood cell may be clinical risk factors. [ABSTRACT FROM AUTHOR]

Atherosclerosis is the most common cause of cardiovascular morbidity in end-stage renal disease (ESRD) patients and carotid intima-media thickness (IMT) is an early independent predictor of atherosclerosis. The aim of this study is to compare the continuous ambulatory peritoneal dialysis (CAPD) and the maintenance hemodialysis (MHD) for carotid IMT in Chinese ESRD patients. A total of 72 CAPD patients, 92 MHD patients, and 50 age- and sex-matched healthy controls were included. Dialysis patients were divided into five subgroups according to dialysis duration: 3-6, 7-12, 13-59, 60-119, and 120-179 months. Carotid IMT and carotid plaques were detected for each patient. The carotid IMT and total plaque detection rate in the CAPD and MHD groups were considerably higher than in the healthy control group ( p < 0.01). No significant difference was found in the carotid IMT and total plaque detection rate between the CAPD group and the MHD group ( p > 0.05). However, after stratification by dialysis duration, the total carotid IMT in the CAPD subgroup was higher than in the MHD subgroup in dialysis duration of 60-119 and 120-179 months ( p < 0.05), and there was no significant difference in the total plaque detection rate between the CAPD and MHD subgroups in the same dialysis duration ( p > 0.05). Our study showed that both CAPD and MHD affect carotid IMT in Chinese ESRD patients, and the degree of atherosclerosis in CAPD patients might be higher than that in MHD patients after 5 years of dialysis. [ABSTRACT FROM AUTHOR]

Trace element disturbance is often observed in hemodialysis patients. While trace element concentrations have been reported in blood samples from hemodialysis patients, they have not been well investigated in scalp hair. In the present study, 22 trace elemental concentrations were measured by inductively coupled plasma-atomic emission spectrometry in the scalp hair of 80 male hemodialysis patients and compared with those of 100 healthy male subjects. In hemodialysis patients, the concentrations of beryllium, arsenic, magnesium, chromium, manganese, iron, selenium, molybdenum, iodine, vanadium, and cobalt were significantly higher than those in healthy subjects, while lead, mercury, copper, germanium, and bromine were significantly lower than those in the former group. No significant differences were observed for lithium, aluminum, cadmium, zinc, boron, or nickel. There were significant positive correlations between the duration of hemodialysis and the magnesium and manganese concentrations. There was a significant negative correlation between cadmium concentration and the duration of hemodialysis. There were significant positive correlations between dialysis efficacy (Kt/V) and magnesium, manganese, zinc, and selenium concentrations. In conclusion, trace element concentrations of the scalp hair are different between hemodialysis patients and healthy subjects. Essential trace elements, such as magnesium, manganese, zinc, and selenium, may be affected by the duration of hemodialysis and Kt/V. [ABSTRACT FROM AUTHOR]

We studied phosphorus (P) dynamics and its relation to urea dynamics in a wide range of dialyses by measuring predialysis and postdialysis serum P levels and all removed P and urea in dialysate during 455 hemodialyses. Dialyses were performed at different frequencies (range 3-6 treatments/wk); duration of dialysis (t) (range 80-560 minutes), varied blood and dialysate flow, and with high-flux and low-flux membranes. Kt/V-P, Kt/V-urea, weekly removal of P-and urea and removal volumes (Vr) and their relationships to varying dialyses, and predialysis concentrations, and protein catabolic rates were studied in linear and multiple regression analyses. A weekly dialysis time of >30 hours was needed to maintain serum P concentration normal without the use of phosphate binders. Vr-P as a percentage of body weight was dependent on predialysis serum P and increased steeply as predialysis serum P decreased and dialysis time was prolonged. There was no relationship between Vr-urea and Vr-P. Phosphorus removal per week was mainly dependent on weekly frequency, and time on dialysis and >38 h/wk were necessary to remove the recommended P intake. Phosphorus shows highly variable dynamics during dialysis. The body maintains extracellular P concentration by releasing P from large compartments when the dialysis time is prolonged and the serum concentration of P decreases during dialysis. Vr-P shows huge variation between patients and in an individual patient, depending on predialysis serum P. Kt/V is inaccurate in describing P removal. To remove P efficiently, it is most important to perform long and more frequent hemodialysis. [ABSTRACT FROM AUTHOR]

Introduction: Dialysis treatment prior to transplantation may contribute to premature mortality and graft loss in kidney-transplanted patients. In this prevalent cohort study (TransQol-HU Study), we analyzed the association between pre-transplant dialysis duration versus mortality and death-censored graft loss in kidney-transplanted patients. Methods: Data from 926 kidney-transplanted patients followed at a single outpatient transplant center were analyzed. Socio-demographic parameters, laboratory data, medical history, donor characteristics and information on co-morbidities were collected at baseline. Data on 5-year outcome (graft loss, mortality) were collected. Results: In multivariate analyses, pre-transplant dialysis duration was an independent risk factor for mortality (HR = 1.011; 95% CI: 1.005-1.016) and also for death-censored graft loss (HR = 1.008; 95% CI: 1.001-1.015) after adjustment for several co-variables. In the multivariate model, patients with less than 1 year (HR = 0.498; 95% CI: 0.302-0.820; P = 0.006) and 1-3 years (HR = 0.577; 95% CI: 0.371-0.899; P = 0.015) of pre-transplant dialysis had significantly better survival after transplantation compared to those with more than 3 years on dialysis. Conclusions: These findings add further strength to existing evidence about the significant association between longer pre-transplant dialysis duration and poor outcome in kidney-transplanted patients. [ABSTRACT FROM AUTHOR]

Several studies have stressed the importance of dialysis time in the removal of uremic retention solutes. To further investigate this, nine stable chronic hemodialysis patients were dialyzed for 4, 6, or 8 h processing the same total blood and dialysate volume by the Genius system and high-flux FX80 dialyzers. Inlet blood and outlet dialysate were analyzed for urea, creatinine, phosphorus, and β2-microglobulin at various times. Total solute removal, dialyzer extraction ratios, and total cleared volumes were significantly larger during prolonged dialysis for urea, creatinine, phosphorus, and β2-microglobulin. Reduction ratios increased progressively, except for phosphate and β2-microglobulin, where the ratios remained constant after 2 h. In contrast, no significant difference was found for the reduction ratios of all solutes and Kt/Vurea between the three different sessions. With longer dialyses, solutes are efficiently removed from the deeper compartments of the patient's body. Our study shows that care must be taken when using Kt/Vurea or reduction ratios as the only parameters to quantify dialysis adequacy.Kidney International (2008) 73, 765–770; doi:10.1038/sj.ki.5002750; published online 26 December 2007 [ABSTRACT FROM AUTHOR]

The aim of this study was to identify risk factors for redialysis in postoperative patients with acute renal failure (ARF) who had previously been weaned from acute dialysis. Although recovery of renal function is anticipated in patients with ARF, no data have been reported on successful weaning from acute dialysis. Retrospective observational case-control study in a 64-bed surgical ICU. Success in discontinuing dialysis was defined as cessation from dialysis for at least 30 days. A total of 304 postoperative patients who underwent acute renal replacement therapy in a surgical ICU between July 2002 and April 2005 were included. SOFA score biochemical data and renal function parameters were assessed on the day after the last session of renal replacement therapy, designated as day 0 (D0). We could wean 94 patients (30.9%) from acute dialysis for more than 5 days, and 64 of these (21.1%) were successfully weaned for at least 30 days. The independent predictors for resuming dialysis within 30 days were: (a) longer duration of dialysis (OR 1.06), (b) higher SOFA score on D0 (OR 1.44), (c) oliguria (urine output < 100cc/8 h; OR 4.17) on D1, and (d) age over 65 years (OR 6.35). The area under the ROC curve was 0.880. Two-way analysis of variance with repeated measurements over time showed a larger decline in SOFA score and an increase in urine output in patients with successful cessation of dialysis. Kaplan–Meier analysis showed a significant difference in early resumption of dialysis between patients with or without oliguria at D0. More than two-thirds of patients weaned from postoperative acute dialysis for more than 5 days were free of dialysis for at least 30 days. Less urine output, longer duration of dialysis, age over 65 years, and higher disease severity score are predictive of a patient's redialysis after initial weaning from acute dialysis. [ABSTRACT FROM AUTHOR]

Chronic hemodialysis sessions, as developed in Seattle in the 1960s, were long procedures with minimal intra- and interdialytic symptoms. Over the next three decades, dialysis duration was shorten to 4, 3, even 2 h in thrice weekly schedules. This method spread rapidly, particularly in the United States, after the National Cooperative Dialysis Study suggested that the time of dialysis is of minor importance as long as urea clearance multiplied by dialysis time and scaled to total body water (Kt/Vurea) equals 0.95-1.0. This number was later increased to 1.3, but the assumption that hemodialysis time is of minimal importance remained unchanged. However, Kt/Vurea measures only the removal of low molecular weight substances and does not consider the removal of larger molecules. Nor does it correlate with the other important function of hemodialysis, namely ultrafiltration. Rapid ultrafiltration is associated with cramps, nausea, vomiting, headache, fatigue, hypotensive episodes during dialysis, and hangover after dialysis; patients remain fluid overloaded with subsequent poor blood pressure control leading to left ventricular hypertrophy, diastolic dysfunction, and high cardiovascular mortality. Kt/Vurea should be abandoned as a measure of dialysis quality. The formula suggests that it is possible to decrease t as long as K is proportionately increased, but this is not true. Time of dialysis should be adjusted in such a way that patients would not suffer from symptoms related to rapid ultrafiltration, would not have other uremic symptoms and most patients would have blood pressure controlled without antihypertensive drugs. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Hyperphosphatemia is an independent risk factor for mortality in hemodialysis (HD) patients. The relative importance of HD frequency and duration for phosphate removal is not clear. Short daily hemodialysis (SDHD) is a form of HD which offers increased treatment frequency. SDHD studies have not been shown to normalize serum phosphate. Methods: Twenty-one patients were converted from conventional thrice weekly HD (CHD, 4 h/session) to SDHD (2 - 3.75 h/session, 5 - 6 sessions per week). The primary endpoint was the change in pre-dialysis serum phosphate levels after conversion from CHD to SDHD. Changes in serum calcium levels, phosphate binder and vitamin D analogue usage, and serum parathyroid hormone (PTH) levels were measured as secondary endpoints. Results: Mean duration of SDHD was 17.7 ± 1.9 months. Mean treatment time was 2.63 ± 0.10 h, and mean frequency was 5.3 ± 0.1 sessions per week. Predialysis serum phosphate decreased from 1.99 ± 0.12 mM at three months pre conversion to 1.27 ± 0.10 mM at six months post conversion to SDHD (p = 0.002). Serum phosphate remained stable between six and 12 months post conversion (1.27 ± 0.10 mM to 1.38 ± 0.14 mM, p = 0.8). When patients were grouped according to SDHD sessional frequency (five sessions/week versus six sessions/week) and compared, no significant differences were found in predialysis serum phosphate levels at six or 12 months post conversion. There were no changes in serum calcium. Overall phosphate binder usage did not change pre and post conversion to SDFID. Serum PTH tended to decrease after one year of SDHD (44.2 ± 13.4 pM to 21.4 ± 5.9 pM, p = 0.07). Conclusion: Conversion to SDHD significantly decreased serum phosphate. There may be a minimum hemodialysis duration below which increases in frequency are not able to compensate to achieve normal phosphate levels. Future studies are necessary to better characterize the relationship between HD duration and frequency with respect to phosphate removal. [ABSTRACT FROM AUTHOR]

Chronic hemodialysis sessions, as developed in Seattle in the 1960s, were long procedures with minimal intra- and interdialytic symptoms. Financial and logistical pressures related to the overwhelming number of patients requiring hemodialysis created an incentive to shorten dialysis time to four, three, and even two hours per session in a thrice weekly schedule. This method spread rapidly, particularly in the United States, after the National Cooperative Dialysis Study suggested that time of dialysis is of minor importance as long as urea clearance multiplied by dialysis time and scaled to total body water (Kt/Vurea ) equals 0.95–1.0. This number was later increased to 1.3, but the assumption remained unchanged that hemodialysis time is of minimal importance as long as it is compensated by increased urea clearance. Patients accepted short dialysis as a godsend, believing that it would not be detrimental to their well-being and longevity. However, Kt/Vurea measures only removal of low molecular weight substances and does not consider removal of larger molecules. Besides, it does not correlate with the other important function of hemodialysis, namely ultrafiltration. Whereas patients with substantial residual renal function may tolerate short dialysis sessions, the patients with little or no urine output tolerate short dialyses poorly because the ultrafiltration rate at the same interdialytic weight gain is inversely proportional to dialysis time. Rapid ultrafiltration is associated with cramps, nausea, vomiting, headache, fatigue, hypotensive episodes during dialysis, and hangover after dialysis; patients remain fluid overloaded with subsequent poor blood pressure control, left ventricular hypertrophy, diastolic dysfunction, and high cardiovascular mortality. Short, high-efficiency dialysis requires high blood flow, which increases demands on blood access. The classic wrist arteriovenous fistula, the access with the best longevity and... [ABSTRACT FROM AUTHOR]