Hemodialysis International最新文献

{"title":"Safety and Efficacy of Iron Chelators in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis","authors":"Humam Emad Rajha,&nbsp;Richard Shamoon,&nbsp;Ameer Almeshagbeh,&nbsp;Samah Masry,&nbsp;Fadel Alqatati,&nbsp;Baha H. Abuajameia,&nbsp;Abdulqadir J. Nashwan","doi":"10.1111/hdi.70103","DOIUrl":"10.1111/hdi.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Iron overload in chronic kidney disease contributes to oxidative injury. The role of iron chelators, standard in transfusion-related overload, remains unclear in chronic kidney disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the efficacy and safety of iron chelators in adults with chronic kidney disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis followed PRISMA 2020 guidelines. Databases were searched for randomized controlled trials and observational studies reporting on iron indices, hematological parameters, and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eleven studies (206 patients) were included. Iron chelation significantly reduced serum ferritin (weighted mean difference [WMD]: −1.48 μg/L; 95% CI: −2.09, −0.87), transferrin (WMD: −10.6 mg/dL; 95% CI: −15.6, −5.61), and serum iron (WMD: −24.2 μg/dL; 95% CI: −42.5, −5.9). Hemoglobin increased (WMD: 1.07 g/dL; 95% CI: 0.20, 1.94). Glucose levels decreased, but lipid parameters were unaffected. Evidence was limited by high heterogeneity and potential bias. Gastrointestinal adverse events were common; serious events were rare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Iron chelation effectively reduces iron stores and may improve anemia in chronic kidney disease patients. However, the evidence is limited by small sample sizes and heterogeneity. High-quality randomized controlled trials are needed to establish clinical utility and safety before routine use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"745-756"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medium Cut-Off Versus High-Flux Dialyzers and Changes in Beck Depression Inventory Scores in Maintenance Hemodialysis: An Exploratory Observational Study","authors":"Fevzi Necati Avsar,&nbsp;Osman Erinc,&nbsp;Tuncay Sahutoglu","doi":"10.1111/hdi.70091","DOIUrl":"10.1111/hdi.70091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Depression is prevalent in maintenance hemodialysis patients and is influenced by the interplay of physical and mental health. Rather than a direct antidepressant effect of dialyzer membrane type, improved clearance of middle and large uremic solutes may alleviate uremia-related symptoms that indirectly influence mood and quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective observational study compared changes in Beck Depression Inventory (BDI) scores over 6 months between thrice-weekly hemodialysis patients treated with Theranova-400 or FX80 dialyzers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty participants were included (Theranova-400/FX80: 25/25; median age 52.5 [27.7] years; 27 females; dialysis vintage 60 [86] months). The reduction in BDI scores did not differ significantly between the two groups (<i>p</i> = 0.203). In the within-group analysis, a significant decline was observed in the FX80 arm (−4.72 ± 6.62, <i>p</i> = 0.003) but not in the Theranova-400 arm (−3.20 ± 10.3, <i>p</i> = 0.199). However, in the subgroup of patients with baseline BDI scores &gt; 14, both dialyzer groups showed statistically significant decreases in BDI scores (FX80: 24.7 ± 7.3 to 16.5 ± 6.6, <i>p</i> = 0.016; Theranova-400: 24.1 ± 8.4 to 14.8 ± 10, <i>p</i> = 0.037).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this exploratory observational study, BDI scores decreased over 6 months in both groups; however, between-group change in BDI did not differ significantly. These findings do not support a dialyzer-specific antidepressant effect of Theranova-400 compared with FX80. Within-group changes, particularly in the FX80 arm, should be interpreted cautiously considering possible repeated-measurement effects, regression to the mean, and unmeasured confounding. Future studies should evaluate whether changes in uremic symptom burden mediate mood-related scores.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"765-772"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to “Association of Early Initiation of Dialysis With All-Cause and Cardiovascular Mortality: A Propensity Score Weighted Analysis of the United States Renal Data System”","authors":"","doi":"10.1111/hdi.70093","DOIUrl":"10.1111/hdi.70093","url":null,"abstract":"<p>\u0000 <span>S. Bozorgmehri</span>, <span>H. Aboud</span>, <span>G. Chamarthi</span>, et al., “ <span>Association of Early Initiation of Dialysis With All-Cause and Cardiovascular Mortality: A Propensity Score Weighted Analysis of the United States Renal Data System</span>,” <i>Hemodialysis International</i> <span>25</span> no. <span>2</span> (<span>2021</span>): <span>188</span>–<span>197</span>, https://doi.org/10.1111/hdi.12912.\u0000 </p><p>In the published version, we inadvertently omitted the following disclaimer: “The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government.”</p><p>We apologize for this error.</p>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiological and Clinical Implications of Timing of Hemoglobin Measurement in Hemodialysis","authors":"Hiroshi Matsumoto,&nbsp;Seizo Murai","doi":"10.1111/hdi.70106","DOIUrl":"10.1111/hdi.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Management of anemia in patients undergoing maintenance hemodialysis is primarily based on predialysis hemoglobin measurements. However, hemoglobin concentrations vary substantially across the hemodialysis cycle because of interdialytic fluid accumulation, ultrafiltration-induced hemoconcentration, and ongoing plasma refilling. Consequently, hemoglobin values obtained at different time points are not physiologically equivalent and may reflect distinct circulatory states.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This narrative review summarizes the physiological determinants of hemoglobin variation during the hemodialysis cycle and examines the clinical implications of different hemoglobin sampling strategies in patients undergoing maintenance hemodialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Sampling practices differ across regions: in Japan, hemoglobin is commonly assessed during the first dialysis session of the week, whereas midweek predialysis sampling is frequently used in North America and Europe and is explicitly recommended by the 2025 UK Kidney Association guideline. Pre- and postdialysis hemoglobin measurements reflect different physiological conditions and may lead to different interpretations of anemia severity and hemoglobin variability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Greater attention to the timing and standardization of hemoglobin measurement may improve interpretation of anemia severity and hemoglobin variability and enhance the international comparability of clinical data in patients undergoing maintenance hemodialysis. Consideration of physiologically relevant sampling strategies may contribute to a more accurate assessment of anemia in routine dialysis practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"659-664"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Hemodialysis: Current Clinical Applications and Future Perspectives","authors":"Hui Ren,&nbsp;Cong Yang,&nbsp;Zibo Xiong,&nbsp;Wei Liang,&nbsp;Chunyan Su,&nbsp;Guang Yang","doi":"10.1111/hdi.70110","DOIUrl":"10.1111/hdi.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Timely adjustment of intervention strategies based on multidimensional hemodialysis data is essential for improving patients' quality of life, enhancing clinical outcomes, and reducing complications. However, conventional management (relying heavily on clinician experience and intermittent monitoring) often fails to provide personalized, real-time, and proactive care. Efficient, data-driven methods are therefore urgently needed. In recent years, artificial intelligence (AI) has shown increasing potential in hemodialysis management, yet comprehensive reviews in this area remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This narrative review synthesizes recent advances in AI applications for hemodialysis, examining their potential, technical approaches, and practical effectiveness in addressing current management challenges. We focus on five representative domains: hemodynamic management, volume management, dialysis adequacy assessment, vascular access management, and renal anemia prediction. Furthermore, we discuss emerging opportunities from wearable devices and multimodal data integration, while also highlighting major barriers to translation, particularly the gap between retrospective predictive performance and proven improvement in hard clinical outcomes. By offering theoretical insights and practical directions, this review aims to support the transition from experience-based care toward an AI-driven, data-informed paradigm, facilitating the development of intelligent, closed-loop decision-support systems that cover the entire dialysis journey.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"708-720"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health Disorders in End-Stage Kidney Disease: A Narrative Review of Clinical Considerations for Integrated Management","authors":"Kunal Malhotra,&nbsp;Jordan Fangue-Nelon,&nbsp;Garima Singh","doi":"10.1111/hdi.70102","DOIUrl":"10.1111/hdi.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>End stage kidney disease (ESKD) is associated with a high prevalence of depression and anxiety, arising from both biological factors and the psychosocial burden of chronic dialysis care. Approximately 25%–30% of dialysis patients experience clinically significant depressive symptoms when assessed by structured clinical interview, though reported prevalence varies widely by assessment method. These disorders negatively impact adherence, hospitalization rates, and mortality, with diagnostic challenges arising from overlapping uremic symptoms and reliance on self-report tools. Biological contributors such as uremia, anemia, chronic inflammation, and polypharmacy, together with social stressors including unemployment, isolation, and financial hardship, exacerbate psychiatric vulnerability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Randomized trials demonstrate that cognitive behavioral therapy (CBT) reduces depressive symptoms, improves quality of life, and enhances treatment adherence, and lessons from oncology and primary care support collaborative care models. However, dialysis centers often lack resources and are constrained by reimbursement policy. This narrative review synthesizes evidence across epidemiology, biopsychosocial mechanisms, pharmacotherapy considerations specific to renal impairment, and non-pharmacologic interventions, and proposes a roadmap for integrated mental health care in dialysis that clearly distinguishes evidence-based recommendations from expert opinion. Integrated, multidisciplinary approaches hold promise for enhancing patient well-being and reducing the burden of mental illness in dialysis care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"679-688"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Care Dependency and Self-Efficacy in Patients Receiving Hemodialysis Treatment","authors":"Ezgi Mutluay Yayla,&nbsp;Mehmet Ağaslan","doi":"10.1111/hdi.70101","DOIUrl":"10.1111/hdi.70101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study evaluates the association between care dependency and self-efficacy in patients undergoing hemodialysis, representing one of the first domestic contributions to this area of research in Turkey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This descriptive and correlational study was conducted in two dialysis centers in Mersin province, Turkey, between September 2025 and December 2025. The study included 143 hemodialysis outpatients who met the inclusion criteria. Care dependency and self-efficacy were assessed using the General Self-Efficacy Scale and the Care Dependency Scale. Statistical analyses were performed using SPSS version 25.0.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants demonstrated moderate levels of care dependency and self-efficacy, with a mean Care Dependency Scale score of 55.6 ± 23.6 and a mean General Self-Efficacy Scale score of 27.8 ± 9.33. Self-efficacy was significantly associated with care dependency (<i>β</i> = 0.67, <i>p</i> &lt; 0.001). The inclusion of self-efficacy in the regression model explained an additional 20.7% of the variance in care dependency (<i>ΔR</i>\u0000 ² = 0.21).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings suggest that self-efficacy is a key determinant of care dependency among hemodialysis patients. Care dependency appears to be closely related to patients' perceived self-efficacy, beyond sociodemographic characteristics. Interventions aimed at enhancing self-efficacy may therefore be beneficial in reducing care dependency and improving patient outcomes in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"781-785"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tenapanor-Associated Bowel Effects in Hemodialysis: Persistence Barriers and Practical Continuation Strategies","authors":"Yoshitaka Furuto,&nbsp;Daiki Yoshino,&nbsp;Akio Namikawa,&nbsp;Dai Sato,&nbsp;Yuko Shibuya","doi":"10.1111/hdi.70099","DOIUrl":"10.1111/hdi.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tenapanor is a mechanistically distinct treatment for hyperphosphatemia in hemodialysis and can reduce phosphate-binder pill burden in selected patients. However, its real-world value is constrained by bowel effects, particularly diarrhea, which commonly emerges early after initiation and may lead to treatment aversion or discontinuation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary</h3>\u0000 \u0000 <p>In this review, treatment persistence refers to the ability to continue tenapanor through the early bowel-symptom period without permanent discontinuation due to gastrointestinal symptoms or treatment aversion, while maintaining clinically meaningful phosphate control. Current evidence indicates that tenapanor-associated bowel effects are clinically bidirectional. They may improve stool consistency and reduce laxative dependence in constipation-prone patients, whereas the same bowel shift may cause loose stools, urgency, discomfort, dialysis-session anxiety, and discontinuation in others. Longer-term studies suggest that patients who remain on therapy may maintain phosphate control with fewer concomitant phosphate-binder tablets, although early discontinuation and completer effects require cautious interpretation. A persistence-oriented approach includes baseline bowel-habit assessment, region-specific and label-consistent initiation and dose adjustment, individualized timing around dialysis sessions, review of concomitant bowel-active medications, anticipatory patient education, and monitoring for fluid and electrolyte consequences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Tenapanor-associated bowel effects are a central implementation barrier rather than a secondary tolerability issue. Persistence may be improved by matching treatment to baseline bowel phenotype and using a tolerability-first, safety-conscious continuation framework. Prospective studies should define predictors of persistence and validate supportive strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"698-707"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Low Serum microRNA-26a Levels and Major Adverse Cardiovascular or Cerebrovascular Events in Patients Undergoing Hemodialysis","authors":"Yuanfang Li,&nbsp;Ke Wu,&nbsp;Yuezhen Zhang,&nbsp;Xianfang Wang","doi":"10.1111/hdi.70086","DOIUrl":"10.1111/hdi.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Patients with end-stage kidney disease face an extremely high risk of major adverse cardiovascular and cerebrovascular events. This study investigated the role of microRNA-26a in patients with end-stage kidney disease who have been receiving long-term hemodialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Blood samples were collected from patients with chronic kidney disease stages I–III and from those with end-stage kidney disease. Basic clinical information was recorded for all participants. Serum expression of microRNA-26a was measured using real-time quantitative polymerase chain reaction. Pearson correlation analysis was used to examine the relationships between microRNA-26a levels and clinical indicators, including serum albumin, estimated glomerular filtration rate, high-sensitivity C-reactive protein, serum creatinine, and blood urea nitrogen. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the association of microRNA-26a with disease progression and the occurrence of major adverse cardiovascular and cerebrovascular events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Serum microRNA-26a levels were significantly lower in patients with end-stage kidney disease compared with those with earlier-stage chronic kidney disease. MicroRNA-26a expression showed a positive correlation with serum albumin and estimated glomerular filtration rate, and negative correlations with high-sensitivity C-reactive protein, serum creatinine, and blood urea nitrogen. ROC curve analysis demonstrated that serum microRNA-26a levels had good diagnostic value for identifying end-stage kidney disease (area under the curve = 0.842). During follow-up, the cumulative incidence of major adverse cardiovascular and cerebrovascular events was 14% at 12 months, 22% at 24 months, and 34% at 36 months. MicroRNA-26a expression was significantly lower in patients who experienced these events. Both univariate and multivariate logistic regression analyses identified higher serum microRNA-26a levels as an independent protective factor against major adverse cardiovascular and cerebrovascular events in patients with end-stage kidney disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with end-stage kidney disease receiving long-term hemodialysis, microRNA-26a levels are associated with disease severity and the risk of major adverse cardiovascular and cerebrovascular events. Lower miR-26a expression may serve as a potential biomarker for disease monitoring and risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"757-764"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Performance of Plasma Levels of sST2 (Soluble Suppression of Tumorigenicity 2) in the Evaluation of Hypervolemia in Hemodialysis Patients: A Comparative Analysis With Traditional and Alternative Biomarkers","authors":"Emre Can Hartavi,&nbsp;Sami Uzun,&nbsp;Serhat Karadağ,&nbsp;Emre Hoca,&nbsp;Abdülkadir Çelik,&nbsp;Hüseyin Oğuz,&nbsp;Gamze Ekin Yılmaz,&nbsp;Özlem Menken,&nbsp;Egemen Cebeci","doi":"10.1111/hdi.70092","DOIUrl":"10.1111/hdi.70092","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Persistent hypervolemia in patients undergoing maintenance hemodialysis is a major modifiable determinant of cardiovascular morbidity and mortality. Accurate estimation of dry weight and identification of hypervolemia remain challenging due to limitations of current assessment methods.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To evaluate the diagnostic performance of plasma levels of sST2 (soluble suppression of tumorigenicity 2), a biomarker reflecting myocardial stress and fibrosis, in detecting clinician-defined hypervolemia in hemodialysis patients, and to compare it with plasma levels of B-type natriuretic peptide (BNP) and the plasma fibrinogen to serum albumin ratio (FAR), indicators of hemodynamic and inflammatory stress.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This single-center, prospective cross-sectional study included 80 maintenance hemodialysis patients. Hypervolemia was defined by a nephrologist based on structured clinical assessment, supported by findings from bioelectrical impedance analysis, echocardiography, and chest radiography. Predialysis blood samples were analyzed for BNP, sST2, fibrinogen, and albumin. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of the 80 hemodialysis patients included in the study, 45 were classified as euvolemic and 35 as hypervolemic. Compared with the euvolemic group, hypervolemic patients exhibited significantly higher pre- and post-dialysis blood pressure, greater interdialytic weight gain, higher ultrafiltration volumes, and increased left ventricular mass index and left atrial diameter (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05). FAR levels were significantly elevated in hypervolemic patients (110.9 ± 35.0 vs. 89.1 ± 23.9; &lt;i&gt;p&lt;/i&gt; = 0.002). In ROC analysis, FAR demonstrated the strongest discriminative ability for identifying hypervolemia (area under the curve [AUC]: 0.714), outperforming BNP (AUC: 0.645). A FAR cut-off value of ≥ 106 achieved 60% sensitivity and 84.4% specificity. In contrast, sST2 did not display diagnostic discriminative performance (AUC: 0.490).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In hemodialysis patients, the FAR demonstrated moderate diagnostic accuracy in identifying hypervolemia and showed better discriminative performance than BNP, whereas sST2 did not provide diagnostic value. These findings indicate that no single biomarker is sufficient for volume assessment and support the use of a multimodal approach. Within this context, FAR may rep","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"797-806"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}