Hemodialysis International最新文献

{"title":"Longitudinal micro-incision creation prior to balloon angioplasty for treatment of arteriovenous access dysfunction in a real-world patient population: 6-month cohort analysis","authors":"John Aruny,&nbsp;Jeffrey E. Hull,&nbsp;Alexander Yevzlin,&nbsp;Alejandro C. Alvarez,&nbsp;Jason D. Beaver,&nbsp;Robert W. Heidepriem III,&nbsp;Michael T. Serle","doi":"10.1111/hdi.13111","DOIUrl":"10.1111/hdi.13111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Routine hemodialysis depends on well-functioning vascular access. In the event of vascular access dysfunction, percutaneous transluminal balloon angioplasty (PTA) is conducted to restore patency. Although an angioplasty procedure can provide an excellent immediate result by opening the access to allow dialysis to continue, the long-term patency rates are less than satisfactory. The goal of this study was to assess the outcomes of patients who underwent a novel vessel preparation via longitudinal, controlled-depth micro-incisions prior to PTA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter, prospective, observational registry enrolled hemodialysis patients scheduled to undergo PTA of their arteriovenous fistula or graft due to clinical or hemodynamic abnormalities. A primary endpoint was anatomic success, defined as angiographic confirmation of &lt;30% residual stenosis post-procedure without an adverse event. Additional assessments included device technical success, clinical success, freedom from target lesion revascularization, target lesion primary patency, and circuit primary patency at 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>A total of 148 lesions were treated with the FLEX Vessel Prep™ System (FLEX VP) prior to PTA in 114 subjects at eight clinical sites. Target lesions were 21 ± 25 mm in length with mean pre-procedure stenosis of 75.2% ± 4.7%. Five procedural complications were recorded without serious adverse events. Two subjects did not complete the follow-up evaluation. Target lesion primary patency across all subjects at 6-months was 62.2% with mean freedom from target lesion revascularization of 202.7 days. Target lesion primary patency and freedom from target lesion revascularization for AVF cases (<i>n</i> = 72) were 67.5% and 212.9 days, respectively. Target lesion primary patency and freedom from target lesion revascularization for AVGs (<i>n</i> = 42) were 52.4% and 183.3 days, respectively. In cases treating AVF cephalic arch stenosis (<i>n</i> = 25), 6-month target lesion primary patency was 70.6% and freedom from target lesion revascularization was 213.4 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This FLEX-AV registry demonstrates safety and effectiveness, notably in the cephalic arch and AVGs, when FLEX VP is used prior to PTA for treatment of vascular access dysfunction in a population of end-stage renal disease subjects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"27 4","pages":"378-387"},"PeriodicalIF":1.3,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10374704","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":"Improved nursing home end-stage renal disease patient participation in physical therapy with onsite, more frequent dialysis","authors":"Eran Y. Bellin,&nbsp;William T. Markis,&nbsp;Alice M. Hellebrand,&nbsp;Christine M. Busby,&nbsp;Katy A. Wane,&nbsp;Camille R. Jordan,&nbsp;Jordan G. Ledvina,&nbsp;Steven M. Kaplan,&nbsp;Todd R. Metzroth,&nbsp;Greg S. Williams,&nbsp;Arif Nazir,&nbsp;Nathan W. Levin,&nbsp;Allen M. Kaufman","doi":"10.1111/hdi.13112","DOIUrl":"10.1111/hdi.13112","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;For end-stage renal disease (ESRD) patients residing in skilled nursing facilities (SNFs), the logistics and physical exhaustion of life-saving hemodialysis therapy often conflict with rehabilitation goals. Integration of dialysis care with rehabilitation programs in a scalable and cost-efficient manner has been a significant challenge. SNF-resident ESRD patients receiving onsite, more frequent hemodialysis (MFD) have reported rapid post-dialysis recovery. We examined whether such patients have improved Physical Therapy (PT) participation.&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;We conducted a retrospective electronic medical records review of SNF-resident PT participation rates within a multistate provider of SNF rehabilitation care from January 1, 2022 to June 1, 2022. We compared three groups: ESRD patients receiving onsite MFD (Onsite-MFD), ESRD patients receiving offsite, conventional 3×/week dialysis (Offsite-Conventional-HD), and the general non-ESRD SNF rehabilitation population (Non-ESRD). We evaluated physical therapy participation rates based on a predefined metric of missed or shortened (&lt;15 min) therapy days. Baseline demographics and functional status were assessed.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Findings&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Ninety-two Onsite-MFD had 2084 PT sessions scheduled, 12,916 Non-ESRD had 225,496 PT sessions scheduled, and 562 Offsite-Conventional-HD had 9082 PT sessions scheduled. In mixed model logistic regression, Onsite-MFD achieved higher PT participation rates than Offsite-Conventional-HD (odds ratio: 1.8, CI: 1.1–3.0; &lt;i&gt;p&lt;/i&gt; &lt; 0.03), and Onsite-MFD achieved equivalent PT participation rates to Non-ESRD (odds ratio: 1.2, CI: 0.3–1.9; &lt;i&gt;p&lt;/i&gt; &lt; 0.46). Baseline mean ± SD Charlson Comorbidity score was significantly higher in Onsite-MFD (4.9 ± 2.0) and Offsite-Conventional-HD (4.9 ± 1.8) versus Non-ESRD (2.6 ± 2.0; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Baseline mean self-care and mobility scores were significantly lower in Onsite-MFD versus Non-ESRD or Offsite-Conventional-HD.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;SNF-resident ESRD patients receiving MFD colocated with rehabilitation had higher PT participation rates than those conventionally dialyzed offsite and equivalent PT participation rates to the non-ESRD SNF-rehabilitation general population, despite being sicker, less independent, and less mobile. We report a scalable program integrating dialysis and rehabilitation care as a potential solution for ESRD patients recovering from acute hospitalization.&lt;/p&gt;\u0000 &lt;/se","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"27 4","pages":"465-474"},"PeriodicalIF":1.3,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9974657","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":"Long-term patency of arteriovenous fistulas for hemodialysis: A decade's experience in a transplant unit","authors":"Matthias Pfister,&nbsp;Lorenzo Viggiani d'Avalos,&nbsp;Philip C. Müller,&nbsp;Olivier de Rougemont,&nbsp;Marco Bonani,&nbsp;Adrian Kobe,&nbsp;Gilbert Puippe,&nbsp;Felix Nickel,&nbsp;Fabian Rössler","doi":"10.1111/hdi.13110","DOIUrl":"10.1111/hdi.13110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The heterogeneous quality of studies on arteriovenous fistulas outcome, with variable clinical settings and large variations in definitions of patency and failure rates, leads to frequent misinterpretations and overestimation of arteriovenous fistula patency. Hence, this study aimed to provide realistic and clinically relevant long-term arteriovenous fistula outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed all autologous arteriovenous fistulas at our center over a 10-year period (2012–2022). Primary and secondary patency analysis was conducted using the Kaplan–Meier method; multivariate analysis of variance was used to detect outcome predictors. Vascular access-specific endpoints were defined according to the European guidelines on vascular access formation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Of 312 arteriovenous fistulas, 57.5% (<i>n</i> = 181) were radio-cephalic (RC_AVF), 35.2% (<i>n</i> = 111) brachio-cephalic (BC_AVF), and 6.3% (<i>n</i> = 20) brachio-basilic (BB_AVF). 6, 12, and 24 months follow-up was available in 290 (92.1%), 282 (89.5%), and 259 (82.2%) patients, respectively. Primary patency rates at 6, 12, and 24 months were 39.5%, 34.8%, and 27.2% for RC_AVF, 58.3%, 44.4%, and 27.8% for BC_AVF, and 40.0%, 42.1%, and 22.2% for BB_AVF (<i>p</i> = 0.15). Secondary patency rates at 6, 12, and 24 months were 65.7%, 63.8%, and 59.0% for RC_AVF, 77.7%, 72.0%, and 59.6% for BC_AVF, and 65.0%, 68.4%, and 61.1% for BB_AVF (<i>p</i> = 0.29). Factors associated with lower primary and secondary patency were hemodialysis at time of arteriovenous fistula formation (<i>p</i> = 0.037 and <i>p</i> = 0.024, respectively) and higher Charlson Comorbidity Index (<i>p</i> = 0.036 and <i>p</i> &lt; 0.001, respectively). Previous kidney transplant showed inferior primary patency (<i>p</i> = 0.005); higher age inferior secondary patency (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Vascular access care remains challenging and salvage interventions are often needed to achieve maturation or maintain patency. Strict adherence to standardized outcome reporting in vascular access surgery paints a more realistic picture of arteriovenous fistula patency and enables reliable intercenter comparison.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"27 4","pages":"388-399"},"PeriodicalIF":1.3,"publicationDate":"2023-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10319287","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":"Glucose variability in maintenance hemodialysis patients with type 2 diabetes","authors":"Lucia Fačkovcová,&nbsp;Drazenka Pongrac Barlovic,&nbsp;Jan Brož","doi":"10.1111/hdi.13089","DOIUrl":"10.1111/hdi.13089","url":null,"abstract":"To the Editor: We read with interest the article by Bomholt et al, “Glucose variability in maintenance hemodialysis patients with type 2 diabetes: Comparison of dialysis and non-dialysis days” published online in this journal. With the use of continuous glucose monitoring the study aimed to examine glucose variations induced by hemodialysis (HD) in patients with type 2 diabetes. Similar median sensor glucose values were found for days on and off HD and nocturnal glucose levels were modestly increased on dialysis days. The authors concluded that findings indicate that antidiabetic treatment does not need to be differentiated on dialysis versus nondialysis days in patients with type 2 diabetes undergoing maintenance HD. We congratulate the authors on their efforts in conducting a comprehensive assessment of HD-influenced glucose excursions and highlighting a very clinically relevant topic. We do not have any criticism of the study, but we would like to make a comment and propose a data sub-analysis. The authors suggested that the reduction in plasma insulin possibly explains the nocturnal increase in mean sensor glucose on dialysis days as insulin is removed from plasma in the HD filter by diffusion, convection, and absorption leading to relative hypoinsulinemia. A total of 27 patients were included in the study, 20 were treated with insulin only, 5 were treated with a combination of oral antidiabetics (OADs) and insulin, and 2 with OADs only. As the types of OADs were not stated and they may have varying impacts on glycemia in connection with HD we respectfully suggest providing a similar separate analysis as published with the data of those 20 insulin-only treated patients. We believe it might show a more prominent difference between days on and off HD. In addition, the type of insulin may matter in end-stage renal disease. For example, the pharmacokinetics of insulin detemir or degludec is not affected by renal impairment, whereas this is not true for insulin glargine or human insulin products. Also, an analysis of the correlation between the daily amount of insulin and glucose concentration changes might support the author’s explanation for the above-mentioned glycemia difference. We respectfully suggest taking these points into account, especially if a study continuation is planned.","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"27 4","pages":"475-476"},"PeriodicalIF":1.3,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9900164","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":"International Society for Hemodialysis—A new horizon","authors":"Christopher Chan","doi":"10.1111/hdi.13087","DOIUrl":"10.1111/hdi.13087","url":null,"abstract":"","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"27 3","pages":"203"},"PeriodicalIF":1.3,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9849770","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":"Effect of needle orientation during arteriovenous access puncture on needed compression time after hemodialysis: A randomized controlled trial","authors":"Valérie Loizeau,&nbsp;Hanan Tanouti,&nbsp;Audrie Marcheguet,&nbsp;Guillaume Loubière,&nbsp;Philippe Aegerter,&nbsp;Hocine Drioueche,&nbsp;Sandra Pembebjoglou","doi":"10.1111/hdi.13105","DOIUrl":"10.1111/hdi.13105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There are two techniques for puncturing an arteriovenous fistula: one where the needle is inserted bevel up and then rotated to a bevel down position, and another where the needle is inserted bevel down. The aim of this study was to compare these two methods of needle insertion on minimum compression time required for hemostasis after needle removal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a prospective, randomized, cross-over, blinded, single-center, routine care study. Each patient's average post-dialysis puncture site compression time was determined during a 2-week baseline period while using bevel-up access puncture. Subsequently, minimum post-dialysis puncture-site compression time was determined during each of two sequential follow-up periods, during which fistula puncture was done with needles inserted bevel up or down, respectively. The order of treatments (bevel up or bevel down insertion) was randomized. During each follow-up period, the minimum compression time necessary to avoid bleeding on needle removal was determined by progressively shortening the compression time. Puncture-associated pain was also assessed as prepump and venous pressures and ability to achieve desired blood flow rate during the dialysis session.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-two patients were recruited. The baseline compression time after needle removal averaged 9.99 ± 2.7 min During the intervention periods, the minimum compression time was on average 10.8 min (9.23–12.4) when the access needles had been inserted bevel down versus 11.1 min (9.61–12.5) when the access needles had been inserted bevel up (<i>p</i> = 0.72). There was no difference in puncture-associated pain between the two insertion techniques, and no difference in prepump or venous pressures or ability to achieve the desired blood flow rate during the dialysis session.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Bevel-up and bevel-down needle orientation during arteriovenous fistula puncture are equivalent techniques in terms of achieving hemostasis on needle removal, and puncture-associated pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"27 4","pages":"364-369"},"PeriodicalIF":1.3,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9815322","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":"A phase 3b, multicenter, open-label, single-arm study of roxadustat (ASPEN): Operational learnings within United States dialysis organizations","authors":"Steven Fishbane,&nbsp;Mark Vishnepolsky,&nbsp;Yemmie Oluwatosin,&nbsp;Jacqueline Nolen,&nbsp;Lixia Zhu,&nbsp;Kerry Cooper,&nbsp;Amy Young","doi":"10.1111/hdi.13100","DOIUrl":"10.1111/hdi.13100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor approved in several regions for the treatment of anemia of chronic kidney disease (CKD). ASPEN evaluated the efficacy, safety, and feasibility of roxadustat in patients with anemia of CKD in US dialysis organizations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This open-label, single-arm study (NCT04484857) comprised a 6-week screening period, followed by 24 weeks of treatment (with optional extension ≤1 year) and a 4-week follow-up. Patients aged ≥18 years, receiving chronic dialysis, with hemoglobin (Hb) 9.0–12.0 g/dL if converting from erythropoiesis-stimulating agents (ESAs), or &lt;10.0 g/dL if receiving ESAs for &lt;6 weeks, received oral roxadustat three times weekly in-center. Primary efficacy endpoints included proportion of patients with mean Hb ≥10 g/dL, averaged over weeks 16–24, and mean Hb change from baseline to the average over weeks 16–24. Safety was also assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Overall, 283 patients were enrolled and treated, 282 (99.6%) were included in the full analysis set, and 216 (76.3%) continued into the extension period. Most patients enrolled were from DaVita sites (71%), with the rest from US Renal Care sites (29%). Mean (standard deviation [<i>SD</i>]) baseline Hb was 10.6 (0.7) g/dL. Nearly all patients were prior ESA users (<i>n</i> = 274; 97.2%). The proportion of patients with mean Hb ≥10 g/dL during weeks 16–24 was 83.7% (95% confidence interval 78.9–88.6). Mean (<i>SD</i>) Hb increase from baseline to the average over weeks 16–24 was 0.2 (1.0) g/dL. During the treatment period, 82 (29.0%) patients reported treatment-emergent serious adverse events (TESAEs). The most common TESAEs were COVID-19 pneumonia (<i>n</i> = 10; 3.5%), acute respiratory failure (<i>n</i> = 9; 3.2%), COVID-19 (<i>n</i> = 7; 2.5%), acute myocardial infarction (<i>n</i> = 7; 2.5%), and fluid overload (<i>n</i> = 6, 2.1%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Roxadustat was effective in maintaining Hb in patients with anemia of CKD on dialysis in large, community-based dialysis organizations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"27 4","pages":"400-410"},"PeriodicalIF":1.3,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9686508","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":"Evaluation of partial pressure CO2 change in the dialyzer blood inlet during hemodialysis as a measure of vascular access recirculation","authors":"Silverio Rotondi,&nbsp;Adolfo Perrotta,&nbsp;Giovanni Pintus,&nbsp;Laura Capasso,&nbsp;Marzia Pasquali,&nbsp;Alessio Farcomeni,&nbsp;Emanuela Paoloni,&nbsp;Sandro Mazzaferro,&nbsp;Lida Tartaglione","doi":"10.1111/hdi.13109","DOIUrl":"https://doi.org/10.1111/hdi.13109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Vascular access recirculation during hemodialysis is associated with reduced effectiveness and worse survival outcomes. To evaluate recirculation, an increase in pCO₂ in the blood of the arterial line during hemodialysis (threshold of 4.5 mmHg) was proposed. The blood returning from the dialyzer in the venous line has significantly higher pCO₂, so in the presence of recirculation, pCO2 in the arterial blood line may increase (ΔpCO₂) during hemodialysis sessions. The aim of our study was to evaluate ΔpCO₂ as a diagnostic tool for vascular access recirculation in chronic hemodialysis patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated vascular access recirculation with ΔpCO₂ and compared it with the results of a urea recirculation test, which is the gold standard. ΔpCO₂ was obtained from the difference in pCO₂ in the arterial line at baseline (pCO₂T1) and after 5 min of hemodialysis (pCO₂T2). ∆pCO₂ = pCO₂T2–pCO₂T1.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>In 70 hemodialysis patients (mean age: 70.52 ± 13.97 years; hemodialysis vintage of 41.36 ± 34.54, KT/V 1.4 ± 0.3), ∆pCO₂ was 4 ± 4 mmHg, and urea recirculation was 7% ± 9%. Vascular access recirculation was identified using both methods in 17 of 70 patients, who showed a ∆pCO₂ of 10 ± 5 mmHg and urea recirculation of 20% ± 9%; time in months of hemodialysis was the only difference between vascular access recirculation and non-vascular access recirculation patients (22 ± 19 vs. 46 ± 36, <i>p</i>: 0.05). In the non-vascular access recirculation group, the average ΔpCO₂ was 1.9 ± 2 (<i>p</i>: 0.001), and the urea recirculation % was 2.8 ± 3 (<i>p</i>: 0.001). The ΔpCO₂ correlated with the urea recirculation % (<i>R</i>: 0.728; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>ΔpCO₂ in the arterial blood line during hemodialysis is an effective and reliable diagnostic tool for identifying recirculation of the vascular access but not its magnitude. The ΔpCO₂ test application is simple and economical and does not require special equipment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"27 4","pages":"370-377"},"PeriodicalIF":1.3,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50146699","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":"Necessity of adjusting the blood hemoglobin target owing to interdialytic weight gain in patients on maintenance hemodialysis","authors":"Masayuki Tanemoto","doi":"10.1111/hdi.13108","DOIUrl":"10.1111/hdi.13108","url":null,"abstract":"To the Editor: Anemia is a common complication in patients on maintenance hemodialysis, and its correction with erythropoiesis-stimulating agents is an established therapy. Current guidelines indicate the target blood hemoglobin levels for administering erythropoiesisstimulating agents but do not specify the hemoglobin measurement conditions, which reportedly affect hemoglobin in maintenance hemodialysis patients. Notably, hemoglobin decreases in case of hemodilution, such as that caused by interdialytic weight gain, and a difference in the gain would generally result in pre-dialysis hemoglobin measured early in the week (early-week-preHb) being lower than that measured midweek (midweekpre-Hb). However, studies examining this hemoglobin difference are scarce and have reported varying results; the difference was only 0.9% in one study but 4.3% in another. Thus, we aimed to examine this difference. This study was performed at a dialysis center in accordance with the Declaration of Helsinki. Pre-dialysis hemoglobin was measured during consecutive earlyweek and midweek maintenance hemodialysis sessions in 12 patients who were undergoing three maintenance hemodialysis sessions per week and were not on the therapy with erythropoiesis-stimulating agents. Comparisons were performed using Student’s paired t-test. Table 1 summarizes the measurements. The mean and median of the early-week-pre-Hb to midweek-pre-Hb ratio were 96.1% and 96.8%, respectively. Therefore, early-week-pre-Hb was lower than midweek-pre-Hb by approximately 4%. In the present analysis, interdialytic weight gain relative to dry weight—the target weight after a dialysis session (IDWG/DW)—was approximately 5.5% and 4.2% in the early-week and midweek sessions, respectively. This increase reduced early-week-pre-Hb by approximately 4% compared with midweek-pre-Hb. Thus, hemoglobin decreased by approximately 3% per additional 1% increase in IDWG/DW. As the daily IDWG/DW is typically 1.5%, the present findings support the previous finding that early-week-pre-Hb was lower than midweekpre-Hb by approximately 4.5%. Interdialytic weight gain is primarily attributed to increased extracellular fluid. As extracellular fluid accounts for approximately one-third of the total body fluid, which in turn accounts for approximately","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"27 4","pages":"477-478"},"PeriodicalIF":1.3,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9692337","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":"Pharmacotherapy considerations in pregnant patients on hemodialysis","authors":"Beatrice Drambarean,&nbsp;Justyna Mastalerz,&nbsp;Lisa Wendt,&nbsp;Stephanie Toth-Manikowski","doi":"10.1111/hdi.13107","DOIUrl":"10.1111/hdi.13107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Successful pregnancy rates on dialysis are increasing with the advent of intensive hemodialysis and advances in medical management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary</h3>\u0000 \u0000 <p>Data support the use of intensive hemodialysis in pregnant women with end-stage kidney disease (ESKD). This paper provides an overview of common pharmacotherapeutic changes in management when caring for a pregnant woman receiving intensive hemodialysis. Pregnant patients on peritoneal dialysis were excluded from this analysis due to insufficient data. Topics covered include those related to anemia (iron and erythropoietin stimulating agents), blood pressure agents, monitoring of phosphorus, as well as nutrition and anticoagulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>When patients on hemodialysis become pregnant, medication adjustments are needed regarding antihypertensives, anemia management, and mineral-bone disease management as many agents require dose adjustment, switching agents due to teratogenicity, or cessation due to fetal complications. There are minimal data in this population; however, successful and healthy infants have been delivered in this patient population with the medication changes discussed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"27 3","pages":"212-223"},"PeriodicalIF":1.3,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10225438","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}