Hemodialysis International最新文献

{"title":"Tenapanor Beyond Phosphate: Gut Sodium Transport, Stool Transit Time, and Volume Balance in Dialysis Patients","authors":"Lucas Maciel de Almeida Corrêa,&nbsp;Luiggi Kevin Virgino Brandão,&nbsp;Clara Belo Gamon Santiago,&nbsp;Alexandre de Assis Barbosa,&nbsp;Gabriel Rian Mazur,&nbsp;Gabriel Costa de Santana,&nbsp;Yan Roberth Delmiro Silva,&nbsp;Letícia Esteves Dante,&nbsp;Ivan Felipe Dutra Júnior","doi":"10.1111/hdi.70095","DOIUrl":"10.1111/hdi.70095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Tenapanor, a minimally absorbed intestinal NHE3 inhibitor approved for hyperphosphatemia in dialysis, lowers phosphate and reduces intestinal sodium absorption. Its sodium–water signal may have implications beyond phosphate but remains poorly separated from diarrhea-mediated losses and dialysis prescription artifacts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This perspective synthesizes pharmacologic, trial, dialysis physiology, and CKD-MBD evidence to propose a hypothesis-generating framework for evaluating tenapanor beyond serum phosphate. We focused on intestinal sodium handling, stool transit, interdialytic weight gain, ultrafiltration stress, hemodynamic tolerance, and fibroblast growth factor 23.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Tenapanor-associated diarrhea and modest serum sodium reduction should be interpreted not only as tolerability events but also as potential markers of on-target intestinal sodium–water modulation. In selected phenotypes, reduced effective sodium loading could theoretically attenuate thirst, lower interdialytic weight gain, and reduce ultrafiltration demand; in others, diarrhea-mediated losses could worsen hypovolemia or intradialytic instability. Tenapanor-induced fibroblast growth factor 23 reduction is biologically plausible but remains an unvalidated bridge to cardiovascular or patient-centered outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Future studies should prospectively distinguish sodium–volume benefit from gastrointestinal intolerance using standardized dialysis endpoints, stool metrics, dialysate sodium data, bioimpedance, and imaging or patient-centered outcomes. Tenapanor should therefore be studied as an intestinal sodium–phosphate–volume intervention, not merely a phosphate-lowering drug.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"689-697"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140401","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":"Bedside Placement of Right Internal Jugular Tunneled Dialysis Catheters by Nephrologists Without Fluoroscopy: Safety and Outcomes From a Retrospective Single-Center Study","authors":"Ganesh Srinivasa Prasad P,&nbsp;Aravind Sarvepalli,&nbsp;Limesh M,&nbsp;Vinod Nagesh,&nbsp;Nitin Kumar Hegde","doi":"10.1111/hdi.70097","DOIUrl":"10.1111/hdi.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Guidelines recommend fluoroscopic guidance for tunneled hemodialysis catheter placement, but fluoroscopy is costly, not universally available, and increases patient radiation exposure. Ultrasound-guided bedside placement by nephrologists, using anatomical landmarks, may provide a safe and cost-effective alternative. To evaluate the immediate safety and outcomes of nonfluoroscopic right internal jugular vein tunneled catheter placement performed by nephrologists in a tertiary care center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Conducted a retrospective analysis of all tunneled dialysis catheters placed bedside at our center between January 2021 and December 2022. Ultrasound was used for venous cannulation, anatomical landmarks for surface marking, and postprocedure chest radiography for tip confirmation. The primary outcome was procedure-related complications within 24 h. Access failure, defined as the inability to use the catheter for dialysis within 24 h, was the secondary outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 235 patients (77.4% male; mean age 55.8 years), 7 (2.9%) developed immediate complications. Minor exit-site bleeding occurred in four patients (1.7%), all managed conservatively; two received fresh frozen plasma. Catheter malposition occurred in two cases (0.85%); one required repositioning and the other replacement with a femoral catheter. One patient (0.4%) had a cardiac arrest attributed to acute coronary syndrome unrelated to the procedure. Access failure occurred in one case (0.4%). All remaining catheters functioned successfully for immediate dialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Ultrasound-guided, nonfluoroscopic bedside placement of right internal jugular vein tunneled catheters by nephrologists is feasible, safe, and cost-effective. This technique reduces radiation exposure and costs, supporting its role in resource-limited settings. Prospective multicenter studies are warranted to assess long-term patency, infection rates, and dialysis adequacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"739-744"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255276","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":"Demystifying Needle Phobia: Facilitating Home Hemodialysis Through Self-Cannulation: A Literature Review and Case Series","authors":"Maria C. Bermudez,&nbsp;Osama El Shamy","doi":"10.1111/hdi.70085","DOIUrl":"10.1111/hdi.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Needle phobia is a significant barrier to home HD adoption, affecting 20%–60% of adults andchildren. This comprehensive review explores the complexities of needle phobiain dialysis patients, examining its origins, mechanisms, and impact through patient experiences and coping strategies. The necessity of cannulation in home HD patients with an AV access can deter patients from adopting self-care, yet mastering self-cannulation can effectively help overcome needle phobia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Factors contributing to needle phobia include genetic predisposition, traumatic experiences, andchronic pain. The physiological response involves a diphasic reaction, with initial sympathetic activation followed by a parasympathetic surge, potentially leading to vasovagal syncope.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A holistic approach to managing needle-related distress, addressing physiological pain, fear, and lack of control is proposed. This includes both pharmacological and non-pharmacological methods, such as desensitization therapy, topical anesthetics, distraction techniques, and cognitive-behavioral interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Systematic screening for needle phobia, education and targeted interventions can empower patientsand improve outcomes. Only then can we foster a culture of compassion, empathy, and personalized support, thereby transforming dialysis care and improving patient experiences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"651-658"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019628","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":"Effects of Ice Massage on Pain, Ecchymosis, Hematoma, and Patient Satisfaction When Applied Prior to Hemodialysis Arteriovenous Fistula Cannulation: A Crossover Trial","authors":"Ercan Bakır,&nbsp;Şeyda Karasu,&nbsp;Ulviye Aydan Nacak,&nbsp;Elanur Yılmaz Karabulutlu,&nbsp;Gülcan Bahçecioğlu Turan","doi":"10.1111/hdi.70089","DOIUrl":"10.1111/hdi.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate the effects of precannulation ice massage on pain, ecchymosis, hematoma, and patient satisfaction during arteriovenous (AV) fistula cannulation in patients receiving maintenance hemodialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This nonrandomized, sequential crossover study included 40 hemodialysis patients. Each participant underwent routine cannulation (control condition) followed by precannulation ice massage (intervention condition) in subsequent sessions. Pain and satisfaction were assessed using a 10-point Visual Analog Scale. Ecchymosis and hematoma were measured using transparent grid film with computerized area calculation. Data were analyzed using repeated-measures analysis of variance and Cohen's <i>d</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ice massage significantly reduced pain during cannulation (Visual Analog Scale: 2.90 ± 1.08 vs. 6.12 ± 1.34; <i>p</i> &lt; 0.001, <i>d</i> = 2.64), 72-h ecchymosis (2.02 ± 0.80 mm² vs. 4.95 ± 1.41 mm²; <i>p</i> &lt; 0.001, <i>d</i> = 2.55), and 72-h hematoma (1.57 ± 1.05 cm vs. 2.85 ± 0.83 cm; <i>p</i> &lt; 0.001, <i>d</i> = 1.35). Patient satisfaction was significantly higher in the intervention condition (8.12 ± 0.72 vs. 5.02 ± 1.07; <i>p</i> &lt; 0.001, <i>d</i> = 3.39).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Precannulation ice massage is an effective, noninvasive intervention to reduce cannulation pain, minimize local complications, and enhance patient satisfaction. This simple and cost-effective method should be integrated into evidence-based hemodialysis care protocols.</p>\u0000 \u0000 <p>\u0000 <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT06332118 (prospectively registered).</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"721-729"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007724","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":"Hemodialysis-Related Protein and Amino Acid Losses in Children","authors":"Derya Cevizli,&nbsp;Mustafa Soran,&nbsp;İsa Yılmaz,&nbsp;Emre Leventoğlu","doi":"10.1111/hdi.70090","DOIUrl":"10.1111/hdi.70090","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Kidney failure in children causes systemic complications and protein-energy malnutrition due to losses of amino acids, dipeptides, and proteins during dialysis, which may impair growth. This study measured protein and amino acid losses during hemodialysis in children and examined clinical and dialysis-related factors associated with these losses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 11 children on chronic hemodialysis at Konya City Hospital were prospectively studied. Demographics, nutritional intake, dialysis parameters, and anthropometric measurements were recorded. Blood and dialysate effluent samples were analyzed for total protein, albumin, and 31 individual amino acids. Losses were grouped as essential amino acids, nonessential amino acids, and branched-chain amino acids. Associations between losses and clinical variables were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The median age was 10.2 years (IQR: 4.2); the median height standard deviation score was −2.96 (IQR: 5.47), and the median weight standard deviation score was −2.42 (IQR: 2.92). All patients showed measurable albumin and amino acid losses in dialysate. Median albumin loss was 1.0 g per 120 L (IQR: 1.10). Higher dietary protein intake, older age, and higher blood flow rate were associated with greater effluent essential and branched-chain amino acid levels (<i>p</i> &lt; 0.05). Greater protein and amino acid losses showed a trend toward association with lower height and weight standard deviation scores, though not consistently statistically significant. Higher Kt/V and urea reduction ratios were associated with larger reductions in plasma amino acid concentrations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Children on hemodialysis experience measurable albumin and amino acid losses. These findings suggest that such losses may contribute to protein-energy wasting and impaired growth, highlighting the potential importance of individualized dialysis prescriptions and nutritional strategies in pediatric patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"773-780"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148045093","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":"Kidney Replacement Therapy as a Rescue Strategy for Severe Acidosis in Diabetic Ketoacidosis: A Case Report","authors":"Vahideh Sadra,&nbsp;Masoud Nazemiyeh,&nbsp;Negin Frounchi,&nbsp;Farahnoosh Farnood","doi":"10.1111/hdi.70094","DOIUrl":"10.1111/hdi.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Diabetic ketoacidosis is a serious complication mainly affecting individuals with type 1 diabetes. It occurs due to insulin deficiency, leading to high blood glucose levels and ketone production, which causes metabolic acidosis. Treatment involves fluid resuscitation, insulin therapy, and correcting metabolic imbalances. Complications can arise from insulin resistance and acidosis. In severe cases of refractory metabolic acidosis, renal replacement therapy can improve outcomes by correcting potassium levels and aiding recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 43-year-old Iranian woman with poorly controlled type 2 diabetes was admitted to Imam Reza Hospital with diabetic ketoacidosis. Despite initial treatment at a local health center, she required hemodialysis due to persistent severe metabolic acidosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>After hemodialysis and further treatment in the intensive care unit, her condition improved, and she was discharged on a multiple daily injection insulin regimen. The patient's presentation was complex, with hypokalemia being a rare finding in an initial diabetic ketoacidosis presentation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The refractory hypokalemia was likely due to prolonged gastrointestinal losses from vomiting. The most significant error in management was the delay in initiating insulin infusion despite the diabetic ketoacidosis diagnosis. Renal replacement therapy was used as a salvage method to correct severe acidosis and potassium deficits, showing its potential effectiveness in such cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"808-812"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140410","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":"Ultrafiltration Rate in Prolonged Intermittent Kidney Replacement Therapy in Critically Ill Patients: A Randomized Controlled Trial","authors":"Vijay Kalathia,&nbsp;Snehal Gaikwad,&nbsp;Vipul Chakurkar,&nbsp;Sagar Kulkarni,&nbsp;Meetali Bidaye,&nbsp;Valentine Lobo","doi":"10.1111/hdi.70087","DOIUrl":"10.1111/hdi.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fluid overload is a significant risk factor for mortality in critically ill patients with acute kidney injury. Ultrafiltration during kidney replacement therapy frequently produces hypotension. The optimal ultrafiltration rate in patients on vasopressor agents undergoing prolonged intermittent kidney replacement therapy (prolonged intermittent KRT) is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study was carried out to determine the optimal ultrafiltration rate among critically ill patients with acute kidney injury undergoing prolonged intermittent kidney replacement therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We randomized patients to ultrafiltration rates of 2, 4 mL/kg/h, and a control (nephrologist's prescription) group. The mean arterial pressure, inotrope score, and vasopressor dependency index were measured before, at the mid-point, and after completing a session of prolonged intermittent KRT. Episodes of hypotension were also documented. The difference in hypotensive episodes and vasopressor dependency index between groups was the primary endpoint of the study. Exploratory analysis by stepwise logistic regression to determine the independent contribution of various factors to mortality was carried out.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was no difference between the groups at baseline. A significantly lower incidence of hypotension and premature session termination was found in the group randomized to a 4 mL/kg/h ultrafiltration rate compared with the groups prescribed 2 mL/kg/h and the control group (prescribed 2.65 mL/kg/h). The difference in pre and post mean arterial pressure and vasopressor dependency index was not significantly different between the 3 groups. Hypotension significantly increased the 30-day mortality risk and the length of stay (intensive care unit).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this study, we found that the group prescribed an ultrafiltration rate of 4 mL/kg/h had the lowest number of complications in critically-ill patients undergoing prolonged intermittent KRT for acute kidney injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"786-796"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944396","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":"Intima-Media Thickness Progression Rate and Primary Unassisted Patency Failure in Arteriovenous Fistulas: A Prospective Cohort Study","authors":"Gen Li,&nbsp;Zhengjiang Cao","doi":"10.1111/hdi.70084","DOIUrl":"10.1111/hdi.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Failure of autogenous arteriovenous fistulas (AV fistulas) due to venous neointimal hyperplasia is a major clinical challenge. Whether the rate of progression in venous intima-media thickness predicts primary unassisted patency failure remains unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective cohort study, we performed a 6-month landmark analysis to minimize immortal time bias among patients with newly created AV fistulas. Intima-media thickness was measured serially by ultrasound. We calculated the early progression rate (0–6 months) as the primary predictor and the 0–12 month rate as a sensitivity analysis. Cox proportional hazards models were used to assess the association between the early progression rate and subsequent primary unassisted patency failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis included 129 patients who were event-free at the 6-month landmark. Over a median follow-up of 13.2 months after the landmark, 35 patients (27.1%) experienced primary unassisted patency failure. Faster early intima-media thickness progression was a strong independent predictor of failure (adjusted hazard ratio [HR] 1.63 per 0.05 mm/year increase; 95% CI 1.41–1.88; <i>p</i> &lt; 0.001), together with baseline intima-media thickness and diabetes. Adding the early progression rate to a model containing clinical and baseline ultrasound variables significantly improved discrimination (C-index increased from 0.69 to 0.76, <i>p</i> = 0.002) and risk reclassification (net reclassification improvement = 0.21, <i>p</i> = 0.008).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early venous intima-media thickness progression rate is a powerful independent predictor of subsequent AV fistula failure and adds substantial prognostic value beyond standard clinical and ultrasound factors. Serial ultrasound monitoring of this parameter may support the development of risk-adapted surveillance strategies to prolong AV fistula survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"730-738"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019597","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":"Small Bowel Lesions and Bleeding Risk in Hemodialysis Patients: A Narrative Review","authors":"Andreas Smyrlis,&nbsp;Konstantia Kantartzi,&nbsp;Konstantinos Mimidis,&nbsp;Stylianos Panagoutsos","doi":"10.1111/hdi.70088","DOIUrl":"10.1111/hdi.70088","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;Gastrointestinal bleeding is very common among hemodialysis patients. This high bleeding risk is caused by uremic platelet dysfunction, vascular fragility, intradialytic hemodynamic instability, and widespread antithrombotic therapy. Small bowel lesions, especially angiodysplasias, constitute a significant but often overlooked source of recurrent or occult hemorrhage while conventional endoscopy frequently fails to identify these lesions.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Investigation of small bowel lesions in hemodialysis patients and identification of bleeding risk of this vulnerable population.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Narrative review.&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;English language studies in the last 25 years using PubMed and Google Scholar databases up to November 2025. Search terms included “hemodialysis,” “small bowel lesions,” “angiodysplasia,” and “gastrointestinal bleeding.” The review incorporates different types of research including observational cohorts, randomized trials, cross-sectional studies, systematic reviews, and narrative reviews involving hemodialysis adult or end stage renal disease populations.&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;Across the analysis of 26 studies, capsule endoscopy revealed a significantly higher prevalence of small bowel lesions in hemodialysis patients compared to controls, with angiodysplasias being the most frequent finding. Large-scale epidemiological analyses identified hemodialysis as an independent risk factor for gastrointestinal hemorrhage compared to peritoneal dialysis, providing the clinical background for the increased susceptibility of these patients to small bowel-specific lesions. Overall, patients have a higher risk of rebleeding tendency than controls and exhibited a high-risk phenotype characterized by recurrent angiodysplasia-related bleeding and elevated one-year mortality rates following the first bleeding episode.&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;Small bowel lesions may constitute a major and underrecognized cause of gastrointestinal bleeding in hemodialysis patients. Capsule endoscopy offers the highest diagnostic yield, yet optimal treatment strategies remain undefined, and recurrent bleeding episodes are common. Thus, effective management requires early detection","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 4","pages":"665-678"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990451","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 Outcome of Brachial-Basilic Arteriovenous Fistulas","authors":"Kajan Raj Shrestha,&nbsp;Prashiddha Bikram Kadel,&nbsp;Rajat Pradhan,&nbsp;Uttam Krishna Shrestha","doi":"10.1111/hdi.70070","DOIUrl":"10.1111/hdi.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Autogenous arteriovenous fistulas are the preferred vascular access for hemodialysis due to superior patency and lower infection rates compared with grafts or catheters. The brachiobasilic AV fistula provides a valuable option for patients with unsuitable veins, though it remains underutilized due to technical challenges and wound morbidity. This study aimed to evaluate the clinical outcomes, patency, and complications of brachiobasilic-AV fistula creation over a 10-year period at a tertiary vascular center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective descriptive analysis was conducted of all patients who underwent brachiobasilic AV fistula creation between January 2014 and December 2024 at the Manmohan Cardiothoracic Vascular and Transplant Center. Demographics, comorbidities, operative details, and outcomes were obtained from hospital records and follow-up interviews. Preoperative vessel diameters were assessed using Doppler ultrasonography. Brachiobasilic AV fistulas were created using either single-stage (82.6%) or two-stage (17.4%) techniques. Statistical analysis was performed to assess maturation, patency, and complication rates (<i>p &lt;</i> 0.05 considered significant).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 167 brachiobasilic AV fistulas were created in 158 patients (62 males, 96 females; mean age 55.6 ± 15.8 years). The most common comorbidities were hypertension (91.1%) and diabetes (49.4%). The mean basilic vein and brachial artery diameters were 3.46 ± 1.6 mm and 3.23 ± 0.8 mm, respectively. Successful maturation occurred in 141 cases (84.4%) within 6 weeks, while 21 (12.6%) experienced early failure. Primary patency was 22 ± 5 months, and secondary patency was 6 ± 2.1 months. Kaplan–Meier analysis demonstrated primary patency rates of 98%, 65%, and 28% at 1, 3, and 5 years, respectively. The most frequent complications included bleeding (40.7%), infection (12.6%), and pseudoaneurysm (11.4%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For the patients with exhausted autogenous vascular access, brachiobasilic AV fistula is a viable procedure in our setting with acceptable complication and patency outcomes comparable to international standards. Outcome and postoperative complication can be reduced by adoption of newer techniques which need further evaluation considering cost and benefit issue.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 3","pages":"557-562"},"PeriodicalIF":1.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147461465","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}