Seminars in Dialysis最新文献

{"title":"Measures of Equivalent Hemodialysis Urea Clearance and Their Proposed Utility for Monitoring Adequacy.","authors":"John T Daugirdas","doi":"10.1111/sdi.70036","DOIUrl":"10.1111/sdi.70036","url":null,"abstract":"<p><p>The details of four measures of \"equivalent\" clearances based on urea that have been proposed to monitor hemodialysis adequacy are reviewed. These measures fall into two groups: one based on urea nitrogen generation rate divided by the time-averaged serum urea nitrogen concentration, and the other based on urea nitrogen generation rate divided by the average predialysis serum urea nitrogen concentration. After the original variants were proposed, a potential problem regarding relative weights of dialysis and residual kidney clearances was identified, and revised equivalent urea clearances were proposed that give a higher weight to residual kidney clearance relative to dialysis clearance. These measures suggest that the target dialysis dose should be set to achieve dialysis solute concentrations typically found in patients at the point of needing dialysis, e.g., with a glomerular filtration rate of around 10 mL/min, corresponding to a urea clearance of approximately 6 mL/min and a creatinine clearance of 14. Despite the theoretical attractiveness of equivalent urea clearances to monitor hemodialysis adequacy, their utility has not been conclusively demonstrated in observational studies of incremental or more frequent hemodialysis.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"139-143"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043569","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":"Topical Timolol for Peritoneal Dialysis Catheter Exit-Site Granulomas: First Report of Successful Use in CAPD Patients.","authors":"Veenaa Manjari S, Rajeevalochana Parthasarathy, Prashanth N, Bhavadharani Saravanan, Hemanath Krishnamoorthy","doi":"10.1111/sdi.70039","DOIUrl":"10.1111/sdi.70039","url":null,"abstract":"<p><p>Exit-site granuloma is a frequent and challenging complication in patients undergoing peritoneal dialysis, predisposing to exit-site infections. Recent evidence suggests a potential role for topical timolol in promoting regression of granulomatous tissue. We report two patients on continuous ambulatory peritoneal dialysis who developed exit-site granulomas. Both patients were treated with topical 0.5% timolol maleate ophthalmic solution applied locally to the exit site three times weekly as part of routine exit-site care. Clinical response was monitored using serial photographs. Complete resolution of the granuloma was achieved within 3 weeks in one patient and within 2 months in the other. Neither patient developed local or systemic adverse effects, and no exit-site infections occurred during treatment. Topical 0.5% timolol maleate may represent a safe, non-invasive, and effective treatment option for peritoneal dialysis exit-site granulomas. Larger studies are warranted to establish its efficacy in larger cohorts.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"204-206"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520830","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":"Risk of Serious Adverse Events and Death With Low-Dose Methotrexate Versus Hydroxychloroquine in Adults Receiving Dialysis.","authors":"Flory T Muanda, Peter G Blake, Matthew A Weir, Fatemeh Ahmadi, Mohammad Ali Omrani, Sheikh S Abdullah, Eric McArthur, Jessica M Sontrop, Brad L Urquhart, Amit X Garg","doi":"10.1111/sdi.70035","DOIUrl":"10.1111/sdi.70035","url":null,"abstract":"<p><strong>Background: </strong>Several case reports have linked low-dose methotrexate to serious adverse events, including death, in dialysis patients. We compared the risk of serious adverse events in dialysis patients initiating low-dose methotrexate versus hydroxychloroquine.</p><p><strong>Methods: </strong>Using linked healthcare databases in Ontario, Canada (1997-2020), we identified 55 new users of low-dose methotrexate and 407 new users of hydroxychloroquine. The primary outcome was the 90-day risk of death or hospitalization with myelosuppression, sepsis, pneumotoxicity, or hepatotoxicity. Adjusting for age, sex, and a proxy for polypharmacy, a modified Poisson regression was used to estimate adjusted risk ratios (aRR), and a binomial regression was used to estimate adjusted risk differences (aRD).</p><p><strong>Results: </strong>The median prescribed dose was 10 mg/week (IQR, 10-17.5) for methotrexate and 300 mg/day (IQR, 200-400) for hydroxychloroquine. The primary outcome occurred in 16/55 low-dose methotrexate users (29.1%) and in 29/407 hydroxychloroquine users (7.1%); aRR: 3.14 (95% CI, 1.75 to 5.63); aRD: 19.5% (95% CI, 7.5% to 31.4%). Findings were consistent across sensitivity analyses.</p><p><strong>Conclusion: </strong>Low-dose methotrexate should be avoided in dialysis patients whenever possible, and alternative DMARDs should be considered.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"168-176"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147932937","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":"Intracardiac Vascular Access for Hemodialysis Despite Associated Ascending Aortic Aneurysm.","authors":"Huseyin Durmaz","doi":"10.1111/sdi.70037","DOIUrl":"10.1111/sdi.70037","url":null,"abstract":"<p><p>We planned a case presentation of right atrial hemodialysis catheter placement via minithoracotomy, an unusually good alternative in cases where venous access is exhausted and there is an associated ascending aortic aneurysm.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"200-203"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272804","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":"Treatment of Restless Legs Syndrome in Dialysis Patients.","authors":"Kenji Sakurai, Yoshitaka Kurihara, Hiromi Hosoya, Fumi Yamouchi, Takeshi Saito","doi":"10.1111/sdi.70040","DOIUrl":"10.1111/sdi.70040","url":null,"abstract":"","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"207-209"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456814","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":"Regional vs. Local Anesthesia for Arteriovenous Fistula Creation in Adults With End-Stage Kidney Disease: A Grade Assessed Systematic Review and Meta-Analysis.","authors":"Hammad Saif, Salar Khan, Muhammad Shahzaib, Syed Muhammad Rayyan, Muhammad Uzair, Mueed Iqbal, Bakhtiyar Ameer, Hira Shehzad, Sarmad Nazir, Abdur Rehman Noor","doi":"10.1111/sdi.70038","DOIUrl":"10.1111/sdi.70038","url":null,"abstract":"<p><p>Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis in patients with end-stage renal disease (ESRD), yet high rates of primary failure and suboptimal patency remain significant challenges. The choice of anesthetic technique may influence vascular dynamics and AVF outcomes. This study aims to compare the effectiveness of regional anesthesia (RA) versus local anesthesia (LA) on clinical outcomes following AVF creation in adults with ESRD. A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov were searched from inception to November 2025. Randomized controlled trials and comparative observational studies evaluating RA versus LA in adult AVF creation were included. Primary outcomes included primary patency, functional patency, and primary failure rate. Secondary outcomes included complications, re-interventions, anesthesia time, and vascular parameters. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were pooled using a random-effects model where appropriate. Ten studies involving 1920 patients (RA: 949; LA: 971) were included. RA was associated with significantly higher primary patency (RR = 0.93; 95% CI: 0.87-0.98; p = 0.01) and lower primary failure rates (RR = 1.47; 95% CI: 1.00-2.16; p = 0.05). Complications (RR = 1.49; p = 0.03) and re-interventions (RR = 2.28; p = 0.03) were significantly higher in the LA group. No significant differences were observed in functional patency, anesthesia time, or brachial artery diameter. RA is associated with improved early AVF outcomes, including higher primary patency and reduced failure, complications, and re-interventions, without increasing operative time. These findings suggest that RA may improve early AVF outcomes in selected settings where expertise and resources are available.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"144-156"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412766","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":"Beyond Bioremediation: A Rare Case of Comamonas testosteroni Bloodstream Infection in a Patient With Stage 5 Chronic Kidney Disease on Maintenance Hemodialysis.","authors":"Syeda Bushra Fatima, Moiz Ahmed Khan, Summaya Zafar","doi":"10.1111/sdi.70026","DOIUrl":"10.1111/sdi.70026","url":null,"abstract":"<p><p>Comamonas testosteroni is a gram-negative aerobic bacillus commonly found in environmental sources and known for its bioremediation potential. Although it is widely distributed in nature, human infection is rare, but it is increasingly being recognized as a nosocomial pathogen. A 68-year-old female with stage 5 chronic kidney disease (CKD V) on maintenance hemodialysis since 2017 presented with fever and decreased consciousness. On examination, a tunneled cuffed catheter (TCC) was noted in the right internal jugular vein. Two sets of blood cultures, one drawn from the TCC and the other from a peripheral vein, grew C. testosteroni after 48 h. The organism was identified using API ID strips and was sensitive to amikacin, gentamicin, ceftazidime, imipenem, and meropenem but resistant to ciprofloxacin. She was treated with catheter removal and intravenous ceftazidime. The patient recovered completely after 5 days of hospitalization, with resolution of fever and improved consciousness. This case highlights C. testosteroni as an emerging nosocomial pathogen in immunocompromised patients undergoing invasive procedures. It underscores the importance of vigilant surveillance and strict catheter management protocols.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"132-135"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676253","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":"Impact of Expanded Hemodialysis on Inflammation and Iron Metabolism in Chronic Hemodialysis Patients.","authors":"Berrak Itır Aylı, Gülay Ulusal Okyay, Mehmet Deniz Aylı","doi":"10.1111/sdi.70033","DOIUrl":"10.1111/sdi.70033","url":null,"abstract":"<p><p>Microinflammation and functional iron deficiency are major contributors to anemia and treatment burden in maintenance hemodialysis (HD). Medium cutoff (MCO) membranes enhance the removal of middle- and large-sized solutes implicated in these pathways, yet real-world data using routinely measured inflammatory and iron-related markers are scarce. This study examined the effects of MCO-based expanded HD on inflammatory indices, iron metabolism, and anemia-related treatment requirements. In this single-center retrospective study, 22 maintenance HD patients (11 who continued on high-flux dialyzers and 11 who were switched to MCO dialyzers) were followed for 24 weeks. Baseline and 24-week assessments included C-reactive protein (CRP), the CRP/albumin ratio, neutrophil count, and composite inflammatory indices, as well as serum iron, transferrin saturation (TSAT), total iron-binding capacity (TIBC), and ferritin. Monthly intravenous iron supplementation and weekly erythropoiesis-stimulating agent (ESA) doses were also documented. Baseline characteristics were comparable between groups. Over the 24-week period, the MCO group showed a significant decline in neutrophil count (p = 0.042) and downward trends in CRP and the CRP/albumin ratio, while both markers increased significantly in patients maintained on high-flux dialyzers. Serum albumin remained stable in all participants. Parallel to the improvement in inflammation, the MCO group demonstrated significant enhancements in iron-handling parameters, with higher serum iron (p = 0.008) and TSAT (p = 0.005), and lower TIBC (p = 0.007), none of which were observed in the high-flux group. Between-group Δ-differences were significant for CRP (p = 0.010), CRP/albumin ratio (p = 0.013), serum iron (p = 0.040), TIBC (p = 0.005), and TSAT (p = 0.005). Hemoglobin levels remained stable in both groups, while intravenous iron and ESA requirements showed modest within-group reductions in the MCO cohort. In this exploratory retrospective analysis, MCO membrane use was associated with favorable trends in inflammatory markers and iron-handling parameters, alongside modest within-group reductions in intravenous iron and ESA requirements, without compromising serum albumin. These findings suggest that MCO therapy may help mitigate microinflammation and support more efficient anemia management in real-world HD practice.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"105-115"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780063","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":"Risk Prediction Models for Frailty in Maintenance Hemodialysis Patients: A Systematic Review and Meta-Analysis.","authors":"Fan Yang, Hua Kang, Shuyao Wang, Yiting Wang, Huiyu Hu","doi":"10.1111/sdi.70025","DOIUrl":"10.1111/sdi.70025","url":null,"abstract":"<p><strong>Objective: </strong>The aim is to systematically evaluate the frailty risk prediction models for Chinese maintenance hemodialysis patients and to provide a reference for the construction and optimization of such models.</p><p><strong>Methods: </strong>Relevant studies on prediction models for frailty in Chinese maintenance hemodialysis patients were retrieved from PubMed, Embase, Web of Science, Cochrane Library, CINAHL, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Database, and VIP Database. The search period was from the inception of each database to October 23, 2024. Two researchers independently screened the literature, extracted data, and assessed the quality of the included models using the Prediction model Risk of Bias Assessment Tool (PROBAST). A meta-analysis of predictors was performed using Stata 18.0 software.</p><p><strong>Results: </strong>A total of 13 studies from China were included, which developed 15 distinct prediction models. These models involved 4341 patients. The area under the receiver operating characteristic curve (AUC) for these models ranged from 0.722 to 0.998, indicating good predictive performance (AUC > 0.7). However, the overall risk of bias was high, primarily in the domain of data analysis. The meta-analysis identified the following significant predictors of frailty (p < 0.05): age (OR = 1.14, 95% CI 1.05-1.23), serum albumin (OR = 0.66, 95% CI 0.52-0.83), exercise (OR = 0.50, 95% CI 0.49-0.63), comorbidity (OR = 1.70, 95% CI 1.47-1.97), nutritional score (OR = 3.64, 95% CI 1.53-8.67), ADL score (OR = 0.77, 95% CI 0.68-0.88), female sex (OR = 6.24, 95% CI 1.97-19.80), and depression (OR = 1.26, 95% CI 1.04-1.53).</p><p><strong>Conclusion: </strong>Our results indicate the incidence of frailty among maintenance hemodialysis patients in China is as high as 39%. The identified predictors-advanced age, hypoalbuminemia, physical inactivity, comorbidities, poor nutritional status, impaired activities of daily living, female sex, and depression-form the basis for developing targeted preventive measures for frail patients on maintenance hemodialysis. The prediction model of frailty risk in maintenance hemodialysis patients in China is still in its infancy. Future research can refer to the model construction method of this study and the common predictors integrated by meta-analysis and select appropriate methods to develop and verify the frailty prediction model in combination with clinical practice. Targeted preventive measures should be given to maintenance hemodialysis patients with high risk in the early stage.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"59-75"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780105","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":"Green Dialysis: A Framework for Environmentally Sustainable Renal Replacement Therapy.","authors":"Pranav Sivaram, Toby Johnson, Mojgan Mortazavi, Urmila Anandh, Jing Chen, Fernanda Oliveira Coelho, Simon Davies, Rasha Darwish, Faiçal Jarraya, Zehra Aydin, K S Nayak, Talerngsak Kanjanabuch, Sourabh Sharma, Rupesh Raina","doi":"10.1111/sdi.70028","DOIUrl":"10.1111/sdi.70028","url":null,"abstract":"<p><strong>Background: </strong>Dialysis is a life-sustaining therapy for patients with end-stage renal disease, yet it is among the most resource-intensive treatments in modern healthcare. Hemodialysis requires large volumes of treated water, substantial energy input, and extensive single-use consumables, resulting in significant greenhouse gas emissions and clinical waste when scaled to millions of treatments performed annually. Climate change further threatens kidney health through heat stress, dehydration, and climate-related disruptions, creating a bidirectional relationship in which kidney care both contributes to and is adversely affected by environmental degradation.</p><p><strong>Methods: </strong>This white paper synthesizes current evidence surrounding environmentally sustainable dialysis practices, collectively termed \"green dialysis,\" reviewing technical and system-level interventions across water stewardship, energy management, waste reduction, and clinical practice innovation.</p><p><strong>Results: </strong>Green dialysis strategies, including dialysate flow optimization, improved reverse-osmosis efficiency and water reuse, energy-efficient infrastructure, renewable energy integration, waste segregation, central concentrate delivery systems, and incremental dialysis, have been shown to reduce water consumption, energy use, waste generation, and operational costs while maintaining dialysis adequacy and clinical outcomes. Adoption remains uneven due to operational complexity, regulatory gaps, and financial constraints, particularly in low- and middle-income countries.</p><p><strong>Conclusions: </strong>Context-sensitive implementation, staff education, standardized monitoring, and transparent reporting are essential for overcoming these barriers. Broader integration of sustainability into routine dialysis care represents a critical opportunity to reduce the environmental footprint of kidney replacement therapy without compromising patient safety or treatment efficacy.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"76-87"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692045","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}