Seminars in Dialysis最新文献

{"title":"The Multidimensional Impact of Expanded Hemodialysis: A Comprehensive Review.","authors":"Georges Kosmadakis, Aura Necoara, Julien Baudenon, Clemence Deville, Ioana Enache, Elena Chelaru","doi":"10.1111/sdi.13257","DOIUrl":"https://doi.org/10.1111/sdi.13257","url":null,"abstract":"<p><p>Expanded hemodialysis (HDx) represents a transformative innovation in renal replacement therapy, addressing the limitations of conventional hemodialysis and high-flux modalities. By employing medium cut-off (MCO) membranes, HDx ensures efficient clearance of middle- and large-molecular-weight uremic toxins, such as β₂-microglobulin and cytokines, while selectively retaining vital proteins like albumin. This comprehensive review examines the clinical efficacy, safety, and broader implications of HDx, highlighting its potential to improve outcomes for patients with chronic kidney disease (CKD). The review synthesizes findings from comparative studies, emphasizing HDx's superior toxin removal capabilities, particularly for solutes implicated in systemic inflammation and cardiovascular complications. Key mechanisms, including the internal filtration-backfiltration process, contribute to hemodynamic stability and enhanced toxin clearance. HDx demonstrates significant reductions in inflammatory biomarkers, improved arterial compliance, and better cardiovascular outcomes compared with traditional methods. Patient-reported outcomes further underscore HDx's benefits, with shorter recovery times, enhanced quality of life, and reduced intradialytic complications. While albumin loss remains a consideration, studies confirm its clinical acceptability and minimal impact on nutritional status. HDx's economic viability, reduced infrastructure requirements, and compatibility with existing systems position it as a cost-effective alternative, especially in resource-limited settings. Despite promising evidence, the review identifies gaps in long-term data, particularly regarding mortality and sustained quality-of-life improvements. Future directions include refining membrane technologies and incorporating personalized medicine approaches to optimize HDx protocols. By bridging these gaps, HDx has the potential to redefine renal replacement therapy, offering a safer, more effective, and scalable solution for CKD management.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"38 3","pages":"176-186"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022589","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":"Comparative Outcomes of Tunneled and Non-Tunneled Catheters as Bridge to Arteriovenous Fistula Creation in Incident Hemodialysis Patients.","authors":"Himansu Sekhar Mahapatra, Muthukumar B, Chandra Krishnan, Tanvi Thakker, Lalit Pursnani, Renju Binoy, Beauty Suman, Md Mahboob Alam, Abhishek Jha, Vipul Gupta, Sutanay Bhattacharyya, Rajesh Tarachandani, Preeti Chaudhary","doi":"10.1111/sdi.13256","DOIUrl":"10.1111/sdi.13256","url":null,"abstract":"<p><strong>Background: </strong>This study compares the outcomes of tunneled catheters (TCs) and non-tunneled catheters (NTCs) in incident hemodialysis patients undergoing early arteriovenous fistula (AVF) creation.</p><p><strong>Methods: </strong>Adult incident ESKD patients were randomized in two catheter groups (TC and NTC) for hemodialysis initiation and were followed for 12 weeks from March 2021 in a 3-year study period. Catheter salvage was attempted in both the groups until AVF maturation in cases of catheter-related bloodstream infection (CRBSI) or mechanical dysfunction. Catheter insertion and removal dates, infection episodes, and mechanical dysfunction events were recorded. CRBSI rates, dysfunction rates, and catheter survival were compared.</p><p><strong>Results: </strong>A total of 133 patients were randomized into TC (65) and NTC (68) groups. Seventy-six patients developed symptoms of CRBSI, of whom eight patients required catheter removal (TC: 2, NTC: 6). CRBSI episodes per 1000 catheter days were 15.14 for TCs and 16.85 for NTCs, but mechanical dysfunction rates were 0.96 and 1.68, respectively. By 6 weeks, one catheter was removed in the TC group (AVF maturation), and eight in the NTC group were removed (four due to AVF maturation, three due to CRBSI, and one due to mechanical dysfunction). Kaplan-Meier analysis showed significantly longer catheter survival for TCs compared to NTCs (66.9 vs. 57.9 days, p = 0.001).</p><p><strong>Conclusion: </strong>CRBSI rates and catheter patency were comparable between TCs and NTCs at 6 weeks, but TCs demonstrated better survival beyond this period. When early AVF creation is ensured, NTCs may serve as a viable short-term vascular access option, particularly in resource-limited settings.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"38 3","pages":"187-193"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029798","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":"Comparison of the Effects of Hemodialysis and Peritoneal Dialysis on Exhaled Nitric Oxide in Renal Replacement Therapy.","authors":"Buğra Kerget, Alperen Aksakal, İbrahim Ethem Doğdu, Can Sevinç, Edip Erkuş","doi":"10.1111/sdi.13254","DOIUrl":"10.1111/sdi.13254","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis (PD) and hemodialysis (HD) form the basis of renal replacement therapy (RRT) in patients with end-stage renal disease. Both methods have advantages, and in our study, we aimed to examine the effect of both methods on exhaled nitric oxide (FeNO) levels.</p><p><strong>Methods: </strong>Our study included RRT patients between 18 and 65 who our hospital's nephrology clinic followed up for at least 2 years. A total of 100 patients, 35 patients from both RRT groups and 30 healthy control groups, were included in our study. Echocardiography (ECHO) and FeNO measurements were performed.</p><p><strong>Results: </strong>In the comparison of the groups' mean pulmonary arterial pressure (PAP) and pre-RRT FeNO levels, it was observed that both levels were higher in HD patients compared to PD patients (p = 0.04, < 0.001, respectively). The control group observed that both predialysis and postdialysis FeNO levels in HD patients showed a statistically significant difference compared to the control group (p ≤ 0.001, 0.01, respectively). It was observed that mean arterial pressure (MAP) levels were higher in HD patients compared to PD patients before RRT (p = 0.01). FeNO positively correlated with age and gamma-glutamyl transferase (GGT) level (R = 0.542, p = 0.01, R = 0.629, p = 0.01, respectively).</p><p><strong>Conclusion: </strong>FeNO is known as an essential indicator of oxidative stress and inflammation. The higher FeNO level in HD patients compared to PD and its positive correlation with oxidative stress markers such as GGT suggest that PD may be more suitable for the physiological structure.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"194-200"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764953","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":"From Venous to Arterial Blood in the Same Tunneled Dialysis Catheter After Starting a Continuous Renal Replacement Therapy: A Case Report.","authors":"Amandine Becquet, Pierre Louis Hermet, Dominique Bertrand, Amandine Verbecke, Maximilien Grall, Christophe Girault, Jonathan Nicolas","doi":"10.1111/sdi.13235","DOIUrl":"10.1111/sdi.13235","url":null,"abstract":"<p><p>Tunneled dialysis catheter is the alternative for dialysis patients who cannot benefit from an arteriovenous fistula. The insertion of such catheters is usually ultrasound-guided to prevent complications. A 36-year old patient had an unexpected complication following the insertion of a right femoral tunneled dialysis catheter: Although the blood collected from the catheter was venous after insertion, the blood turned arterial few minutes after initiating a continuous renal replacement therapy (CRRT). It became venous again after stopping the therapy. The first, yet unlikely hypothesis, was an arterial location of the catheter. In fact, it turned out not to be. We describe the management of such a case.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"221-224"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847602","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":"Adverse Outcomes After Tunneled Dialysis Catheter-Related Bloodstream Infections-Too Dark at the End of This Tunnel?","authors":"Niveditha Pandit, Namrata Rao, Majibullah Ansari, Abhilash Chandra, Sai Saran","doi":"10.1111/sdi.13232","DOIUrl":"10.1111/sdi.13232","url":null,"abstract":"<p><strong>Background: </strong>Tunneled dialysis catheters (TDCs) are preferred over temporary noncuffed catheters for access in patients on maintenance hemodialysis. The removal of TDC after catheter-related blood stream infections (CRBSIs) is often not practiced even when indicated, and the adverse outcomes after such salvage are presently unclear.</p><p><strong>Aims and objectives: </strong>The study aimed to evaluate adverse outcomes after the first episode of definite or probable CRBSI. The composite adverse outcome was recorded as the presence of at least one of three adverse outcomes-death in the index hospital admission, occurrence of recurrent bacteremia, and death within 3 months.</p><p><strong>Results: </strong>During the study period, the TDC CRBSI incidence rate was 6.9/1000 catheter days. Of the 110 study participants, majority were male (63%), with a median age of 35 years, belonging to rural (56%) and agrarian (39%) communities, and 66% were getting dialyzed at stand-alone dialysis units. Gram-negative infections predominated (64%), with 37% of isolates showing resistance to carbapenems. Catheter salvage was practiced in 80%, and immediate catheter removal was done only in the sickest of patients (in seven of eight with in-hospital mortality). Predictors of composite adverse outcomes included sites other than right internal jugular vein (OR 3.6) and resistance to β lactam-β lactamase inhibitors (OR 16.2). At a median follow-up of 7 months, all survivors at 3 months were alive and 46% had recurrent TDC CRBSIs.</p><p><strong>Conclusion: </strong>Up to one-half of patients with end-stage kidney disease experienced composite adverse outcomes after the first episode of TDC CRBSI, with infection-related 3-month mortality of 15%.</p><p><strong>Trial registration: </strong>Clinical trial number: CTRI/2023/10/058556.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"124-131"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787041","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 of Hypokalemia With Mortality in Patients Undergoing Hemodialysis: A Systematic Review and Meta-Analysis.","authors":"Zhongcui Huo, Xueli Zhu, Yong Yang, Sai Wang","doi":"10.1111/sdi.13234","DOIUrl":"10.1111/sdi.13234","url":null,"abstract":"<p><strong>Background: </strong>Potassium imbalance, particularly hypokalemia, is a critical risk factor for adverse outcomes in patients undergoing hemodialysis (HD). However, the association between hypokalemia and mortality is unclear.</p><p><strong>Methods: </strong>For this systematic review and meta-analysis, we assessed the association between hypokalemia and mortality in patients undergoing HD. We performed a systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Scopus) to identify relevant studies published up to April 2024. Eligible studies were prospective or retrospective cohort studies reporting hazard ratios (HRs) for mortality in association with the presence of hypokalemia among patients undergoing HD. We used the assessed study Newcastle-Ottawa Scale to assess quality of the selected studies.</p><p><strong>Results: </strong>We carried out both qualitative and quantitative assessments. For the meta-analysis, we pooled the HRs for all-cause and cardiovascular mortalities. The overall pooled HR for all-cause mortality and cardiovascular mortality were 1.34 (95% CI, 1.15, 1.55) and 1.49 (95% CI, 1.12, 1.98), respectively, indicating significant associations between hypokalemia and all-cause mortality and cardiovascular mortality in patients undergoing HD. Additionally, we conducted subgroup analyses based on study design, geographical location, type of dialysis, and serum potassium levels.</p><p><strong>Conclusion: </strong>Our findings provide robust evidence of a significant association between hypokalemia and mortality in patients undergoing HD. Early detection and proactive management of hypokalemia are crucial for improving outcomes and reducing mortality risk in these patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"85-101"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807918","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":"Hemoperitoneum in a Peritoneal dialysis Patient: An Unusual Case of Right Gastric Artery Aneurysm Rupture.","authors":"Vijoy Kumar Jha, Yashvir Mathur, Sanjay Kumar Panda, Vishvanath Pole, Chanchal Roy","doi":"10.1111/sdi.13247","DOIUrl":"10.1111/sdi.13247","url":null,"abstract":"","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"156-157"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415103","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":"Ulnar-Basilic Arteriovenous Fistula for Hemodialysis: A 15-Year Overview.","authors":"Ana Esther Sirvent, María Rosa Vigueras-Hernández, Ricardo Enríquez, Juan Mariano Pérez-Abad, Antonio Pérez-Pérez, Guadalupe Ruiz-Merino, Alberto J Andreu-Muñoz","doi":"10.1111/sdi.13231","DOIUrl":"10.1111/sdi.13231","url":null,"abstract":"<p><strong>Introduction: </strong>Distal forearm arteriovenous fistulas (AVFs) for hemodialysis (HD) include radiocephalic fistulas (RCFs) and ulnar-basilic fistulas (UBFs). However, due to the unique anatomical peculiarities of the latter approach, UBFs are only established in a limited subset of patients undergoing vascular access procedures. This study aimed to present a retrospective case series detailing the creation of UBFs, emphasizing both the technical challenges and clinical outcomes associated with this approach.</p><p><strong>Methods: </strong>We conducted a retrospective review of UBFs created between 2008 and 2023. Data collected included patient demographics, comorbidities, patency, functionality, and outcomes. Adequate blood flow and personalized Kt/Vurea levels were prerequisites for defining UBF functionality for HD.</p><p><strong>Results: </strong>Among 253 patients receiving HD, 82.2% had an AVF, with only 3.3% (n = 5) of the 150 distal AVFs functional for HD being UBFs. In this series, a total of 11 UBF fistulas were created, with nine patients experiencing an immediate thrill. Among those with UBF failure, three patients were aged > 85 years, and three had concurrent diabetes mellitus, peripheral vascular disease, and ischemic heart disease. The survival rate in the UBF group correlated with the duration of dialysis in the three patients for whom the UBF was the sole AVF, with one patient achieving a remarkably prolonged period of > 10 years. No incidences of ischemia, hand edema, or ulnar nerve lesions were noted.</p><p><strong>Conclusion: </strong>While the difficulties experienced in achieving functional UBFs for HD are highlighted in this long-term perspective, its safety and durability make it a viable option in managing an increasingly comorbid patient population.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"118-123"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780997","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":"Simultaneous Treatment of Two Severe Acute Intoxication and Acute Kidney Injury.","authors":"Fulvia Zappulo, Laura Martano, Ines Ullo, Veronica Catalano, Sara Donini, Anna Scrivo, Anna Laura Croci Chiocchini, Gaetano La Manna","doi":"10.1111/sdi.13233","DOIUrl":"10.1111/sdi.13233","url":null,"abstract":"<p><p>Extracorporeal therapies could be required for treatment of life-threatening severe acute intoxication. We present the case of an 82-year-old patient admitted to our Nephrology Unit because of metformin-associated lactic acidosis (MALA) and acute kidney injury (AKI stage III AKIN criteria). The patient also presented severe intoxication of digoxin and apixaban. The electrocardiogram presented a junctional escape rhythm with atrial fibrillation (AF) and lateral ST-segment depression that, despite fab-fragments' administration, has not regress. Due to patient's hemodynamic instability, an 8 h of sustained low-efficiency diafiltration (SLED) was prescribed. This treatment allowed to reduce serum concentration of apixaban and digoxin. Similarly, patient's hemodynamic and ECG trace improved with the resolution of junctional rhythm and persistence of AF. Even if continuous renal replacement therapy (CRRT) is the first choice in critical ill patients, SLED could represent a valid option for patients without indication to ICU.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"152-155"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839056","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":"Catheter Exchange With Elongation of Tunnel (CEET) Procedure-A Novel Technique for Cuff Extrusion of Tunneled Dialysis Catheter: Surgical Experience and Early Outcomes.","authors":"Vineet Behera, Hemant Mehta, C S Vishwanath, J Balasubramaniam, G Shanmugraj, R Ananthakrishnan, Vivek Hande","doi":"10.1111/sdi.13230","DOIUrl":"10.1111/sdi.13230","url":null,"abstract":"<p><strong>Background: </strong>Cuff extrusion of tunneled dialysis catheter (TDC) leads to catheter dysfunction, leading to loss of vascular access and the need for new catheter. Definitive management is to remove TDC and reinsert new catheter by new venous puncture and tunnel, which may not be possible in all cases. The study evaluated the surgical experience and early outcomes of a novel \"Catheter Exchange with Elongation of Tunnel (CEET)\" procedure for cuff extrusion.</p><p><strong>Methods: </strong>The retrospective study included all cases of hemodialysis with TDC with partial or complete cuff extrusion and excluded complete catheter dislodgement, tunnel infection, or any catheter related infection. All patients also underwent the CEET procedure under fluoroscopy guidance, and the clinical details and outcomes were analyzed.</p><p><strong>Results: </strong>Eleven cases of TDC cuff extrusion underwent the CEET procedure of which three (27.2%) had previous and four (36.4%) had partial cuff extrusion, and seven cases (63.6%) had short tunnel length, which likely predisposed to cuff extrusion. CEET procedure was successful in 10 cases (success rate 90.1%) with desired position of catheter tip and good blood flow. Study population was divided into early and late cuff extrusion (≥1 month). Short tunnel length was associated with late extrusion (p = 0.05), whereas premature removal of TDC anchor sutures was associated with early cuff extrusion (p = 0.04).</p><p><strong>Conclusion: </strong>CEET procedure is a successful alternative technique for correction of cuff extrusion of TDC with good success rate. Premature removal of anchor sutures was associated with early cuff extrusion, whereas short tunnel length was associated with late cuff extrusion.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"111-117"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507138","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}