Seminars in Dialysis最新文献

{"title":"Value-Based Model for Vascular Access Management in the End-Stage Kidney Disease Population.","authors":"Daniel Raskin, Tushar J Vachharajani, Sasan Partovi, Abdullah Khan, Sean P Lyden, Levester Kirksey","doi":"10.1111/sdi.70024","DOIUrl":"10.1111/sdi.70024","url":null,"abstract":"<p><strong>Background: </strong>Value-based medicine (VBM) seeks to maximize patient-relevant outcomes per unit cost. In end-stage kidney disease (ESKD), vascular access (VA) is a dominant, modifiable driver of morbidity, mortality, and expenditure.</p><p><strong>Methods: </strong>We performed a narrative review of published studies and gray literature on VA creation, maintenance, and salvage in ESKD, focusing on clinical outcomes, patient experience, and economic impact. Findings were synthesized within a VBM framework relevant to clinicians, health-system leaders, and policymakers.</p><p><strong>Results: </strong>Contemporary data confirm that tunneled dialysis catheters (TDCs) are associated with high rates of bloodstream infection, central venous injury, and mortality, and substantially higher costs than autogenous access. Arteriovenous fistulas (AVFs) offer the best long-term value when creation is risk-based, maturation is supported, and the access is actually used; nonmaturation, nonuse, and prolonged catheter dependence erode this advantage. Endovascular AVF and external support devices improve technical success and early patency but have uncertain cost-effectiveness at current device prices. Arteriovenous grafts (AVGs) can provide greater net value than AVFs in selected patients (older, frail, or with poor veins) by shortening catheter exposure, at the expense of higher reintervention rates and maintenance costs. Across access types, circuit failure and recurrent interventions drive a substantial share of hemodialysis admissions and Medicare spending. Selective preoperative imaging, targeted duplex ultrasound in response to clinical findings, and ultrasound-guided cannulation can improve access selection, maturation, and salvage while avoiding low-value routine surveillance. Peritoneal dialysis remains underutilized despite comparable outcomes in many cohorts and lower average per-patient costs than in-center hemodialysis. Site-of-service optimization (office-based/ASC vs. hospital) and multidisciplinary, life-plan-based access programs further reduce admissions, catheter days, and per-patient costs.</p><p><strong>Conclusions: </strong>A value-based VA strategy for ESKD should prioritize minimizing catheter exposure, tailoring AVF versus AVG use to patient risk, integrating PD where feasible, using selective imaging and monitoring, matching site of service to case complexity, and organizing multidisciplinary access teams aligned with quality and cost metrics.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"15-25"},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Renal Replacement Therapy on FeNO Levels and Pulmonary Function in End-Stage Renal Disease Patients.","authors":"Buğra Kerget, İsmail Çınar, Eda Çelik, Can Sevinç, Edip Erkuş","doi":"10.1111/sdi.70011","DOIUrl":"10.1111/sdi.70011","url":null,"abstract":"<p><strong>Background: </strong>Renal replacement therapy (RRT) is crucial for end-stage renal disease, yet its pulmonary effects remain unclear. Fractional exhaled nitric oxide (FeNO) serves as a biomarker for airway inflammation. This study evaluates FeNO levels in hemodialysis (HD) and peritoneal dialysis (PD) patients and their relationship with pulmonary function.</p><p><strong>Methods: </strong>RRT patients aged 18-65, followed for at least 2 years in our nephrology clinic, were included. FeNO tests were performed after routine blood sampling. The study comprised 110 patients: 50 HD, 30 PD, and 30 controls.</p><p><strong>Results: </strong>FeNO levels before and after dialysis were statistically significantly higher in HD patients compared to PD patients (p = < 0.001 for both). Exhaled NO levels measured in the control group were 7.6 ± 5.2 ppb and were statistically significantly lower compared to HD patients before and after dialysis (p = < 0.001 for both). A negative correlation was observed between FeNO and FEV1 and FVC percent (R = -0.807, p = 0.01; R = -0.801, p = 0.01, respectively). A positive correlation was observed between exhaled NO levels before and after dialysis and ΔFVC, ΔFEV1, and ΔPEF25-75 (R = 0.74, p = 0.01; R = 0.74, p = 0.01; R = 0.89, p = 0.01, respectively).</p><p><strong>Conclusion: </strong>This study showed that FeNO levels were significantly higher in HD patients before and after RRT compared to PD and healthy controls, suggesting a greater impact of HD on airway inflammation. FeNO measurement may serve as a biomarker for monitoring pulmonary health in RRT patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"340-346"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701549","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":"Comparing Concurrent and Countercurrent Dialysate Flow in Hemodialysis: A Pilot Study on Hyponatremic Patients.","authors":"Amandeep Singh, Lalit Pursnani, Himansu Sekhar Mahapatra, Muthukumar Balakrishna, Sanket Patil, Manoj Prabhakaran, Abhishek Gautam, Anubhav Chakraborty","doi":"10.1111/sdi.70008","DOIUrl":"10.1111/sdi.70008","url":null,"abstract":"<p><strong>Background: </strong>In hyponatremic patients, concurrent dialysate flow during hemodialysis may be an ideal option to mitigate complications such as osmotic demyelination syndrome (ODS).</p><p><strong>Methods: </strong>Present randomized controlled trial enrolled dialysis-requiring chronic kidney disease (CKD) and acute kidney injury (AKI) patients with serum sodium levels < 125 mEq/L during January 2020 over 16 months. Hemodynamically unstable patients, as well as those with a history of seizures and neurological conditions, were excluded. All were randomized to concurrent and countercurrent dialysate flow groups during two-h dialysis session. Hydration status was evaluated by Body Composition Monitor BCMTM and hourly sodium was estimated to guide ultrafiltration. Comparative analysis of sodium correction rates (meq/L/h) during dialysis, neurological deterioration via Mini-Mental State Examination (MMSE) scores, and ODS during 1 week and 1 month in both groups was done. Two-way repeated measures ANOVA was used to compare sodium correction trends.</p><p><strong>Results: </strong>A total of 44 hyponatremic patients of AKI (17.39%), CKD (56.52%) and acute on CKD (26.09%) were randomized to concurrent (n = 23) and countercurrent (n = 21) dialysate groups. Postdialysis sodium correction rate was nonsignificantly slower in the concurrent group (45.45%) vs. the countercurrent group (36.36% group, p = 0.44). Neurological deterioration, measured via MMSE scores, and ODS incidence were absent in both groups. The concurrent group exhibited a higher proportion of patients without neurological deterioration (73.91%) compared to the countercurrent group (57.14%, p = 0.241). Comparable survival between the two groups was seen at 10, 20, and 30 days. No significant risk factors for mortality were identified in either group.</p><p><strong>Conclusion: </strong>Concurrent dialysate flow demonstrates a slower but nonsignificant rate of sodium correction, making it a safer alternative for managing severe hyponatremia during hemodialysis by reducing the risk of rapid neurological shifts.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"326-332"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016185","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 Patients' Needs for Self-Care Structured Teaching Programs: A Pre- and Post-Test Study.","authors":"Radhe Shyam, Himanshu Verma, Daisy Thomas, Harindarjeet Goyal, Sourabh Sharma","doi":"10.1111/sdi.70013","DOIUrl":"10.1111/sdi.70013","url":null,"abstract":"<p><strong>Background: </strong>Patients on hemodialysis need to have sufficient knowledge, skill, and ability to carry out their treatment regimen. The aim of this study was to identify factors that affect adherence to hemodialysis and to assess the role of a structured teaching program on self-care in terms of knowledge and practice.</p><p><strong>Methods: </strong>This was a pre-experimental one-group pre-test post-test design study conducted at a tertiary care center in India, from January 10, 2022, to March 30, 2022, involving 50 participants by convenience sampling. Electronic training (self-care structured teaching program), structured knowledge interview, ESRD-AQ tool, and structured 4-point Likert-practice rating scale were implied.</p><p><strong>Results: </strong>Most patients (38/50; 76%) were non-adherent. Educational status (p = 0.0002), occupation (p = 0.0006), monthly income (p = 0.0017), dialysis frequency (p = 0.019), transportation mode (p = 0.0003), education frequencies (p = 0.0006), and perceived relative importance of hemodialysis (p = 0.0001) were statistically significantly associated with adherence. The mean pre-test knowledge score was 10.82 while the mean post-test knowledge score was 19.50. The mean difference between the pre-test and post-test score was 8.68 ± 0.12 and the difference was clinically significant (p = 0.001). Similarly, the mean pre-test practice rating scale was 23.70 while the mean post-test practice rating scale was 42.36. The mean difference between the pre-test and post-test score was 18.66 ± 0.95 and the difference was clinically significant (p = 0.001). There was a significant association between the post-test knowledge and practice scores on the self-care and educational status of patients.</p><p><strong>Conclusion: </strong>Most patients were non-adherent and were deficient in knowledge and practices regarding self-care. Patient education and self-care teaching are beneficial in improving adherence.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"347-356"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865272","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 Insulin Dosage Adjustment on Hemodialysis Day for Blood Glucose Levels, Glycated Albumin, Interleukin-6, and TNF-α in Patients With Type 2 Diabetes Mellitus and End-Stage Renal Disease.","authors":"Hendra Zufry, Krishna Wardhana Sucipto, Agustia Sukri Ekadamayanti, Sarah Firdausa, Maulina Debbyousha","doi":"10.1111/sdi.70007","DOIUrl":"10.1111/sdi.70007","url":null,"abstract":"<p><strong>Background: </strong>Previous studies suggested adjusting insulin doses during hemodialysis to reduce intra- and post-hemodialysis hypoglycemia. However, the impact of insulin adjustment on cardiovascular morbidity and mortality in diabetic patients with end-stage renal disease (ESRD) remains unclear. Although reducing hypoglycemia is a well-documented benefit of insulin dose modification in this population, the broader metabolic and inflammatory consequences-particularly those related to cardiovascular risk-are not well understood. This study aimed to investigate the effects of a 25% reduction in total daily insulin dose on hemodialysis days in T2DM patients with ESRD, focusing on daily blood glucose profiles, glycated albumin, IL-6, and TNF-α.</p><p><strong>Methods: </strong>A multicenter study with clinical trials was designed in five hemodialysis centers. It was a 4-week clinical trial involving 17 eligible type 2 diabetic patients with ESRD on insulin therapy and regular hemodialysis. Self-monitoring blood glucose was performed seven times a day before, during, and 1 month after the intervention. Blood samples were collected before and after the intervention. The Wilcoxon test was used to assess differences in daily glucose profiles, glycated albumin, IL-6, and TNF-α before and after insulin dose adjustment.</p><p><strong>Results: </strong>After 1 month of adjusting total daily insulin dose during hemodialysis, no statistically significant difference was observed in daily blood glucose, IL-6, and TNF-α levels. However, glycated albumin levels increased both before and after the insulin dosage modification.</p><p><strong>Conclusions: </strong>Reducing the total daily insulin dose by 25% during hemodialysis day effectively reduces hypoglycemia incidence intra- and post-hemodialysis in T2DM patients with ESRD without impacting pro-inflammatory factors IL-6 and TNF-α, which are associated with increased cardiovascular morbidity and mortality risk.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"316-325"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967340","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 Low Dialysate Temperature on Intradialytic Hypotension and Dialysis Adequacy in Chronic Hemodialysis: A Systematic Review and Meta-Analysis.","authors":"Ting-Wan Tan, Han-Ling Tan, Wen-Shu Lin, Yu-Chu Chung","doi":"10.1111/sdi.70010","DOIUrl":"10.1111/sdi.70010","url":null,"abstract":"<p><strong>Background: </strong>Intradialytic hypotension (IDH) is a common and clinically significant complication in patients undergoing chronic hemodialysis. The application of low-temperature dialysate has been proposed as a potential intervention to mitigate this condition; however, its effectiveness requires further evaluation through systematic reviews and meta-analyses.</p><p><strong>Methods: </strong>A comprehensive literature search of articles published up to April 10, 2025, systematically searched electronic databases (PubMed, Embase, CINAHL, and Cochrane Library). Quality assessment was performed using the Cochrane Risk of Bias 2 tool for randomized crossover trials.</p><p><strong>Result: </strong>Low dialysate temperature significantly decreases the incidence of IDH (OR = 0.35, 95% CI: [0.28, 0.46], p < 0.001), increases mean arterial pressure (SMD = 0.67, 95% CI: [0.38, 0.96], p < 0.001), and mean systolic blood pressure (SMD = 0.54, 95% CI: [0.30, 0.79], p < 0.001). Additionally, low dialysate temperature improves urea clearance dialysis adequacy (SMD = 0.25, 95% CI: [0.03, 0.47], p = 0.029) and urea reduction rate (SMD = 0.24, 95% CI: [0.02, 0.47], p = 0.035), while decreasing intradialytic mean body temperature (SMD = -0.68, 95% CI: [-0.99, -0.37], p < 0.001). The subgroup analysis revealed that dialysate temperatures between 34.5°C and 35.0°C were more effective in improving these related outcomes compared to temperatures ranging from 35.1°C to 36.0°C.</p><p><strong>Conclusions: </strong>Maintaining low dialysate temperatures between 34.5°C and 36.0°C is recommended to reduce the incidence of IDH and improve dialysis adequacy in chronic hemodialysis patients. The specific low dialysate temperature should be individualized to minimize IDH risk, enhance patient comfort, and optimize treatment outcomes.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"303-315"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329770","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":"Utility of Adding Once-Weekly Hemoadsorption to High-Volume Hemodiafiltration for Refractory Restless Legs Syndrome: A Clinical Case Report.","authors":"Cristian Pedreros-Rosales, Gonzalo Ramírez-Guerrero, Hans Müller-Ortiz, Jonathan Alarcón-Fuentes, Beatriz Calderón-Salazar","doi":"10.1111/sdi.70014","DOIUrl":"10.1111/sdi.70014","url":null,"abstract":"<p><p>Dialysis improves survival in kidney failure but does not effectively remove larger uremic toxins, contributing to persistent symptoms like restless legs syndrome (RLS). High-volume hemodiafiltration (HDF) has improved these issues, but refractory cases may require combined therapies with hemoadsorption (HA). We present a patient with refractory RLS treated with HDF plus hemoadsorption using Jafron HA130 cartridges. The β2 microglobulin (β2M) reduction ratio was higher during HDF+HA (76.4% [75.8-77.8] vs. 72.9% [71.1-73.2]), with further improvement at Q_B > 400 ml/min (77.6% [77.2-79.4]). Despite similar baseline β2M levels, the patient's RLS score dropped from 32 to 0 points. Adding once-weekly hemoadsorption to high-volume HDF using HA130 adsorption may enhance refractory uremic symptom management, particularly at higher Q_B values. Given the scarce literature on this approach, our case highlights its potential benefits for dialysis patients with persistent uremic symptoms.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"357-360"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906675","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":"Creatinine Kinetic Modeling to Estimate Residual Kidney Creatinine Clearance in Patients Being Hemodialyzed Once or Twice Per Week.","authors":"John T Daugirdas, Piergiorgio Bolasco","doi":"10.1111/sdi.70009","DOIUrl":"10.1111/sdi.70009","url":null,"abstract":"<p><strong>Background: </strong>Knowledge of residual kidney function is potentially useful in patients receiving hemodialysis for risk stratification, adjusting the dialysis prescription, and early identification of renal function recovery. However, periodic urine collection is problematic. We examined the potential of predicting residual kidney creatinine (water) clearance (KrCrW) without urine collection using a creatinine kinetic model, which allows KrCrW to be estimated based on previously measured or anthropometrically estimated creatinine generation rate (GCr), volume of distribution (VdCr), and measured predialysis serum creatinine.</p><p><strong>Methods: </strong>Studies were done in 12 patients receiving once weekly hemodialysis and 12 other patients being dialyzed twice a week in whom KrCrW was measured by collection of urine. GCr and VdCr were taken either from the modeling outputs or were estimated from anthropometric values.</p><p><strong>Results: </strong>The mean modeled GCr was 1091 ± 377 (SD) mg/day, similar to the value predicted by an anthropometric equation suggested by Ix et al. (1198 ± 304). The mean kinetically modeled VdCr was 22.7 ± 2.4 L, somewhat lower than expected. The KrCrW from urine collection was 7.43 ± 4.07 mL/min. Predicted KrCrW from modeled GCr, modeled VdCr, and measured predialysis serum creatinine was similar (7.35 ± 4.01, r² = 0.987) with an average error less than 1%. When anthropometric estimates of GCr and VdCr were used as inputs, the mean modeled KrCrW was somewhat higher (8.66 ± 4.27, y = 1.09x, R² = 0.585) and the mean error was 1.23 ± 2.6 mL/min.</p><p><strong>Conclusions: </strong>Residual kidney creatinine clearance (KrCrW) can be estimated in patients receiving one or two dialysis treatments weekly based on creatinine kinetic modeling. Using anthropometric estimates of GCr and VdCr in the modeling equations yields similar values of KrCrW to those when modeled GCr and VdCr inputs are used, but with a substantial error. A strategy of using a baseline modeled values of GCr and VdCr for future KrCrW change prediction may be promising, but the stability of GCr over time needs to be confirmed.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"333-339"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12812499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213642","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":"Delayed Recanalization of an Acutely Thrombosed Dialysis Arteriovenous Graft to Facilitate Effective Treatment for Perigraft Seroma: A Case Report.","authors":"Lihong Zhang, Fan Zhang, Yuzhu Wang, Shen Zhan","doi":"10.1111/sdi.70012","DOIUrl":"10.1111/sdi.70012","url":null,"abstract":"<p><p>This report describes a novel and effective salvage strategy for managing perigraft seroma complicated by a small-caliber expanded polytetrafluoroethylene arteriovenous graft (AVG). Our patient developed a persistent seroma near the arterial anastomosis following AVG placement. The patient underwent successful seroma removal and delayed graft recanalization after 1 week of spontaneous graft thrombosis, which permitted partial tissue incorporation. The treatment was successful, achieving complete resolution of the seroma and restoration of graft function. The patient has remained free of recurrence for 40 months of follow-up. This approach represents an effective strategy for treating perigraft seromas of hemodialysis grafts.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"365-371"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757607","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":"Arteriovenous Fistula-Associated Ascites.","authors":"Michael Kolman, Lincoln Kavinsky, Jeffrey Soble, Roger Rodby, William Whittier","doi":"10.1111/sdi.70015","DOIUrl":"10.1111/sdi.70015","url":null,"abstract":"<p><p>Dialysis-associated ascites (DAA) is a diagnosis of exclusion in end-stage kidney disease (ESKD). The prognosis is grim and typically obviates kidney transplantation. We report a case initially misdiagnosed as DAA, which was later correctly identified as cardiac ascites due to high-output heart failure (HOHF) resulting from an aneurysmal arteriovenous fistula (AVF). We propose the term \"AVF-associated ascites\" (AFAA) to describe this entity. The HOHF improved with AVF ligation with complete resolution of the ascites, thus making the patient eligible to receive a kidney transplant. This case emphasizes the importance of recognizing potential adverse cardiac outcomes in the setting of a large or aneurysmal AV fistula and to appreciate AFAA as an alternate diagnosis to DAA in the hemodialysis patient with ascites.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"361-364"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906597","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}