BMC Nephrology最新文献

{"title":"The impact of Hemodiafiltration with endogenous reinfusion (HFR) on micronutrient status in patients undergoing maintenance hemodialysis: study protocol of a randomized controlled trial.","authors":"Changhao Zhu, Lingling Ding, Naiying Lan, Fanzhou Zeng, Dan Ye, Hao Wang, Bo Yang","doi":"10.1186/s12882-025-04148-6","DOIUrl":"https://doi.org/10.1186/s12882-025-04148-6","url":null,"abstract":"<p><strong>Background: </strong>End-stage renal disease (ESRD) is associated with significant morbidity and mortality, with patients often experiencing micronutrient deficiencies due to dialysis treatments. Hemodiafiltration with Endogenous Reinfusion (HFR) is a novel dialysis modality that combines diffusion, convection, and adsorption mechanisms to remove uremic toxins while potentially preserving essential nutrients. This study aims to assess the impact of HFR on micronutrient levels and removal rates in patients undergoing maintenance hemodialysis (HD).</p><p><strong>Methods: </strong>This is a single-center, open-label, randomized controlled trial. Adult patients on maintenance HD will be randomized to two treatment arms: Arm A (Hemodiafiltration (HDF) followed by HFR) and Arm B (HFR followed by HDF), with a two-week washout period between treatments. Blood samples will be collected pre- and post-treatment to measure trace elements, water-soluble vitamins, and fat-soluble vitamins. Statistical analyses will include paired t-tests and Wilcoxon signed-rank tests for within-group comparisons, and repeated measures ANOVA for between-group differences, adjusting for potential confounders.</p><p><strong>Discussion: </strong>This study will evaluate whether HFR offers superior retention of micronutrients compared to traditional HDF therapies, which may contribute to improved clinical outcomes for ESRD patients. Findings could provide valuable insights into the role of HFR in optimizing nutritional status and reducing dialysis-related complications. The cross-over design minimizes patient variability, enhancing the reliability of comparisons between treatment modalities.</p><p><strong>Trial registration: </strong>This trial is registered with the Chinese Clinical Trial Registry (ChiCTR2500096698).</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"222"},"PeriodicalIF":2.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964092","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":"Navigating risks: insights on unrelated overseas renal transplantations from two Saudi centers.","authors":"Hany M El Hennawy, Omar Safar, Abdullah S Al Faifi, Maryam H El Hennawy, Balqees Alghamdi, Amani Ali, Manar Alqahtani, Mohammad F Zaitoun, Sharifah A Alasmari, Ahmed Serageldeen, Konstantinos Fourtounas, Mostafa Ayyad, Ahmed Ali, Mohamed H Zahran","doi":"10.1186/s12882-025-04143-x","DOIUrl":"10.1186/s12882-025-04143-x","url":null,"abstract":"<p><strong>Background: </strong>Due to a shortage of cadaveric organs for transplantation, some Saudi patients seek to purchase kidneys in other countries. However, kidney transplantation (KT) abroad is often associated with negative outcomes. This study shared the experiences of two Saudi transplantation centers regarding unrelated KT overseas.</p><p><strong>Methods: </strong>This retrospective comparative cohort study included patients who underwent commercial KT abroad (Group I) and local patients who received living unrelated KT between September 2017 and July 2024, with available follow-up for at least one year. The primary outcome was to compare the perioperative outcomes. The secondary outcome was to compare the cumulative graft survival between both groups using cox-regression analysis.</p><p><strong>Results: </strong>Group I included 96 patients and group II included 108 patients. Group I had a statistically significant longer 30-day hospital stay (9.4 ± 1.6 vs. 7.9 ± 1 days, P < 0.001). Primary functioning graft was significantly lower in Group I (83.3% vs. 93.5%; p = 0.01). Group I was associated with statistically significant higher incidence of surgical site infection (SSI) (P = 0.03), lymphocele (P = 0.007) and UTI (P = 0.002). The 1-, 2-, 3-, and 5-year cumulative graft survivals were 80%, 79%, 74%, and 54%, respectively in group I compared to 98%, 97%, 90%, and 60%, respectively in group II. [HR = 2, 95% CI = 1.1-3.8, P = 0.02] CONCLUSION: Commercial transplantation graft survival rates are lower, and overall outcomes are worse than those of traditional unrelated transplantation in the midterm. Educating patients about the risks associated with overseas KT and promoting public registration for deceased organ donation could help mitigate this practice.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"221"},"PeriodicalIF":2.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974155","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":"\"You can't put your luck on people\": a qualitative study of family views on the best interests decision-making process concerning adult kidney care in England.","authors":"Jordan A Parsons, Fergus J Caskey, Jonathan Ives","doi":"10.1186/s12882-025-04147-7","DOIUrl":"10.1186/s12882-025-04147-7","url":null,"abstract":"<p><strong>Background: </strong>When an adult patient lacks decision-making capacity, care decisions must be made on their behalf in their \"best interests\". We know little about the experiences of the family members of adult kidney patients with cognitive impairments, particularly in relation to best interests decisions. It is anticipated that they have varied experiences, with many feeling excluded from the most complex care decisions.</p><p><strong>Methods: </strong>This study aimed to understand the views and experiences of family members of adult kidney patients who had undergone a best interests decision in England. Semi-structured interviews (n = 6) were conducted with family members to explore their experiences and their views of the best interests process. Interview transcripts were then thematically analysed.</p><p><strong>Results: </strong>A range of experiences were reported, with four themes developed: prioritising patient preferences; family involvement; opposition to the best interests approach; and the importance of communication amongst all involved. Our findings suggest inconsistencies in how best interests decisions are approached in England, which can affect the nature and extent of family involvement. Participants highlighted the value of clear communication on all aspects of the decision-making process, including clarity on the roles of different stakeholders.</p><p><strong>Conclusions: </strong>When caring for adults who lack decision-making capacity, improvements in communication amongst all involved may minimise disagreements that escalate to legal proceedings.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"220"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954260","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":"Self-management assessment tools for people with hypertension: a scoping review.","authors":"Li Mengjiao, Zhao Xujie, Jiang Ping, Huang Liwen, Ning Yuping, Zhang Yangjing, Yan Jianjun","doi":"10.1186/s12882-025-04134-y","DOIUrl":"https://doi.org/10.1186/s12882-025-04134-y","url":null,"abstract":"<p><strong>Background: </strong>This is a scoping review of the evidence for the use of the Patient Self-Management Assessment Tool for Hypertension (PAT) in people with hypertension. This review examines the content features, reliability, and validity of the PAT for people with Hypertension, as well as contextual and environmental evidence for the tool implementation in clinical practice.</p><p><strong>Objective: </strong>To synthesize and evaluate the self-management assessment tools available for people with hypertensive, and to guide healthcare professionals in selecting appropriate tools.</p><p><strong>Methods: </strong>A systematic search was conducted across nine databases, including PubMed, Web of Science, Scopus, Embase, Cochrane Library, CNKI (China National Knowledge Infrastructure), VIP (VIP Information Database), CMB (China Biology Medicine disc) and Wanfang, from their inception to August 17, 2024. The authors extracted and analyzed self-management assessment tools developed for people with hypertension, using a scoping review approach to report the findings.</p><p><strong>Results: </strong>A total of 41 papers were identified, which reported on 20 assessment tools. These included 12 multidimensional assessment tools for assessing self-management and 8 unidimensional assessment tools for measuring adherence to self-management practices.</p><p><strong>Conclusion: </strong>The quality of self-management assessment tools for people with hypertension varies widely. There is a need to develop tailored tools for different patient populations to accurately assess self-management capabilities, design intervention strategies, and enhance patient engagement in hypertension management.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"219"},"PeriodicalIF":2.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971937","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":"Hyperlactatemia in critically ill patients with acute kidney injury treated with renal replacement therapy in the intensive care unit.","authors":"Robert Ekart, Barbara Kobal, Tea Korošec, Eva Jakopin, Franc Svenšek, Nejc Piko, Sebastjan Bevc, Radovan Hojs","doi":"10.1186/s12882-025-04149-5","DOIUrl":"https://doi.org/10.1186/s12882-025-04149-5","url":null,"abstract":"<p><strong>Background: </strong>Hyperlactatemia is common in intensive care unit (ICU) patients. The aim of our retrospective observational study was to analyse the impact of serum lactate on admission on mortality in patients with acute kidney injury (AKI) treated with renal replacement therapy (RRT).</p><p><strong>Methods: </strong>During the study period of 4 years, 2939 patients were admitted to the ICU, 503 patients were diagnosed with AKI and 209 of them required RRT. After excluding patients on chronic dialysis and with known malignant disease, we retrospectively analysed 154 patients. Hyperlactatemia was defined as a serum lactate concentration above 4 mmol/L on admission to the ICU.</p><p><strong>Results: </strong>The mean age of patients was 62.8 years, and 69.5% were men. The mean Charlson Comorbidity Index (CCI) on admission to the ICU was 3.7 and fifty-six (36.4%) patients had acute hyperlactatemia. All included patients had AKI stage 3 and were treated with RRT, 125 (81.2%) with continuous RRT and 29 (18.8%) with intermittent hemodialysis. The mean length of stay in the ICU was 15.7 ± 13 days and 118 (76.6%) patients died during the 60-day observation period. A Kaplan-Meier survival analysis showed that the survival rate was statistically significantly lower in the group of patients with hyperlactatemia (log-rank; p = 0.032). The univariate Cox regression analysis showed that serum lactate on admission to the ICU significantly predict 60-day survival (HR 1.075; 95%CI 1.015-1.140; p = 0.014). In the multivariate Cox regression analysis, which included age, gender, diabetes, hypertension, chronic kidney disease, estimated glomerular filtration rate, serum lactate, CCI and C-reactive protein, only age (HR 1.031; 95%CI 1.007-1.056; p = 0.011) and serum lactate (HR 1.067; 95%CI 1.004-1.134; p = 0.035) were independent predictors of mortality.</p><p><strong>Conclusion: </strong>Our study underscores the independent association between hyperlactatemia of more than 4 mmol/L on admission to the ICU and increased 60-day mortality in patients with AKI treated with RRT. These findings, which have significant implications for the management and prognosis of critically ill patients with AKI, provide a new understanding of the role of serum lactate in patient outcomes.</p><p><strong>Trial registration: </strong>Name of the registry: ClinicalTrials.gov; Trial registration number: NCT06565403; Date of registration, followed by the words 'Retrospectively registered': August, 19,2024; URL of trial registry record: https://clinicaltrials.gov/study/NCT06565403.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"217"},"PeriodicalIF":2.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974153","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":"Transplant centers' prophylaxis and monitoring strategies: a key determinant of current herpes and polyomavirus incidences - results from the DZIF kidney transplant cohort.","authors":"Claudia Sommerer, Iris Schröter, Katrin Gruneberg, Daniela Schindler, Christian Morath, Lutz Renders, Gunilla Einecke, Martina Guthoff, Uwe Heemann, Paul Schnitzler, Martin Zeier, Thomas Giese","doi":"10.1186/s12882-025-04084-5","DOIUrl":"https://doi.org/10.1186/s12882-025-04084-5","url":null,"abstract":"<p><strong>Background: </strong>Herpes- and polyomaviruses are major opportunistic pathogens after renal transplantation. Despite established guidelines, there is limited data on transplant centers' prophylaxis and monitoring strategies and centers' adherence to these guidelines and their impact on infection rates and patient outcomes.</p><p><strong>Methods: </strong>This multicenter cohort study, conducted by the German Center for Infection Research, included 1035 kidney transplant recipients from five centers (01/2014-02/2021), focusing on herpes- and polyomavirus viremia within the first year and adherence to prophylaxis strategies.</p><p><strong>Results: </strong>Among 1035 recipients, 26.6% developed herpes- or polyomavirus viremia, predominantly Cytomegalovirus (CMV, 14.3%) and BK-virus (BKV, 13.2%). BKV monitoring frequency was below guideline recommendations. Deviations from guidelines were most common in CMV D-/R- (34.6% with prophylaxis) and D-/R + groups (37.3% without prophylaxis), doubling CMV-incidence in D-/R+ (28.9% vs. 12.5%, p < 0.01). In D+/R - group, six-month-prophylaxis reduced CMV-incidence compared to three months (22.5% vs. 38.4%, p < 0.01). Breakthrough-viremia was most commonly observed in D+/R - recipients who received a six-month-prophylaxis. Overall, viremia was associated with higher incidence of acute rejection (31.9% vs. 17.6%, p < 0.01), with most CMV-viremias occurring after rejection. CMV-viremia was associated with a higher risk of bacterial infection (HR = 1.77, [1.03;3.02]). Other herpesviruses were associated with a quadrupled risk for fungal infection (HR = 4.34, [1.03;18.30]) and the non-administration of CMV-prophylaxis (HR = 0.22, [0.11;0.47]). Graft survival and mortality were unaffected within the first year.</p><p><strong>Conclusion: </strong>Clinical variability in guideline implementation drives high herpes- and polyomavirus infection rates with suboptimal outcomes. Future guidelines should focus on differentiated risk stratification to address breakthrough, post-prophylaxis, and post-rejection CMV, and include protocols for the early detection of secondary infections.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"218"},"PeriodicalIF":2.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958496","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":"Correspondence: Carotid intima-media thickness, fibroblast growth factor 23, and mineral bone disorder in children with chronic kidney disease.","authors":"Retno Palupi-Baroto, Kristia Hermawan, Indah Kartika Murni, Tiara Nurlita, Chika Carnation Tandri, Cahyani Gita Ambarsari","doi":"10.1186/s12882-025-04125-z","DOIUrl":"https://doi.org/10.1186/s12882-025-04125-z","url":null,"abstract":"","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"216"},"PeriodicalIF":2.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974790","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":"Global trends in chronic kidney disease mortality and disability-adjusted life years attributable to low physical activity (1990-2021): a growing public health challenge.","authors":"ZhenYi Zhao, Jing Mi, HaoDong Jin, ShuaiRan Li, Xia Bai","doi":"10.1186/s12882-025-04117-z","DOIUrl":"https://doi.org/10.1186/s12882-025-04117-z","url":null,"abstract":"<p><strong>Background: </strong>Low physical activity (LPA) is a major contributor to the global burden of chronic kidney disease (CKD). Our goal was to assess the spatiotemporal trends in the CKD burden attributable to LPA from 1990 to 2021, with a focus on the globe, China, five SDI regions, and four continents.</p><p><strong>Methods: </strong>We analysed CKD-related deaths, DALYs, the ASMR, the ASDR, and the EAPC attributable to low physical activity (LPA). This study focused on trends from 1990 to 2021 across the globe, China, five SDI regions, and four continents. Decomposition analysis, frontier analysis, and forecasting models were employed to explore changes in these indicators and their influencing factors.</p><p><strong>Results: </strong>In 2021, CKD attributable to low physical activity (LPA) resulted in 913,070 [95% UI: 348,170-1,619,770] DALYs and 40,920 [95% UI: 16,170-72,560] deaths globally, both of which were higher than those reported in 1990. The AOSD increased from 9.63 (95% UI: 3.73-17.02) to 10.81 (95% UI: 4.14-19.18) per 100,000, with an EAPC of 0.42 (95% CI: 0.35-0.48). The ASMR increased from 0.42 (95% UI: 0.17-0.74) to 0.50 (95% UI: 0.20-0.90) per 100,000, with an EAPC of 0.65 (95% CI: 0.57-0.73). The burden was greater among females, with more rapid increases in the ASDR and ASMR. The Americas and high-SDI regions presented the greatest growth in DALY and mortality rates.</p><p><strong>Conclusions: </strong>The burden of CKD attributable to low physical activity (LPA) has increased significantly, particularly in low-SDI regions, women, and elderly individuals. The findings highlight the importance of promoting physical activity and implementing early interventions to inform public health policies.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"215"},"PeriodicalIF":2.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976296","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":"Potassium binders in clinical practice: understanding potassium binder use in contemporary Swedish healthcare-the DEMONSTRATE database.","authors":"Hans Furuland, Anders Olof Larsson, Per Bjellerup, Milica Uhde, Thomas Cars, Matilda Almstedt, Maria K Svensson","doi":"10.1186/s12882-025-04146-8","DOIUrl":"https://doi.org/10.1186/s12882-025-04146-8","url":null,"abstract":"<p><strong>Background: </strong>Potassium binders mitigate hyperkalemia, allowing patients to maintain their renin-angiotensin-aldosterone-system inhibitor (RAASi) treatment. This study characterized patients treated with first- or second-generation potassium binders, usage patterns and their effectiveness in reducing potassium levels, and changes in RAASi treatment in a Swedish population-based study.</p><p><strong>Methods: </strong>A National Cohort included patients who had record of a treatment episode with a first-generation or second-generation potassium binder between 2018 and 2022. A Mid-Sweden Cohort included patients from the National Cohort who also had a record of a potassium measurement within the 60 days prior to beginning potassium binder treatment. Comorbidities, prior medication use, persistence with potassium binder treatment, subsequent changes in potassium levels and RAASi treatment were evaluated. Persistence was analyzed using the Kaplan-Meier estimator and changes in potassium levels were assessed using linear mixed-effects models.</p><p><strong>Results: </strong>23,892 treatment episodes involving 14,235 patients (mean age 70 years, 33% women) were followed in the National Cohort, and 4860 episodes involving 3179 patients (mean age 72 years, 34% women) in the Mid-Sweden Cohort. Patients treated with second-generation potassium binders had more comorbidities and higher median persistence with treatment compared to those on first-generation potassium binders, 112.5 (95% CI:112.5-117.5) vs. 87.5 (95% CI: 87.5-87.5) days in the National Cohort; 165.5 (95% CI: 121.0-198.0) vs. 97.6 (95% CI: 87.5-110.0) days in the Mid-Sweden Cohort. Both first- and second-generation potassium binders reduced potassium levels from baseline by day 15, 5.7 [95% CI: 4.5-6.8] mmol/L to 4.7 [95% CI: 3.6-5.9] mmol/L and 5.5 (95% CI: 4.3-6.7) mmol/L to 4.9 (95% CI: 3.8-6.1) mmol/L, respectively. Dose reduction or discontinuation of renin-angiotensin system inhibitors (RASi) or mineralocorticoid receptor antagonists (MRAs) was found in 31.4% and 47.7%, respectively, within 120 days of initiating therapy.</p><p><strong>Conclusion: </strong>Both potassium binders effectively reduced potassium levels, but frequent discontinuation or dose reduction of RAASi therapy were still observed during this period. The adjustments of RAASi therapy, despite the achievement of normokalemia within 15 days, may be premature and warrants careful reconsideration to ensure optimal patient outcomes.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"213"},"PeriodicalIF":2.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963560","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":"Intermittent hypoxemia during hemodialysis: AI-based identification of arterial oxygen saturation saw-tooth pattern.","authors":"Hanjie Zhang, Andrea Nandorine Ban, Peter Kotanko","doi":"10.1186/s12882-025-04133-z","DOIUrl":"https://doi.org/10.1186/s12882-025-04133-z","url":null,"abstract":"<p><strong>Background: </strong>Maintenance hemodialysis patients experience high morbidity and mortality, primarily from cardiovascular and infectious diseases. It was discovered recently that low arterial oxygen saturation (SaO₂) is associated with a pro-inflammatory phenotype and poor patient outcomes. Sleep apnea is highly prevalent in maintenance hemodialysis patients and may contribute to intradialytic hypoxemia. In sleep apnea, normal respiration patterns are disrupted by episodes of apnea because of either disturbed respiratory control (i.e., central sleep apnea) or upper airway obstruction (i.e., obstructive sleep apnea). Intermittent SaO₂ saw-tooth patterns are a hallmark of sleep apnea. Continuous intradialytic measurements of SaO₂ provide an opportunity to follow the temporal evolution of SaO₂ during hemodialysis. Using artificial intelligence, we aimed to automatically identify patients with repetitive episodes of intermittent SaO₂ saw-tooth patterns.</p><p><strong>Methods: </strong>The analysis utilized intradialytic SaO₂ measurements by the Crit-Line device (Fresenius Medical Care, Waltham, MA). In patients with an arterio-venous fistula as vascular access, this FDA approved device records 150 SaO₂ measurements per second in the extracorporeal blood circuit of the hemodialysis system. The average SaO₂ of a 10-second segment is computed and streamed to the cloud. Periods comprising thirty 10-second segments (i.e., 300 s or five minutes) were independently adjudicated by two researchers for the presence or absence of SaO₂ saw-tooth pattern. We built one-dimensional convolutional neural networks (1D-CNN), a state-of-the-art deep learning method, for SaO₂ pattern classification and randomly assigned SaO₂ time series segments to either a training (80%) or a test (20%) set.</p><p><strong>Results: </strong>We analyzed 4,075 consecutive 5-minute segments from 89 hemodialysis treatments in 22 hemodialysis patients. While 891 (21.9%) segments showed saw-tooth pattern, 3,184 (78.1%) did not. In the test data set, the rate of correct SaO₂ pattern classification was 96% with an area under the receiver operating curve of 0.995 (95% CI: 0.993 to 0.998).</p><p><strong>Conclusion: </strong>Our 1D-CNN algorithm accurately classifies SaO₂ saw-tooth pattern. The SaO₂ pattern classification can be performed in real time during an ongoing hemodialysis treatment, provide timely alert in the event of respiratory instability or sleep apnea, and trigger further diagnostic and therapeutic interventions.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"214"},"PeriodicalIF":2.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974176","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}