Hemodialysis international. International Symposium on Home Hemodialysis最新文献

{"title":"Long-Term Outcome Analysis of Peritoneal Dialysis and Hemodialysis in Patients With End-Stage Kidney Disease: A Real-World Data Analysis.","authors":"Yi-Hsien Chen, Yun-Yi Chen, Yu-Wei Fang, Hung-Hsiang Liou, Jing-Tong Wang, Ming-Hsien Tsai","doi":"10.1111/hdi.13267","DOIUrl":"https://doi.org/10.1111/hdi.13267","url":null,"abstract":"<p><strong>Background: </strong>Despite extensive research on peritoneal dialysis (PD) and hemodialysis (HD), understanding long-term outcomes between these modalities remains limited. We conducted a retrospective cohort study to assess the clinical outcomes of PD and HD in a real-world context.</p><p><strong>Methods: </strong>Utilizing the National Health Insurance Research Database in Taiwan, we studied patients who underwent dialysis from January 2006 to December 2017. Patients with a history of cancer, renal transplantation, age < 20 or > 84 years, or patients on PD who switched to HD within 3 months of starting the modality were excluded. They were categorized into three groups: HD-only (n = 59,751), PD-only (n = 3969), and PD-to-HD transition (n = 3196). Propensity score matching based on sex, age, and the Charlson comorbidity index was used to create comparable groups. Hazard ratios (HR) for clinical outcomes were calculated using the Cox regression model, comparing HD-only versus PD-only and the transition group outcomes. Follow-up continued until December 31, 2020. Finally, external validation was performed using the global TriNetX dataset.</p><p><strong>Results: </strong>After 1:1 propensity score matching and multivariable adjustment, the HD-only group (n = 3969) exhibited significantly lower all-cause mortality and infection-related admissions compared to the PD-only group (n = 3969) (HRs 0.77 and 0.75, 95% CI: 0.72-0.83 and 0.70-0.80, respectively), with a survival advantage across most subgroups. Conversely, the PD-to-HD transition group (n = 2014) had worse hospitalization and major adverse cardiovascular event outcomes than those on PD-only (n = 2014) (HRs 1.83 and 1.22, 95% CIs: 1.71-1.97 and 1.10-1.36, respectively) but showed neutral mortality rates. A survival benefit emerged 2 years post-transition from PD to HD, with an HR of 0.62 (95% CI: 0.54-0.74). These findings were corroborated by the TriNetX data.</p><p><strong>Conclusion: </strong>Our study indicates that HD patients tend to have better clinical outcomes, including greater longevity, compared to PD patients. Thus, the choice of dialysis modality should be tailored to individual patient needs for optimal outcomes.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rifampin Induced Ataxia and Clonus in an Adolescent Male Hemodialysis Patient: A Case Report.","authors":"Christine E Tabulov, Alaina Mui, Anne E Gargasz, Kristy M Shaeer","doi":"10.1111/hdi.13260","DOIUrl":"https://doi.org/10.1111/hdi.13260","url":null,"abstract":"<p><p>We present a case of a 14-year-old African American male on hemodialysis who experienced ataxia and clonus after the addition of rifampin to treat a hemodialysis catheter-associated bloodstream infection. This observation should raise awareness of a rare but serious adverse reaction to rifampin.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of the Qualitative Research on Barriers and Facilitators to Home Hemodialysis.","authors":"Áine Earley, Sinéad Lydon, Rachael C Walker, Lisa Gannon, Donal Reddan, Lorna Durack, Paul O'Connor","doi":"10.1111/hdi.13266","DOIUrl":"https://doi.org/10.1111/hdi.13266","url":null,"abstract":"<p><strong>Introduction: </strong>The growing prevalence of chronic kidney disease has led to an increased demand for kidney replacement therapies. Although a kidney transplant is the preferred treatment for patients, many patients require dialysis temporarily before receiving a transplant or are unsuitable transplant candidates requiring long-term dialysis. Home hemodialysis (home HD) is cost-effective and associated with improved patient outcomes; however, its adoption remains low. There is a need to understand the factors that may support or hinder the use of home HD. Accordingly, a systematic review of the qualitative literature was conducted to identify barriers and facilitators to home HD for patients, their carers/family, and healthcare professionals.</p><p><strong>Methods: </strong>This systematic review was carried out following ENTREQ guidelines. Electronic searches were conducted on Medline (OVID), EMBASE, CINAHL (EBSCO), and PsycINFO. The COM-B and Theoretical Domains Framework (TDF) were used to collate the barriers and enablers identified within the papers through deductive content analysis.</p><p><strong>Results: </strong>Thirteen studies met the inclusion criteria. Within the capability component of the COM-B model, lack of knowledge of home HD was identified as a barrier by healthcare professionals and patients. Within the opportunity component, the suitability of patients' homes (e.g., home modifications) and the healthcare system was identified as barriers to home HD. Fostering an environment of support and community was seen as a facilitator of home HD. Within the motivation component of the model, a lack of confidence and reluctance of patients to burden their family members with the responsibility of treatment were perceived as barriers. Improvements in the quality of life for the person receiving home HD were regarded as a motivator.</p><p><strong>Conclusion: </strong>To encourage widespread home HD use, understanding its barriers and facilitators for patients and the healthcare system is key to developing and implementing effective interventions to increase uptake.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Periodontitis and Nitric Oxide in Patients Undergoing Maintenance Hemodialysis.","authors":"Gabriela Keiko Izumi, Caroline Vidal Paseto, Rafael Fiorese Costa, Gabrielle Delfrate, Aline Borsato Hauser, Daniel Fernandes, Maria Ângela Naval Machado, Reila Tainá Mendes","doi":"10.1111/hdi.13264","DOIUrl":"https://doi.org/10.1111/hdi.13264","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The inflammatory processes associated with periodontitis have been implicated in the development and progression of systemic diseases, including chronic kidney disease (CKD). Notably, individuals with CKD frequently exhibit shared risk factors with those affected by periodontitis, such as hypertension, smoking, and diabetes mellitus. Nitric oxide (NO), a free radical with diverse physiological and pathological roles, exerts both anti-inflammatory (e.g., vasodilation, modulation of platelet function) and pro-inflammatory effects, the latter of which have been observed in patients with CKD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;This study aimed to investigate the relationship between nitric oxide levels in saliva and plasma and various periodontal parameters in patients with chronic kidney disease (CKD), in comparison to a control group without CKD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study enrolled 90 participants seeking dental treatment. The participants were divided into two groups: a CKD group (n = 40) consisting of patients undergoing dialysis or hemodialysis treatment at the Pró-Renal Foundation Dental Clinic, and a control group (n = 50) comprising individuals without CKD who were receiving treatment at the UFPR Dental Clinic. Two calibrated examiners conducted comprehensive periodontal examinations for all participants. Additionally, saliva samples were collected from each participant to assess pH, flow rate, and nitric oxide levels. Venous blood samples were also obtained to quantify plasma nitric oxide concentrations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients in the CKD group exhibited significantly poorer periodontal health compared to the control group (p &lt; 0.05), characterized by a larger Periodontal Inflamed Surface Area, greater probing depth, increased clinical attachment level, and a higher visual plaque index (p &lt; 0.05). Furthermore, the CKD group presented with significantly reduced salivary flow (p &lt; 0.05). Notably, this group also showed elevated levels of both nitrate and nitrite in saliva and serum (p &lt; 0.05) compared to the control group. Correlation analyzes revealed significant positive associations between nitrate and nitrite levels (in both plasma and saliva) and several periodontal variables: probing depth (r = 0.38 and 0.41, respectively), clinical attachment level (r = 0.40 and 0.38, respectively), and Periodontal Inflamed Surface Area (r = 0.27 and 0.48, respectively). Conversely, nitrate and nitrite levels in both fluids showed significant negative correlations with glomerular filtration rate (GFR) (r = -0.55 and -0.40, respectively). The visual plaque index demonstrated a significant positive correlation only with salivary nitrate and nitrite levels (r = 0.23), highlighting the potential influence of oral biofilm on nitric oxide metabolism. Interestingly, the comparable levels of nitrate and nitrite observed in saliva and plasma suggest that saliva may be a suitable non-invasive biofluid for","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Nurse-Led Coaching on Discordant Home Hemodialysis Patients.","authors":"Ana Sanchez-Escuredo, Klement Yeung, Daniela Arustei, Celine D'Gama, Rose Faratro, Eduardo Magtoto, Kalavani Renganathan, Christopher T Chan","doi":"10.1111/hdi.13259","DOIUrl":"https://doi.org/10.1111/hdi.13259","url":null,"abstract":"<p><strong>Introduction: </strong>Home hemodialysis (home HD) has demonstrated superior clinical outcomes, improved quality of life, and enhanced treatment flexibility in comparison to 3 days/week in-center HDs. Nonetheless, some patients are discordant with their dialysis prescription and require a coaching program in order to maintain their normal lifestyle and ameliorate their illness behavior.</p><p><strong>Objective: </strong>To describe the feasibility of conducting a nurse-led coaching program for discordant home HD patients and its effect on hospitalization and technique complications.</p><p><strong>Methods: </strong>This is a retrospective single center observational cohort study of all prevalent home HD patients at University Health Network (UHN) from the period of January 2018 to December 2022. Demographic and clinical data were extracted from chart review. Nurses conducted weekly motivational interviewing with patients by phone, email, or in-clinic visits in the home HD unit to discuss the importance of being concordant to treatment and adapting the length and schedule of dialysis to avoid clinical complications. Health coaching was defined as patient-centered, incorporating patient-determined goals, self-discovery processes, accountability, and content information in the context of an ongoing helping relationship. Patients were categorized as concordant, concordant with agreement doing at least 75% of dialysis prescription, or discordant for those skipping/shortening home HD sessions without prior agreement with the clinical team. Comparisons were carried out using chi-squared or ANOVA testing as appropriate. p < 0.05 was defined as statistical significance.</p><p><strong>Results: </strong>From 94 patients, 61 were concordant and 33 (35%) required coaching: 15 (16%) were concordant patients with agreement and 18 (19%) were discordant patients. Patients' demographics were summarized respectively for concordant patients, concordant with agreement, and for discordant patients. Age was 51 (37-61), 53 (47-61), 46 (35-54) [p = 0.102]; male gender was 62%, 53%, 72% [p = 0.519]; diabetes status was 21%, 7%, 6% [p = 0.219] and proportions of patients living alone were 13%, 7%, 17% [p = 0.739]. Patients requiring coaching tended to have a higher median time on home HD, 7.6 versus 4.3 years [p = 0.145] and tended to be less likely to be listed for kidney transplant [p = 0.174]. There were no differences in hospitalization and technique complications among patients who required coaching versus standard care.</p><p><strong>Conclusion: </strong>We demonstrated that it is feasible to provide coaching to home HD patients. Ongoing clinical testing of nurse-led coaching in home HD is warranted.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of B. Braun Hemodialysis Machine to Provide Home Hemodialysis.","authors":"Rachid Daoui, Paul Feustel, Christina Manning, Loay Salman","doi":"10.1111/hdi.13254","DOIUrl":"https://doi.org/10.1111/hdi.13254","url":null,"abstract":"<p><strong>Background: </strong>Home hemodialysis (home HD) continues to be an underutilized dialysis modality despite its potential advantages when compared to peritoneal dialysis (PD) and in-center hemodialysis (HD).</p><p><strong>Methods: </strong>We conducted a retrospective study to evaluate the feasibility of using the B. Braun Dialog+ HD machine to provide home HD with the necessary requirements and modifications at home to be able to provide such treatments. In this retrospective study, we compared data obtained from patients who received home HD using the B. Braun Dialog+ HD machine since we started utilizing it for home HD (n = 27 patients) to data obtained from eligible patients who received home HD using the NxStage System One machine around the same period (n = 36 patients).</p><p><strong>Results: </strong>Our results showed that the B. Braun group had a better single treatment single-pool Kt/V (spKt/V) (1.48 ± 0.27 for B. Braun vs. 1.14 ± 0.32 for NxStage, p < 0.001), better standard weekly Kt/V (4.44 ± 0.82 for B. Braun vs. 2.65 ± 0.57 for NxStage, p < 0.001), and better urea reduction rate (URR) (71.4 ± 6.2 for B. Braun vs. 59.2 ± 9.1 for NxStage, p < 0.001). The duration for the HD treatments among the B. Braun group patients was significantly shorter than that of the NxStage group patients (3.48 ± 0.32 vs. 4.58 ± 1.52, p < 0.001) while the ultrafiltration rate for the B. Braun group patients was significantly larger than that of the NxStage group patients (1.83 ± 0.64 vs. 1.18 ± 0.66, p < 0.001). The average laboratory data for both groups showed that there was only a significant difference between the two groups in bicarbonate level, with B. Braun having a lower level (23.5 ± 2.0 for B. Braun vs. 24.9 ± 2.8 for NxStage, p = 0.021). There were no significant differences between the two groups in the average albumin, BUN, calcium, creatinine, hemoglobin, phosphorus, platelets, potassium, WBC, or PTH.</p><p><strong>Conclusion: </strong>B. Braun HD machine is another HD device that can be considered to provide home HD. Our study has shown that B. Braun machine had higher spKt/V in addition to standard weekly Kt/V and URR when compared to the NxStage machine. Larger, well-designed, and well-powered studies are needed to confirm these results.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Biomarkers in Nocturnal Hemodialysis and Their Association With Physical Performance.","authors":"Manouk Dam, Laura M M de Haan, Tiny Hoekstra, Marc Vervloet, Frans J van Ittersum, Peter J M Weijs, Brigit C van Jaarsveld","doi":"10.1111/hdi.13265","DOIUrl":"https://doi.org/10.1111/hdi.13265","url":null,"abstract":"<p><strong>Introduction: </strong>The cardiovascular biomarkers troponin T, N-terminal pro-B-type natriuretic peptide, and fibroblast growth factor 23 are elevated in hemodialysis patients and associated with an increased cardiovascular mortality risk. Nocturnal hemodialysis improves the fluid status in hemodialysis patients. Therefore, we investigated whether nocturnal hemodialysis (7-8 h sessions) was associated with lower levels of troponin T, N-terminal pro-B-type natriuretic peptide, and fibroblast growth factor 23 in comparison to conventional hemodialysis. Second, we investigated whether these biomarkers were independently associated with physical performance in hemodialysis patients.</p><p><strong>Methods: </strong>A prospective cohort of 33 hemodialysis patients was compared to 32 patients who voluntarily switched from conventional hemodialysis to nocturnal hemodialysis. First, we studied the difference between the two cohorts in change over 12 months of troponin T, N-terminal pro-B-type natriuretic peptide, and fibroblast growth factor 23 with linear mixed models. Second, the associations between these biomarkers and physical-activity monitor, six minute walk test, and physical component summary score were assessed at baseline, 6 and 12 months.</p><p><strong>Findings: </strong>N-terminal pro-B-type natriuretic peptide increased 122% during conventional hemodialysis, whereas it decreased 31% during nocturnal hemodialysis (p = 0.001). In conventional hemodialysis, fibroblast growth factor 23 rose numerically by 19% (23%-66%) in 12 months, while a decline of 44% (21%-58%) was found in nocturnal hemodialysis patients (p = 0.17). Troponin T did not differ between groups. Regarding physical performance, a higher N-terminal pro-B-type natriuretic peptide (per 1000 ng/L) and fibroblast growth factor 23 (per 1000 RU/mL) were associated with lower physical component summary scores of -0.02 (p = 0.02) and -0.04 (p = 0.05), respectively. Troponin T was not associated with physical performance.</p><p><strong>Discussion: </strong>Our findings showed that nocturnal hemodialysis was associated with a decrease in N-terminal pro-B-type natriuretic peptide. This suggested that nocturnal hemodialysis diminished volume overload and thereby myocardial stretch. Additionally, lower levels of N-terminal pro-B-type natriuretic peptide and fibroblast growth factor 23 were found to be associated with better self-reported physical performance scores.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Physical Examination in Assessing Arteriovenous Access: A Narrative Review.","authors":"Jingying Chen, Jinghua Lu, Xia Fu, Hongzhen Zhou","doi":"10.1111/hdi.13256","DOIUrl":"https://doi.org/10.1111/hdi.13256","url":null,"abstract":"<p><strong>Background: </strong>A functional arteriovenous access is crucial for hemodialysis patients. Regular monitoring of vascular access allows for early detection and treatment of complications, which helps the access last longer and improves the effectiveness of dialysis. Clinical guidelines emphasize physical examination as the main way to monitor vascular access. To highlight the importance of physical examination among hemodialysis clinicians, this review investigates its application in AV access assessment.</p><p><strong>Methods: </strong>We searched the China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, Web of Science, Cochrane Library, Embase, ProQuest, and UpToDate databases from their inception to November 25, 2022, for studies on the physical examination of arteriovenous access.</p><p><strong>Results: </strong>Physical examination exhibits acceptable sensitivity and specificity for detecting AV fistula maturation and stenosis. Quantitative physical examination indicators demonstrate high accuracy in assessing AV fistula stenosis and thrombosis. While widely used to evaluate vascular access function, dialysis practitioners often lack sufficient training and knowledge in physical examination. Therefore, comprehensive training for dialysis professionals in this area is essential.</p><p><strong>Conclusions: </strong>Several factors hinder the widespread use of physical examination in clinical settings. To optimize AV access care, hemodialysis managers should prioritize the development of standardized physical examination protocols that include quantitative indicators and assessment tools. Furthermore, regular training and competency assessments for dialysis staff are vital. Strengthening practitioners' physical examination proficiency will lead to earlier identification of AV access issues, greater access durability, and improved patient well-being.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter-Related Infection in Uncuffed, Non-Tunneled Dual-Lumen Catheters: Incidence and Risk Factors by Internal Jugular Versus Femoral Site in a Retrospective Cohort.","authors":"Tanwaporn Phatpituk, Suthiya Anumas, Aphichat Chatkrailert","doi":"10.1111/hdi.13261","DOIUrl":"https://doi.org/10.1111/hdi.13261","url":null,"abstract":"<p><strong>Background: </strong>Uncuffed, non-tunneled dual-lumen catheters are often required for kidney replacement therapy (KRT), but catheter-related bloodstream infections (CRBSIs) remain a serious complication. Whether the jugular site poses a lower CRBSI risk than the femoral site is unclear.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed patients with uncuffed, non-tunneled dual-lumen catheters. CRBSI incidence, catheter dwelling time, and mortality rates were compared between jugular and femoral sites. Regression analyses identified CRBSI risk factors.</p><p><strong>Results: </strong>A total of 572 patients were included in the study. The incidence proportion of CRBSI was 3.5% in both the femoral and jugular groups (10 of 286 patients in each group; p = 1.0). The incidence rates of CRBSI were 1.7 and 0.9 per 1000 patient-days for the femoral and jugular sites, respectively (p = 0.154). The median catheter dwelling time was significantly longer for jugular catheters (25 days) compared to femoral catheters (12 days; p < 0.001). The 30-day incidence proportion of death at the jugular site was significantly lower than at the femoral site (0.105 vs. 0.608, p < 0.001). Pre-existing cerebrovascular disease and congestive heart failure were identified as significant risk factors for CRBSI.</p><p><strong>Conclusion: </strong>For uncuffed, non-tunneled dual-lumen catheters used for dialysis vascular access, the jugular insertion site does not demonstrate a reduced risk of CRBSI compared to the femoral site. However, jugular catheter placement is associated with a longer dwelling time and a lower mortality rate.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Organization of In-Center Nocturnal Hemodialysis in the Netherlands: Practical Guidance for Centers Willing to Initiate Nocturnal Hemodialysis.","authors":"Jos N M Barendregt, Tizza P Zomer, Yolande M Vermeeren, Paul A Rootjes, Brigit C van Jaarsveld","doi":"10.1111/hdi.13253","DOIUrl":"https://doi.org/10.1111/hdi.13253","url":null,"abstract":"<p><strong>Introduction: </strong>Nocturnal in-center hemodialysis (HD) offers a higher dialysis dose and longer ultrafiltration time than regular HD, which potentially benefits at least a selection of patients. Currently, only a minority of HD patients have access to in-center nocturnal HD. Many practical and logistical problems must be overcome by an HD center before the treatment can become operational.</p><p><strong>Methods: </strong>For assessing the detailed organization of in-center nocturnal HD in the Netherlands, an observational cross-sectional study was performed using Nefrodata (Dutch Registry of dialysis patients) and structured questionnaires for center managers and nephrologists. Descriptive analyses were performed, followed by an analysis of best practices.</p><p><strong>Findings: </strong>Out of 55 Dutch dialysis centers, 27 offer in-center nocturnal HD, treating 255 out of 5200 patients treated with intermittent HD. Of these 27 centers, 4 stopped providing in-center nocturnal HD, mostly due to organizational problems. Our survey showed that some aspects of treatment were similar in the various centers, such as duration of sessions (7-8 h), patient education at the pre-dialysis outpatient department, treatment prescription, and blood pressure monitoring. In contrast, patient selection varied between centers, for example, regarding functional vascular access: non-tunneled catheters were not allowed during in-center nocturnal HD in some centers. Also, hemodynamic instability observed during daytime treatment was, by some centers, considered a problem for starting in-center nocturnal HD. Furthermore, large differences regarding the organization of nursing staff exist. Importantly, all nephrologists agree that in-center nocturnal HD is a useful part of the treatment repertoire offered in their centers.</p><p><strong>Discussion: </strong>Practical guidance to organize a successful and safe in-center nocturnal HD program is provided. Patients' safety should be guaranteed without affecting the patient's night's sleep. In-center nocturnal HD offers patients the most optimal metabolic control, excellent intradialytic hemodynamic stability, and volume control with more free time during the day.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}