To investigate the efficacy of a traffic light diary in volume management for patients undergoing maintenance hemodialysis. A total of 80 patients undergoing maintenance hemodialysis were enrolled and randomly assigned using a random number table to either an intervention group (n = 40) or a control group (n = 40) for a 12-week intervention period. The control group received routine hemodialysis treatment and health education on volume management in the hemodialysis unit. The intervention group additionally implemented volume management based on a traffic light diary. Comparisons were made between the two groups regarding before and after the intervention scores on the knowledge, attitude, and practice scales for volume management. The volume management compliance rate, interdialytic weight gain, ultrafiltration rate, and blood pressure levels were statistically analyzed. Acute dialysis complications during the intervention period were recorded and statistically evaluated for both groups. Before the intervention, there were no statistically significant differences between the two groups in terms of fluid management knowledge, attitude, and practice scores; fluid management compliance rate; or blood pressure levels (all p > 0.05). After the intervention, the intervention group scored significantly higher than the control group in knowledge (median [IQR]: 9 [8-10] vs. 7 [6-8]), attitudes (9.2 [8.5-10.0] vs. 7.0 [6.1-8.2]), and practice (22.9 ± 1.62 vs. 18.7 ± 1.01) (all p < 0.05). The fluid management compliance rate was 95% in the intervention group, which was significantly higher than the 75% in the control group (p < 0.05). Interdialytic weight gain and ultrafiltration rate decreased significantly in the intervention group compared with the control group (p < 0.05). Blood pressure control was also superior in the intervention group compared to the control group (p < 0.05). The incidence of acute intradialytic complications, namely hypotension and muscle cramps, was significantly lower in the intervention group than in the control group (p < 0.05). The implementation of fluid management based on a traffic light diary, which combines self-monitoring feedback with professional health education, is of significant importance for improving patients' knowledge, attitude, and practice regarding fluid management, enhancing fluid management efficacy, stabilizing blood pressure levels, and reducing the incidence of acute intradialytic complications.
Tenapanor is a mechanistically distinct treatment for hyperphosphatemia in hemodialysis and can reduce phosphate-binder pill burden in selected patients. However, its real-world value is constrained by bowel effects, particularly diarrhea, which commonly emerges early after initiation and may lead to treatment aversion or discontinuation. In this review, treatment persistence refers to the ability to continue tenapanor through the early bowel-symptom period without permanent discontinuation due to gastrointestinal symptoms or treatment aversion, while maintaining clinically meaningful phosphate control. Current evidence indicates that tenapanor-associated bowel effects are clinically bidirectional. They may improve stool consistency and reduce laxative dependence in constipation-prone patients, whereas the same bowel shift may cause loose stools, urgency, discomfort, dialysis-session anxiety, and discontinuation in others. Longer-term studies suggest that patients who remain on therapy may maintain phosphate control with fewer concomitant phosphate-binder tablets, although early discontinuation and completer effects require cautious interpretation. A persistence-oriented approach includes baseline bowel-habit assessment, region-specific and label-consistent initiation and dose adjustment, individualized timing around dialysis sessions, review of concomitant bowel-active medications, anticipatory patient education, and monitoring for fluid and electrolyte consequences. Tenapanor-associated bowel effects are a central implementation barrier rather than a secondary tolerability issue. Persistence may be improved by matching treatment to baseline bowel phenotype and using a tolerability-first, safety-conscious continuation framework. Prospective studies should define predictors of persistence and validate supportive strategies.
Data on the efficacy and safety of sacubitril/valsartan in hemodialysis patients with heart failure and preserved left ventricular ejection fraction (≥ 50%, HFpEF) or mildly reduced left ventricular ejection fraction (41%-49%, HFmrEF) were analyzed, as well as cardiac functional parameters and safety after withdrawal of sacubitril/valsartan. Ninety-eight maintenance hemodialysis patients with heart failure with preserved or mildly reduced ejection fraction were included in the present study. Patients were divided into sacubitril/valsartan and control groups according to whether they had been, or were being, treated with sacubitril/valsartan. Patients were further divided into continuation and discontinuation groups based on whether sacubitril/valsartan was discontinued at the end of follow-up. Laboratory examination results, echocardiographic parameters, and the occurrence of major adverse cardiac events were recorded and analyzed. There were 50 patients in the control group and 48 in the sacubitril/valsartan group. The median follow-up time was 14.5 months. Compared with the control group, the serum B-type natriuretic peptide levels and echocardiographic parameters in the sacubitril/valsartan group significantly decreased from baseline at 6-month follow-up (p < 0.05). In the sacubitril/valsartan group, there were 28 patients in the continuation group and 20 in the discontinuation group. The reduction in left ventricular end-diastolic diameter in the sacubitril/valsartan group reversed in the discontinuation group (by 10%) after drug withdrawal, whereas it was stable in the continuation group (change 0.66%, p = 0.030). Patients with lower left ventricular end-diastolic diameters at the end follow-up (≤ 50 mm) exhibited a lower incidence of major adverse cardiac events compared to those with higher diameters (>50 mm; p = 0.012). Sacubitril/valsartan improved cardiac function in patients on hemodialysis with heart failure and preserved or mildly reduced left ventricular ejection fraction. Long-term continuous use of sacubitril/valsartan may reduce left ventricular end-diastolic diameter and positively impact prognosis.
Gastrointestinal bleeding is very common among hemodialysis patients. This high bleeding risk is caused by uremic platelet dysfunction, vascular fragility, intradialytic hemodynamic instability, and widespread antithrombotic therapy. Small bowel lesions, especially angiodysplasias, constitute a significant but often overlooked source of recurrent or occult hemorrhage while conventional endoscopy frequently fails to identify these lesions. Investigation of small bowel lesions in hemodialysis patients and identification of bleeding risk of this vulnerable population. Narrative review. English language studies in the last 25 years using PubMed and Google Scholar databases up to November 2025. Search terms included "hemodialysis," "small bowel lesions," "angiodysplasia," and "gastrointestinal bleeding." The review incorporates different types of research including observational cohorts, randomized trials, cross-sectional studies, systematic reviews, and narrative reviews involving hemodialysis adult or end stage renal disease populations. Across the analysis of 26 studies, capsule endoscopy revealed a significantly higher prevalence of small bowel lesions in hemodialysis patients compared to controls, with angiodysplasias being the most frequent finding. Large-scale epidemiological analyses identified hemodialysis as an independent risk factor for gastrointestinal hemorrhage compared to peritoneal dialysis, providing the clinical background for the increased susceptibility of these patients to small bowel-specific lesions. Overall, patients have a higher risk of rebleeding tendency than controls and exhibited a high-risk phenotype characterized by recurrent angiodysplasia-related bleeding and elevated one-year mortality rates following the first bleeding episode. Small bowel lesions may constitute a major and underrecognized cause of gastrointestinal bleeding in hemodialysis patients. Capsule endoscopy offers the highest diagnostic yield, yet optimal treatment strategies remain undefined, and recurrent bleeding episodes are common. Thus, effective management requires early detection, individualized therapeutic planning, and careful treatment with anticoagulant and antiplatelet drugs.
Complementary treatment methods support medical treatment in symptom control. The aim of this study was to investigate the effect of virtual museum visits on dialysis symptoms and anxiety in hemodialysis patients. This randomized controlled trial included 60 participants (intervention group = 30, control group = 30). In the intervention group, a passive immersive virtual reality based virtual museum intervention was applied during hemodialysis sessions. Participants viewed pre-recorded museum environments through virtual reality glasses without interaction. The intervention was administered once weekly for five consecutive weeks (30 min per session). The control group received routine hemodialysis care only. Data were collected using a Patient Information Form, the Dialysis Symptom Index and the Beck Anxiety Inventory Outcomes were assessed at baseline and after completion of the intervention period. The mean Dialysis Symptom Index and Beck Anxiety Inventory scores decreased more in the intervention group compared with the control group (p < 0.001). In addition, improvements in symptoms such as feeling uncomfortable, irritability, fatigue/decreased energy, bone/joint pain, muscle pain, and nausea were greater in the intervention group (p < 0.05). Within-group analyses showed significant reductions in both Dialysis Symptom Index and Beck Anxiety Inventory scores in the intervention group, while no significant changes were observed in the control group. Virtual museum visits using VR technology may be a supportive intervention for reducing dialysis-related symptoms and anxiety levels in hemodialysis patients. Further studies with larger samples and more robust designs are recommended to confirm these findings.
Management of anemia in patients undergoing maintenance hemodialysis is primarily based on predialysis hemoglobin measurements. However, hemoglobin concentrations vary substantially across the hemodialysis cycle because of interdialytic fluid accumulation, ultrafiltration-induced hemoconcentration, and ongoing plasma refilling. Consequently, hemoglobin values obtained at different time points are not physiologically equivalent and may reflect distinct circulatory states. This narrative review summarizes the physiological determinants of hemoglobin variation during the hemodialysis cycle and examines the clinical implications of different hemoglobin sampling strategies in patients undergoing maintenance hemodialysis. Sampling practices differ across regions: in Japan, hemoglobin is commonly assessed during the first dialysis session of the week, whereas midweek predialysis sampling is frequently used in North America and Europe and is explicitly recommended by the 2025 UK Kidney Association guideline. Pre- and postdialysis hemoglobin measurements reflect different physiological conditions and may lead to different interpretations of anemia severity and hemoglobin variability. Greater attention to the timing and standardization of hemoglobin measurement may improve interpretation of anemia severity and hemoglobin variability and enhance the international comparability of clinical data in patients undergoing maintenance hemodialysis. Consideration of physiologically relevant sampling strategies may contribute to a more accurate assessment of anemia in routine dialysis practice.
Hemodialysis, the primary treatment for chronic kidney disease, prolongs life but is frequently accompanied by physical and psychological symptoms that impair quality of life. Progressive muscle relaxation exercises offer a novel non-pharmacological approach to symptom management. This study aimed to evaluate progressive muscle relaxation exercises on dialysis-related symptoms (primary outcome) and quality of life (secondary outcome) in patients undergoing hemodialysis. A randomized controlled pre-test-post-test study was conducted between May and September 2025 in two dialysis units in eastern Türkiye. Ninety-two hemodialysis patients were randomly assigned to either an intervention group (n = 46) or a control group (n = 46). The intervention group received 24 sessions of progressive muscle relaxation exercises over 8 weeks, while the control group received routine care. Data were collected at baseline and after the intervention using the dialysis symptom index and the Short Form-36 quality-of-life scale. The groups were similar in baseline. After the intervention, the progressive muscle relaxation exercises group demonstrated a significant reduction in symptom burden, with mean dialysis symptom index scores decreasing from 29.4 ± 13.3 to 16.3 ± 6.77 (t = 7.21, p < 0.001). Short-Form-36 quality-of-life scores increased from 51.4 ± 9.83 to 65.8 ± 10.1 (t = 4.67, p < 0.001), with significant improvements in physical functioning, vitality, pain, general health, and mental well-being (p < 0.05). Progressive muscle relaxation exercises reduced dialysis-related symptoms and improved quality of life in hemodialysis patients. Given its simplicity, non-invasive nature, and low cost, it may be used as a complementary intervention in routine hemodialysis care. Further research should examine long-term effects and broader clinical applicability.
Recently, the Teach-Back Method has gained recognition in the literature as a promising, evidence-based strategy for patient education. This study aimed to assess the impact of individualized education delivered via the Teach-Back Method on depression levels among adult patients with kidney failure undergoing hemodialysis. A parallel-group trial with a pre-test and post-test design was conducted. The sample comprised 40 hemodialysis patients. Baseline (pre-test) data were collected from all participants. The intervention group received individualized education using the Teach-Back Method, delivered across three sessions. A post-test was administered 12 weeks after the initial assessment. Pre-test depression scores were comparable between the intervention and control groups (mean = 13.35 and 13.55, respectively), reflecting mild depression. Following the intervention, the mean depression score in the intervention group decreased significantly to 6.20, indicating a reduction below the mild depression threshold. Conversely, the control group's post-test score increased to 16.40, remaining within the mild depression range. These findings suggest that Teach-Back education may reduce depression levels in hemodialysis patients. However, given the small sample size and relatively short follow-up period, larger studies with longer follow-up are needed to confirm these findings. NCT07069634.
The relationship between serum calcium levels at the initiation of hemodialysis and coronary artery calcium score (CACS) remains unclear. This study examined whether albumin-corrected calcium (correctedCa; Payne's formula) and ionized calcium (ionizedCa) measured at dialysis initiation are associated with CACS assessed by screening coronary computed tomography. This single-center cross-sectional study included 176 adults who initiated hemodialysis between 2015 and 2023 and underwent coronary computed tomography with CACS measurement within ±30 days. Restricted cubic spline (RCS) logistic regression was used to evaluate the associations of correctedCa and ionizedCa with CACS ≥ 400, adjusting for clinical covariates. Subgroup analyses were performed according to the median serum albumin level. For models in which nonlinearity was not significant, logistic models treating the variable as a linear term were fitted to calculate odds ratios (OR) per 1-standard deviation (SD) increase. The mean age was 70.9 years, 32.9% were women, 54.3% had diabetes, and the mean eGFR was 5.45 mL/min/1.73 m2. Higher calcium levels were associated with higher CACS. ionizedCa showed a linear association with CACS ≥ 400 (OR per 1-SD, 1.51; 95% CI, 1.08-2.11). correctedCa also showed a statistically linear association (OR per 1-SD, 1.53; 95% CI, 1.09-2.13), although the RCS curve visually plateaued at higher correctedCa levels. Subgroup analyses revealed that this convex pattern was driven by the low-albumin group. Higher calcium at hemodialysis initiation was associated with increased coronary calcification. ionizedCa tended to show a more stable linear relationship with CACS than correctedCa, as correctedCa may overestimate ionizedCa in patients with low albumin. Measurement of ionizedCa at dialysis initiation may help refine vascular calcification risk stratification as patients enter the dialysis period.
Shared hemodialysis care, or "shared care," empowers in-center hemodialysis patients to undertake some dialysis-related tasks. Although its benefits are increasingly recognized, data on shared care is not routinely reported, and its impact on patient experience is less studied. Shared decision-making-a key component of patient experience-is consistently rated poorly by renal patients. Using data from the UK Kidney Patient Reported Experience Measure survey, we examined the variation in shared care offered across 67 UK kidney centers and assessed its association with shared decision-making scores. Shared care offer and acceptance was assessed by a single survey question. A measure of shared decision-making was derived from patient responses to three questions (scored between 1 = low and 7 = high). Associations between shared care and shared decision-making scores were analyzed at an individual level using linear mixed models. Analyzes included 6861 patients. 53% of respondents were offered shared care (47% in 2022), with rates from 13% to 93% between centers. Shared care was more likely to be offered to those aged 31-55 years, ethnic minorities and in satellite units. Those offered shared care gave higher scores for each question on shared decision-making, with a mean increase of 0.61 (95% CI 0.51-0.70, p < 0.0001) across all questions. Shared care participation in the UK is increasing but there remains considerable variation between centers with inequitable access to the opportunities it brings according to patient age, ethnicity and dialysis unit location. This study is the first to demonstrate a positive association between shared care and shared decision-making, suggesting that offering shared care can support shared decision-making and improve patient experience of care.
To investigate the effects of precannulation ice massage on pain, ecchymosis, hematoma, and patient satisfaction during arteriovenous (AV) fistula cannulation in patients receiving maintenance hemodialysis. This nonrandomized, sequential crossover study included 40 hemodialysis patients. Each participant underwent routine cannulation (control condition) followed by precannulation ice massage (intervention condition) in subsequent sessions. Pain and satisfaction were assessed using a 10-point Visual Analog Scale. Ecchymosis and hematoma were measured using transparent grid film with computerized area calculation. Data were analyzed using repeated-measures analysis of variance and Cohen's d. Ice massage significantly reduced pain during cannulation (Visual Analog Scale: 2.90 ± 1.08 vs. 6.12 ± 1.34; p < 0.001, d = 2.64), 72-h ecchymosis (2.02 ± 0.80 mm2 vs. 4.95 ± 1.41 mm2; p < 0.001, d = 2.55), and 72-h hematoma (1.57 ± 1.05 cm vs. 2.85 ± 0.83 cm; p < 0.001, d = 1.35). Patient satisfaction was significantly higher in the intervention condition (8.12 ± 0.72 vs. 5.02 ± 1.07; p < 0.001, d = 3.39). Precannulation ice massage is an effective, noninvasive intervention to reduce cannulation pain, minimize local complications, and enhance patient satisfaction. This simple and cost-effective method should be integrated into evidence-based hemodialysis care protocols. ClinicalTrials.gov identifier: NCT06332118 (prospectively registered).
Patients with kidney failure receiving dialysis are at an increased risk of cardiovascular events. Hemodiafiltration (HDF) has been shown to decrease cardiovascular mortality. Due to concerns around technical challenges and the need to achieve ultra-pure water standards, HDF is not readily available for those receiving hemodialysis at home. This study was conducted to describe the process and outcomes in implementing a home HDF program. Patients who received home HDF training between 2014 and 2024 at the Princess Alexandra Hospital, Australia were included. The primary outcome was the proportion of patients who successfully completed training for HDF at home. Outcomes related to training duration, water, and clinical outcomes including hospitalizations, transfer to facility-based hemodialysis were analyzed descriptively. In total, 42 patients (67% male, mean age 51.1 ± 12.8 years) undertook HDF therapy at home. About 39 patients commenced HDF training with a 100% training success rate, and 3 patients were supported by nursing-assisted HDF therapy at home. Median training duration was 61 days, which was longer for patients who were new to starting home dialysis (126 days), compared to those who converted from home hemodialysis to HDF (14.5 days, p < 0.05). HDF prescriptions were highly variable (mean treatment hours 15.7 ± 4.9 h/week). The median time of home HDF treatment was 17.5 months (interquartile range IQR 9.9-31). In the first 6 months after starting HDF at home, there were no hospitalizations due to dialysis-related technical issues including water-related problems. Three patients (7%) transitioned to facility-based hemodialysis. HDF at home is a safe therapy for patients who are considered to receive hemodialysis at home, offering increased flexibility and personalized prescriptions.
Patients with end-stage kidney disease face an extremely high risk of major adverse cardiovascular and cerebrovascular events. This study investigated the role of microRNA-26a in patients with end-stage kidney disease who have been receiving long-term hemodialysis. Blood samples were collected from patients with chronic kidney disease stages I-III and from those with end-stage kidney disease. Basic clinical information was recorded for all participants. Serum expression of microRNA-26a was measured using real-time quantitative polymerase chain reaction. Pearson correlation analysis was used to examine the relationships between microRNA-26a levels and clinical indicators, including serum albumin, estimated glomerular filtration rate, high-sensitivity C-reactive protein, serum creatinine, and blood urea nitrogen. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the association of microRNA-26a with disease progression and the occurrence of major adverse cardiovascular and cerebrovascular events. Serum microRNA-26a levels were significantly lower in patients with end-stage kidney disease compared with those with earlier-stage chronic kidney disease. MicroRNA-26a expression showed a positive correlation with serum albumin and estimated glomerular filtration rate, and negative correlations with high-sensitivity C-reactive protein, serum creatinine, and blood urea nitrogen. ROC curve analysis demonstrated that serum microRNA-26a levels had good diagnostic value for identifying end-stage kidney disease (area under the curve = 0.842). During follow-up, the cumulative incidence of major adverse cardiovascular and cerebrovascular events was 14% at 12 months, 22% at 24 months, and 34% at 36 months. MicroRNA-26a expression was significantly lower in patients who experienced these events. Both univariate and multivariate logistic regression analyses identified higher serum microRNA-26a levels as an independent protective factor against major adverse cardiovascular and cerebrovascular events in patients with end-stage kidney disease. In patients with end-stage kidney disease receiving long-term hemodialysis, microRNA-26a levels are associated with disease severity and the risk of major adverse cardiovascular and cerebrovascular events. Lower miR-26a expression may serve as a potential biomarker for disease monitoring and risk stratification.
In Erythropoiesis-Stimulating Agent (ESA)-hyporesponsive hemodialysis patients, hemoglobin (Hb) change from baseline may not fully capture durable treatment response. This secondary analysis evaluated sustained Hb ≥ 10 g/dL achievement and month-to-month Hb variability with roxadustat versus continued ESA therapy. This multicenter retrospective secondary analysis included adult maintenance hemodialysis patients with ESA-hyporesponsive anemia and complete monthly Hb data from Months 1-6. Sustained target achievement was defined as Hb ≥ 10 g/dL in at least 3 of 6 months. Hb variability was assessed using within-patient Hb SD, coefficient of variation, range, mean absolute monthly change, and maximum absolute change. Predictors were evaluated using logistic and linear regression. Among 108 patients, 78 received roxadustat and 30 continued ESA therapy. Sustained Hb ≥ 10 g/dL achievement occurred in 52 patients. Roxadustat was associated with higher adjusted odds of sustained target achievement versus ESA therapy (adjusted OR: 4.44, 95% CI: 1.24-15.84; p = 0.022). Higher baseline Hb was also independently associated with sustained response (adjusted OR: 2.95 per 1 g/dL, 95% CI: 1.57-5.55; p < 0.001). By Month 6, Hb ≥ 10 g/dL was achieved by 50.0% of roxadustat-treated patients versus 33.3% of ESA-treated patients. Hb variability metrics were numerically lower with roxadustat but were not significantly different between groups. In ESA-hyporesponsive hemodialysis patients, roxadustat was associated with higher adjusted odds of sustained Hb ≥ 10 g/dL achievement but did not clearly reduce month-to-month Hb variability over 6 months. These retrospective findings support sustained target achievement as a clinically relevant response metric and warrant prospective validation.
Patients on hemodialysis have comorbidities and malnutrition and are subject to polypharmacy, which contributes to disability and sarcopenia. These conditions increase the risk of falls and are associated with fractures, morbidities, substantial costs, nursing home admissions, hospitalization, and mortality. This prospective study evaluated the association of physical function, postural balance, frailty, fear of falling, and quality of life with the occurrence and number of falls within a 12-month interval in patients on hemodialysis. Patients were assessed for physical function (gait speed over 15 ft., timed up and go [TUG] test, 5-repetition sit-to-stand [5-STS] test, and handgrip strength), postural balance (Mini-Balance Evaluation Systems Test [Mini-BESTest]), frailty, fear of falling (Falls Efficacy Scale-International [FES-I]), and quality of life (36-Item Short Form Health Survey [SF-36]). Interviews were conducted for 12 months to monitor falls. One hundred twelve patients were included and the incidence rate was 1.62 falls/person-years. The occurrence of falls was associated with the TUG (OR: 1.24; 95% CI: 1.01-1.53) and 5-STS (OR: 1.11, 95% CI: 1.02-1.21) performance and frailty (OR: 7.22, 95% CI: 1.71-30.50). The number of falls was associated with the gait speed (OR: 0.22; 95% CI: 0.06-0.77), TUG test results (OR: 1.37; 95% CI: 1.16-1.62), handgrip strength (OR: 0.95; 95% CI: 0.91-0.99), Mini-BESTest (OR: 0.87; 95% CI: 0.78-0.96), frailty (OR: 4.43; 95% CI: 1.87-10.51), FES-I score (OR: 1.11; 95% CI: 1.06-1.17), and SF-36 scores in the physical functioning (OR: 0.98; 95% CI: 0.96-0.99), physical role (OR: 0.99; 95% CI: 0.98-0.99), and physical component summary (OR: 0.96; 95% CI: 0.92-0.99) domains. Patients undergoing hemodialysis have a higher incidence of falls. Falls are associated with physical function, postural balance, frailty, and quality of life.
Clinical guidelines recommend antimicrobial lock solutions when infection rates exceed specific thresholds, yet their ability to modify duration-dependent risk accumulation remains unexplored. This study compared catheter-related bloodstream infection (CRBSI) outcomes and duration-modifying effects between gentamicin-heparin and heparin-only lock protocols. This retrospective dual-center cohort study (January 2020-December 2024) included 266 maintenance hemodialysis patients with tunneled catheters (gentamicin-heparin: n = 198, 52,193 catheter-days; heparin-only: n = 68, 15,443 catheter-days). Primary outcome was CRBSI incidence density. Firth logistic regression with interaction analysis explored duration-modifying effects. Safety was evaluated through antimicrobial resistance patterns and a cross-sectional hearing assessment (15 gentamicin-exposed patients vs. 15 matched controls) using the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S). Gentamicin-heparin lock was associated with a 67% reduction in CRBSI (0.17 vs. 0.52 per 1000 catheter-days; incidence rate ratio 0.33, 95% CI 0.13-0.86, p = 0.024). Stratified analysis revealed divergent duration-risk relationships: each 30-day increment significantly increased CRBSI risk with heparin-only (OR 1.11, p = 0.006) but not with gentamicin-heparin (OR 1.02, p = 0.547). The duration-protocol interaction approached significance (coefficient -0.089, p = 0.061), suggesting gentamicin lock may attenuate time-dependent risk accumulation. Among CRBSI isolates in the gentamicin cohort, 87.5% (7/8) demonstrated gentamicin resistance. HHIE-S scores did not differ significantly between the gentamicin and control groups (p = 0.507). Gentamicin-heparin lock effectively reduced CRBSI incidence. Stratified analysis suggested attenuation of duration-dependent risk, though the interaction did not reach significance (p = 0.061). Sustained clinical efficacy despite high resistance, alongside a favorable preliminary hearing safety profile, suggests its clinical utility while warranting careful stewardship and prospective study.
Central venous stenosis and occlusion are recognized complications in hemodialysis patients and commonly present with ipsilateral arm, neck, or facial swelling. Unilateral breast edema is an uncommon manifestation that may mimic primary breast disorders and delay diagnosis. A 58-year-old woman with end-stage kidney disease receiving maintenance hemodialysis through a left-arm arteriovenous fistula presented with progressive unilateral left breast swelling accompanied by ipsilateral arm edema and facial congestion. Clinical evaluation excluded infection, malignancy, and lymphedema. Duplex ultrasonography suggested a central venous abnormality, and venography demonstrated complete occlusion of the left brachiocephalic vein with extensive collateral venous circulation. Endovascular treatment was performed with balloon angioplasty followed by self-expanding stent implantation because of significant elastic recoil. Post-procedural venography confirmed restoration of venous flow. The patient experienced rapid improvement in breast, arm, and facial swelling, with near-complete resolution at 1-month follow-up while maintaining functional dialysis access. Central venous obstruction should be considered in the differential diagnosis of unilateral breast swelling in hemodialysis patients. Prompt recognition and endovascular intervention can provide effective symptom relief, prevent unnecessary diagnostic procedures, and preserve vascular access.
This study aimed to evaluate the effects of three different music-based interventions on anxiety and fatigue levels in patients undergoing hemodialysis, compared to a concurrent control group receiving standard care. This randomized controlled trial involved 64 patients receiving maintenance hemodialysis. They were randomly assigned to four equal groups (n = 16 each): live music, live ney sound therapy (using a traditional reed flute known for its soothing, breath-like tones), a music-repeating robotic parrot therapy (an interactive robotic parrot that repeats music or sounds provided by the patient), or a control group (no intervention). The experimental groups received 30-min sessions 3 days per week for 2 months. The "Beck Anxiety Scale" and "Fatigue Severity Scale" were used to measure anxiety and fatigue, respectively. Assessments were performed before the intervention, immediately after the 2-month intervention period, and at 2 months after the end of the intervention period. Before the intervention, there were no significant differences in anxiety or fatigue scores across the four groups (p > 0.05). After the interventions, all three groups exposed to music therapy showed significant reductions in both anxiety and fatigue scores compared to the control group (p < 0.001). All three therapies were effective in managing anxiety and fatigue symptoms in hemodialysis patients. Among them, music-repeating robotic parrot therapy demonstrated the most superior and longest-lasting effects in reducing both anxiety and fatigue levels. ClinicalTrials.gov identifier: NCT07238374.
Late arteriovenous fistula (AV fistula) occlusion is a major cause of morbidity in hemodialysis patients. The Systemic Immune-Inflammation Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), and Geriatric Nutritional Risk Index (GNRI) have emerged as candidate prognostic biomarkers. This study aimed to compare their predictive accuracy, evaluate their independent prognostic value, and develop a combined risk score. This retrospective cohort study included 750 hemodialysis patients undergoing primary AV fistula creation. Baseline Systemic Immune-Inflammation Index, Neutrophil-to-Lymphocyte Ratio, and Geriatric Nutritional Risk Index were collected preoperatively. The primary outcome was late AV fistula occlusion (> 90 days). Predictive performance was assessed using ROC analysis and Cox proportional hazards regression. Over a median follow-up of 48 months, 38.0% of patients developed late AV fistula occlusion. Systemic Immune-Inflammation Index demonstrated the highest predictive accuracy (AUC: 0.79), significantly outperforming Geriatric Nutritional Risk Index (p < 0.001). In multivariate analysis, Systemic Immune-Inflammation Index > 850 (Hazard ratios 3.15, 95% CI: 2.28-4.35), Neutrophil-to-Lymphocyte Ratio > 4.5 (Hazard ratios 2.78, 95% CI: 2.02-3.82), and Geriatric Nutritional Risk Index < 92 (Hazard ratios 1.92, 95% CI: 1.41-2.62) were independent predictors. A combined risk score integrating these biomarkers achieved superior discrimination (AUC: 0.83). Baseline vascular diameters were not independently associated with occlusion risk in this cohort. The synergistic interaction between inflammation and malnutrition identifies a distinct high-risk phenotype. The combined risk score is a readily implementable tool that may support personalized surveillance strategies to improve long-term AV fistula outcomes in hemodialysis patients.
Hemodiafiltration has demonstrated improved outcomes in end-stage kidney disease, particularly with higher convection volumes than conventional hemodialysis. However, data on multiethnic Asian populations remain limited. This study evaluated the feasibility of achieving relatively high targeted convection volumes in hemodiafiltration in patients with end-stage kidney disease in Singapore. This retrospective cohort analysis included 1404 patients undergoing hemodiafiltration between 2019 and 2023 at Fresenius Kidney Care clinics in Singapore using data obtained from the EuCliD database. Patients aged ≥ 18 years and on hemodiafiltration for > 3 months were included. Multivariate regression models were used to assess the factors associated with the attainment of convection volume. Over 291,000 hemodiafiltration sessions were analyzed. The mean convection volumes achieved were 21.8 L in post-dilution and 40.8 L in pre-dilution mode. Higher blood flow rates and treatment durations were significantly associated with relatively high targeted convection volume (p < 0.001). The distribution of convection volume was similar among Chinese, Indian, and Malay patients. Ethnicity, age, and vascular access were not significant predictors. Approximately 29% of the variation in achieved convection volume was attributable to center-related factors. Relatively high targeted convection volume in hemodiafiltration was consistently achieved across a multiethnic cohort in Singapore. These findings support the feasibility of delivering high-volume hemodiafiltration to diverse real-world settings.