The efficiency of hemodialysis varies substantially across different solute classes, but the determinants of this variability remain poorly characterized, limiting personalized prescription. In this prospective randomized study, 60 maintenance hemodialysis patients were assigned to three modalities: hemodiafiltration (HDF), hemodialysis with HA130 hemoperfusion, and hemodialysis with KHA130 hemoperfusion. Clearance of p-cresyl sulfate (PCS), β2-microglobulin (β2-MG), advanced glycation end products (AGEs), and indoxyl sulfate (IS) was assessed. Multivariable linear regression, interaction analysis, subgroup analysis stratified by dialysis vintage tertiles, nonlinear quadratic regression, and machine learning (LASSO and Elastic Net) were applied. HD + KHA130 significantly improved PCS clearance compared with HDF (β = 45.26, 95% CI: 6.26-84.27, P = 0.023), an effect robust to multivariable adjustment. Significant interactions between treatment modality and dialysis vintage were observed for PCS (P = 0.008), β2-MG (P = 0.002), and IS (P = 0.044). Exploratory subgroup analyses suggested that adsorption may benefit β2-MG and IS more in short dialysis vintage, whereas HD + KHA130 appeared more advantageous for PCS in long vintage patients. The relationship between dialysis vintage and PCS clearance followed a U-shaped pattern, with a nadir at approximately 60 months (bootstrap median; 95% CI: 9.6-218.1; P = 0.038). Machine learning identified dialysis vintage, age, treatment method, and CRP as the most stable predictors of PCS clearance. HD + KHA130 significantly enhances PCS clearance, and may be most beneficial in patients with longer dialysis vintage. These findings support personalized treatment selection based on both solute type and dialysis vintage.
A targeted UPLC-MS/MS method was developed for the comprehensive characterization of 58 anthocyanins and their derivatives (A&D) in Marselan wines. Significant differences among vintages were observed for 12 compounds, with acetylated anthocyanins and pyranoanthocyanins emerging as potential vintage markers. Multi-vintage analysis revealed a pronounced decline in total A&D during aging, accompanied by an increasing proportion of pyranoanthocyanins. Geographical comparison indicated that the A&D profiles clearly discriminated wines from distinct regions (Ning xia, Hebei, Xinjiang), whereas subregional distinction within Ningxia was limited. Multivariate models, particularly SVM, achieved high accuracy at the regional level (> 96%), confirming the potential of A&D fingerprints as robust markers for vintage differentiation and regional traceability of Marselan wines.
Chardonnay (Vitis vinifera L.) is one of the most widely cultivated white grape varieties in Chile, yet integrated studies addressing phenolic composition, polysaccharides, and color in commercial wines remain limited. This study characterized 30 commercial Chardonnay wines from major Chilean regions through a comprehensive analysis of phenolic composition, polysaccharide fractions, and CIELab color parameters, considering multiple sources of variability including vintage (2023-2024), closure type, geographic location, and valley of origin. Basic oenological parameters showed low variability, confirming their strong technological regulation in commercial wines. In contrast, total tannins, selected chromatic coordinates (particularly a* and hue angle), polysaccharide fractions, and several low-molecular-mass phenolics exhibited significant differences mainly associated with geographic origin and closure type. Among phenolic families, hydroxycinnamates, phenolic alcohols, and flavonols emerged as the most discriminant compositional domains. Multivariate analysis revealed that wine differentiation was structured by overlapping compositional gradients involving phenolic evolution, color expression, and polysaccharide composition rather than by vintage alone. Overall, the results highlight the multifactorial nature of Chardonnay wine composition and the combined contribution of grape origin, closure-associated bottle evolution, and winemaking factors. Nevertheless, because wines were commercially sourced and bottle age and storage conditions were not standardized, closure-associated differences should be interpreted cautiously as associations rather than causal effects.
The malnutrition-inflammation score (MIS) is a composite indicator widely used in dialysis populations to evaluate nutritional deficiency and chronic inflammation. However, its association with structural peritoneal alterations remains unclear. This study aimed to investigate the relationship between MIS and the peritoneal sclerosis index (PSI) in long-term peritoneal dialysis (PD) patients. This single-center cross-sectional study included 191 PD patients with dialysis duration≥3 years. MIS was assessed using a standardized scoring system, and PSI was quantified based on structural abnormalities identified on abdominal computed tomography (CT). In response to the reviewer comment, beta2-microglobulin was additionally incorporated into the comparative analysis together with dialysis vintage, age, peritoneal equilibration test score, and dialysis adequacy. The association between MIS and CT-defined peritoneal sclerosis was evaluated using Spearman correlation, multivariate linear regression, and logistic regression analyses, and an exploratory screening of other candidate clinical indicators associated with PSI was also performed. When PSI was used as the CT-based marker of peritoneal sclerosis, dialysis vintage showed the strongest correlation with PSI (r = 0.333, P < .001). MIS showed only a weak correlation with PSI (r = 0.114, P = .116), whereas beta2-microglobulin was also weakly correlated (r = 0.154, P = .034). In univariate logistic analysis, MIS was associated with clinically significant peritoneal sclerosis (PSI≥5; odds ratio 1.13, P = .017), but this association was attenuated after adjustment for dialysis vintage, age, peritoneal equilibration test score, dialysis adequacy, and beta2-microglobulin. Exploratory analysis further showed that lower urine output and higher PD volume were associated with higher PSI values. MIS may be clinically useful as a composite risk-stratification marker reflecting malnutrition-inflammatory burden and systemic vulnerability, rather than as an independent specific predictor of CT-defined peritoneal sclerosis. In this cohort, dialysis vintage remained the most stable correlate of CT-defined sclerosis burden, while beta2-microglobulin provided only limited additional discriminatory value.
The spontaneous fermentation of grape must, driven by indigenous microbial consortia, is a key process underpinning wine typicity and regional character. While large-scale biogeography shapes vineyard microbiomes, the relative influence of host grape variety versus annual vintage conditions on the fermenting ecosystem and its metabolic output remains poorly resolved under similar cultivation terroir conditions. To address this, a time-resolved study across six grape varieties from two consecutive vintages was analyzed fungal community dynamics via amplicon sequencing, and characterized volatile aroma profiles through HS-SPME-GC-MS during wine spontaneous fermentations. Our results demonstrate that grape variety is the principal determinant of the initial epiphytic microbiota and the ensuing successional trajectory. The differences observed between the 2023 and 2024 vintages secondarily modulated this dynamic, primarily through alterations in must chemistry, leading to distinct shifts in microbial network complexity and volatile compound accumulation. Crucially, the final aroma profile emerged from a multi-species interaction network, where a defined cohort of non-Saccharomyces yeasts acted as keystone taxa (mainly Hanseniaspora, Wickerhamomyces, Torulaspora, and Starmerella), contributing significantly to ester and higher alcohol production before the dominance of Saccharomyces. This work establishes a mechanistic framework linking varietal traits and vintage-related differences (2023 vs. 2024) to microbial community function and flavor formation, providing critical insights into the influence of variety and temporal variation on wine terroir expression.
Pre-harvest foliar application of chitooligosaccharide (COS) was evaluated for its impact on the flavor quality of Cabernet Gernischt wines. COS was applied at the young berry (YB) and early veraison (EV) stages across the 2022 and 2023 vintages. Physicochemical parameters, phenolic compounds, color index, volatile composition, and sensory quality were systematically analyzed. In 2022, alcohol content and total acidity increased in both treatment groups, total phenols increased in the EV group but decreased in the YB group. In 2023, alcohol and acidity showed opposite trends between the two treatment groups, while phenolic compounds decreased. COS treatment increased wine lightness and yellow tone but reduced red tone and color saturation. In 2022 vintage, YB treatment increased total volatiles with 8.18% and terpenoids with 138.91%, while esters increasing by 34.72-53.60%. In 2023 vintage, total volatiles decreased by approximately 15%, with esters significantly decreasing by 26.60% (YB) and alcohols by 25.96% (EV), while fatty acids increased by 32.70% (EV). OPLS-DA identified key aroma compounds, including phenethyl acetate, ethyl caprate, heptyl acetate, and isoamyl acetate. Aroma wheel analysis showed that fruity and floral notes were enhanced in 2022 but reduced in 2023, with the EV stage consistently performing better. Overall, COS application at the early veraison stage represents a promising strategy for modulating wine flavor quality.
Intradialytic (ID) oral nutritional support is recommended as part of comprehensive nutritional care for patients on maintenance hemodialysis (HD). Evidence on food-based, patient-centered, coherent and consistent approaches implemented at national scale is scarce. This study aimed to characterize the nutritional profile of a structured, autonomy-based ID meal model across a national HD clinics; to assess the differences in intradialytic nutritional intake between patients stratified by malnutrition-inflammation risk (MIS <6 vs. MIS ≥6) and by diabetes status; and to identify independent predictors of nutritional goal attainment and of intradialytic energy and protein intake. Cross-sectional nationwide analysis of 3032 HD patients from 27 outpatient clinics. The ID meal chosen during the mid-week session was recorded and quantified. Group comparisons used the Chi-square test and Mann-Whitney U test. Binary logistic regression identified independent predictors of nutritional goal attainment ≥300 kcal and ≥7 g protein per session. Multiple linear regression examined predictors of energy and protein intake, adjusting for age, sex, diabetes status, Charlson Comorbidity Index (CCI), HD vintage and body mass index (BMI). Meal adherence was 97%. Sixty-six percent of patients attained the dual nutritional goal; median intake was 358 kcal, 12.7 g protein and 4.2 g fiber. Energy and protein intake were equivalent between MIS subgroups (p = 0.883 and p = 0.193). Diabetic patients consumed lower energy and carbohydrate, but equivalent protein compared with non-diabetic patients (p = 0.207). In logistic regression, older age (adjusted OR 0.808 per 10-year increment, 95% CI 0.763-0.856, p < 0.001) and shorter HD vintage (adjusted OR 1.024 per 12 months, 95% CI 1.012-1.048, p < 0.001) were the only independent predictors of goal non-attainment; diabetes and MIS ≥6 were not (p = 0.378 and p = 0.453 respectively). In linear regression, age and HD vintage were the only significant predictors of both energy (R2 = 2.2%) and protein intake (R2 = 1.0%); diabetes was not independently associated with either. A structured, food-based, patient-centered intradialytic meal model, sustained by systematic education and monthly reassessment, delivers high adherence and nutritionally adequate macronutrient intake across a clinically heterogeneous HD population. Within the constraints of a cross-sectional design, these findings support the feasibility and nutritional appropriateness of a structured, food-based intradialytic meal model across clinically heterogeneous patient groups. Whether this translates into improved clinical outcomes requires longitudinal evaluation. The model should be considered as a component of a comprehensive nutritional strategy, complemented by individualzed counselling and regular re-assessment. In patients at high risk of malnutrition and diabetes, promoting autonomy in choosing the contents of the intra-dialytic meal appears to be safe and suitable for these patients' needs. Therefore, we believe it should be encouraged and complemented with nutritional education and counseling.
To evaluate the relationship between the Weston Score (WS) and the degree of stenosis on coronary angiography (CAG) in patients with End-Stage Renal Disease (ESRD), and to investigate whether the WS for coronary artery calcification (CAC) can aid in the early diagnosis of coronary artery disease. This retrospective study analyzed chest computed tomography (CT) scans from 105 ESRD patients who underwent CAG between January 2021 and January 2025. The presence and extent of calcium in the main coronary arteries-the left main coronary artery (LMCA), left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA)-were visually assessed. The WS (range 0-12) was calculated by summing the scores for each vessel, with a score of WS ≥ 7 indicating severe calcification. Spearman correlation analysis was used to assess the correlation between the WS and the degree of coronary stenosis (< 50% vs. ≥50%). The predictive value of the WS for significant stenosis was evaluated using receiver operating characteristic (ROC) curve analysis. Agreement between the WS and CAG findings was assessed with the Kappa test. Clinical data were compared between groups based on the WS. Among the 105 patients, the majority were male (79.05%), with a mean age of 63.44 ± 9.30 years. Unstable angina was the most common cardiovascular event (44.76%), and hypertension was the most frequent comorbidity (82.86%). CAG revealed that severe four-vessel disease (Grade IV) was most common (79.05%), with the LAD being the most severely affected vessel. WS assessment showed the highest calcification prevalence in the LAD (95.24%), with 69% classified as severe. The LMCA had the lowest calcification prevalence (42.86%), with mostly mild calcification. The LCX and RCA had intermediate prevalence, with the LCX having a higher proportion of moderate-to-severe calcification than the RCA. Significant coronary stenosis (≥ 50%) was present in 90.48% of patients, and 66.31% of these had a WS ≥ 5. All 10 patients with stenosis < 50% had a WS < 5. Spearman analysis confirmed significant positive correlations between the WS and stenosis degree for all coronary branches (all P < 0.05), with varying correlation strengths. ROC analysis indicated the highest diagnostic performance for the LMCA (area under the curve [AUC] = 0.878, P < 0.001), followed by the LCX (AUC = 0.737, P < 0.001). The LAD showed statistical significance (AUC = 0.683, P = 0.009), while the RCA had the weakest predictive ability (AUC = 0.608, P = 0.071). The combined WS for all four vessels predicted significant stenosis with an AUC of 0.902 (P < 0.001). The optimal diagnostic cutoff was a score of 5, yielding a sensitivity of 66.3% and specificity of 100%. Furthermore, patients in the WS ≥ 5 group had a lower mean age than those in the WS < 5 group (P = 0.034); dialysis vintage was significantly longer (P = 0.009); and levels of troponin I, creatinine, and serum calcium were all higher than those in the WS < 5 group (all P < 0.05). WS is significantly positively associated with coronary stenosis severity in ESRD patients. It provides a reliable assessment for LMCA and LCX stenosis but has limited value for the RCA. A WS cutoff of ≥ 5 offers improved identification of coronary stenosis in these patients and can serve as a preliminary screening tool, although CAG remains essential for definitive diagnosis. Age, dialysis vintage, troponin I, creatinine, and serum calcium levels may be associated with CAC in ESRD.
Minimizing delays during the pre-kidney transplant workup is critical for patients and providers. We evaluated the factors associated with workup completion times across the processes and key investigations in our program. In this single-center, retrospective cohort study, we included all candidates who initiated their pretransplant workup between January 1, 2019 - December 31, 2022. Patients were allocated, based on their consecutive referrals, alternately to an intensified pretransplant clinic follow-up process with more frequent assessment visits every 4 months during evaluation (Cohort 1), or a single initial assessment with no interim visits until full workup completion (Cohort 2). Follow-up was continued until June 1, 2025. Ethical approval was obtained with waived informed consent. In total, 207 patients were allocated to Cohort 1 (n = 94, Age 52.2 ± 14.2 years, 45.7% female) and Cohort 2 (n = 113, Age 56.8 ± 12.1 years, 43.4% female), with no significant demographic differences between cohorts. Cohort 1 demonstrated a significantly shorter median workup duration (12.8 vs. 17.1 (-4.1 months), P = 0.007) and reduced dialysis vintage at the time of transplant decision (22.3 vs. 29.4 (-7.1 months), P = 0.056). Frequent pre-transplant assessment visits were associated with expedited workup completion and reduced dialysis vintage.
Oxidative stress (OS) is elevated in patients with end-stage kidney disease undergoing maintenance dialysis and contributes to increased cardiovascular risk. While kidney dysfunction and dialysis can generate OS, the acute effects of a single dialysis session remain unclear due to variability in study design and the biomarkers used. In this observational study, blood samples from 68 hemodialysis patients were collected before and after a single session. Plasma levels of the reactive oxygen species marker superoxide (O2•-) and OS-damage marker lipid hydroperoxides (LOOHs), protein-bound malondialdehyde (PrMDA), protein-bound thiobarbituric acid reactive substances (PrTBARSs), and protein carbonyls (PrCOs) were measured. LOOHs increased significantly by 50% post-dialysis, whereas PrMDA and PrTBARSs decreased modestly by ~10%. No significant changes were observed in O2•- or PrCOs. Dialysis vintage correlated positively with LOOHs, PrMDA, and PrTBARSs, but not with O2•- or PrCOs. No significant associations were found between OS markers and comorbidities, medication or sex. The post-dialysis rise in LOOHs, an early-formed and least accumulating lipid peroxidation marker, may reflect acute changes in OS during a single HD session. The rising association of PrMDA and PrTBARSs with dialysis vintage may suggest cumulative OS over time.
This study aims to determine the latent categories of family resilience among patients undergoing maintenance hemodialysis (MHD) and to explore the influencing factors. This cross-sectional study was conducted at two tertiary grade A hospitals affiliated with Jiangnan University from September 2025 to December 2025. The Family Resilience Assessment (FRAS-C) in its shortened version, Family Care Index Questionnaire, and the Medical Coping Modes Questionnaire (MCMQ) were utilized to assess the patients. Additionally, general information regarding the patients was collected. Latent Profile Analysis (LPA) was employed to identify potential subgroups of family resilience among MHD patients. Using these latent profile subgroups as the dependent variable, a multinomial logistic regression analysis was performed to investigate their influencing factors. The results of the multivariate logistic regression were visualized through a forest plot generated by GraphPad Prism version 10.1.2 software. The potential profile analysis revealed three distinct categories of family resilience: the Low Family Resilience - Insufficient Resource Utilization Group (n=72, 23.1%), the Moderate Family Resilience - Balanced Adaptation Group (n=139, 44.5%), and the High Family Resilience - Positive Interaction Group (n=101, 32.4%). The results of the multiple logistic regression analysis indicated that significant influencing factors for these categories of family resilience included marital status, the number of complications, dialysis vintage, family functioning, and medical coping. This study employed LPA to categorize the family resilience of patients undergoing maintenance hemodialysis into three distinct profiles. The findings revealed significant heterogeneity in family resilience within this population. Hill's ABC-X family crisis model serves as a viable framework for exploring factors associated with family resilience among maintenance hemodialysis patients. The study demonstrated that family resilience in patients is significantly correlated with marital status, the number of complications, dialysis vintage, family functioning, and medical coping. In future treatment and care strategies for maintenance hemodialysis patients, implementing targeted interventions based on the identified profiles of family resilience holds important clinical significance.
Sagliker syndrome (SS) is a severe, disfiguring manifestation of refractory secondary hyperparathyroidism (SHPT). Although parathyroidectomy (PTX) corrects biochemical abnormalities, long-term outcomes after PTX in patients with SS remain uncertain. This study hypothesized that SS represents a high-risk phenotype associated with adverse long-term outcomes despite surgical intervention. This single-center retrospective cohort study included 740 dialysis patients with severe refractory SHPT who underwent PTX. The patients were classified into SS (n = 70) and non-SS (n = 670) groups. Multivariable logistic regression was used to identify factors associated with SS; Cox models were used to evaluate associations of SS with all-cause and cardiovascular disease (CVD) mortality. Sensitivity and subgroup analyses were used to assess robustness. The prevalence of SS was 9.5%. Independent factors associated with SS included longer dialysis vintage (odds ratio [OR] = 1.21, P < 0.001), alkaline phosphatase (ALP) > 315 U/L (OR = 4.14, P < 0.001), hypoalbuminemia (OR = 0.92, P = 0.013), cardiac valve calcification (OR = 2.11, P = 0.014), and abdominal aortic calcification (OR = 2.14, P = 0.016). Exploratory cephalometry in a small subset was consistent with previous SS reports. Exploratory post-PTX analyses suggested improved quality of life (QOL; n = 25), reduced bone pain (n = 45), and stabilization of height loss (n = 15) in patients with SS (all P < 0.05). Over a median follow-up of 81 months, SS was independently associated with higher all-cause mortality (hazard ratio [HR] = 1.71, 95% confidence interval [CI]: 1.01-2.89; P = 0.045) and CVD mortality (HR = 2.44, 95% CI: 1.17-5.06; P = 0.018) after PTX. In this PTX-treated cohort, SS was associated with longer dialysis vintage, high bone turnover, and vascular calcification. Although PTX may provide symptomatic benefit, SS remained associated with higher long-term mortality after PTX and may reflect irreversible systemic damage.
A rapid and robust mass spectrometric approach based on ion suppression effects was developed for the identification and authentication of liquid food samples. Wine was used as a model system to evaluate sample discrimination according to vintage, country of origin, producer and name. A defined mixture of 25 chemical marker compounds was added to each sample, followed by dilution and direct analysis using electrospray ionization mass spectrometry (ESI-MS) operated in selected ion monitoring (SIM) mode. Sample-specific matrix effects on the ionization efficiencies of the marker compounds produced characteristic mass spectral response patterns, which were acquired within approximately 1 min per sample. These patterns were compared with reference data derived from a comprehensive wine database. Multivariate statistical analysis was performed using linear discriminant analysis (LDA) combined with complementary distance-based metrics. The approach was validated using five vintages of several premium wines. High authentication scores were obtained for all samples, demonstrating the suitability of the approach for rapid wine authentication and verification of origin. The results indicate that ion suppression-based MS fingerprinting represents a promising tool for fast, minimal-preparation assessment of authenticity in food analysis.
Older adults represent the fastest-growing demographic group initiating hemodialysis (HD) in the United States. Compared with older adults who do not receive HD, they commonly report a lower quality of life (QOL). However, their perspectives on QOL are poorly understood. The objective of this study was to identify and characterize QOL priorities of older adults receiving HD. Cross-sectional study using Q-methodology. Participants were recruited from dialysis centers in and around Durham, North Carolina. Each participant sorted 35 QOL statements based on the level of agreement (eg, agree, disagree, or neutral). Factor analysis of the Q-sorts was performed using the PQ Method software. Factors were interpreted and described as QOL priorities. Demographic and clinical characteristics were summarized overall and based on factors. 29 older adults were recruited with a mean age of 76.2 ± 5.6 years, a median dialysis vintage of 3 (1-4.8) years, and 18 (62.1%) women. Ten (34%) participants screened positive for frailty questionnaire responses and 16 (55.2%) participants reported using an assisted device. Factor analysis revealed the following 2 distinct QOL prioritization profiles: (1) "Everyday Well-Being" and (2) "Safety and Security." "Everyday Well-Being," defined using 16 Q-sorts, represented a perspective that highly valued cognitive function (memory/thinking ability), spirituality, adequate pain control, and well-functioning dialysis access. "Safety and Security," defined using 11 Q-sorts, represented a perspective that highly valued socioeconomic stability, including financial stability, access to reliable transportation, and safety. We observed no difference in age, dialysis vintage, or performance on cognitive, physical function, and frailty assessments between participants whose Q-sorts defined each prioritization profile. Cross-sectional design, confinement to 1 geographical region. Using Q-methodology, we identified 2 dominant profiles of QOL priorities among older adults receiving HD. These findings highlight heterogeneity in what matters most to older adults receiving HD and the need for personalized, patient-centered approaches to evaluating and improving their QOL. Older adults receiving hemodialysis (HD) experience unique challenges, yet their perspectives on quality of life (QOL) are not well understood. We examined the QOL priorities of older adults receiving HD through a series of rankings and identified 2 distinct priority profiles. The first group of older adults focused on their everyday well-being, maintaining cognitive function, pain management, and functional dialysis access. The second group prioritized safety and security, including socioeconomic stability and recovery after dialysis treatments. Understanding what matters most to older adults receiving HD will facilitate individualized, patient-centered care and development of patient-centered interventions to improve the QOL of older adults.
Background and Objectives: Psychological resilience is central to emotional adaptation in patients undergoing maintenance hemodialysis (HD). Although psychosocial determinants have been widely studied, the role of routinely monitored biochemical markers remains insufficiently defined. Materials and Methods: This study examined the associations between selected metabolic-inflammatory biomarkers and psychological resilience in adults receiving maintenance HD and explored potential gender-related differences. Resilience was assessed using the Resilience Scale-14 (RS-14). β2-microglobulin, serum albumin, calcium, and 25-hydroxyvitamin D were analyzed as continuous predictors. Multiple linear regression models with heteroscedasticity-consistent robust standard errors (HC3) were adjusted for age, HD vintage, diabetes, and cardiovascular disease. Two interaction terms (Gender × β2-microglobulin and Gender × albumin) were specified a priori. Model stability was evaluated using nonparametric bootstrap resampling (5000 iterations) and penalized regression with cross-validation. Results: In bivariate analyses, higher β2-microglobulin levels were associated with lower resilience (ρ = -0.24; p = 0.041), whereas serum albumin showed a positive but non-significant association (p = 0.14). These relationships did not remain statistically significant in fully adjusted models (β2-microglobulin: p = 0.107). No Gender × Biomarker interaction reached statistical significance (p = 0.162). Stratified analyses showed consistent directional patterns across gender groups. Conclusions: Metabolic-inflammatory biomarkers, particularly β2-microglobulin and serum albumin, may be associated with psychological resilience in HD. However, gender-specific effects were not supported in adjusted analyses. These findings require validation in larger, longitudinal, multicenter studies.
This study explores the maintenance of dietetic full time equivalent staffing alongside malnutrition rate in a metropolitan renal dialysis service in Victoria, Australia. Objectives were to: (1) describe changes in dietitian staff-to-patient ratios over time; (2) evaluate dietetic service delivery against best practice guidelines and (3) report malnutrition prevalence over a 10-year period. Data were collated from nine retrospective point prevalence audits conducted between 2009 and 2024 across satellite, home haemodialysis and peritoneal dialysis modalities. Nutritional status was primarily assessed using the Subjective Global Assessment, with the Mini Nutritional Assessment and Global Leadership Initiative on Malnutrition criteria introduced in 2024. Malnutrition prevalence was analysed across gender, age and dialysis vintage. Staffing levels were mapped against patient growth, with a target of 1 full time equivalent dietitian per 143 patients (1:143). A decade of renal dietetic staffing and malnutrition prevalence in dialysis patients: An observational study in a large dialysis population RESULTS: Between 2014 and 2024, dietitian staffing levels increased proportionally with patient numbers, maintaining dietitian staff-to-patient ratios between 1:126 and 1:157. Nutritional assessments completed in the home haemodialysis population rose from 25% to 96%. Malnutrition prevalence declined from 25% to 18% in the haemodialysis and from 22% to 11% in the home haemodialysis populations. These improvements were sustained over time. Malnutrition prevalence was higher in older adults, females and individuals on dialysis for less than 1 year. This audit observed that maintaining dietetics staffing in line with recommendations aligned with sustained reductions in malnutrition prevalence. These findings support the integral role of renal dietitians in multidisciplinary renal care.
Although haemodialysis (HD) is an established treatment for kidney failure patients, HD treatments generate greenhouse gases. Hospitals in the United Kingdom have been tasked with reducing the environmental impact of HD. We reviewed the effect of reducing dialysate water usage. Dialysate flows were reduced from 500 mL/min to dialysate/blood flow ratios of 1.5:1 for HD and 1.2:1 for haemodiafiltration (HDF) treatments in a single dialysis centre and the effects evaluated over 3 months. One hundred ninety kidney failure dialysis patients; 65.8% male, 47.4% diabetic, dialysis vintage 48 (19-108) months, were switched to lower dialysate flows. The mean blood flow was 301 ± 16.3 mL/min, so by switching dialysate flows, the volume of dialysate water was reduced from 131 ± 19.4 to 100.7 ± 19.5 L/session, approximately 15 554.3 L/week, with a projected annual saving of 808 821 L of ultrapure quality water, and 1617 642 L accounting for water lost in the production of dialysate. There was no difference in sessional KtVurea (pre 1.18 ± 0.3, 1 month 1.20 ± 0.37, 3 months 1.16 ± 0.25) or serum β2 microglobulin (27.9 ± 6.6, 1 month 28.3 ± 7.5 and 3 months 28.2 ± 6.2 mg/L). Equally there were no differences in pre dialysis serum potassium, bicarbonate, or phosphate. Reducing dialysate flows resulted in a major reduction in ultra-pure dialysis water usage and greenhouse gas emissions, with additional reductions in dialysate acid concentrate usage, and electricity without any adverse impact on small or middle molecular weight solute clearances. Extrapolating to a 30-station dialysis unit this would result in an annual reduction of around 9500 kg carbon dioxide equivalent emissions (CO2e) greenhouse gas.
Patients receiving maintenance hemodialysis (MHD) experience a high mortality burden, with cardiovascular disease remaining a major cause of death. This study aimed to evaluate the association between adjunctive hemoperfusion combined with conventional hemodialysis (HD + HP) and long-term survival outcomes in patients receiving MHD. This single-center retrospective cohort study was conducted at Shanghai Changhai Hospital. Patients with end-stage renal disease who received MHD between January 2015 and December 2023 were retrospectively identified from the center's hemodialysis records. Among the 640 eligible patients, 419 (65.5%) received HD during the study period, whereas 221 (34.5%) received adjunctive HP in addition to HD. HP exposure was modeled as a time-varying covariate in a multivariable time-dependent Cox proportional hazards model to account for treatment timing. A marginal structural model (MSM) using stabilized inverse probability of treatment weighting was further constructed to address measured time-dependent confounding. Propensity score matching was performed as a sensitivity analysis using 1:1 nearest-neighbor matching without replacement, with a caliper width of 0.02. Survival outcomes in the matched cohort were evaluated using Simon-Makuch curves and Mantel-Byar tests. Among the 640 included MHD patients, the median age was 67.5 years, 66.9% were male, and the median dialysis vintage was 48.0 months. During follow-up, 348 patients died, corresponding to all-cause mortality proportion of 54.4% in the study sample. Diabetic kidney disease was the most common primary renal disease (30.9%), followed by chronic glomerulonephritis (29.4%) and hypertensive nephropathy (18.6%). Among the 348 deaths, cardiovascular disease was the leading cause of death (32.8%), followed by multiple organ dysfunction syndrome (21.6%). In both the multivariable time-dependent Cox model and the MSM, HD + HP was consistently associated with a lower risk of all-cause mortality compared with HD, with HRs of 0.69 (95% CI, 0.52-0.90; P = 0.009) and 0.73 (95% CI, 0.55-0.97; P = 0.030), respectively. After 1:1 propensity score matching, 173 patients remained in each group with improved baseline balance. In the propensity score-matched cohort, Simon-Makuch analyses further supported a protective association of HD + HP with all-cause and cardiovascular mortality compared with HD (Mantel-Byar test, P = 0.032 and P = 0.003, respectively). In this single-center retrospective cohort of patients receiving MHD, cardiovascular disease was the leading cause of death. HD + HP therapy was associated with lower all-cause mortality in time-dependent Cox regression and MSM-based weighted analyses, and with lower all-cause and cardiovascular mortality in propensity score-matched Simon-Makuch analyses. These findings suggest a potential survival benefit of adjunctive HP.
Grapevines host diverse microbial communities, including fungal pathogens associated with grapevine trunk diseases (GTDs), which pose a major challenge in viticulture. Despite extensive research, the ecological drivers shaping fungal community composition across different grapevine microhabitats remain insufficiently understood. Using ITS2 metabarcoding, we characterized fungal communities in bark, wood, and soil from Esca symptomatic and asymptomatic vines, and evaluated the effects of season, year, cultivar, microhabitat, and plant health on key functional groups. Seasonal variation had limited effects on fungal richness, whereas interannual differences had a strong impact on functional group diversity. Microhabitat played a key role: plant pathogens, particularly GTD-associated taxa, were most prominent in bark and wood; mycoparasites were dominant in bark; generalist saprotrophs prevailed in soil and bark; and GTD-related wood saprotrophs were most abundant in bark. Soil harbored the highest overall fungal diversity. Plant health status significantly affected only GTD pathogens, which showed higher abundance and diversity in symptomatic vines. Cultivar influenced only the richness of GTD-related wood saprotrophs. Year (vintage) emerged as a major driver of fungal community composition across plant tissues and soil, driving the most pronounced shifts in the mycobiome. Abiotic factors (year and season) were most strongly associated with soil fungal communities, whereas biotic factors (cultivar and plant health) exerted a greater influence on fungi associated with grapevine tissues. These findings underscore the central role of microhabitat and temporal variation in structuring the grapevine mycobiome.
The number of dialysis patients in China is rapidly increasing, with the proportion of older adults aged ≥ 60 years rising, linked to population aging and longer dialysis duration. This study investigated frailty prevalence in Chinese maintenance hemodialysis (MHD) patients, analyzed its status, risk factors and correlation with long-term survival in older dialysis patients to provide evidence for frailty interventions. A total of 391 patients were assessed for frailty using the Frailty Screening Scale. Demographic, clinical, and biochemical data were collected, with 24-month follow-up for survival. Multivariate regression and Cox regression models were used for analyses. The cohort comprised 222 male patients (56.9%), with a mean age of 61 ± 13.9 years and a median dialysis vintage of 4 (2.0, 8.5) years. Patients aged ≥ 60 years accounted for 57.5% of participants. Frailty assessment showed that 85.3% of older patients had varying degrees of frailty, and 52.7% were in the pre-frail status. Increased age and low albumin level were identified as clinical correlates of frailty. During the 24-month follow-up period, a total of 88 deaths occurred. Regression analysis showed that patients under maintenance hemodialysis with frailty syndrome had a 3-5-fold higher mortality risk compared with non-frail individuals, and this association was more prominent in the elderly population aged over 60 years. Compared with patients with frailty syndrome, individuals in the pre-frail stage had markedly reduced mortality (P = 0.009, P = 0.006). Frailty is highly prevalent in older hemodialysis patients and closely correlated with increased mortality. Early frailty screening and risk stratification are essential for older dialysis patients and individuals at high risk of adverse clinical events. This study highlights the clinical value of early identification and standardized management of frailty, which can provide evidence for clinical diagnosis and treatment in this vulnerable population.