Intradialytic hypotension (IDH) is a common and clinically significant complication in patients undergoing chronic hemodialysis. The application of low-temperature dialysate has been proposed as a potential intervention to mitigate this condition; however, its effectiveness requires further evaluation through systematic reviews and meta-analyses.

Knowledge of residual kidney function is potentially useful in patients receiving hemodialysis for risk stratification, adjusting the dialysis prescription, and early identification of renal function recovery. However, periodic urine collection is problematic. We examined the potential of predicting residual kidney creatinine (water) clearance (KrCrW) without urine collection using a creatinine kinetic model, which allows KrCrW to be estimated based on previously measured or anthropometrically estimated creatinine generation rate (GCr), volume of distribution (VdCr), and measured predialysis serum creatinine.

In hyponatremic patients, concurrent dialysate flow during hemodialysis may be an ideal option to mitigate complications such as osmotic demyelination syndrome (ODS).

Previous studies suggested adjusting insulin doses during hemodialysis to reduce intra- and post-hemodialysis hypoglycemia. However, the impact of insulin adjustment on cardiovascular morbidity and mortality in diabetic patients with end-stage renal disease (ESRD) remains unclear. Although reducing hypoglycemia is a well-documented benefit of insulin dose modification in this population, the broader metabolic and inflammatory consequences-particularly those related to cardiovascular risk-are not well understood. This study aimed to investigate the effects of a 25% reduction in total daily insulin dose on hemodialysis days in T2DM patients with ESRD, focusing on daily blood glucose profiles, glycated albumin, IL-6, and TNF-α.

Expanded hemodialysis (HDx) represents a transformative innovation in renal replacement therapy, addressing the limitations of conventional hemodialysis and high-flux modalities. By employing medium cut-off (MCO) membranes, HDx ensures efficient clearance of middle- and large-molecular-weight uremic toxins, such as β-microglobulin and cytokines, while selectively retaining vital proteins like albumin. This comprehensive review examines the clinical efficacy, safety, and broader implications of HDx, highlighting its potential to improve outcomes for patients with chronic kidney disease (CKD). The review synthesizes findings from comparative studies, emphasizing HDx's superior toxin removal capabilities, particularly for solutes implicated in systemic inflammation and cardiovascular complications. Key mechanisms, including the internal filtration-backfiltration process, contribute to hemodynamic stability and enhanced toxin clearance. HDx demonstrates significant reductions in inflammatory biomarkers, improved arterial compliance, and better cardiovascular outcomes compared with traditional methods. Patient-reported outcomes further underscore HDx's benefits, with shorter recovery times, enhanced quality of life, and reduced intradialytic complications. While albumin loss remains a consideration, studies confirm its clinical acceptability and minimal impact on nutritional status. HDx's economic viability, reduced infrastructure requirements, and compatibility with existing systems position it as a cost-effective alternative, especially in resource-limited settings. Despite promising evidence, the review identifies gaps in long-term data, particularly regarding mortality and sustained quality-of-life improvements. Future directions include refining membrane technologies and incorporating personalized medicine approaches to optimize HDx protocols. By bridging these gaps, HDx has the potential to redefine renal replacement therapy, offering a safer, more effective, and scalable solution for CKD management.

The aim of this study is to investigate the impact of the causes of arteriovenous fistula (AVF) stenosis on the 1-year primary patency rate of AVF following percutaneous transluminal angioplasty (PTA) and to identify the independent risk factors that affect vascular access patency post-PTA.

We investigated the clinical characteristics and treatment outcomes of heparin-induced thrombocytopenia (HIT) following therapeutic plasma exchange (TPE) with heparin anticoagulation in patients with neurological autoimmune diseases.

Multiple in vitro and in vivo studies indicate that there is a significant amount of dialysis catheter lock leak with tunneled and nontunneled dual lumen hemodialysis (HD) catheters. The impact of heparin 1000 unit/mL HD catheter lock on outcomes in patients on therapeutic heparin has not been previously reported.

Here we describe six kinetic modeling programs that allow quantification of removal of urea, creatinine, phosphate, and beta-2-microglobulin. They can be used with asymmetric dialysis treatment schedules ranging from one to seven times per week. Once downloaded, the programs can be run locally from a personal computer without requiring connection to the internet. They have been designed to analyze solute removal in a single patient or in thousands of patients. Each program is contained in a single JavaScript-HTML text file, and all of the assumptions and equations used are easily accessible in uncompressed text format and are accompanied by comments and annotations. Inputs are in the form of comma-delimited files which can be imported from spreadsheets. Outputs appear in the form of web pages or as comma-delimited files that can be exported into spreadsheets for graphing and further analysis. This perspective focuses on describing the potential utility of these programs (two pertaining to urea, two to creatinine, one to phosphate, and one to beta-2-microglobulin) as well as two helper calculators, one that computes dialyzer mass transfer area coefficient for urea (K0A) from dialyzer specification chart urea clearance data, and another that can be used to calculate the phosphate binder equivalent dose.

Peritoneal dialysis (PD) and hemodialysis (HD) form the basis of renal replacement therapy (RRT) in patients with end-stage renal disease. Both methods have advantages, and in our study, we aimed to examine the effect of both methods on exhaled nitric oxide (FeNO) levels.

The aim of this review is to summarize the literature on the pathophysiology, diagnosis, and etiology of adrenal insufficiency (AI) in dialysis patients. The prevalence of AI in dialysis patients is unknown, and AI appears to be an uncommon complication associated with dialysis. Data in the literature on the impact of chronic kidney disease and dialysis on adrenal function give conflicting results. Patients with end-stage renal disease are at risk of hypercortisolism due to loss of the nychthemeral cortisol cycle. Dialysis itself may lead to a rebound in cortisol synthesis at the end of dialysis session. Nevertheless, it has recently been suggested that dialysis vintage was associated with loss of adrenal function and with the onset of AI, and that among chronically hypotensive dialysis patients, the prevalence of AI may be as high as 20%. In dialysis patients, adrenal function is preserved, and AI is rare. AI is difficult to diagnose and often goes unnoticed, as symptoms are nonspecific and diminish with dialysis, which partially corrects them. Diagnosis is therefore delayed and often occurs during an adrenal crisis. For hemodialysis patients, diagnosis is based on blood cortisol measurements before and after an ACTH stimulation test, which are performed at the start of dialysis, regardless of the dialysis session schedule. Salivary cortisol measurements can be used instead of blood cortisol measurements for peritoneal dialysis patients to avoid venipunctures. Situations suggestive of AI in dialysis patients include history or current low-dose corticosteroid therapy, unexplained chronic arterial hypotension, recurrent hypoglycemia, and unexplained hypercalcemia.

PD catheter breaks are rare and can occur spontaneously or traumatically. Breaks may cause peritonitis due to wet contamination. We describe the management of three unique cases of catheter breaks without interruption of treatment. We salvaged two PD catheters with breaks that were proximal to the exit site with minimally invasive procedures. Even though one patient required removal of the catheter, a new catheter was exchanged over a guidewire and used immediately. PD therapy was continued without any complications. Out of the box thinking and repair of PD catheter breaks prevents removal and extends its life.

For patients with end-stage renal failure, hemodialysis is a crucial renal replacement therapy, which is meaningful to alleviate patients' symptoms and prolong survival. The principle of hemodialysis is to exchange the substances in the blood and dialysis solution through a semipermeable membrane and to discharge the excess water, metabolic waste, and electrolytes into the dialysis solution, which can balance the water, electrolytes, and acid-base. However, patients on maintenance hemodialysis are at high risk of developing cardiovascular and cerebrovascular diseases. Therefore, the composition of dialysis fluid has been widely studied, and the use of sugar-containing dialysis fluid can reduce the incidence of hypoglycemia, hypotension, and cardiovascular and cerebrovascular complications in hemodialysis patients. This article reviews the effects of current glucose-containing dialysate on cardiovascular and cerebrovascular outcome events in hemodialysis patients.

This study aimed to investigate the effect of fatigue levels of patients undergoing hemodialysis on their sleep quality after dialysis treatment.

This study compares the outcomes of tunneled catheters (TCs) and non-tunneled catheters (NTCs) in incident hemodialysis patients undergoing early arteriovenous fistula (AVF) creation.

Peritoneal dialysis (PD) outcomes analysis presents challenges due to heterogeneous outcomes. Our study aims to evaluate mortality, transition to hemodialysis (HD), and kidney transplant (KT) rates and investigate potential baseline patient characteristics influencing these outcomes. We conducted an observational retrospective registry-based single-center cohort study involving 722 incident adult PD patients admitted between 1985 and 2022. Follow-up duration extended from PD initiation to the first occurrence of death (n = 143), transfer to HD (n = 313), or KT (n = 202). Utilizing competitive risks analysis, we calculated cumulative incidence (CI) functions and applied a Fine and Gray model to baseline variables to understand their impact. The majority of patients were female (n = 401; 55.54%), with an average age of 49.64 ± 15.80 years. Transfer to HD had the highest probability (CI of 0.38 at 60 months), followed by KT (CI of 0.27 at 60 months) and death (CI of 0.19 at 60 months). Diabetes correlated solely with death (HR 1.71 (0.18); p = 0.004). PD-first was associated with a lower risk of HD transfer (HR 0.76 (0.13); p = 0.036) and positively influenced KT (HR 1.73 (0.16); p < 0.01). Vascular access as the reason for PD selection was associated with death (HR 2.16 (0.19); p < 0.001). The main risk for PD patients is transitioning to HD, unaffected by baseline patient characteristics. PD-first option positively influences KT access, and mortality rates remain low and unaffected by this option, ensuring the safety of the technique. Vascular access-related PD initiations correlate with increased mortality, potentially due to comorbidities.

A systematic assessment was conducted to evaluate the effectiveness of digital health technology interventions on anxiety, depression, and treatment adherence in maintenance hemodialysis patients. A computerized search of 10 databases of randomized controlled trials of digital health technologies on anxiety, depression, and treatment adherence in maintenance hemodialysis patients was conducted for the period from database construction to December 5, 2024, and a meta-analysis of the included literature was performed using RevMan 5.4 and Stata 15.0 software to evaluate the level of evidence-based on GRADE. A total of 13 papers were included with 1063 maintenance hemodialysis patients. Meta-analysis results showed that digital health technology could reduce anxiety and depression and improve treatment adherence of maintenance hemodialysis patients. Digital health technology has a positive effect on anxiety, depression, and treatment adherence in maintenance hemodialysis patients. However, due to the limitations of the quality and quantity of included studies, as well as the heterogeneity of the findings, further validation of the results is necessary through the inclusion of more high-quality studies.

The objective of India's One Nation One Dialysis (ONOD) program is to remove the barriers that end-stage kidney disease patients face in accessing consistent, quality dialysis services across the nation. A unified and standardized dialysis care approach is what ONOD aims to achieve at a national level. The objective of ONOD is to improve access to, affordability of, and quality in dialysis services for economically weaker segments of society and those living in remote areas of the country by providing dialysis services through public-private partnerships. The ONOD program places a lot of emphasis on the infrastructure development, funding support, skill development, regulatory reforms, and technological integration of dialysis services. By implementing ONOD, India can improve patient outcomes, close the supply-demand gaps for end-stage kidney disease kidney replacement therapy, and create a more balanced and sustainable kidney healthcare ecosystem.

People receiving dialysis treatment are at higher risk of sarcopenia. This review aimed to determine the global prevalence of sarcopenia in people on peritoneal dialysis and hemodialysis. We investigated whether the prevalence of sarcopenia differs based on assessment criteria, timing of assessment, and measurement tools used and explored the risk factors for sarcopenia in people on dialysis.

Anemia is a common occurrence in people with chronic kidney disease and end-stage kidney disease. Intravenous administration of iron is standard treatment for people undergoing maintenance hemodialysis. However, until the recent PIVOTAL randomized control trial, there was uncertainty around clinically effective regimens. This study found that among incident, people receiving hemodialysis in the first year, a proactive high-dose intravenous iron regimen was superior to reactive low-dose regimen, leading to reduced mortality and cardiac events. Our study investigated whether the research and guidelines have been successfully implemented into clinical care across the United Kingdom, identified barriers experienced, and explored our local hemodialysis population's awareness of the treatment they are receiving.

Arteriovenous fistula (AVF) is the most ideal vascular access for hemodialysis. People with AVF have a longer vascular access survival rate and a lower complication rate. Thrombosis and stenosis are the most common complications of AVF. The annual thrombosis event rate is 10%-50%. Appropriate identification of AVF stenosis and management could reduce the risk of thrombosis and access loss. Guidelines recommended physical examinations as the first line of AVF stenosis monitoring. However, even for health professionals, the diagnosis rate by hearing the bruit varied. The sound waves of AVF can be recorded by electronic stethoscopes and the analysis of the digitalized signal may help predict stenosis of AVF and trigger the next step of management.