Background Vascular stiffness is common among patients with end-stage renal disease (ESRD). Circulating markers of bone formation play an important role in evaluating bone-mineral disease state as ...well as in predicting the risk of developing vascular calcification and hence, arterial stiffness. Aims This study aimed to assess arterial stiffness in maintenance hemodialysis patients using pulse wave analysis as an index of central and peripheral arterial stiffness and serum procollagen type I N-terminal propeptide (P1NP) as a marker for bone turnover. Patients and methods Fifty ESRD patients aged 18 years old or more who have been assigned to regular long-term hemodialysis were included in this study and subjected to complete history taking and physical examination and laboratory investigations including lipid profile, fasting plasma glucose level (mg/dl), serum creatinine, blood urea (mg/dl), serum phosphorus (mg/dl), serum calcium (mg/dl), P1NP (ng/ml), serum parathyroid hormone (PTH) (pg/ml), and serum bone-specific alkaline phosphatase (BALP) (U/l), and aortic pulse wave velocity. Results There was significant positive correlation between P1NP and PTH ( P ≤0.01) and between BALP and serum PTH ( P ≤0.01). There was significant difference between patients with low and high augmentation index regarding BALP ( P =0.018). Conclusion ESRD patients have a high prevalence of vascular stiffness assessed by pulse wave analysis. There is a significant correlation between BALP and PTH and between P1NP and PTH. There is a relation between markers of bone formation and vascular stiffness.
Since World Health Organization (WHO) declared a global Health Emergency at the end of January 2020 caused by the novel coronavirus 2019-nCoV, the rapid spread of this pandemic poses unprecedented ...challenges throughout the world. Hemodialysis patients are more susceptible to SARS-CoV-2 pneumonia than the general population. Dialysis physicians, health workers should have clinical knowledge of epidemic COVID-19, epidemic prevention tools, and required guidelines. This paper aims to focus on the Moroccan society of nephrology recommendations and the Ministry of Health guidelines to protect both healthcare workers and hemodialysis patients from the virus. A package of measures has been recommended by the Ministry of Health to ensure continuity of health services for hemodialysis patients with Covid-19. Besides, the Moroccan society of nephrology recommendations has been adopted to ensure quality care for this vulnerable category throughout the epidemic.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background/aim Emerging evidence on lowering dialysate temperature suggests a cardiorenal protective effect of dialysate cooling (CD) against dialysis-induced ischemia in hemodialysis (HD) patients ...prone to intradialytic hypotension (IDH). Whether this benefit of CD could be extended to incident HD populations without baseline IDH to preserve residual kidney function (RKF) is unknown.
Patients and methods One hundred incident HD patients were randomly assigned to receive either incremental CD less than or equal to 36°C (intervention, N=50 patients) or standard-temperature (ST) dialysate (control, N=50 patients) for 12 months. The primary endpoint was to test the safety and efficacy of CD to preserve RKF.
Results By the end of 12 months, CD patients showed less decline in estimated glomerular filtration rate compared with standard-temperature patients (6.2 vs. 4.6 ml/min/1.73 m2, P=0.025); in addition, Cox regression analysis showed that CD was an independent variable for the preservation of RKF (P=0.044, hazard ratio: 0.478, confidence interval: 0.23-0.89). CD was well tolerated, with less fatigue and IDH; however, coldness, shivering, and discomfort were significantly higher in the CD group.
Conclusion In incident HD patients without baseline IDH, cooled dialysis might help preserve RKF with a reasonable safety profile. Further studies are warranted to explore these findings.
Background Few data are available regarding the long-term mortality rate for patients receiving nocturnal home hemodialysis. Study Design Posttrial observational study. Setting & Participants ...Frequent Hemodialysis Network (FHN) Nocturnal Trial participants who consented to extended follow-up. Intervention The FHN Nocturnal Trial randomly assigned 87 individuals to 6-times-weekly home nocturnal hemodialysis or 3-times-weekly hemodialysis for 1 year. Patients were enrolled starting in March 2006 and follow-up was completed by May 2010. After the 1-year trial concluded, FHN Nocturnal participants were free to modify their hemodialysis prescription. Outcomes & Measurements We obtained dates of death and kidney transplantation through July 2011 using linkage to the US Renal Data System and queries of study centers. We used log-rank tests and Cox regression to relate mortality to the initial randomization assignment. Results Median follow-up for the trial and posttrial observational period was 3.7 years. In the nocturnal arm, there were 2 deaths during the 12-month trial period and an additional 12 deaths during the extended follow-up. In the conventional arm, the numbers of deaths were 1 and 4, respectively. In the nocturnal dialysis group, the overall mortality HR was 3.88 (95% CI, 1.27-11.79; P = 0.01). Using as-treated analysis with a 12-month running treatment average, the HR for mortality was 3.06 (95% CI, 1.11-8.43; P = 0.03). Six-month running treatment data analysis showed an HR of 1.12 (95% CI, 0.44-3.22; P = 0.7). Limitations These results should be interpreted cautiously due to a surprisingly low (0.03 deaths/patient-year) mortality rate for individuals randomly assigned to conventional home hemodialysis, low statistical power for the mortality comparison due to the small sample size, and the high rate of hemodialysis prescription changes. Conclusions Patients randomly assigned to nocturnal hemodialysis had a higher mortality rate than those randomly assigned to conventional dialysis. The implications of this result require further investigation.
Aims: To determine the safety and feasibility of continuous aspiration mechanical thrombectomy (CAT) for restoring patency to thrombosed hemodialysis reliable outflow (HeRO) arteriovenous grafts. ...Subjects and Methods: Between December 2016 and August 2017, eleven consecutive patients (average age 63, range 39-80 years) with thrombosed HeRO grafts underwent percutaneous thrombectomy procedures (n = 21) using the Penumbra Indigo® CAT 8 or CAT D (Alameda, CA, USA) thrombectomy catheter as the primary device to clear the venous outflow tract before removing the arterial plug with a compliant balloon. A total of 21 hemodialysis declot procedures using CAT were documented and analyzed. Average procedure length and fluoroscopy time, length of thrombus cleared, blood loss, complications, and time between thrombectomy procedures were recorded and compared to the same patient's previous three thrombectomy procedures. Results: All procedures were technically successful (100%) at restoring graft patency; however, reocclusion within 5 days occurred in four (19.0%) cases. Three (14.3%) interventions required additional balloon maceration or sweep to clear the venous outflow following thrombectomy. Average thrombus length treated by suction thrombectomy measured 23.15 cm (range 2.2-65 cm). Average blood loss was 162.6 mL (range 50-250 mL). No procedure-related complications were recorded. The average procedure length and fluoroscopy time using suction thrombectomy was 74.7 and 14.2 min, respectively, compared with 82.0 and 14.0 min, respectively, in the previous thrombectomy procedures using standard methods (P > 0.05). Seventeen (81%) HeRO grafts treated by CAT presented with rethrombosis at a mean of 42.47 days (range 1-208 days, median 22 days, standard deviation SD 28.2 days) since CAT procedure compared to patients treated by conventional methods who presented for rethrombosis at a mean of 55.33 days (range 1-321 days, median 34 days, SD 43.1 days) since standard thrombectomy - no statically significant difference (P > 0.05). Conclusion: CAT is a safe and feasible method for removing thrombus and restoring patency to thrombosed HeRO grafts. Further studies are required to elucidate the advantages of CAT over standard thrombectomy techniques.
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