• Antihypertensive drugs
• Erythropoietin
• Frequency
• Hemodialysis
• Mortality
• Residual diuresis
• Residual urine output
• Serum potassium
• Thrice-weekly
• Twice-weekly

• Humans
• Renal Dialysis/methods
• Male
• Female
• Middle Aged
• Aged
• Prospective Studies
• Kidney Failure, Chronic/therapy
• Kidney Failure, Chronic/mortality
• Hypertension/epidemiology
• COVID-19/epidemiology
• Erythropoietin/therapeutic use
• Erythropoietin/administration & dosage
• Hospitalization/statistics & numerical data

• biocompatibility
• chronic kidney disease
• clinical impact
• complement
• dialysis
• inflammation
• technology

• Dialysis
• artificial intelligence
• hemodialysis
• machine learning
• precision dialysis

• Hemodialysis
• Mortality
• Nomogram
• Prognosis
• Pulmonary hypertension

• Humans
• Hypertension, Pulmonary/complications
• Nomograms
• Stroke Volume
• Ventricular Function, Left
• Renal Dialysis

• diabetic kidney disease
• dynamic nomogram
• prognosis
• survival probability

• chronic kidney disease
• kidney replacement therapies
• wearable and implantable artificial kidneys

• Consolidation
• Dialysis
• Innovation

• haemodialysis
• informed-decision making
• sustainability
• value-based healthcare

In most biological or industrial (including medical) separation processes, a membrane is a semipermeable barrier that allows or achieves selective transport between given compartments. In haemodialysis (HD), the semipermeable membrane is in a tubular geometry in the form of miniscule pipes (hollow fibres) and separation processes between compartments involve a complex array of scientific principles and factors that influence the quality of therapy a patient receives. Several conditions need to be met to accomplish the selective and desired removal of substances from blood in the inner cavity (lumen) of the hollow fibres and across the membrane wall into the larger open space surrounding each fibre. Current HD membranes have evolved and improved beyond measure from the experimental membranes available in the early developmental periods of dialysis. Today, the key functional determinants of dialysis membranes have been identified both in terms of their potential to remove uraemic retention solutes (termed ‘uraemic toxins’) as well subsidiary criteria they must additionally fulfill to avoid undesirable patient reactions or to ensure safety. The production of hundreds of millions of kilometres of hollow fibre membranes is truly a technological achievement to marvel, particularly in ensuring that the fibre dimensions of wall thickness and inner lumen diameter and controlled porosity—all so vital to core solute removal and detoxification functions of dialysis—are maintained for every centimetre length of the fragile fibres. Production of membranes will increase in parallel with the increase in the number of chronic kidney disease (CKD) patients expected to require HD therapies in the future. The provision of high-quality care entails detailed consideration of all aspects of dialysis membranes, as quality cannot in any way be compromised for the life-sustaining—like the natural membranes within all living organisms—function artificial dialysis membranes serve.

• haemodialysis
• hollow fibres
• membranes
• semipermeable
• transport phenomena

In Japan, dialyzers are classified based on β₂-microglobulin clearance. Type I dialyzers are classified as low-flux dialyzers (<10 mL/min clearance), type II and III as high-flux dialyzers (≥10 to <30 mL/min and ≥30 to <50 mL/min clearance, respectively), and type IV and V as super high-flux dialyzers (≥50 to <70 mL/min and ≥70 mL/min clearance, respectively). Super high-flux dialyzers are commonly used, but their superiority over low-flux dialyzers is controversial.

In this nationwide prospective cohort study, we analyzed Japanese Society for Dialysis Therapy Renal Data Registry data collected at the end of 2008 and 2011. We enrolled 242,467 patients on maintenance hemodialysis and divided them into five groups by dialyzer type. We assessed the associations of each dialyzer type with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis, adjusting for potential confounders.

By the end of 2011, 53,172 (21.9%) prevalent dialysis patients had died. Mortality significantly decreased according to dialyzer type. Hazard ratios (HRs) were significantly higher for type I, II and III compared with type IV (reference) after adjustment for basic factors and further adjustment for dialysis-related factors. HR was significantly higher for type I, but significantly lower for type V, after further adjustment for nutrition- and inflammation-related factors. These significant findings were also evident after propensity score matching.

Hemodialysis using super high-flux dialyzers might reduce mortality. Randomized controlled trials are warranted to clarify whether these type V dialyzers can improve prognosis.

Patients treated with maintenance hemodialysis experience significant symptom burden resulting in impaired quality of life. However, the association of patient reported symptom burden and the risk of healthcare use for patients with end stage kidney disease on hemodialysis has not been fully explored.

To investigate if higher symptom burden, assessed by the Edmonton Symptom Assessment System-revised (ESASr), is associated with increased healthcare use in patients with end stage kidney disease on hemodialysis.

Prospective, single-center, study of adult patients on HD. Participants completed the ESASr questionnaire at enrollment. Baseline demographic, clinical information as well as healthcare use events during the 12-month following enrollment were extracted from medical records. The association between symptom burden and healthcare use was examined with a multivariable adjusted negative binomial model.

Mean (SD) age of the 80 participants was 71 (13) years, 56% diabetic, and 70% male. The median (IQR) dialysis vintage was 2 (1–4) years. In multivariable adjusted models, higher global [incident rate ratio (IRR) 1.02, 95% confidence interval (CI) 1.00–1.04, p = .025] and physical symptom burden score [IRR 1.03, CI 1.00–1.05, p = .034], but not emotional symptom burden score [IRR 1.05, CI 1.00–1.10, p = .052] predicted higher subsequent healthcare use.

Our preliminary evidence suggests that higher symptom burden, assessed by ESASr may predict higher risk of healthcare use amongst patients with end stage kidney disease on hemodialysis. Future studies need to confirm the findings of this preliminary study and to assess the utility of ESASr for systematic symptom screening.

• Edmonton Symptom Assessment System-revised
• Maintenance hemodialysis
• end-stage kidney disease
• healthcare use

Public policy for kidney replacement therapy eludes most low- and middle-income countries owing to the seemingly low number of cases and high cost. Countries such as Thailand have shown that public health authorities can effectively provide treatment and elevate health care for populations by overcoming some common challenges.

• dialysis
• end of life
• palliative care
• withdrawal
• withhold

Kidney disease is a significant health concern worldwide. Ineffective treatment can lead to disastrous consequences, such as organ failure and death. Research has turned to cell-based therapy, but has yet to produce an effective and reliable treatment for kidney disease. To address this problem, we examined four datasets of gene expression profiles from diseased and healthy kidney tissue in humans, mice, and rats. Differentially expressed genes (DEGs) were screened and subjected to enrichment analyses. Up-regulated genes in diseased kidney tissue were significantly enriched in pathways associated with regulatory T cells (Tregs). Analysis with the xCell tool showed that Tregs were generally increased in diseased kidney tissue in all species. To validate these results in vivo, kidneys were removed from mice with Adriamycin-induced nephropathy, and histology confirmed increase of Tregs. Furthermore, Tregs were adoptively transferred from healthy mice into mice with kidney injury, restoring normal structure to the damaged kidneys. Treg cells that were co-cultured with M2c macrophages exhibited up-regulation of chemokine receptors CCR2, CCR5, CCR7, CD62L, and CX3CR1. This may be the mechanism by which M2c cells enhance the migration of Tregs to the site of inflammation. We propose that Tregs may be an effective, novel candidate for cell-based therapy in pre-clinical kidney injury models.

• M2c macrophage
• Treg
• cell-based therapy
• kidney injury
• regulatory T cell

• Stage 5 chronic kidney disease dialysis
• advancing outcome
• dialysis
• renal replacement therapy
• technology support

• Cardiovascular Diseases/prevention & control
• Humans
• Kidney Failure, Chronic/therapy
• Renal Dialysis/statistics & numerical data
• Renal Replacement Therapy/methods

Diabetic patients undergoing maintenance dialysis (MD) have a particularly high mortality rate. Many of the risk factors for mortality have been identified in diabetics who die before reaching end stage renal disease (ESRD), i.e. before dialysis (BD). In addition, many risk factors for mortality have been identified in diabetics after dialysis onset (AD). However, whether in the BD period there are long-term risk factors for AD mortality in diabetics is unknown. We therefore investigated a new concept, i.e. that clinical and biochemical risk factors during the BD stage affect long-term AD mortality. We performed a population based retrospective cohort study, in diabetic CKD patients in a single center in south Israel who initiated MD between the years 2003 and 2015. Clinical and biochemical data 12 months BD and 6 months AD were collected and evaluated for association with mortality AD using Cox’s proportional-hazards model. BD parameters that were found to be significant were adjusted for significant parameters AD, thus generating a “combined” regression model in order to isolate the contribution of BD factors on long term mortality. Six hundred and fifty two diabetic MD patients were included in the final analysis. Four independent BD parameters were found in the multivariate model to significantly predict AD mortality: age, BMI (inversely), pulse pressure (U-shaped) and cardiovascular comorbidity. AD independent risk factors for mortality were age, BMI (inversely) and albumin (inversely). Of note, BD factors remained dominantly significant even after additionally adjusting for AD factors. No association was found between either BD HbA1C levels or BD proteinuria and AD mortality. In diabetics who reach ESRD, BD parameters can predict long term AD mortality. Thus, some of the factors affecting the poor survival of diabetic MD patients appear to begin already in the BD period.

• Animal models
• Cell-based therapy
• Genetically modified cells
• Kidney disease
• Preclinical safety assessment

Background: A beneficial effect of a ketoanalogue-supplemented low-protein diet (sLPD) in postponing dialysis has been demonstrated in numerous previous studies. However, evidence regarding its effect on long-term survival is limited. Our study assessed the long-term outcomes of patients on an sLPD after commencing dialysis. Methods: This retrospective study examined patients with new-onset end-stage renal disease with permanent dialysis between 2001 and 2013, extracted from Taiwan’s National Health Insurance Research Database. Patients who received more than 3 months of sLPD treatment in the year preceding the start of dialysis were extracted. The outcomes studied were all-cause mortality, infection rate, and major cardiac and cerebrovascular events (MACCEs). Results: After propensity score matching, the sLPD group (n = 2607) showed a lower risk of all-cause mortality (23.1% vs. 27.6%, hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.70–0.84), MACCEs (19.2% vs. 21.5%, HR 0.86, 95% CI 0.78–0.94), and infection-related death (9.9% vs. 12.5%, HR 0.76, 95% CI 0.67–0.87) than the non-sLPD group did. Conclusion: We found that sLPD treatment might be safe without long-term negative consequences after dialysis treatment.

• adverse events
• chronic kidney disease
• ketoacids
• low-protein diet
• nutrition
• survival

• Disease Management Programm
• Evaluation
• Nephrologisches Awarenessprogramm
• awareness program
• cardiovascular disease
• chronic kidney disease
• disease management program
• evaluation
• kardiovaskuläre Erkrankungen
• nephrology

• Germany
• Health Services Research
• Humans
• Incidence
• Mass Screening
• Nephrology
• Organizational Objectives
• Prevalence
• Program Evaluation
• Renal Insufficiency, Chronic/diagnosis
• Renal Insufficiency, Chronic/epidemiology

• Adult
• Aged
• Aged, 80 and over
• Australia
• Canada
• Cost-Benefit Analysis
• Female
• Humans
• Kidney Failure, Chronic/economics
• Male
• Middle Aged
• Renal Dialysis/economics
• Time Factors
• United Kingdom
• United States

• Europe
• end-stage renal disease
• incidence
• renal replacement therapy
• survival

AIM: To investigate the predictive value of low freeT3 for long-term mortality in chronic hemodialysis (HD) patients and explore a possible causative role of chronic inflammation.

METHODS: One hundred fourteen HD patients (84 males) consecutively entered the study and were assessed for thyroid function and two established markers of inflammation, high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). Monthly blood samples were obtained from all patients for three consecutive months during the observation period for evaluation of thyroid function and measurement of inflammatory markers. The patients were then divided in two groups based on the cut-off value of 1.8 pg/mL for mean plasma freeT3, and were prospectively studied for a mean of 50.3 ± 30.8 mo regarding cumulative survival. The prognostic power of low serum fT3 levels for mortality was assessed using the Kaplan-Meier method and univariate and multivariate regression analysis.

RESULTS: Kaplan-Meier survival curve showed a negative predictive power for low freeT3. In Cox regression analysis low freeT3 remained a significant predictor of mortality after adjustment for age, diabetes mellitus, hypertension, hsCRP, serum creatinine and albumin. Regarding the possible association with inflammation, freeT3 was correlated with hsCRP, but not IL-6, and only at the first month of the study.

CONCLUSION: In chronic hemodialysis patients, low plasma freeT3 is a significant predictor of all-cause mortality. Further studies are required to identify the underlying mechanisms of this association.

• C-reactive protein
• Hemodialysis
• Inflammation
• Interleukin-6
• Low T3 syndrome
• Mortality

• Animals
• Apolipoproteins E/genetics
• Bone Density/drug effects
• Bone Density/genetics
• Dialysis Solutions/pharmacology
• Diphosphates/pharmacology
• Female
• Femur/metabolism
• Femur/pathology
• Mice
• Mice, Knockout
• Peritoneal Dialysis/adverse effects
• Peritoneal Dialysis/methods
• Renal Insufficiency, Chronic/metabolism
• Renal Insufficiency, Chronic/pathology
• Renal Insufficiency, Chronic/therapy
• Vascular Calcification/etiology
• Vascular Calcification/genetics
• Vascular Calcification/metabolism
• Vascular Calcification/pathology
• Vascular Calcification/prevention & control

• CKD
• CV risk
• ketoacids
• survival
• very low-protein diet

In-centre haemodialysis (ICHD) is the most common dialysis method used by patients worldwide. However, quality of life and clinical outcomes in patients treated via ICHD have not improved for some time. ‘High-dose’ haemodialysis (HD) regimens – which are longer and/or more frequent than conventional regimens and are particularly suitable to delivery in the home – may offer a route to improved outcomes and quality of life. This survey aimed to determine nephrologists’ views on the validity of alternatives to ICHD, particularly home HD and high-dose HD.

A total of 1,500 nephrologists from Europe, Canada and the United States were asked to respond to an online questionnaire that was designed following previous qualitative research. Certified nephrologists in practice for 2–35 years who managed >25 adult dialysis patients were eligible to take part.

A total of 324 nephrologists completed the survey. ICHD was the most common type of dialysis used by respondents’ current patients (90%), followed by peritoneal dialysis (8%) and home HD (2%). The majority of respondents believed that: home HD provides better quality of life; increasing the frequency of dialysis beyond three times per week significantly improves clinical outcomes; and longer dialysis sessions performed nocturnally would result in significantly better clinical outcomes than traditional ICHD.

Survey results indicated that many nephrologists believe that home HD and high-dose HD are better for the patient. However, the majority of their patients were using ICHD. Education, training and support on alternative dialysis regimens are needed.

• Dialysate
• Haemodialysis
• Hyperkalaemia
• Potassium

• Adult
• Aged
• Education, Nonprofessional
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prospective Studies
• Renal Dialysis/mortality
• Survival Rate

• Adult
• Aged
• Arteriovenous Shunt, Surgical
• Female
• Femoral Artery/surgery
• Humans
• Male
• Middle Aged
• Prospective Studies
• Renal Dialysis
• Saphenous Vein/surgery