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Clinical Advances in Hemodialysis
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Clinical Advances in Hemodialysis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 25 July 2025 | Viewed by 4872

Special Issue Editor

Dr. Maurizio Bossola

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Guest Editor
1. Servizio Emodialisi, Università Cattolica del Sacro Cuore, Rome, Italy
2. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
Interests: dialysis; hemodialysis; interdialytic weight gain; fatigue; cognitive impairment

Special Issue Information

Dear Colleagues,

Maintenance hemodialysis (MHD) is used in about 2.6 million patients with end-stage renal disease, worldwide. Patients on MHD suffer many physical and psychological symptoms, have many comorbidities, a bad quality of life and an increased risk of short and long-term mortality.

The most distressing conditions affecting the life of patients on MHD are the symptom burden and related reduced quality of life, impaired cognitive function, fatigue and post-dialysis fatigue, frustrating attempt to limit the interdialytic weight gain, symptoms of depression and anxiety, frailty and related increased mortality, the need for polypharmacy and hospitalizations, and dietary restrictions.

This Special Issue will focus on these distressing conditions and the strategies to overcome them.

The topics of interest are as follows:

  • The epidemiology of symptom burden and its impact on the quality of life;
  • Cognitive impairment: physiopathology and therapy;
  • Fatigue and post-dialysis fatigue: underlying mechanisms and treatment;
  • Ways to limit interdialytic weight gain;
  • Depression: prevalence and therapy;
  • Anxiety: an underestimated problem;
  • Frailty and mortality;
  • Polypharmacy and hospitalizations: how they impact daily living;
  • Dietary restriction: water, potassium and phosphorus.

Dr. Maurizio Bossola
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hemodialysis
  • interdialytic weight gain
  • symptom burden and quality of life
  • impaired cognitive function
  • fatigue
  • dietary restrictions
  • depression
  • anxiety
  • frailty
  • polypharmacy

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (6 papers)

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Research

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15 pages, 1071 KiB  
Article
Association of Ankle–Brachial Index with Quality of Life and Survival Outcomes in Hemodialysis Patients
by Norihito Yoshida, Tatsuki Tanaka, Yusuke Suzuki, Sadamu Takahashi, Mai Hitaka, Shingo Ishii, Keisuke Yamazaki and Yasushi Ohashi
J. Clin. Med. 2025, 14(5), 1625; https://doi.org/10.3390/jcm14051625 - 27 Feb 2025
Viewed by 415
Abstract
Background/Objectives: Ankle–brachial index (ABI) is frequently measured in hemodialysis patients due to their high cardiovascular risk, while its potential role as a screening tool for assessing overall physical function and health-related quality of life (QOL) remains unclear. This study aimed to evaluate [...] Read more.
Background/Objectives: Ankle–brachial index (ABI) is frequently measured in hemodialysis patients due to their high cardiovascular risk, while its potential role as a screening tool for assessing overall physical function and health-related quality of life (QOL) remains unclear. This study aimed to evaluate the association of the ABI with QOL and survival in hemodialysis patients. Methods: This study included 346 hemodialysis patients, categorized into two groups based on their ABI (≤0.9 vs. >0.9). Clinical parameters, QOL (measured using SF-36 and KDQOL questionnaires), and survival outcomes were analyzed. Results: There were 66 (19.1%) patients with an ABI ≤ 0.9 in this study population. Patients with an ABI ≤ 0.9 exhibited significantly older ages, longer dialysis durations, higher prevalence of diabetes mellites and cardiovascular disease, elevated N-terminal pro-brain natriuretic peptide levels, and higher calcitriol use but lower phase angle, skeletal muscle mass index values, health-related QOL domains, and several kidney disease-specific QOL domains compared to those with an ABI > 0.9. Kaplan–Meier analysis revealed significantly higher cumulative mortality in the ABI ≤ 0.9 group (6.6 vs. 2.5 per 100 patient-years, p < 0.001). Conclusions: A low ABI is significantly associated with decreased QOL and higher mortality risk in hemodialysis patients. While traditionally used for PAD screening, the ABI may serve as a practical tool for predicting QOL decline and survival outcomes. Interestingly, the ABI was also linked to muscle attenuation and volume overload. ABI assessment could aid in early risk stratification and guide multidisciplinary interventions, including exercise programs, nutritional support, and cardiovascular risk management, to improve patient care and outcomes. Full article
(This article belongs to the Special Issue Clinical Advances in Hemodialysis)
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11 pages, 992 KiB  
Article
Perceived Stress Is Linked to Depression but Not to Clinical Outcomes in Maintenance Hemodialysis Patients
by Maurizio Bossola, Laura Angioletti, Marta Di Giovanni, Ilaria Mariani, Enrico Di Stasio and Michela Balconi
J. Clin. Med. 2025, 14(3), 883; https://doi.org/10.3390/jcm14030883 - 29 Jan 2025
Cited by 1 | Viewed by 786
Abstract
Background/Objectives: Over the course of end-stage renal disease, patients undergoing hemodialysis (HD) often face significant psychological distress. Nonetheless, little is known about perceived stress levels and related factors in HD patients. This is a cross-sectional study that explores the prevalence of perceived [...] Read more.
Background/Objectives: Over the course of end-stage renal disease, patients undergoing hemodialysis (HD) often face significant psychological distress. Nonetheless, little is known about perceived stress levels and related factors in HD patients. This is a cross-sectional study that explores the prevalence of perceived stress levels and the associated variables in HD patients. Methods: Participants included 223 HD patients recruited in June 2024 in Italy. Perceived stress and depression levels were measured with the Perceived Stress Scale (PSS) and Beck Depression Inventory (BDI-II). We also collected clinical and laboratory variables to evaluate their association with PSS. Results: PSS score was moderate in 70.8% and high in 11.2% of the patients. The BDI score was significantly higher in patients with moderate or high perceived stress than in those with low perceived stress. The correlation between PSS and BDI scores was statistically highly significant, and in multivariate regression analysis, PSS score was independently associated with BDI, but not with age, sex, and serum creatinine. Patients with moderate or high perceived stress more frequently had a BDI ≥ 17. In women, with respect to men, the frequency of high and moderate perceived stress was higher. PSS does not correlate with some clinical characteristics such as functional disability (ADL and IADL scores), and the number of comorbidities (Charlson comorbidity Index). Also, we found that there was no correlation between PSS and post-dialysis fatigue prevalence/characteristics, nor between PSS and time of recovery after dialysis. Conclusions: These findings emphasize the critical need for targeted interventions addressing stress management in HD patients, especially with gender-specific approaches. Full article
(This article belongs to the Special Issue Clinical Advances in Hemodialysis)
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12 pages, 1487 KiB  
Article
An Observational Study of the First 100 Patients Undergoing Nocturnal Every-Other-Day Online Hemodiafiltration: Clinical Outcomes and Patient and Technique Survival
by Francisco Maduell, Víctor Joaquín Escudero-Saiz, Lida Maria Rodas, Elena Cuadrado, Laura Morantes, Marta Arias-Guillen, Néstor Fontseré, Nayra Rico and José Jesús Broseta
J. Clin. Med. 2025, 14(1), 251; https://doi.org/10.3390/jcm14010251 - 3 Jan 2025
Viewed by 853
Abstract
Background: High-volume online hemodiafiltration (OL-HDF) has proven to be the most efficient dialysis modality and to offer better clinical outcomes in patients on hemodialysis. Longer and more frequent dialysis sessions have demonstrated clinical and survival benefits. Methods: A single-center observational study [...] Read more.
Background: High-volume online hemodiafiltration (OL-HDF) has proven to be the most efficient dialysis modality and to offer better clinical outcomes in patients on hemodialysis. Longer and more frequent dialysis sessions have demonstrated clinical and survival benefits. Methods: A single-center observational study of the first one hundred patients on nocturnal every-other-day OL-HDF was conducted with the aim of reporting the experience with this treatment schedule and evaluating analytical and clinical outcomes as well as the patient and technique survival. Results: Nocturnal OL-HDF on alternate days was highly accepted, with no adverse symptoms, good clinical tolerance, and maintained active work in 62%. Kt, and the convective volume increased from 67.6 ± 12 L to 105.4 ± 11.7 L, and from 27.1 ± 4.6 L to 48.1 ± 6.4 L, respectively, from the baseline to 24 months. An improved calcium–phosphate balance and blood pressure control were observed, as the use of phosphate binders and antihypertensive medications decreased from 76.7% to 3.3% and from 56.7% to 28.3%, respectively. Furthermore, 58.3% of patients required phosphate supplementation in the dialysis fluid to prevent intradialytic hypophosphatemia. Additionally, doses of iron and erythropoiesis-stimulating agents were reduced. The global patient survival was 94% at the end of the follow-up. It was higher in those on the transplant waiting list, with 98.1% survival compared to 84.6% in non-wait-listed patients at 24 months. The main reason for treatment discontinuation was kidney transplantation, accounting for 78.4% of the 88 withdrawals, while death was the leading cause of discontinuation in non-listed patients (41.6%). Conclusions: Nocturnal every-other-day OL-HDF is a well-tolerated dialysis regimen that offers significant clinical benefits, which may positively impact morbidity and mortality. Additionally, it allows patients to integrate the treatment into their social and occupational lives. Full article
(This article belongs to the Special Issue Clinical Advances in Hemodialysis)
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13 pages, 1084 KiB  
Article
Skeletal Muscle Measurements Based on Abdominal Computerized Tomography (CT) Predict Risk of Osteoporosis in Incident Hemodialysis Patients
by Hwajin Park, Suyeon Han, Yunkyeong Hwang, Wonjung Choi, Yu Ah Hong and Yoon-Kyung Chang
J. Clin. Med. 2024, 13(24), 7696; https://doi.org/10.3390/jcm13247696 - 17 Dec 2024
Viewed by 764
Abstract
Objective: Osteoporosis is prevalent in patients with chronic kidney disease (CKD), with risk increasing as CKD progresses, subsequently elevating fracture risk. While previous studies have shown a link between low skeletal muscle mass and osteoporosis in the general population, there is limited [...] Read more.
Objective: Osteoporosis is prevalent in patients with chronic kidney disease (CKD), with risk increasing as CKD progresses, subsequently elevating fracture risk. While previous studies have shown a link between low skeletal muscle mass and osteoporosis in the general population, there is limited research exploring this relationship in patients with advanced CKD (stages 3-5D). This study aimed to evaluate whether skeletal muscle area (SMA), as measured by abdominal CT, is correlated with bone mineral density (BMD) in advanced CKD patients beginning hemodialysis. Methods: This single-center, retrospective cohort study included patients who started maintenance hemodialysis at Daejeon St. Mary’s Hospital from January 2018 to September 2021. Patients who underwent abdominal CT and BMD assessments within three months of dialysis initiation were enrolled, resulting in a sample of 87 individuals. Baseline characteristics were analyzed, with patients stratified by sex and SMA quartiles. Pearson’s correlation and multivariate regression analyses were conducted to the relationship between SMA and BMD T-scores. Results: The study cohort had an average age of 65.4 years, with 52.9% of participants being male. Male patients exhibited significantly higher SMA and BMD T-scores in both the lumbar spine and femur compared to female patients. SMA showed the strongest positive correlation with BMD at both sites (lumbar spine, r = 0.424; femur, r = 0.514; p < 0.001). Multivariate analysis identified SMA as an independent positive predictor of BMD, while alkaline phosphatase (ALP) was independently associated with lower femur BMD. In the SMA-based subgroup analysis, patients with lower SMA had significantly lower BMD T-scores and a higher risk of osteoporosis. Logistic regression indicated that patients in the lowest SMA quartile had substantially increased odds of osteoporosis compared to those in the highest quartile, with an adjusted odds ratio of 30.59 (p = 0.008). Conclusions: Lower skeletal muscle mass is significantly associated with lower bone density and a higher risk of osteoporosis in advanced CKD patients initiating hemodialysis. SMA, as measured by abdominal CT, may serve as a useful marker for identifying patients at elevated osteoporosis risk in this population. Full article
(This article belongs to the Special Issue Clinical Advances in Hemodialysis)
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12 pages, 266 KiB  
Article
Association of Ego Defense Mechanisms with Electrolyte and Inflammation Marker Levels, Interdialytic Weight Gain, Depression, Alexithymia, and Sleep Disorders in Patients Undergoing Chronic Hemodialysis
by Đorđe Pojatić, Blaženka Miškić, Ivana Jelinčić, Davorin Pezerović, Dunja Degmečić and Vesna Ćosić
J. Clin. Med. 2024, 13(23), 7415; https://doi.org/10.3390/jcm13237415 - 5 Dec 2024
Viewed by 879
Abstract
Background/Objectives: Ego defense mechanisms are subconscious processes that help individuals cope with stressors from both external and internal realities. They are divided into three levels based on their adaptive function. Patients undergoing chronic hemodialysis are those who have been treated with this [...] Read more.
Background/Objectives: Ego defense mechanisms are subconscious processes that help individuals cope with stressors from both external and internal realities. They are divided into three levels based on their adaptive function. Patients undergoing chronic hemodialysis are those who have been treated with this method for longer than three months. Only a few studies have examined the defense mechanisms in hemodialysis patients. Our study aimed to examine the association between ego defense mechanisms and alexithymia, depression, and sleep disorders, as well as clinical and biochemical variables, in a group of 170 hemodialysis patients. Methods: We used the Defense Style Questionnaire-40, the Toronto Alexithymia Scale-26, the Pittsburgh Sleep Quality Index, and the Hamilton Depression Inventory as our analyses methods. Clinical and biochemical variables, along with interdialytic weight gain, were measured before the hemodialysis session. Results: There was a positive correlation between the affect displacement and dissociation with leukocyte levels (Spearman’s rho = 0.192, p = 0.02; rho = 0.165, p = 0.04), and between autistic fantasy and phosphorus levels (rho = −0.163, p = 0.04). Depressive HD patients had higher levels of somatization, affect displacement, and splitting compared to the HD patients without depression (Man–Whitney U test, p = 0.005, p = 0.022, p = 0.045). There were higher levels of immature defense mechanisms in the group of patients with alexithymia than in the group without alexithymia (Mann–Whitney U test, p < 0.001). Conclusions: The immature defense mechanisms were our research model’s strongest predictive factor of alexithymia (OR = 1.87, 95% CI 1.27 to 2.75). Full article
(This article belongs to the Special Issue Clinical Advances in Hemodialysis)

Review

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19 pages, 1097 KiB  
Review
Geriatric Assessment in Older Patients with Advanced Kidney Disease: A Key to Personalized Care and Shared Decision-Making—A Narrative Review
by Elisabeth J. R. Litjens, Melanie Dani, Wouter R. Verberne, Nele J. Van Den Noortgate, Hanneke M. H. Joosten and Astrid D. H. Brys
J. Clin. Med. 2025, 14(5), 1749; https://doi.org/10.3390/jcm14051749 - 5 Mar 2025
Viewed by 752
Abstract
As the global population ages, so too does the prevalence of older people with chronic kidney disease (CKD). Helping people age well with CKD and supporting older people with end-stage kidney disease (ESKD) to make personalized decisions regarding kidney replacement therapy (KRT) or [...] Read more.
As the global population ages, so too does the prevalence of older people with chronic kidney disease (CKD). Helping people age well with CKD and supporting older people with end-stage kidney disease (ESKD) to make personalized decisions regarding kidney replacement therapy (KRT) or conservative care (CC) are an essential component of care. However, these factors are relatively underreported in both the fields of nephrology and geriatric medicine, and prospective, randomized evidence is lacking. This narrative review article, authored by both nephrologists and geriatricians, discusses specific geriatric issues that arise in older people with CKD and why they matter. The available evidence for KRT or CC in older people with frailty is outlined. The importance of performing a comprehensive geriatric assessment, or a modified nephrogeriatric assessment, to ensure a systematic evaluation of the person’s medical problems and life needs, goals, and values is described. We consider different models of nephrogeriatric care and how they may be implemented. Kidney supportive care—addressing an individual’s symptoms and overall well-being alongside the more traditional nephrological principles of preventing disease progression and optimizing risk—is highlighted throughout the article. We outline ways of identifying the later stages of a person’s disease journey, when transition to palliative care is indicated, and elaborate methods of preparing patients for this through multidisciplinary advance care planning. Finally, we discuss practice and systems for nephrogeriatric care in five different European countries and consider future directions, challenges, and highlights in this rapidly evolving, increasingly relevant field. Full article
(This article belongs to the Special Issue Clinical Advances in Hemodialysis)
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