Kidney and Dialysis

Background: Chronic kidney disease (CKD) is a major global health burden. Patient education is a crucial part of CKD management. Large language models (LLMs) such as ChatGPT and Gemini may help patients access medical information, but their reliability in CKD-related contexts is uncertain. Methods: We collected 291 questions from 100 CKD patients and selected and analyzed 123 of them across three categories: medical condition and treatment, nutrition and diet, and symptom management. Responses from ChatGPT and Gemini were assessed by two nephrology specialists using the Quality Assessment of Medical Artificial Intelligence (QAMAI) scale. Results: When all 123 questions were evaluated together, ChatGPT outperformed Gemini in terms of clarity and usefulness. However, when the questions were analyzed by category, Gemini demonstrated relatively stronger performance in the nutrition and symptom management domains. Accuracy and relevance were comparable between the two models. Neither consistently provided adequate citations. Conclusion: ChatGPT and Gemini demonstrate potential as supplementary tools for CKD patient education, with complementary strengths across different domains. Although they cannot replace clinical expertise, their supervised use could enhance information access and reduce clinician burden.

Therapeutic plasma exchange is a procedure in which plasma is removed and replaced with another fluid to correct blood abnormalities. There is growing evidence of its benefit in certain clinical conditions, including thrombotic thrombocytopenic purpura, hematological diseases, and immune-mediated neurological disorders. Therapeutic plasma exchange prescription includes the choice of technique (centrifugation or membrane filtration) and the choice of vascular access, as well as the total plasma volume to be exchanged, the type of replacement fluid, the number and frequency of sessions, and the method of anticoagulation. These patients may be critically ill and undergo this technique in an intensive care unit, where the intensivist manages the procedure independently or in collaboration with other specialists. We aim to make an easy-to-follow general prescription of this procedure, by offering a practical revision that empowers physicians, such as non-autonomous intensivists, to autonomously prescribe and manage this procedure, reducing delays in initiating treatment and addressing complications.

Introduction: Temporary non-tunneled catheters are necessary in patients with chronic kidney disease requiring acute hemodialysis care, and complications associated with these catheters, such as infection and thrombosis, represent the most important sources of morbidity. There are no studies available that suggest the optimum duration of their use before catheter exchange or removal. This study aimed to explore the duration of temporary catheter insertion before the occurrence of catheter-related infection and mechanical complications in hemodialysis patients. Methods: Systematic searches were conducted according to the PRISMA 2020 guidelines on four databases up to 1 May 2025 (PROSPERO: CRD420251069657). The study outcome was the occurrence time to catheter-related infection and mechanical complications (thrombosis, obstruction, and kinking, causing dysfunction, failure, or insufficient blood flow) in days, pooled using a single-arm meta-analysis. Mean and 95% confidence interval (CI) were used as the summary statistics. Results: Nine studies involving 1448 participants undergoing hemodialysis using temporary catheters were included. Incidence of infection ranged from 0.7 to 13.58 per 1000 catheter-days. The most common bacterium identified was Staphylococcus aureus and Pseudomonas aeruginosa. The pooled mean time to catheter-related infection from 298 catheters was 15.98 days (95% CI 10.47–21.50; I² = 97.73%). We also found that the pooled mean time to mechanical complications from 507 catheters was 6.69 days (95% CI 2.49–10.90; I² = 98.03%). Conclusion: Among patients who developed complications, the mean time from temporary catheter insertion was approximately two weeks to the occurrence of catheter-related infection and one week to mechanical complications. Our finding was consistent with the recommendation of the KDOQI guideline, which suggests limiting catheter duration to typically less than two weeks.