Search Results (206)

Background/Objectives: Regional citrate anticoagulation (RCA) is guideline-preferred for continuous renal replacement therapy (CRRT), yet implementation requires expertise, calcium protocols, and reliable monitoring. Evidence for standardized low-molecular-weight heparin strategies without routine anti-Xa monitoring remains limited. Methods: We retrospectively analyzed adult ICU patients receiving protocolized divided-dose enoxaparin during CRRT from January 2020 to December 2024. Enoxaparin 1.5 mg/kg/24 h was divided into six equal prefilter doses every 4 h. The primary outcome was circuit clotting; death and hemodynamic instability were treated as competing termination events. Safety endpoints were ISTH major bleeding, clinically relevant non-major bleeding (CRNMB), minor bleeding, thrombosis, and suspected heparin-induced thrombocytopenia (HIT). Results: The cohort included 200 patients and 223 CRRT runs, contributing 8829.8 CRRT-hours. Median run duration was 35.0 h (IQR, 27.2–52.1). Circuit clotting occurred in 31 runs (13.9%; 95% CI, 9.6–19.1), equivalent to 0.35 events per 100 CRRT-hours. Kaplan–Meier clotting-free survival at 48 h was 89.8% (95% CI, 84.3–95.2), and the competing-risk cumulative incidence of clotting was 9.0%. Any classified bleeding occurred in 10 runs (4.5%; 95% CI, 2.2–8.1), including one ISTH major bleeding event and one CRNMB event. No thrombotic or HIT events were identified. In a prespecified four-variable Cox model with patient-level cluster-robust standard errors, no predictor was significantly associated with clotting. Conclusions: In a citrate-unavailable or citrate-not-routinely-implemented ICU setting, this standardized divided-dose enoxaparin protocol showed low observed major/clinically relevant bleeding rates and acceptable clotting-free circuit performance. Prospective comparative evaluation is warranted. Full article

Background: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is associated with adverse outcomes in sepsis, but risk stratification within MASLD remains insufficiently defined. We investigated whether an admission liver–metabolic phenotype framework combining cardiometabolic burden with liver injury/fibroinflammatory risk markers identifies clinically relevant organ-support vulnerability in community-acquired sepsis. Methods: This secondary analysis of the prospective SepsisFAT cohort (378 adults with community-acquired sepsis) classified patients into four phenotypes by cardiometabolic burden (≥2 of: diabetes, hypertension, dyslipidemia, BMI ≥ 30 kg/m²) and liver-risk positivity (FIB-4 ≥ 2.67, APRI ≥ 1.0, liver stiffness ≥ 10 kPa, or FAST ≥ 0.55). The primary outcome was acute kidney injury (AKI), while continuous renal replacement therapy (CRRT), other organ-support outcomes and in-hospital mortality were secondary endpoints. Results: Phenotype distribution was Low-risk 137 (36.2%), Cardiometabolic-only 84 (22.2%), Liver-dominant 88 (23.3%), and Mixed liver–cardiometabolic 69 (18.3%). AKI and CRRT increased across phenotypes (13.9% to 40.6% and 5.1% to 26.1%, respectively), and in-hospital mortality was highest in the Mixed phenotype (26.1%). After Firth-penalized adjustment for age, sex, and admission SOFA, the Mixed phenotype remained independently associated with AKI (aOR 2.82, 95% CI 1.37–5.90) and CRRT (aOR 3.87, 1.50–10.80), confirmed in non-renal SOFA and admission eGFR-adjusted sensitivity analyses. Cardiometabolic burden alone did not confer excess organ-support risk. The same gradient persisted within the MASLD subgroup. Conclusions: Admission liver–metabolic phenotyping identified a renal-vulnerable sepsis subgroup not captured by binary MASLD classification alone. These findings support prospective, multicenter external validation of liver–metabolic phenotyping as a pragmatic approach to renal risk stratification in community-acquired sepsis. Full article

Background: The utilization of renal replacement therapy (RRT) is crucial for the management of patients with acute kidney injury (AKI) in emergency departments (EDs). The prompt initiation of RRT, encompassing both intermittent hemodialysis (HD) and continuous renal replacement therapy (CRRT), is acknowledged as beneficial for critically ill patients. The purpose of this study is to investigate the implementation of RRT within EDs and its impact on ED length of stay (EDLOS) in South Korea. Methods: This retrospective study utilized data from the National Emergency Department Information System (NEDIS) for the year 2019 to assess the utilization of RRT in emergency medical centers (EMCs) across South Korea. The analysis focused on RRT, which includes intermittent HD and CRRT, as identified through insurance billing codes for patients treated during ED visits and subsequent admissions. EMCs were categorized into three groups based on the frequency of RRT sessions, and the median EDLOS was evaluated. Results: Among 5,937,569 ED visits to Level I and II emergency medical centers (EMCs), 40,130 cases (0.68%) received RRT. Of the 162 EMCs, 58 centers (35.8%) did not perform intermittent HD in the ED and 106 centers (65.4%) did not perform CRRT in the ED during the study period. Centers that frequently performed CRRT in the ED showed significantly longer EDLOS compared with centers that seldom or never performed CRRT (588 min [IQR 286–767] vs. 270 min [IQR 147–337] and 205 min [IQR 149–363], respectively; p = 0.01). Regional disparities in the availability of ED-based RRT were also observed across South Korea. Conclusions: The frequency of RRT administration in EMCs in South Korea varied by region and facility. ED-based RRT utilization was associated with longer EDLOS, particularly in centers frequently performing CRRT. These findings suggest that patient acuity, institutional characteristics, and RRT-related resource utilization should be considered when evaluating EMC performance based on EDLOS. Full article

Background: Postoperative hyperbilirubinemia is a serious complication after cardiac surgery and has been associated with increased perioperative morbidity and mortality. However, data specifically addressing patients undergoing redo valve surgery remain limited. This study aimed to determine the incidence and risk factors of postoperative hyperbilirubinemia after redo valve surgery, and evaluate its association with early postoperative outcomes. Methods: We retrospectively reviewed 259 adult patients who underwent elective redo valve surgery under cardiopulmonary bypass (CPB) between March 2018 and July 2024. Postoperative hyperbilirubinemia was defined as a serum total bilirubin level > 3 mg/dL at any time after surgery. Patients were divided into a hyperbilirubinemia group and a non-hyperbilirubinemia group. Perioperative variables were compared between groups. Univariable and multivariable logistic regression analyses were performed to identify risk factors for postoperative hyperbilirubinemia. Postoperative complications and in-hospital mortality were also compared. Results: Postoperative hyperbilirubinemia occurred in 101 of 259 patients (39.0%). Compared with patients without hyperbilirubinemia, those with hyperbilirubinemia had longer mechanical ventilation and intensive care unit stay, and higher rates of pneumonia, reintubation, tracheostomy, continuous renal replacement therapy, and in-hospital mortality. Univariable logistic regression showed that higher EuroSCORE II, higher preoperative total bilirubin and direct bilirubin levels, lower hemoglobin and platelet count, pulmonary hypertension, anemia, longer operative time, CPB duration, and aortic cross-clamp time, lower nasopharyngeal temperature, greater intraoperative blood loss, larger red blood cell and plasma transfusion volumes, and concomitant surgery on all three valves were associated with postoperative hyperbilirubinemia. Multivariable analysis identified elevated preoperative direct bilirubin, prolonged CPB duration, and more plasma transfusion as independent risk factors. Receiver operating characteristic analysis showed that peak postoperative total bilirubin had moderate prognostic discrimination for in-hospital mortality, with an optimal cut-off value of 3.95 mg/dL (AUC 0.756, sensitivity 66.7%, specificity 80.2%, p = 0.003). Conclusions: Postoperative hyperbilirubinemia is common after redo valve surgery and is associated with worse early postoperative outcomes and higher in-hospital mortality. In this setting, postoperative bilirubin elevation should be interpreted primarily as a prognostic marker of perioperative stress and hepatic vulnerability rather than a direct causal driver of adverse outcomes. Elevated preoperative direct bilirubin, prolonged CPB duration, and greater plasma transfusion were independently associated with the development of postoperative hyperbilirubinemia in this high-risk population. Full article

Background: Vasoplegic shock (VS) in critically ill patients without microbiological evidence of infection poses a major clinical challenge in intensive care units (ICUs). Extracorporeal cytokine hemadsorption using the oXiris^® membrane—a high-permeability polyacrylonitrile-based (AN69-ST) filter with adsorptive properties against inflammatory mediators—has emerged as a potential adjunct to restore haemodynamic stability. Evidence supporting its use remains limited, particularly regarding timing of initiation and downstream mortality biomarkers. Methods: We conducted a single-centre prospective observational study at the ICU of Istanbul Prof. Dr. Cemil Taşcıoğlu City Hospital between October 2022 and January 2023. Adults aged ≥18 years with VS (CRP ≥ 100 mg/L, procalcitonin [PCT] < 2 μg/L, no positive microbiological culture) requiring continuous renal replacement therapy (CRRT) with the oXiris^® membrane were enrolled (n = 34), of whom 30 completed the study period without microbiological exclusion and comprised the final analysis cohort. Pre- and post-treatment (72 h) clinical and cytokine parameters were compared. The association of VS resolution and 7-day mortality with timing of oXiris^® initiation, cytokine levels, and treatment duration was assessed. This study was conducted and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. Results: Significant changes were observed across all principal haemodynamic and inflammatory parameters at 72 h of oXiris^® treatment, including mean arterial pressure (MAP: 50.8 ± 6.3 to 69.3 ± 17 mmHg, p < 0.001), SOFA score (8.33 ± 2.29 to 4.9 ± 3.22, p < 0.001), IL-6 (767.3 ± 1205.7 to 294.4 ± 686.3 pg/mL, p < 0.001), IL-1β, TNF-α, CRP, lactate, and creatinine. VS resolved in 24/30 patients (80%). Younger age was associated with VS resolution (57.8 ± 19.7 vs. 76.6 ± 13.9 years; p = 0.021). Initiation of oXiris^® within 8 h was associated with significantly shorter VS resolution time (52.5 ± 23.9 vs. 85.9 ± 48.2 h; p = 0.045). Seven-day mortality was 20% (n = 6) and hospital mortality was 50% (n = 15). Post-treatment IL-1β (856.7 ± 548.5 vs. 1086.9 ± 353.6 pg/mL; p = 0.044) and TNF-α (111.0 ± 70.0 vs. 145.4 ± 47.8 pg/mL; p = 0.011) at 72 h were significantly higher in hospital non-survivors, representing exploratory prognostic associations. Conclusions: Changes in haemodynamic and inflammatory parameters were observed during oXiris^®-based CRRT treatment in critically ill patients with non-septic VS. Early initiation (≤8 h) was associated with shorter VS resolution time in this exploratory, uncontrolled analysis. Residual IL-1β and TNF-α at 72 h were associated with hospital mortality in exploratory analyses and may represent hypothesis-generating prognostic signals requiring prospective validation. Randomised controlled trials are warranted to confirm these findings and define optimal timing strategies. Full article

Background: Early external validation studies demonstrated the robust and consistent predictive performance of the International IgA Nephropathy Prediction Tool (IIgAN-PT) across diverse ethnic populations. However, emerging evidence suggests that, in contemporary cohorts of patients with IgA nephropathy, the IIgAN-PT increasingly tends to overestimate the risk of adverse renal outcomes. Subclassification of segmental glomerulosclerosis (S lesions) in the Oxford Classification system (MEST-C) could identify high-risk IgAN patients, with evidence that different S subclassifications respond differently to treatment. Our study aimed to evaluate the predictive performance of the IIgAN-PT in a contemporary Chinese external validation cohort and to optimize its prognostic accuracy by incorporating the most severe and prevalent pathological subclassification of S lesions, NOS⁺Adh⁺, into the original model. Methods: A total of 746 Chinese patients were included with biopsy-proven IgAN in this study. Major adverse kidney events (MAKEs) were defined as death from any cause, initiation of renal replacement therapy, or a 50% decline in eGFR. This study evaluated the discrimination and model fit of three predictive models. The performance of the original and modified IIgAN-PT models was compared and evaluated through reclassification, survival analysis, calibration, decision curve analyses and subgroup analyses. Results: In the study cohort, the median follow-up duration was 4.2 years, during which 77 patients experienced MAKEs. The discriminative ability of the three original models was relatively limited. In contrast, the modified IIgAN-PT incorporating the NOS⁺Adh⁺ subtype of S subclassification demonstrated improved global performance for predicting 5-year risk, achieving a C-index of 0.808 (95% CI, 0.756–0.861). Kaplan–Meier survival curves showed clear risk stratification, particularly between low- and intermediate-risk categories. Reclassification analyses (continuous NRI and IDI) and decision curve analysis further supported enhanced predictive performance, while calibration curves corrected the original model’s risk overestimation. The modified model maintained stable performance across clinically relevant subgroups, including patients with hypertension, proteinuria, or receiving immunosuppression. Conclusions: This study further confirms the independent and clinically relevant prognostic value of the S pathological subclassification. The modified IIgAN-PT model, incorporating the NOS⁺Adh⁺ subtype of S subclassification, demonstrated consistent performance in individualized risk assessment for patients with IgA nephropathy. Full article

Background and Objectives: Major burn injury causes profound hypermetabolism and altered thermoregulation. While perioperative hypothermia is linked to adverse outcomes, the prognostic significance of preoperative core temperature in major burn patients remains poorly defined. Therefore, we investigated the association between preoperative core temperature and postoperative mortality in patients with major burns. Materials and Methods: This retrospective study included 635 adult patients with major burns who underwent surgery. Preoperative core temperature was measured in the intensive care unit before surgery. The primary outcome was 90-day postoperative mortality. Secondary outcomes were 30-day postoperative complications, including major adverse cardiovascular events (MACE), bloodstream infection, and continuous renal replacement therapy (CRRT) requirement. Cox proportional hazards regression, receiver operating characteristic (ROC) curve, Kaplan–Meier survival, and restricted cubic spline analyses were performed. Results: The 90-day postoperative mortality rate was 35.6%. Mortality increased in a graded manner as preoperative core temperature decreased. In multivariable Cox regression analysis, preoperative core temperature remained independently associated with 90-day mortality. Restricted cubic spline analysis showed an inverse linear association between preoperative core temperature and mortality risk. ROC curve analysis identified 37.0 °C as an exploratory and hypothesis-generating cohort-specific threshold for risk stratification. Regarding secondary outcomes, the core temperature ≤37.0 °C group had higher rates of MACE, bloodstream infections, and CRRT requirement (all p < 0.05). Conclusions: Lower preoperative core temperature was associated with increased 90-day postoperative mortality in adults with major burns undergoing surgery. Preoperative temperature may serve as a clinically relevant marker of physiologic vulnerability and postoperative risk. Full article

Background: The combined prognostic value of the fibrinogen-to-albumin ratio (FAR) and uric acid-to-albumin ratio (UAR) in acute kidney injury patients undergoing continuous renal replacement therapy remains unclear. Methods: This retrospective cohort study utilized the MIMIC-IV database. Adult patients with AKI receiving CRRT were included and stratified into four groups based on optimal FAR and UAR cut-offs. Multivariable Cox proportional hazards regression and restricted cubic spline analyses were employed to examine associations with 30-, 90-, and 360-day all-cause mortality. Results: Patients with high FAR/high UAR had the poorest survival (log-rank p < 0.001). After multivariable adjustment, high FAR/high UAR was associated with higher 30-day (HR = 2.17, 95%CI: 1.61–2.92) and 360-day mortality (HR = 1.50, 95%CI: 1.18–1.90) vs. low FAR/low UAR. The association was stronger in patients with an SOFA score > 12 or vasopressin use (interaction p < 0.05). Conclusions: In critically ill AKI patients undergoing CRRT, the combined assessment of the FAR and UAR is associated with elevated mortality risk. These readily obtainable composite markers may support risk stratification in clinical practice. Full article

Liver transplantation (LT) is the definitive treatment for patients with end-stage liver disease. Since its inception in the 1960s, transplant medicine has undergone substantial advances in surgical technique, immunosuppression, organ preservation, and organ allocation policies. According to the 2023 WHO census, approximately 47,180 LT procedures occur worldwide each year, with living donors contributing to up to 23% of cases. Additional milestones include the expansion of transplant eligibility to patients with hilar cholangiocarcinoma and advanced colorectal liver metastasis, the incorporation of viscoelastic testing into perioperative blood management algorithms, and the increasing use of mechanical circulatory support for pre-transplant optimization. In parallel, medical training has evolved to meet the complexities associated with these high-risk procedures. Structured fellowship programs now provide focused expertise, and guide investigations to resolve complex clinical dilemmas. Experience accumulated over decades has improved clinicians’ ability to manage the expanding spectrum of comorbidities seen in contemporary transplant candidates. Key perioperative challenges include accurate assessment of fluid status, optimization of intravascular volume, management of vasoplegia, intraoperative renal replacement therapy, treatment of right-ventricular failure, and the mitigation of severe lactic acidosis. As transplant recipients increasingly present at older ages and with multiple comorbidities, perioperative management has become more demanding. One emerging strategy for select high-risk patients involves performing concurrent surgical procedures within a single operative session. This narrative review focuses on the intraoperative management of five variables that proved challenging during the first case of concurrent liver transplantation and off-pump coronary artery bypass surgery in our institution. Full article

Background: The landscape of paediatric oncology has undergone a remarkable transformation over recent decades. Advances in both oncological and supportive therapies have dramatically improved survival in children with haematological malignancies and solid tumours, with current survival rates exceeding 80% for many childhood cancers. However, this therapeutic success has brought with it an unexpected consequence: the intensification of treatment protocols has led to a parallel increase in life-threatening complications requiring intensive care support. Current evidence indicates that up to 40% of paediatric oncology patients will require admission to a Paediatric Intensive Care Unit (PICU) at some point during their disease trajectory. Objectives: This comprehensive review synthesises current evidence to provide an updated framework for PICU admission decision-making in oncology haematology patients. We have integrated the most recently published international guidelines, including the groundbreaking Phoenix 2024 sepsis criteria and the updated PALICC-2 2023 recommendations for paediatric acute respiratory distress syndrome. Beyond establishing admission criteria, we critically analyse the efficacy of advanced support strategies and examine emerging therapeutic approaches in this uniquely vulnerable population. Methods: Our methodology encompassed a systematic review of the literature published between 2011 and 2024, complemented by a detailed analysis of current international guidelines and expert consensus statements. We included randomised controlled trials, observational studies, meta-analyses, and consensus conference proceedings specifically addressing the intensive care management of paediatric patients with oncological or haematological conditions. Main Results: Several key findings emerge from our analysis. The Phoenix 2024 criteria represent a fundamental reconceptualisation of paediatric sepsis diagnosis, validated through an unprecedented dataset encompassing more than 3 million paediatric encounters. In the realm of respiratory support, early implementation of non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) has demonstrated remarkable efficacy, reducing the need for invasive mechanical ventilation by 45% (RR 0.45, 95% CI 0.26–0.78) when applied to appropriately selected patients. Extracorporeal membrane oxygenation (ECMO), whilst increasingly utilised, shows survival to decannulation ranging from 52% to 64%, though survival to hospital discharge remains less encouraging at 36–42%. Continuous renal replacement therapy (CRRT) has proven highly effective for tumour lysis syndrome, achieving metabolic correction in 90% of severe cases. Perhaps most promisingly, emerging biomarkers—particularly interleukin-6, interleukin-10, and procalcitonin—have substantially enhanced our ability to stratify infection risk, demonstrating sensitivity exceeding 85% for bacteraemia detection. Conclusions: The evidence unequivocally supports several core principles for optimising outcomes in this population. Early identification of deterioration through validated scoring systems enables timely intervention before irreversible organ failure develops. Prompt implementation of non-invasive respiratory support, when appropriately applied, can obviate the need for mechanical ventilation with its attendant complications. Perhaps most critically, centralisation of care in centres with dedicated expertise and comprehensive support capabilities fundamentally improves survival. These findings argue compellingly for the establishment of a formal national network of reference centres, implementing standardised protocols and structured care pathways specifically designed for critically ill paediatric oncology haematology patients. Full article

Background: Artificial intelligence in nephrology has largely focused on predictive models for outcomes such as acute kidney injury (AKI), chronic kidney disease (CKD) progression, and transplant complications. Although these models demonstrate technical performance, their real-world clinical impact has remained limited because prediction alone rarely translates into coordinated clinical action. Clinical artificial intelligence agents represent workflow-native systems that operate in real time, interact bidirectionally with clinical environments, adapt to evolving patient and workflow states, and support coordinated clinical action rather than generating isolated predictions. This review proposes clinical artificial intelligence agents as a new paradigm for integrating artificial intelligence directly into nephrology workflows. Methods: We conducted a narrative synthesis of emerging literature on artificial intelligence systems, agentic artificial intelligence architectures, clinical decision support, and digital health infrastructures relevant to kidney care. Drawing from interdisciplinary sources in medicine, health informatics, and artificial intelligence research, we developed a conceptual framework describing the architecture, governance requirements, and evaluation principles of clinical artificial intelligence agents in nephrology. Results: Clinical artificial intelligence agents represent workflow-integrated systems capable of continuously perceiving patient data, reasoning under clinical constraints, planning tasks, and supporting coordinated clinical actions over time. We describe a layered architecture consisting of perception, cognition, planning and control, action, and learning components. Potential applications span the nephrology care continuum, including CKD management, AKI monitoring, dialysis and continuous renal replacement therapy (CRRT) optimization, kidney transplantation care coordination, glomerulonephritis management, and supervised patient-facing systems. Conclusions: Clinical artificial intelligence agents shift the role of artificial intelligence from isolated prediction toward longitudinal clinical orchestration. Future evaluation should prioritize workflow integration, time-to-action, clinician oversight, safety, and patient-centered outcomes rather than relying solely on traditional model performance metrics. This roadmap provides a conceptual foundation for the responsible development and clinical integration of agentic artificial intelligence systems in nephrology. Full article

Background: Acute kidney injury (AKI) is a serious complication of acute pancreatitis and is frequently associated with the need for continuous renal replacement therapy. Early identification of patients at risk of requiring continuous venovenous hemofiltration (CVVHF) remains challenging because conventional renal markers often reflect delayed kidney injury. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a potential biomarker of early renal tubular damage. Methods: This observational study included 219 patients with acute pancreatitis. Plasma and urinary NGAL levels were measured at hospital admission. Clinical characteristics, laboratory parameters, and severity scores were compared between patients who required CVVHF and those who did not. Multivariate logistic regression analysis was performed to identify factors associated with CVVHF requirement, and predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: During hospitalization, 28 patients (12.8%) required CVVHF and had significantly more severe disease. Both plasma and urinary NGAL levels were higher in patients requiring CVVHF. In multivariate analysis, urinary NGAL remained independently associated with CVVHF requirement. ROC analysis demonstrated moderate predictive performance for urinary NGAL (AUC 0.708). Conclusions: Urinary NGAL was independently associated with the requirement for CVVHF and demonstrated moderate predictive performance. These findings suggest that urinary NGAL may provide kidney-specific information and improve early risk stratification beyond conventional clinical parameters. Full article

Background: Pediatric kidney failure, whether acute or chronic, constitutes a major public health issue because of its impact on survival, linear growth, neurocognitive development, and long-term quality of life. While high-income countries have markedly improved outcomes through early diagnosis, advanced dialysis technologies, and kidney transplantation, management remains limited in low- and middle-income countries, particularly in the Maghreb region. Objective: This review aims to provide an updated synthesis of pediatric kidney failure, with emphasis on renal replacement therapy modalities and the specific challenges encountered in resource-limited contexts, particularly in Algeria. Methods and Content: We successively address the pathophysiological and clinical bases of pediatric acute kidney injury and chronic kidney disease, followed by a discussion of available therapeutic strategies: peritoneal dialysis, intermittent hemodialysis, continuous renal replacement therapy, and pediatric kidney transplantation. Particular attention is given to organizational constraints, actual availability of modalities, limited access to consumables and immunosuppressive therapies, and the specificities of pediatric kidney care in the Maghreb region in comparison with international recommendations. Perspectives: Improving outcomes for children with kidney failure in Maghreb countries requires a multidimensional approach integrating early screening, strengthening peritoneal dialysis programs, structured development of pediatric kidney transplantation, and enhanced regional and international collaboration. Reinforcing local research capacity and participation in international registries are essential steps toward reducing disparities in care and adapting global guidelines to local realities. Full article

Patients receiving dialysis treatments suffer from a high rate of systemic comorbid conditions, including cardiovascular disease, mineral and bone disorders, chronic inflammation, amyloidosis, and recurring infections, leading to increased morbidity and mortality rates despite the progress made in the field of renal replacement therapies. The aforementioned conditions result from the continued dysregulation and overproduction of molecular biomarkers, which cannot be adequately monitored by traditional, intermittent laboratory tests. This review critically assesses the newly developed biosensor technologies for the detection of major dialysis biomarkers, including potassium, phosphorus, parathyroid hormone (PTH), β₂-microglobulin, creatinine, and cystatin C, with special emphasis on biosensors based on electrochemistry, optics, impedimetry, nanophotonics, and biological engineering techniques. These recent biosensors have been evaluated based on their analytical performance, the biofluids used in the studies, and their suitability for measuring relevant concentrations of these biomarkers. Special attention is given to biosensors capable of continuous operation or minimally invasive sampling, as well as to newly developed biofluid sampling techniques, including microneedle-, microtube-, and micropillar-based systems, for the long-term monitoring of the biomarkers in the serum of patients receiving dialysis treatments. The biosensing techniques for measuring infection biomarkers have also been discussed, given the high risk of bloodstream and access infections among patients receiving dialysis. The limitations of these biosensors include biofouling, calibration drift, and their integration into the dialysis treatment workflow. Finally, the future prospects of the recent biosensors offer the possibility of the proactive management of the high rate of comorbid conditions in this high-risk population of patients receiving dialysis treatments. Full article

Background: Sepsis is one of the leading causes of early death after a liver transplant, with a frequency of up to 45% and a high death rate of 50% in more severe forms. Standard diagnostic and therapeutic algorithms are often not applicable to this specific population, where immunosuppression, reperfusion injury, and systemic inflammation overlap and generate a clinical picture that is significantly different from sepsis in immunocompetent patients. Methods: This paper analyzes the available literature and clinical experiences of characteristic immune and hemodynamic profiles of sepsis after liver transplants. Biomarkers (IL-6, IL-10, HLA-DR, lactate, and IgM) are discussed as tools for assessing immune status and guiding timely interventions, including the early application of continuous renal replacement therapy (CRRT) and the selective use of IgM-enriched immunoglobulins. Results: Sepsis after liver transplantation frequently unfolds in two phases, an initial hyper-inflammatory response driven by cytokine release and reperfusion injury and a second phase of secondary immunoparalysis characterized by reduced HLA-DR expression and increased anti-inflammatory signaling. The immunometabolic shift appears to influence the clinical course and may inform therapeutic decision-making. The immunoparalysis phase is accompanied by mitochondrial dysfunction and impaired vascular reactivity. This type of mechanism contributes to hemodynamic instability and a reduced response to standard therapy. Individualized monitoring and early use of hemofiltration and immunomodulatory measures can improve results in carefully selected patients. Conclusions: In this setting, an individualized immunometabolic approach may complement standard sepsis management in liver transplant recipients. The introduction of biomarkers of immune function into routine practice and the recognition of early signs of exhaustion of the immune response can assist in timely therapeutic decision-making and improve survival. Full article