Search Results (184)

Early and accurate identification of causative microorganisms is essential for improving outcomes in peritoneal dialysis (PD)-associated peritonitis. However, nontuberculous mycobacterial (NTM) peritonitis remains difficult to diagnose and manage, often resulting in delayed treatment and unfavorable clinical outcomes. We conducted a scoping review to summarize the clinical features, microbiological profiles, treatment strategies, and outcomes of PD-associated NTM peritonitis. A total of 107 patients from 81 published reports were identified, including one patient treated at our institution. The mean age was 50.1 years, with a slight male predominance. Diabetes mellitus was the most common underlying cause of end-stage renal disease. Abdominal pain, fever, and cloudy dialysate were the most frequently reported symptoms, and exit-site infection was present in 55% of cases. Rapid-growing NTM species predominated, with Mycobacterium fortuitum being the most frequently identified organism. A substantial delay was observed between symptom onset and initiation of appropriate therapy. The mean duration of antimicrobial treatment was six months. PD catheters were removed in 90% of patients, and 69% were permanently transitioned to hemodialysis. The overall mortality rate during treatment was 18%. These findings suggest that NTM infection should be considered in cases of culture-negative peritonitis unresponsive to standard antibiotics. Early catheter removal combined with prolonged multidrug antimicrobial therapy for at least six months may be beneficial. In pediatric patients, temporary conversion to hemodialysis followed by PD catheter reinsertion or renal transplantation may represent a reasonable management option after successful infection control. Full article

Background: Patients undergoing hemodialysis commonly exhibit deficiencies in water-soluble vitamins, primarily as a result of inadequate dietary intake and loss into the dialysate. Given the essential role of vitamin C in numerous metabolic pathways, routine supplementation has been proposed as a potentially beneficial intervention in this population. Aim: We aimed to evaluate the current evidence on vitamin C supplementation in patients undergoing hemodialysis, with particular attention to clinical conditions associated with renal replacement therapy, including anemia, chronic inflammation, restless legs syndrome (RLS), and secondary hyperparathyroidism. Methods: This systematic review was conducted in accordance with PRISMA guidelines. The MEDLINE (via PubMed) and EMBASE databases were searched. The initial search yielded 844 articles, of which 37 studies met the inclusion criteria for this review. Results: Evidence indicates that hemodialysis patients exhibit vitamin C deficiency, both in dietary intake and in plasma or serum concentrations. Despite its intrinsic antioxidant properties and proposed anti-inflammatory effects, vitamin C supplementation has demonstrated inconsistent effects on inflammatory markers. Most clinical studies support a beneficial role of vitamin C supplementation in functional iron deficiency and in alleviating symptoms of RLS within this population. Conclusions: Evidence on vitamin C supplementation for functional iron deficiency and RLS suggests that it might be an effective therapeutic approach. However, despite low serum vitamin C level in hemodialysis patients, current data does not justify the routine use of vitamin C in the hemodialyzed population for other comorbidities, including chronic inflammation and secondary hyperparathyroidism. Further high-quality studies are required to establish the broader clinical utility of targeted vitamin C supplementation. Full article

Investigation of dialyzer thrombogenicity is a critical step during the development of a new dialyzer. Novel dialyzer membranes aim to reduce the inherent thrombogenic potential of artificial surfaces by, e.g., increasing membrane hydrophilicity. Reliable in vitro testing is fundamental during dialyzer development and must be in line with the current standards. Using the novel FX CorAL dialyzer with its increased membrane hydrophilicity as an example, this study characterizes dialyzer thrombogenicity in an in vitro test setup in line with ISO 10993-4 and identifies factors which influence dialyzer thrombogenicity. In a recirculation setup with human blood, platelet activation (platelet counts, β-thromboglobulin, platelet adsorption), coagulation (thrombin–antithrombin III complex) and complement activation (sC5b-9) were investigated among polysulfone- (FX CorAL, FX CorDiax, Optiflux, xevonta), polyethersulfone- (ELISIO, Revaclear, Theranova) and AN69 ST-based (Nephral) dialyzers. Additionally, the impact of dialysate and electrolyte composition on thrombogenicity was investigated. The FX CorAL showed the lowest platelet activation compared to all poly(ether)sulfone-based dialyzers and lower complement activation compared to most poly(ether)sulfone-based dialyzers and to the Nephral dialyzer. No significant differences were observed between the investigated dialyzers with regard to plasmatic coagulation. Among the tested parameters, the dialyzer showed the strongest impact on the thrombogenicity results. This study proposes guidance on in vitro testing of dialyzer thrombogenicity in line with current standards and may contribute to reducing the current heterogeneity among in vitro hemocompatibility testing. Full article

Background/Objectives: Background: Dyslipidaemia and oxidative stress (OS) are frequent in peritoneal dialysis (PD). The Lipoprotein Combine Index (LCI) integrates lipid parameters, but its relationship with peritoneal transport and OS is unclear. Methods: This cross-sectional study included 100 clinically stable adults on continuous ambulatory PD with preserved ultrafiltration and adequate dialysis. LCI was calculated as (total cholesterol × triglycerides × LDL-C)/HDL-C and analyzed by tertiles. Lipid peroxidation and antioxidant markers were measured in serum, erythrocytes, urine, and spent dialysate. Multivariable regression models examined associations between LCI, peritoneal solute transport, and dialysate OS markers. Results: Higher LCI was independently associated with lower peritoneal solute transport. LCI correlated inversely with the 4 h dialysate-to-plasma creatinine ratio (ρ = −0.32, p = 0.001) and remained significant after adjustment (adjusted R² = 0.224, p < 0.001). Increasing LCI was associated with higher malondialdehyde levels in serum, urine, and dialysate (all p ≤ 0.008) and impaired antioxidant defenses, including lower total peroxidase activity in erythrocytes and dialysate (both p = 0.001), reduced serum sulfhydryl groups (p = 0.011), decreased oxidative resistance of erythrocytes, and increased peroxide-induced hemolysis (both p = 0.001). In adjusted models, logLCI was independently associated with higher dialysate malondialdehyde (p < 0.001) and lower dialysate peroxidase activity (p = 0.005). Conclusions: In clinically stable PD patients, higher lipid burden assessed by LCI is independently associated with lower peritoneal solute transport and a marked increase in systemic and local OS. Our findings suggest that dyslipidaemia may contribute to early metabolic and oxidative changes even before overt peritoneal membrane dysfunction develops. Full article

Background/Objectives: Studying the role of UV-induced metabolic changes in skin physiology, and especially skin diseases, has gained importance in both medicine and cosmetics. With the development of new technologies, a variety of approaches have been implemented to model these metabolic effects. In this study, we explore the reproducibility of the UVA1-induced metabolic changes observed in different in vitro, ex vivo, and in vivo systems with escalating complexity. Our aim is to elaborate on the role of experimental setups in the reliable representation of in vivo data in other systems. Methods: Metabolic profiles post UVA1 treatment were assessed in skin cell culture, skin explants, and intact skin. For cell culture and explants, the metabolites from the culture medium were assessed via 1D-CPMG NMR. Intact skin samples were collected via microdialysis and the resulting dialysate was measured with GC–TOF-MS. Results: Data show that, despite great metabolic variations between the systems, several metabolites, such as glutamic acid, succinic acid, and threonine, change in a similar manner across multiple systems after UVA1 irradiation, including in vivo settings. Some metabolites, like phenylalanine, citric acid, and pyruvic acid, show similar UVA-mediated metabolic patterns between corresponding in vitro and ex vivo systems, but do not overlap well with in vivo data. Conclusions: Our findings emphasize the need for a metabolite-by-metabolite approach when deciding on the proper experimental system to perform UV irradiation experiments with regard to cutaneous physiology. Full article

The removal of protein-bound uremic toxins (PBUTs) from the blood of kidney failure patients with conventional dialysis is limited. However, as their harmful effects and association with morbidity and mortality in dialysis patients are increasingly recognized, PBUTs have become important therapeutic targets. In this review, PBUT removal with current state-of-the-art dialysis technologies and future perspectives are discussed. Strategies to enhance PBUT clearance include methods that interfere with PBUT–albumin binding, such as chemical displacers, high ionic strength, pH changes, or electromagnetic fields, thereby increasing the free fraction available for dialysis. While these methods have shown promise in vitro, and some also in vivo, long-term safety data are lacking. PBUT removal can also be increased by adsorption, either directly via hemoperfusion, or indirectly, e.g., via sorbents incorporated in a mixed-matrix membrane or dissolved in the dialysate. In the kidney, PBUTs are secreted in the proximal tubules; hence, a cell-based bioartificial kidney (BAK) that secretes PBUTs is proposed as an add-on to current dialysis. Yet both PBUT adsorption strategies and, in particular, BAKs face considerable challenges in upscaling and mass production at acceptable costs. In conclusion, many novel technologies are under development, all requiring further (pre)clinical testing and upscaling before these strategies can be applied in the clinic. Full article

Background and Objectives: The obesity paradox in maintenance hemodialysis (MHD) patients (better survival of obese as compared to non-obese patients in MHD) remains controversial, with many published papers supporting the idea that higher BMI is protective. Data from Eastern Europe, in particular from the elderly population on hemodialysis, are limited. The aim of this study was to describe the distribution of body weight status and cardiometabolic comorbidities and to evaluate the association of BMI categories with all-cause mortality in a multi-center Romanian hemodialysis cohort. Materials and Methods: We conducted a retrospective cohort study of 679 patients with end-stage kidney disease (ESKD) undergoing maintenance haemodialysis in eight Romanian centers. All patients received thrice-weekly treatments (≥4 h/session) using high-flux dialysers. Baseline demographic, clinical, laboratory, and echocardiographic data were extracted from dialysis records. Survival across BMI groups was assessed using Kaplan–Meier curves and the log-rank test. Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality, with normal weight as the reference category. Multivariable models incorporated progressive adjustment for age, sex, dialysis vintage, diabetes, major cardiovascular comorbidities, and ESKD-related factors, including anemia parameters and CKD–mineral and bone disorder (CKD-MBD) markers. Results: A total of 679 haemodialysis patients were included (mean age 57.2 ± 12.9 years; 59.1% male); 52.7% were normal weight, 28.9% overweight, and 18.4% obese. During follow-up, 360 patients (53.0%) died, with similar crude mortality across BMI groups (normal weight 51.7%, overweight 55.1%, obese 53.6%; p > 0.05). In univariate Cox analyses, older age, obesity, hypoalbuminaemia, elevated CRP, hyperphosphataemia, peripheral and cerebrovascular disease, diabetes, low dialysis adequacy (eKt/V < 1.2), and lower ultrafiltration were associated with higher mortality, whereas preserved LVEF (≥50%) was protective. In multivariable analyses, independent predictors of mortality included older age (HR 1.042 per year, p < 0.001), obesity (HR 1.411, p = 0.045), elevated CRP (HR 1.781, p < 0.001), diabetes (HR 1.775, p < 0.001), inadequate dialysis dose (eKt/V < 1.2; HR 1.343, p = 0.029), and preserved LVEF remained protective (HR 0.665, p = 0.013). The Kaplan–Meier analysis showed significantly lower survival with increasing BMI: median survival was 7.56 years in normal-weight patients, 4.56 years in overweight patients, and 3.92 years in obese individuals (log-rank p < 0.05). Conclusions: In this Romanian cohort of multicenter hemodialysis patients, obesity as measured by BMI was associated with an increased incidence of all-cause mortality, while overweight did not confer a clear survival advantage over normal weight. These findings call into question the classic hemodialysis obesity paradox and support a more cautious interpretation of the increased BMI. Full article

Tinea is a superficial fungal infection of keratinized structures caused by specific filamentous fungi called dermatophytes. Terbinafine, a drug used to treat tinea, is poorly soluble in water, and its delivery into the skin via nanoparticle formulation usingpoly(lactic-co-glycolic acid) (PLGA) has been demonstrated. In this study, we investigated the preparation conditions for nanoparticles (NPs) to achieve efficient intradermal delivery of terbinafine. Terbinafine-loaded PLGA NPs were prepared using the nanoprecipitation method, and the particle size distribution and average particle size were measured using dynamic light scattering. Skin permeability tests were conducted using mouse dorsal skin, and the amount of terbinafine delivered into the skin was measured to evaluate the release behavior in the skin. In the preparation of terbinafine-loaded PLGA NPs, under conditions where the external solution was purified water, the mean volume diameter was 40.49 ± 15.63 nm, the terbinafine-loaded content was 3.31 ± 0.29%, and the entrapment efficiency was 55.08 ± 4.88%. Under conditions of an external solution containing 1.0 × 10⁻³ w/v% arginine(Arg) aq. solution, the mean volume diameter was 41.71 ± 16.08 nm, the terbinafine-loaded content was 5.17 ± 0.37%, and the entrapment efficiency was 86.48 ± 6.01%. The entrapment efficiency and content were higher under the condition using 1.0 × 10⁻³ w/v% Arg aq. solution compared to purified water. In addition, in the skin permeability test, no drug was detected in the receptor solution sampled from both the NPs suspension group and the simple solution group, and no drug was detected in the intradermal solution in the simple solution group. The intradermal drug concentration was 77.94 ± 10.66 µg/g under conditions where purified water was used as the dialysate, and 96.42 ± 61.62 µg/g under conditions using 1.0 × 10⁻³ w/v% arginine, exceeding the reported minimum inhibitory concentration (MIC) of 8.87 µg/g, suggesting the efficacy of terbinafine-loaded PLGA NPs for the treatment of tinea versicolor. Since tinea treatment is a long-term process, it is desirable to deliver a stable amount of drug to the treatment site at all times. Therefore, the nanoparticle preparation conditions using purified water as the external solution, where the intradermal drug concentration exceeded the MIC and remained stable in the skin permeability test, were suggested to be suitable for tinea treatment. Full article

The ever-increasing number of discarded end-of-life dialysate polyamide thin-film composite membranes (DEoLMs) from presents both environmental and economic challenges for health centers. Traditional thermo-chemical cleaning techniques have been deployed for the rehabilitation of DEoLMs. This study further investigated the application of chemo-ultrasonication rehabilitation of dialysate-production-related DEoLM for potential reuse in spent dialysate recovery considering salt and creatinine—a typical uremic toxin-removal from water. The DEoLM was rehabilitated using low-concentration citric acid (CA) and sodium lauryl sulfate (SLS) under ultrasonic waves (45 kHz, 30 min agitation). Considering different rehabilitation protocols, the synergistic effects of heating (HT) and the chemical agents, with and without and ultrasonic waves (SC) were evaluated through FTIR, SEM, and EDX analyses, and the performance of the rehabilitated DEoLM was assessed via water flux and permeance, and efficiencies for conductivity and creatinine rejection. The fully integrated protocol chemo-ultrasonication (HT + SC + chemical agents) yielded the highest performance, achieving 93.56% conductivity and 96.83% creatinine removal, with water flux of 113.48 L m⁻² h⁻¹ and permeances of 6.31 L m⁻² h⁻¹ bar⁻¹, at markedly reduced pressures. The chemo-sonic-rehabilitated-DEoLM removed the organic–inorganic foulants beyond thermo-chemical cleaning. This suggests that the sonication waves had a great impact regarding rejuvenating the fouled DEoL dialysate membrane, offering a sustainable, cost-effective pathway for extending membrane life, and supporting sustainable water management to achieve circular economy goals within healthcare centers. Full article

Background/Objectives: Protein–energy wasting (PEW) is a common complication in patients with chronic kidney disease (CKD) receiving renal replacement therapy by dialyses. This condition is associated with higher morbidity, mortality, and poorer quality of life. The aim of this systematic review was to evaluate the effectiveness of different nutritional strategies—such as oral nutritional supplements and intra-dialytic parenteral nutrition—in improving the nutritional status of these patients. Methods: A systematic review was carried out in accordance with the PRISMA statement. Searches were performed in PubMed, BVS, and Scopus between January and March 2025. Randomised or controlled clinical trials published in English or Spanish, available in full text, involving adults on haemodialysis (HD) or peritoneal dialyses (PD) were included. Fourteen studies met the inclusion criteria. Results: The nutritional interventions assessed produced consistent benefits in biochemical markers (e.g., serum albumin), muscle mass, inflammatory indices, and perceived quality of life. Intra-dialytic supplementation and multidisciplinary management were particularly effective in patients with moderate-to-severe malnutrition. Conclusions: Malnutrition is frequent and clinically significant in dialyses patients. Nutritional strategies—including oral supplementation, IDPN, and personalised counselling—effectively prevent and treat PEW. Early, tailored, evidence-based, and multidisciplinary implementation could decisively improve clinical prognosis and quality of life in this population. Full article

Background and objectives: Cast nephropathy is the main cause of acute renal failure in patients with multiple myeloma. There are conflicting data on whether removal of serum free light chains (sFLCs) with a high-cutoff (HCO) dialyzer has a favorable effect on the recovery of renal function. This may in part be explained by differences in the efficacy of sFLC removal by HCO dialysis and treatment responses to anti-plasma cell therapy between studies. We studied the removal of sFLCs during HCO treatment in detail in relation to treatment response. Materials and methods: Pre-dialysis serum and dialysate levels of sFLCs were simultaneously and repeatedly measured during the first two HCO treatments in 10 patients with kappa (κ)- and 5 patients with lambda (λ)-producing myeloma that presented with dialysis-dependent renal failure at our institution between 2009 and 2024. Results: The average change in sFLCs during 6 h treatments was −57 ± 13%, but it varied widely between −29% and −77%. Mean reductions in sFLCs were comparable for κ and λ (−61.4 ± 19.1% and −55 ± 16.7%, respectively; p = 0.78). The average clearance of sFLCs at 15 min after the start of HCO dialysis was 42.1 ± 8.5 and 27.4 ± 15.6 mL/min for κ and λ, respectively (p < 0.01). Clearances decreased to 27.2 ± 11.3 for κ and 13.8 ± 7.9 mL/min for λ after 6 h of HCO treatment (p = 0.042). Renal function recovered in 11 patients (73%). In three of the four patients whose renal function did not recover, sFLC levels were >5 g/L at any time beyond 2 weeks after the start of HCO treatment. Conclusions: Although the clearance of κ was higher compared to λ, reductions in sFLCs were similar for κ and λ. We speculate that this discrepancy is explained by greater adherence of λ to the HCO membrane. Patients whose renal function did not recover had less of a reduction in sFLC levels during HCO treatment, probably due to a suboptimal hematological response to anti-plasma cell therapy. Full article

Polymeric reverse osmosis (RO) membranes are critical for producing ultrapure water for hemodialysis process, but once they reach their end-of-life (EoL) stage, mainly due to fouling, they are usually discarded—adding to the growing challenges of medical waste management. This study explores a sustainable alternative by rehabilitating EoL thin-film composite (TFC) membrane and its reuse in recovery of spent dialysate. Using different cleaning agents that included citric acid (CA), EDTA, sodium lauryl sulfate (SLS), and sodium dodecyl sulfate (SDS), the mixture of CA and SLS (1:1) exhibited the most effective combination for balanced flux recovery, salt rejection, and creatinine clearance at lower TMP, achieving 90% conductivity reduction, 46.89 L/m²/h water flux, and 1.24 L/m²/h/bar permeance. FTIR, SEM, and EDX results confirmed the removal of both organic and inorganic foulants, while further process optimization revealed the critical role of cleaning temperature, SLS ratio and pressure on water permeability and improving creatinine removal. Under the optimal operational conditions, 99.89% creatinine removal, while restoring up to 80% hydraulic performance, yielding water flux and permeance of 59.36 L/m²/h and 1.79 L/m²/h/bar, respectively. These findings suggest that reduced dialysate production costs and minimize environmental impact can be significantly, achieved by extending the useful life of dialysate membranes, thereby opening a pathway toward implementing closed-loop water management and circular economy practices at dialysis centers. Full article

Objective: To explore the lived experiences of type 2 diabetes mellitus (T2DM) patients undergoing peritoneal dialysis (PD) or hemodialysis (HD) using continuous glucose monitoring (CGM). Research Design and Methods: A qualitative phenomenological study was conducted with 50 adult T2DM patients on PD or HD who used CGM for at least 14 days. Semi-structured interviews were audio-recorded and transcribed verbatim. A thematic analysis framework was applied to identify major themes regarding insulin management, CGM utilization, and emotional and social dimensions. Results: Four main themes emerged, each with multiple subthemes. PD patients emphasized enhanced autonomy and frequent insulin adjustments due to dialysate glucose absorption. Conversely, HD patients reported severe post-dialysis fatigue, emotional distress, and limited social engagement often associated with intra-dialytic hypoglycemia. CGM was valued by 85% of participants for improving metabolic awareness and self-management. However, 15% reported barriers such as device cost and technical difficulties. The insights clearly distinguish the differential impact of dialysis modality on daily glucose control and patient well-being. Conclusions: These findings underscore the critical need for patient-centered care incorporating access to CGM and tailored insulin regimens. Equitable implementation of CGM in dialysis settings could significantly enhance glycemic control, emotional resilience, and overall quality of life. Full article

The number of patients with end-stage renal disease continues to grow worldwide, placing increasing demands on dialysis technologies. Conventional hemodialysis remains the dominant modality but is often limited by frequent intradialytic hypotension and the insufficient removal of medium-sized toxins. Intermittent infusion hemodiafiltration (I-HDF) is an emerging, hybrid dialysis technique that combines standard hemodialysis with the cyclic backfiltration of ultrapure dialysate. This approach enables dynamic blood volume control and periodic backflushing of the dialyzer membrane. Recent clinical studies demonstrate that I-HDF can reduce intradialytic hypotension incidence, improve systemic and microcirculatory perfusion, and enhance the clearance of middle molecules such as β₂-microglobulin, while minimizing albumin loss. These benefits are particularly relevant to toxin clearance and hemodynamic stabilization, key priorities in optimizing dialysis outcomes. Large-scale cohort data suggest that I-HDF may be linked to improved long-term survival in dialysis patients. Given its physiological advantages and operational flexibility, I-HDF may also offer a practical solution in healthcare systems with limited access to high-volume online hemodiafiltration or kidney transplantation. Further research is warranted to develop individualized infusion protocols and validate its broader applicability. Full article

Background and Objectives: This study aimed to compare the effects of HIPEC procedures using oxaliplatin and mitomycin C on serum electrolyte, glucose, and lactate levels, with a specific focus on the carrier solutions employed. Materials and Methods: A retrospective analysis was performed on 82 patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases. Patients were assigned to one of two groups based on the chemotherapeutic agent used: oxaliplatin (n = 63) or mitomycin C (MMC, n = 19). The oxaliplatin group was further subdivided based on the carrier solution used: 5% dextrose (D5W, n = 29) or peritoneal dialysate (n = 34). The assignment of regimens was based on institutional protocols and surgeon preference. Pre- and post-HIPEC serum levels of sodium, potassium, bicarbonate, glucose, and lactate were compared. Results: Significant biochemical changes were observed across groups, depending on both the chemotherapeutic agent and carrier solution. In the MMC group (peritoneal dialysate), only lactate increased significantly post-HIPEC (p = 0.001). In the oxaliplatin–peritoneal dialysate group, significant changes were observed in bicarbonate (p = 0.009), glucose (p = 0.001), and lactate (p < 0.001), whereas sodium and potassium remained stable. The oxaliplatin–D5W group showed significant changes in all parameters: sodium (p = 0.001), potassium (p = 0.001), bicarbonate (p = 0.001), glucose (p < 0.001), and lactate (2.4 → 7.6 mmol/L, p < 0.001). Between-group comparisons revealed significant differences in sodium, potassium, glucose, and lactate changes (p < 0.05), but not in bicarbonate (p = 0.099). Demographic and clinical characteristics—including age, sex, primary disease, ICU stay, and 90-day mortality were similar across groups. Conclusions: The use of dextrose-containing solutions with oxaliplatin was associated with marked metabolic disturbances, including clinically meaningful hyponatremia, hypokalemia, and hyperglycemia in the early postoperative period. These findings suggest that the choice of carrier solution is as important as the chemotherapeutic agent in terms of perioperative safety. Closer postoperative electrolyte monitoring is recommended when using dextrose-based regimens. The retrospective design and sample size imbalance between groups are acknowledged limitations. Nonetheless, this study offers clinically relevant insights and lays the groundwork for future prospective research. Full article