Search Results (308)

Background: High-sensitivity cardiac troponin (hs-cTn) is useful for detecting acute myocardial infarction, but chronic hemodialysis patients often have elevated baseline levels that exceed the upper reference limit (URL). This study aimed to determine whether hs-cTnI levels in asymptomatic hemodialysis patients exceed the URL established for the general population, evaluate the impact of high-flux hemodialysis on hs-cTnI concentrations, and examine associations between hs-cTnI levels and subsequent hospitalization or mortality. Methods: A prospective, single-center cohort study was conducted at a tertiary care center from August 2023 to July 2024. Blood samples for hs-cTnI were collected from asymptomatic hemodialysis patients aged ≥ 40 years, measured before and after dialysis within one month. Patients were followed for up to 12 months. Results: Fifty-six patients were enrolled. The mean hs-cTnI levels were 28.4 ng/L pre-dialysis and 27.9 ng/L post-dialysis, with ranges of <6–223 ng/L and <6–187 ng/L, respectively. The mean hs-cTnI delta between pre- and post-dialysis was −0.5 ng/L, with 52% showing a negative delta, 30% no change, and 18% a positive delta. No association was found between baseline hs-cTnI levels and mortality or hospitalization during follow-up. Conclusions: Most asymptomatic hemodialysis patients had hs-cTnI levels in the “gray zone”, thus neither confirming nor excluding acute myocardial infarction. Dialysis did not significantly affect hs-cTnI levels, and elevated baseline hs-cTnI was not linked to increased mortality or hospitalization over 12 months. Full article

Background: Kidney transplantation from a living donor is considered the most beneficial form of treatment for end-stage renal failure, which, in addition to providing patients with better treatment results, significantly improves their quality of life. Understanding factors that influence the willingness to donate kidneys to strangers is critical in promoting and expanding the living donor pool. When considering the decision to become an altruistic kidney donor, individuals must evaluate multiple factors, including the identity of the recipient and their own perceived level of safety. This study aimed to assess the willingness of dialysis center employees to act as living kidney donors for a stranger. Methods: We conducted a cross-sectional study from February 2023 to June 2024 among dialysis specialists across Poland. The study involved 1093 people (doctors and nurses). The study used our survey questionnaire and standardized tools. Results: Nurses (vs. physicians) and those who advocated the regulation of unspecified living kidney donation in Poland, did not believe in the risk of organ trafficking, and would donate a kidney to a husband/wife or friend and accept kidney transplantation from a husband/wife were more likely to donate a kidney to a stranger. Furthermore, respondents who accepted a loved one’s decision to donate a kidney to a stranger were significantly more willing to donate a kidney to such a person themselves. Perceived self-efficacy was positively associated with the willingness to donate a kidney to a stranger. Conclusions: Less than half of healthcare professionals supported unspecific living organ donation in Poland, and nurses were more willing to donate than physicians. The factors supporting the decision generally included knowledge about organ donation and transplantation, a lack of fear of organ trafficking, and attitudes towards donation. Full article

Background and Objectives: Chronic kidney disease frequently progresses to end-stage renal disease, requiring dialysis, which imposes significant physical, psychological, and social burdens. Age is a key factor influencing symptom experience and quality of life in dialysis patients, yet findings on its impact remain mixed. This study aimed to examine how age relates to a broad range of health domains—including fatigue, pain, cognition, mental health, sexual satisfaction, bowel control, visual impairment, social support, and quality of life—among hemodialysis patients. Materials and Methods: A cross-sectional study was conducted at a single dialysis center in Poland, involving 79 adult patients undergoing maintenance hemodialysis. Standardized, validated psychometric instruments were used, including the Modified Fatigue Impact Scale (MFIS), Perceived Deficits Questionnaire (PDQ), Pain Effects Scale (PES), Mental Health Inventory (MHI), Modified Social Support Survey (MSSS), Sexual Satisfaction Scale (SSS), Bowel Control Scale (BWCS), Impact of Visual Impairment Scale (IVIS), and WHOQOL-BREF for quality of life. Spearman’s or Pearson’s correlation coefficients were used to evaluate relationships between age and scale scores. Full and abbreviated versions of scales were also compared. Results: Age showed moderate positive correlations with fatigue (ρ = 0.44–0.53), cognitive deficits (ρ = 0.37–0.45), pain (r = 0.41), bowel control issues (ρ = 0.32), and visual impairment (ρ = 0.37), all statistically significant (p < 0.01). No significant associations were observed between age and mental health (MHI), perceived social support (MSSS), or quality of life (WHOQOL-BREF). Abbreviated versions of the scales showed strong correlations with their full versions (ρ > 0.9). Conclusions: While age is linked to increased symptom burden in select domains such as cognition, fatigue, and pain, it does not significantly affect mental health, perceived social support, or overall quality of life in hemodialysis patients. These findings support the use of age-sensitive, multidimensional assessments to inform individualized care strategies. Full article

Background: The atherogenic index of plasma (AIP), a prognostic indicator for cardiovascular disease, has not been fully explored in relation to clinical outcomes in patients receiving peritoneal dialysis. This study aims to elucidate the relationship between baseline AIP levels and all-cause mortality, cardiovascular mortality, and the peritonitis risk in this population. Methods: This retrospective cohort study included incident peritoneal dialysis patients in our center from 1 January 2006 through 31 December 2021. The end of the follow-up time was 31 December 2023. The participants were stratified by baseline AIP levels. Kaplan–Meier curves, Cox regression analyses, and subgroup analyses were used to evaluate associations with clinical outcomes. Results: The average age of the 2460 participants in this study was 45.9 years, and 1456 (59.2%) of them were men. Diabetic nephropathy (19.5%) was the second most common kidney disease, after primary glomerulonephritis (60.8%). The higher AIP tertile group was significantly associated with increased risks of all-cause mortality, cardiovascular mortality, and peritonitis compared to the lowest AIP group, as evidenced by the Kaplan–Meier curves and the multivariate analyses. Continuous AIP levels also showed a positive correlation with the all-cause mortality and peritonitis risk, even after controlling for covariates. Conclusions: Our study highlights AIP as a predictive marker for adverse outcomes in PD patients, emphasizing its potential utility in risk stratification and clinical management. Full article

Background: The Kidney Disease and Quality of Life Short Form (KDQOL-SF™ 1.3) is widely used to assess health-related quality of life (HRQoL) in patients with end-stage renal disease. However, no prior validation had been conducted in Kazakhstan, where both Kazakh and Russian are commonly spoken. This study aimed to validate the Kazakh and Russian versions of the KDQOL-SF™ 1.3 and to identify predictors of HRQoL among hemodialysis patients in Kazakhstan. Methods: A cross-sectional survey was conducted among 217 adult hemodialysis patients from February to April 2025 using a mixed-methods approach (in-person interviews and online data collection). Psychometric testing included Cronbach’s alpha, floor and ceiling effect analysis, and Pearson correlations with self-rated overall health. Multiple linear regression was used to identify predictors of the Kidney Disease Component Summary (KDCS), Physical Component Summary (PCS), and Mental Component Summary (MCS) scores. Results: Both language versions demonstrated acceptable to excellent internal consistency (Cronbach’s α = 0.692–0.939). Most subscales were significantly correlated with self-rated health, supporting construct validity. Regression analyses revealed that greater satisfaction with care, better economic well-being, and more positive dialysis experiences were significant predictors of higher KDCS and MCS scores. Lower PCS scores were associated with female gender, comorbidities, and financial burden. Importantly, financial hardship and access challenges emerged as strong negative influences on HRQoL, underscoring the role of socioeconomic and care-related factors in patient well-being. Conclusions: The KDQOL-SF™ 1.3 is a valid and reliable tool for assessing quality of life among Kazakh- and Russian-speaking hemodialysis patients in Kazakhstan. Integrating this instrument into routine clinical practice may facilitate more personalized, patient-centered care and help monitor outcomes beyond traditional clinical indicators. Addressing economic and access-related barriers has the potential to significantly improve both physical and mental health outcomes in this vulnerable population. Full article

Background/Objectives: Secondary hyperparathyroidism (SHPT) is a prevalent complication in end-stage renal disease, often necessitating surgical intervention when refractory to medical therapy. The optimal surgical strategy—subtotal parathyroidectomy (SPTX) versus total parathyroidectomy with/without autotransplantation (TPTX ± AT)—remains debated, especially considering postoperative complications like persistent HPT and hungry bone syndrome (HBS). This study aimed to compare early surgical outcomes and identify predictors for postoperative complications in patients undergoing SPTX and TPTX + AT. Methods: We conducted a retrospective, single-center observational study involving 93 dialysis patients who underwent PTX for drug-refractory SHPT. Patients were analyzed according to surgical procedure (SPTX vs. TPTX + AT), focusing on postoperative complications such as cervical bleeding, reintervention rates, and the incidence of HBS. Multivariate logistic regression was utilized to identify predictors of these outcomes. Results: TPTX + AT demonstrated superior control of HPT, with significantly lower rates of reintervention compared to SPTX (7.1% vs. 23.5%, p = 0.037). However, TPTX + AT was associated with a higher incidence of HBS (57.1% vs. 35.3%, p = 0.039). Independent predictors of reintervention included absence of concomitant thymectomy, preoperative hypercalcemia, fewer visualized glands preoperatively, and preoperative PTH > 2000 pg/mL. Elevated alkaline phosphatase levels (>300 U/L), severe bone pain, and the TPTX procedure itself were significant predictors of HBS. Conclusions: Surgical strategy for SHPT should be individualized, balancing the lower recurrence risk associated with TPTX + AT against its higher likelihood of postoperative hypocalcemia. Preoperative biochemical markers and clinical features could potentially influence operative decision-making and optimize patient outcomes. Full article

Diabetic kidney disease (DKD) remains the leading cause of end-stage kidney disease (ESKD) globally. Despite advances in our understanding of its pathophysiology, current therapies are often insufficient to stop its progression. In recent years, microRNAs (miRNAs)—small, non-coding RNA molecules involved in post-transcriptional gene regulation—have emerged as critical modulators of key pathogenic mechanisms in DKD, including fibrosis, inflammation, oxidative stress, and apoptosis. Numerous studies have identified specific miRNAs that either exacerbate or mitigate renal injury in DKD. Among them, miR-21, miR-192, miR-155, and miR-34a are associated with disease progression, while miR-126-3p, miR-29, miR-146a, and miR-215 demonstrate protective effects. These molecules are also detectable in plasma, urine, and renal tissue, making them attractive candidates for diagnostic and prognostic biomarkers. Advances in therapeutic technologies such as antagomiRs, mimics, locked nucleic acids, and nanoparticle-based delivery systems have opened new possibilities for targeting miRNAs in DKD. Additionally, conventional drugs, including SGLT2 inhibitors, metformin, and GLP-1 receptor agonists, as well as dietary compounds like polyphenols and sulforaphane, may exert nephroprotective effects by modulating miRNA expression. Recent evidence also highlights the role of gut microbiota in regulating miRNA activity, linking metabolic and immune pathways relevant to DKD progression. Further research is needed to define stage-specific miRNA signatures, improve delivery systems, and develop personalized therapeutic approaches. Modulation of miRNA expression represents a promising strategy to slow DKD progression and improve patient outcomes. Full article

Background: Kidney transplantation is the treatment of choice for pediatric patients with end-stage kidney disease. However, transplantation in children weighing < 15 kg remains challenging due to limited donor availability and higher surgical and medical risks. We report our 35-year single-center experience in this population, focusing on perioperative and long-term outcomes. Methods: We retrospectively analyzed kidney transplants performed from 1987 to 2023 in children weighing < 15 kg. Data on demographics, donor type, complications, immunosuppression, and outcomes at 2, 5, and 10 years (including survival, graft function, rejection, infections, and urological issues) were collected. Outcomes were compared between deceased and living donors and between recipients weighing < 10 kg and ≥10 kg. Results: Ninety-six transplants were included (mean age 3.3 years; mean weight 11.1 kg), 80 from deceased and 16 from living donors. Most patients (69.8%) had been treated with peritoneal dialysis. Median follow-up was 120 months. Patient survival was 95.8%; graft survival was 78.1%. Eight grafts (8.3%) were lost to renal vein thrombosis, all in deceased-donor recipients (p = 0.60). Preserved renal function (eGFR > 60 mL/min/1.73 m²) declined from 80.4% at 2 years to 66.0% at 5 years and 18.0% at 10 years. Graft survival at 10 years was significantly lower in children < 10 kg vs. ≥10 kg (49.6% vs. 80.3%, p = 0.003). CAKUT was associated with higher urological complication rates (p = 0.017). No significant differences emerged between living and deceased donor groups. Conclusions: Transplantation in children < 15 kg is feasible with good outcomes, but those <10 kg present lower graft survival at 10 years. Multidisciplinary assessment and center experience are key to optimizing results. Full article

The prevalence of end-stage renal disease has surged significantly in recent decades, with an 88% increase reported in the United States between 2002 and 2022. Peritoneal dialysis and home hemodialysis offer numerous advantages over in-center hemodialysis, including improved quality of life, increased treatment flexibility, and reduced healthcare costs. Despite strong preferences among healthcare professionals and the documented benefits of home-based therapies, utilization remains limited in the U.S. One of the many factors that play a role in the underutilization of home therapies is inadequate training and perceived incompetence among nephrology fellows in initiating and managing home dialysis patients. Here in this article, we highlight the current educational gaps in home dialysis training and ways to overcome the barriers. There is a need for a multifaceted approach that includes home dialysis rotations and continuity clinics; a dedicated one-year Home Dialysis Fellowship; and continued medical education through didactics, symposiums, and conferences. Here we emphasize the need for structured, longitudinal programs that combine didactic learning with hands-on clinical in fellowship trainings and the importance of dedicated one-year fellowships in cultivating future leaders and experts in the field. By enhancing training pathways and expanding fellowship opportunities, nephrology education can better equip physicians to meet the growing demand for home dialysis, ultimately improving patient outcomes and advancing public health objectives. Full article

Sex-specific differences in the prevalence of sarcopenia, dynapenia, and the impact of obesity on muscle strength and quality in patients with chronic kidney disease (CKD) remain underexplored. Background/Objectives: In this cross-sectional study, 78 adults with stage 5 CKD undergoing thrice-weekly maintenance hemodialysis in Brazil (44 men, 34 women; mean ± SD age = 57.55 ± 4.06 years) were assessed. Anthropometry (BMI, waist circumference, waist-to-height ratio), dual-energy X-ray absorptiometry, circulating IL-6, Timed Up and Go, handgrip strength (Jamar ^® dynamometer), and muscle quality index (MQI = handgrip/BMI) were obtained. Dynapenia (handgrip < 27 kg men and < 16 kg women) and sarcopenia (1.0 kg/kg for men and 0.56 kg/kg for women) were classified using EWGSOP2-2018 and FNIH thresholds. Results: Compared with reference values, men showed markedly reduced muscle strength and muscle quality (men: handgrip 21.3 ± 5.1 kg; MQI 0.80 ± 0.23 AU) than women. Also, men were 5.1 times more likely to present with dynapenia (88.6%; 95% CI 2.28–11.60) and 3.15 times more likely to present with sarcopenia (75.0%; 95% CI 1.88–5.30) than women. Waist circumference, waist-to-height ratio, BMI, and body fat % correlated inversely with MQI in both sexes (p ≤ 0.01) and with handgrip strength in men (p ≤ 0.01) but not in women. Conclusions: Among hemodialysis patients, men exhibit a substantially higher burden of dynapenia and sarcopenia than women and excess adiposity is independently associated with poorer muscle quality in both sexes. These findings highlight the need for sex-specific screening cut-offs and integrated strategies targeting both muscle dysfunction and central obesity in CKD management. Full article

Resilience, the ability to adapt and thrive in the face of adversity, is an essential yet under-recognized determinant of outcomes in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), particularly those undergoing home-based peritoneal dialysis (PD). While studies have shown that PD can enhance autonomy and quality of life compared to in-center hemodialysis (IHD), it also places substantial emotional, physical and self-management demands on patients. Despite this, resilience is rarely assessed or systematically supported in PD care. This narrative review highlights the importance of resilience in CKD and dialysis populations and extends its application to the unique psychosocial challenges faced by PD patients. This review also introduces psychological frameworks of resilience, in particular the GROW model (Good emotions, Reason and purpose, Others and connections, Wellness flexibility), as tools for clinicians to support PD patients in developing optimism, purpose, strong social networks, and emotional adaptability. We also explore how routine, longitudinal assessment of resilience using validated tools can help improve patient well-being, treatment adherence, and long-term outcomes. Full article

Background/Objectives: Advanced wound healing biologics for diabetic foot ulcer (DFU) are typically withheld from persons who are at high risk for amputation. However, a prospective, single-center cohort study evaluated the use of an advanced biologic, dehydrated amniotic (DAMA) tissue as early treatment for DFUs in patients with a high risk for amputation, demonstrating benefit for a small sample. This is the report of the five-year follow-up of those high-risk participants. Methods: This chart review provides a 5-year follow-up of 18 of 20 participants in the original study. The data were collected by medical record review. Specific data points included mortality, re-ulceration and additional ulceration, amputation (minor and major), end-stage renal disease with dialysis dependence, hospitalization, and limb-threatening ischemia. Results: The 5-year mortality rate from the time of wound healing was 50% (9/18 deceased). Four of the eighteen participants (22.2%) underwent major amputation within 5 years of study completion. Two had amputations of the study limb and two had amputations of the contralateral limb. Fifty percent (2/4) of those who had amputations died within 5 years after the major amputation. Over fifty percent (55.5% or 10 out of 18) of the participants experienced the re-ulceration of the original study ulcer and 94% (17 out of 18) developed a new site ulceration. A total of 25% of the hospitalizations over the 5 years were related to DFU (infection, osteomyelitis, and sepsis). Conclusions: This small-sample 5-year follow-up shows that early treatment with dehydrated amniotic (DAMA) tissue in patients with diabetic foot ulcers of moderate-to-high amputation risk results in similar outcomes as noted in the current research on patients with low risk for amputation. In fact, this paper may suggest that advanced biologics can safely be used for early treatment in moderate-to-high amputation risk without increasing mortality and amputation over 5 years. Full article

Background Socioeconomic factors significantly influence access to kidney transplantation, with socially vulnerable populations experiencing delays in receiving transplants, resulting in prolonged dialysis duration and poorer post-transplant outcomes. This study evaluates the relationship between social vulnerability and disparities in preemptive kidney transplantation using the Social Vulnerability Index (SVI), a composite measure developed by the Centers for Disease Control and Prevention (CDC). Methods Utilizing data from the Scientific Registry of Transplant Recipients (SRTR) from 2012 to 2020, we analyzed 155,424 adult kidney transplant recipients. The primary exposure was SVI, categorized into quartiles, while primary outcomes included preemptive transplant status and dialysis vintage. Multivariable regression models were adjusted for clinical covariates such as age, gender, BMI, diabetes, and peripheral vascular disease. Result Findings indicate that higher social vulnerability is significantly associated with a reduced likelihood of preemptive kidney transplantation (p < 0.0001) and an increased duration of dialysis prior to transplantation. Patients in the highest SVI quartile (0.75–1.00) were more than twice as likely to undergo dialysis before transplantation compared to those in the lowest quartile (OR = 2.21, 95% CI: 1.89–2.57). Similarly, increased SVI was strongly correlated with prolonged dialysis duration (OR = 3.43, 95% CI: 3.31–3.55, p < 0.0001). Conclusions These results highlight the impact of socioeconomic disparities on access to timely kidney transplantation. Addressing social vulnerability factors—such as poverty, education, and healthcare access—may help reduce inequities and improve transplantation outcomes. Future interventions should target high-SVI communities to facilitate earlier transplant access and reduce reliance on prolonged dialysis. Full article

Objectives: This study aimed to evaluate the impact of cannulation site preference—femoral versus axillary—on postoperative complications and in-hospital mortality in patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) due to cardiogenic shock. Methods: In this single-center, retrospective study, 85 patients who received peripheral VA ECMO support between January 2013 and July 2023 were analyzed. Patients were divided into two groups based on arterial cannulation site: femoral cannulation (FC, n = 47) and axillary cannulation (AC, n = 38). Preoperative, intraoperative, and postoperative variables were compared. Cannulation-related complications were categorized as vascular, neurological, or pulmonary. The primary endpoints were postoperative complications and in-hospital mortality. Results: There were no statistically significant differences between the FC and AC groups in terms of demographics, comorbidities, surgical procedures, or ECMO weaning times. Rates of vascular, neurological, and pulmonary complications were similar between groups. Mortality and postoperative dialysis rates did not differ significantly. The low rate of ischemic complications in the FC group may be explained by the use of distal perfusion catheters, which are considered the standard approach to prevent leg ischemia. Both cannulation techniques demonstrated comparable safety and efficacy profiles. Conclusions: Both femoral and axillary cannulation sites can be safely used for peripheral VA ECMO when selected based on individual patient conditions and institutional experience. Cannulation strategy should be tailored according to the urgency of the clinical situation, anatomical feasibility, and anticipated duration of support. Further prospective, randomized studies are required to establish the optimal cannulation approach. Full article

Background: Vascular access (VA) is one of the most critical procedures during dialysis for patients with end-stage renal disease (ESRD), as it influences morbidity, mortality, and quality of life. Methods: This cross-sectional study analyzed the vascular access epidemiology of patients undergoing chronic HD in 15 nephrology centers across Greece from 2013 to 2019. Data on VA type, demographic characteristics, fatigue severity, and quality of life were gathered from a sample of 373 patients. Results: The prevailing result of this study is that arteriovenous fistula (AVF) was the commonly practiced VA, and its associated survival outcomes were better when compared to arteriovenous grafts (AVGs) and central venous catheters (CVCs). Patients with AVFs had significantly longer survival times (median 165 months) compared to non-fistula access. Furthermore, the degree of fatigue and quality of life were also dependent on the type of VA used, with patients on AVF having lower fatigue levels and better quality of life. Age, gender, and an early nephrologist referral were noted to affect the selection and the rate of maturation of VA. Despite AVF being the preferred VA, late referrals and high initial reliance on CVCs remain challenges. Conclusions: This study underscores the need for early nephrological intervention, surveillance programs, and patient education to optimize vascular access outcomes. Future research should focus on national strategies to reduce CVC-related complications and improve long-term HD care in Greece. Full article