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Application of Hemodialysis in the Treatment of Kidney Diseases

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

Deadline for manuscript submissions: closed (28 February 2024) | Viewed by 4849

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Special Issue Editors

Prof. Dr. Tadashi Tomo

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Guest Editor

Clinical Engineering Research Center, Faculty of Medicine, Oita University, Oita 879-5593, Japan
Interests: hemodialysis; dialysis; peritoneal dialysis; nephrology

Dr. Yoshihiro Tange

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Guest Editor Assistant

Department of Advanced Medical Sciences, Faculty of Medicine, Oita University, Oita 879-5593, Japan
Interests: renal replacement therapy; dialysis; hemodialysis

Special Issue Information

Dear Colleagues,

The 68th Annual Meeting of the Japanese Society for Dialysis Therapy (JSDT) will be held from June 16 to 18, 2023 at the Kobe Convention Center. This Annual Meeting provides a yearly venue for many experts, researchers, and company representatives working in the field of dialysis medicine to gather and engage in discussion and debate.

Since its starting point in dialysis therapy, a life-saving treatment for people suffering from renal failure, the field of dialysis medicine has continued to develop thanks to the skills and knowledge of our predecessors. Thus, medical professionals and researchers involved in dialysis care and medicine must continue to utilize our skills and use this as the foundation to put our knowledge into practice, with the aim of continuing to improve dialysis care. Focusing on current topics related to renal replacement therapy presented at the 68th JSDT, this Special Issue will provide a starting point for knowledge and skills relating to these advances.

Prof. Dr. Tadashi Tomo
Guest Editor

Dr. Yoshihiro Tange
Guest Editor Assistant

Manuscript Submission Information

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

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

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

Keywords

artificial kidney
online hemodiafiltration
hemodialysis technology support
uremic toxin
renal replacement therapy

Published Papers (5 papers)

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Research

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15 pages, 2564 KiB

Open AccessArticle

The Impact of Potassium Dynamics on Cardiomyocyte Beating in Hemodialysis Treatment

by Hiroyuki Hamada, Tadashi Tomo, Sung-Teh Kim and Akihiro C. Yamashita

J. Clin. Med. 2024, 13(8), 2289; https://doi.org/10.3390/jcm13082289 - 15 Apr 2024

Viewed by 551

Abstract

Background: Observational studies of intermittent hemodialysis therapy have reported that the excess decrease in K⁺ concentration in plasma (KP) during treatment is associated with the destabilization of cardiac function. Elucidating the mechanism by which the decrease in KP impairs myocardial excitation is indispensable for a deeper understanding of prescription design. Methods: In this study, by using an electrophysiological mathematical model, we investigated the relationship between KP dynamics and cardiomyocyte excitability for the first time. Results: The excess decrease in KP during treatment destabilized cardiomyocyte excitability through the following events: (1) a decrease in KP led to the prolongation of the depolarization phase of ventricular cells due to the reduced potassium efflux rate of the Kr channel, temporarily enhancing contraction force; (2) an excess decrease in KP activated the transport of K⁺ and Na⁺ through the funny channel in sinoatrial nodal cells, disrupting automaticity; (3) the excess decrease in KP also resulted in a significant decrease in the resting membrane potential of ventricular cells, causing contractile dysfunction. Avoiding an excess decrease in KP during treatment contributed to the maintenance of cardiomyocyte excitability. Conclusions: The results of these mathematical analyses showed that it is necessary to implement personal prescription or optimal control of K⁺ concentration in dialysis fluid based on predialysis KP from the perspective of regulatory science in dialysis treatment. Full article

(This article belongs to the Special Issue Application of Hemodialysis in the Treatment of Kidney Diseases)

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13 pages, 2025 KiB

Open AccessArticle

Impact of Albumin Leakage on the Mortality of Patients Receiving Hemodialysis or Online Hemodiafiltration

by Manabu Tashiro, Kazuyoshi Okada, Yusaku Tanaka, Hiroyuki Michiwaki, Hisato Shima, Tomoko Inoue, Toshio Doi and Jun Minakuchi

J. Clin. Med. 2024, 13(7), 1865; https://doi.org/10.3390/jcm13071865 - 24 Mar 2024

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Abstract

Background: Online hemodiafiltration (OHDF) has a lower mortality rate than hemodialysis (HD). We aimed to investigate the impact of the albumin leakage on the mortality of patients receiving HD or OHDF. Methods: In this single-center study, consecutive patients receiving renal replacement therapy between January and April 2018 were retrospectively registered. Using (1:1) propensity score matching, 3-year all-cause mortality was compared between patients receiving HD and OHDF, and the impact of albumin leakage on the mortality rate in both groups was investigated. Results: Of the 460 patients, 137 patients receiving HD were matched with an equal number of patients receiving OHDF. OHDF was associated with higher albumin leakage (p < 0.001) and a lower mortality than HD (log-rank test, p < 0.001). Albumin leakage was associated with mortality in patients receiving HD (per 1 g increase, hazard ratio (HR): 0.495, 95% confidence interval (CI): 0.275–0.888) and patients receiving OHDF (per 1 g increase, HR: 0.734, 95% CI: 0.588–0.915). Patients receiving HD, with the highest albumin leakage tertile (>3 g), had a similar mortality rate to patients receiving OHDF, with similar albumin leakage. Conclusions: The negative relationship between albumin leakage and mortality suggests the benefit of removing middle- to -large-molecular-weight substances to improve survival. Full article

(This article belongs to the Special Issue Application of Hemodialysis in the Treatment of Kidney Diseases)

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11 pages, 2114 KiB

Open AccessArticle

Comparing Survival Outcomes between Hemodialysis and Hemodiafiltration Using Real-World Data from Brazil

by Erica Pires da Rocha, Christiane Akemi Kojima, Luis Gustavo Modelli de Andrade, Daniel Monte Costa, Andrea Olivares Magalhaes, Whelington Figueiredo Rocha, Leonardo Nunes de Vasconcelos Junior, Maria Gabriela Rosa and Carolina Steller Wagner Martins

J. Clin. Med. 2024, 13(2), 594; https://doi.org/10.3390/jcm13020594 - 19 Jan 2024

Cited by 2 | Viewed by 1022

Abstract

The CONVINCE trial demonstrates that high-dose hemodiafiltration offers a survival advantage for patients in the high-flux hemodiafiltration group compared to hemodialysis. We compared the outcomes of hemodialysis and hemodiafiltration using real-world data. We conducted an analysis on a cohort of patients who underwent hemodiafiltration therapy (HDF) at a single center, NefroStar Clinics. The results obtained were then compared with data from patients receiving hemodialysis (HD) therapy within the Brazilian Public Health System (SUS). The primary outcome was mortality from any cause. Results: A total of 85 patients undergoing hemodiafiltration were compared with 149,372 patients receiving hemodialysis through the Brazilian Public Health System (SUS). Using a 2:1 propensity score, we compared the 170 best-match HD patients with 85 HDF patients. In the Cox analysis, HDF therapy showed a reduced risk of mortality with an HR of 0.29 [0.11–0.77]. The propensity score analysis showed a HR of 0.32 [95% CI: 0.11–0.91]. This analysis was adjusted for age, type of access, KT/v, hemoglobin, and phosphorus. The Kaplan–Meier analysis showed respective survival rates for HDF and HD at the end of one year, 92.1% and 79.9%, p < 0.001. These results suggest high-flux hemodiafiltration has survival advantages over hemodialysis in a real-world scenario. Full article

(This article belongs to the Special Issue Application of Hemodialysis in the Treatment of Kidney Diseases)

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Review

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12 pages, 295 KiB

Open AccessReview

Latest Trends in Hemodiafiltration

by Francisco Maduell, Diana Rodríguez-Espinosa and José Jesús Broseta

J. Clin. Med. 2024, 13(4), 1110; https://doi.org/10.3390/jcm13041110 - 16 Feb 2024

Viewed by 1184

Abstract

This review provides a detailed analysis of hemodiafiltration (HDF), its progress from an emerging technique to a potential conventional treatment for chronic hemodialysis patients, and its current status. The article covers the advances, methods, and clinical benefits of HDF, specifically focusing on its impact on cardiovascular health, survival rates, and overall well-being. The review also addresses questions about the safety of HDF and provides evidence to dispel concerns related to the elimination of beneficial substances and infection risks. Additionally, the article explores the potential implications of expanded hemodialysis (HDx) as an alternative to HDF, its classification, safety profile, and an ongoing trial assessing its non-inferiority to HDF. Supported by evidence from randomized controlled trials and observational studies, the review emphasizes the superiority of HDF as a hemodialysis modality and advocates for its positioning as the gold standard in treatment. However, it acknowledges the need for extensive research to define the role of HDx in comprehensive treatment approaches in individuals undergoing dialysis. The synthesis of current knowledge underscores the importance of ongoing exploration and research to refine hemodialysis practices for optimal patient outcomes. Full article

(This article belongs to the Special Issue Application of Hemodialysis in the Treatment of Kidney Diseases)

8 pages, 723 KiB

Open AccessReview

Middle Molecular Uremic Toxin and Blood Purification Therapy

by Hideki Kawanishi

J. Clin. Med. 2024, 13(3), 647; https://doi.org/10.3390/jcm13030647 - 23 Jan 2024

Viewed by 925

Abstract

The purpose of blood purification therapy is to remove uremic toxins, and middle molecules (MMs) are a specific target. An MM is defined as a solute that passes through the glomerulus with a molecular weight in the range of 0.5–58 kDa, and new classifications of “small-middle 0.5–15 kDa,” “medium-middle 15–25 kDa,” and “large-middle 25–58 kDa” were proposed. In Japan, the removal of α1-microglobulin (αMG) in the large-middle range has been the focus, but a new theory of removal has been developed, emphasizing the antioxidant effect of αMG as a physiological function. Clinical proof of this mechanism will lead to further development of blood purification therapies. Full article

(This article belongs to the Special Issue Application of Hemodialysis in the Treatment of Kidney Diseases)

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