Kidney Dial., Volume 5, Issue 1 (March 2025) – 9 articles

Introduction: Diabetes mellitus, a chronic disease characterized by hyperglycemia, is a significant contributor to chronic kidney disease, particularly in patients with diabetic nephropathy undergoing renal replacement therapy. Variations in circadian rhythms can influence the progression of chronic diseases and treatment outcomes. Aims: This observational study evaluated gender-based chronobiological changes in biochemical, hemorheological factors, and cytokines in patients with dialysis-dependent diabetic nephropathy. Materials and Methods: A cross-sectional study was conducted in Barra do Garças, Brazil, involving 46 patients with type 2 diabetes mellitus who were on regular hemodialysis. Participants were divided into four groups for analysis according to gender and period of day. Inclusion criteria included individuals with type 2 diabetes mellitus undergoing periodic hemodialysis, receiving hemodialysis care at the service, and signing a consent form. Patients with an age under 18 years, diabetes mellitus type 1, or with autoimmune diseases were excluded. Blood samples were collected to assess melatonin, cortisol, biochemical and hemorheological parameters, and cytokines such as IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-10, and IL-17. Results: Men exhibited higher melatonin, urea, and creatinine levels in the morning and afternoon phases. At the same time, women showed lower melatonin, increased viscosity, and a decreased deformation rate in the afternoon. Additionally, levels of TNF-α, IFN-γ, and IL-17 were lower in morning serum samples from women. Conclusion: These findings suggest that both gender and circadian timing should be taken into account, when optimizing hemodialysis treatment for patients with diabetic nephropathy. A deeper understanding of these factors could lead to more personalized and effective treatment strategies, ultimately improving patient outcomes and enhancing their quality of life. Full article

Despite the high burden of fatigue in patients with advanced chronic kidney disease (CKD) stage 4–5 including dialysis, little is known about risk factors and treatments for fatigue. This paper provides an overview of measurement, associated risk factors and approaches to alleviate fatigue. Up to now, the 36-Item Short Form Health Survey (SF-36) is the most widely used tool to measure fatigue. Socio-demographic factors, including older age, female, white ethnicity, less education, unemployment and less social support, are risk factors for fatigue. More severe fatigue is related to anemia, protein energy wasting, inflammation, lactic acidosis, comorbidities (including diabetes, cardiovascular disease and chronic obstructive pulmonary disease), depression, anxiety, sleep disorders and uremic symptoms such as restless legs syndrome and pruritus. Dialysis treatment, dialysis-related low blood pressure and low dialysis adequacy, contribute to fatigue. Medication, such as β-blockers, antidepressant medication and medication for sleep disorders, are associated with fatigue, either as a result of the underlying condition or side effects. Currently, the principal treatments encompass pharmacological and nonpharmacological interventions. The utilization of erythropoiesis-stimulating agent (ESA) for anemia may alleviate fatigue. Physical exercise has been proved to be a promising therapeutic approach. Other potential treatments, such as L-carnitine, sodium bicarbonate, antidepressive medication (such as bupropion), psychological interventions and cold dialysis, require more research. To conclude, further research is needed to better understand the risk factors and underlying mechanism of fatigue, as well as to explore potential treatments for patients with advanced CKD. Full article

Hypercalcemia is defined as a serum calcium concentration higher than 10.5 mg/gL or 2.6 mmol/L. Only 50% of serum calcium is active, presented as ionized calcium. The remaining half is bound to albumin, phosphate, and other serum anions, and their changes can affect the serum calcium concentration. Thus, to discriminate true hypercalcemia from pseudo hypercalcemia, an ionized calcium concentration higher than 1.3 mmol/L might be more appropriate. Many variables can lead to hypercalcemia, and managing them is necessary to treat this ion disorder. Indeed, it can be caused by malignancies, hematologic disorders, or genetic diseases such as familial hypocalciuric hypercalcemia, or it can be related to hormone disorders involving parathormone or vitamin D. For this condition, the correct diagnostic algorithm should be followed. In this review, we summarize the diagnostic steps to follow and detail each clinical pathway is involved in hypercalcemia. Full article

Introduction: The potassium removed by various dialysis methods (pre- and post-dilution on-line hemodiafiltration) is not clear in the literature. The aim of the study was to investigate the amount of potassium eliminated with each session of pre- or post-dilution on-line hemodiafiltration with collection of the total ultrafiltrate in a tank. Materials and Methods: We studied in 10 dialyzed patients the removal of potassium by a polyetherosulfone dialysis filter. We sought to investigate whether the amount removed is related to filter surface area and type of dialysis. We examined the removal of potassium by on-line hemodiafiltration and post-dilution with high-flux filters, surface areas 2.5 m² (Group A) and 2.1 m² (Group B). We repeated the same process with low-flux filters with conventional hemodialysis (Group C), as well as with pre-dilution on-line hemodiafiltration and 2.5 m² surface area filters (Group D). Results: Significantly higher potassium removal was noted with post-dilution on-line hemodiafiltration versus conventional haemodialysis, which was not affected by filter surface area, and also higher with pre-dilution on-line hemodiafiltration versus all other methods. The amounts of removed potassium even exceeded 300 mmol of potassium/dialysis session in some cases. Conclusions: It is concluded that, with on-line hemodiafiltration, much higher amounts of potassium are removed (mainly with pre-dilution) compared to conventional haemodialysis. The amount removed is not affected by the surface of the filter. The lower potassium levels of dialysate play an important role in this elimination. Full article

Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage kidney disease (ESKD). To date, no trial has been adequately powered to evaluate the effects of different dialysis modalities on cardiovascular events or mortality. To properly assess the risks and benefits of each modality for individual patients, it is crucial to understand the unique cardiovascular risk factors in patients undergoing dialysis. This review explores the existing literature on cardiovascular risk assessment in this population. It examines the mechanisms contributing to increased risk, including volume overload, blood pressure abnormalities, mineral bone disorder, vascular calcification, uremia, anemia, and chronic inflammation. Additionally, we discuss data from trials assessing cardiovascular outcomes and compare various dialysis modalities, including in-center hemodialysis, frequent dialysis, nocturnal dialysis, and peritoneal dialysis. Full article

Animated video could improve the reach of health education to kidney transplant (KT) seekers and their social network. Usage outcomes are rarely considered. This exploratory study aims to investigate use patterns of an animated video-based intervention (KidneyTIME) and examined associations with patient characteristics. Descriptive, quantitative analyses were conducted on user data (April 2022–March 2024) of KT-seekers allocated to the intervention arm of an ongoing randomized controlled trial of KidneyTIME. Of 195 KT-seekers allocated to KidneyTIME, optional use (defined as ≥1 video view or share) was 74% at 6 months follow-up and significantly higher among patients in the pre-evaluation phase (Odds Ratio [OR] 2.63, p = 0.0051) and with an active Facebook account (OR 2.93, p = 0036). Higher total video viewings were associated with single adult household (p = 0.0496). Not employed participants viewed more different videos (p = 0.0168). More days of viewing was significantly (p < 0.05) associated with older age, worse health, not employed, and single adult household. Video sharing was significantly associated with social media use (OR 2.86, p = 0.0264), active Facebook account (OR 2.55, p = 0.0411), and lower health literacy score (OR 2.80, p = 0.0274) and inversely associated with lower social support score (OR 0.35, p = 0098) and male sex (OR 0.48, p = 0.0394). Web-based animated video education promoted through email or text links is a viable modality to reach diverse KT-seekers. Full article

Primary aldosteronism (PA) is a major cause of hypertension, especially in younger patients. Early diagnosis and treatment are crucial to prevent damage to vital organs, including the heart and kidneys. Independent of blood pressure, aldosterone excess has direct deleterious effects on the kidneys, leading to tubulointerstitial fibrosis, glomerular hypertrophy, and glomerulosclerosis. Emerging biomarkers such as albuminuria and liver fatty acid-binding protein may have the potential to detect renal injury in PA, particularly in the setting of glomerular hyperfiltration. Comprehensive risk assessment of long-term renal dysfunction, based on both modifiable and non-modifiable risk factors, would aid clinicians in prediction and would even, in some cases, allow them to mitigate the risk of patients developing CKD in the setting of PA. Full article

Background: Whether hemodialysis patients want caregivers to discuss spirituality is poorly studied, especially in Europe. The goal of this qualitative study was to explore the spirituality and spiritual expectations of hemodialysis patients in a Swiss dialysis center. Methods: Semi-structured, qualitative interviews were performed by an experienced sociologist with dialysis patients in the ambulatory dialysis unit of the University Hospital of Lausanne. The interviews included a set of open questions on the role that spirituality plays in patients’ lives, in coping with their illness and in the recent COVID-19 epidemic. All interviews were recorded, transcribed, coded and analyzed following the approach of content analysis. Findings: Twenty interviews were performed in 2022. In total, 14/20 patients practiced some form of religion (believers), four were agnostics, and two defined themselves as atheist. The majority (15/20) confirmed that spirituality plays a positive role to preserve hope and to manage the difficulties caused by the disease and its treatment; one out of four wishes to discuss spirituality in the hospital setting. The largest needs are related to social dimensions (isolation, loneliness, need to talk, financial problems). Their level of spirituality has not been impacted by the COVID-19 pandemic. Discussion: In this pilot study, spirituality in a broad sense was important for the majority of the patients, and a quarter of them would like it to be actively addressed by healthcare professionals. They also ask for more attention to social and socio-economic difficulties. Full article

Small interfering RNAs (siRNAs) are short, double-stranded RNA molecules that play a crucial role in the regulation of gene expression, particularly through a natural process called RNA interference (RNAi). Their discovery, about 25 years ago, paved the way for a whole series of research leading to synthetic molecules. The gene silencing potential of these siRNAs was initially oriented towards diseases resulting from genetic dysfunctions. This led to the development of the first synthetic siRNAs approved for human use in hereditary transthyretin amyloidosis. Subsequently, the field of application expanded beyond the confines of genetic diseases. The refinement of pharmacological techniques has led to the synthesis of a variety of siRNAs capable of blocking the production of individual proteins responsible for various disease conditions, thus expanding their field of therapeutic application. The kidney has also been affected by this new therapeutic tool, largely indirectly but also, with some difficulty, directly. The structural complexity of the kidney has made the search for siRNAs targeting its individual components very challenging. Nevertheless, the first results of the application of this new therapeutic technology to the kidney are beginning to be seen in experimental animals and in humans. siRNAs have been approved for the treatment of amyloidosis with patisiran and oxalosis with lumasiran and nedosiran. Studies are ongoing for the use of siRNAs as anti-complement drugs in IgA nephropathy, as angiotensinogen inhibitors in hypertension, or against some mediators of acute kidney injury. In this review, the biological mechanisms underlying the use of siRNAs are briefly exposed. The results of the therapeutic application of RNA interference to the kidney and its diseases are also analyzed and discussed. Full article