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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: 28 November 2024 | Viewed by 8485

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Dr. Grazia Maria Virzì

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Department of Nephrol Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
Interests: dialysis; uremia; cardiorenal syndrome; organ crosstalk; kidney; biomarkers; chronic kidney disease
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Special Issue Information

Dear Colleagues,

The incidence of end-stage renal disease is increasing year by year, and it is one of the most commonly fatal diseases in patients. Kidney replacement therapy (KRT) has made significant progress over the past few decades, with about 70% of people receiving KRT undergoing dialysis, of whom about 10% undergo peritoneal dialysis and 90% undergo hemodialysis.

Nephrologists will face significant challenges in the future as the number of patients requiring KRT increases. In addition, some important pathophysiological features of patients, including accelerated systemic atherosclerosis, vascular calcification, inflammation, frailty, cognitive impairment, etc., have recently been revealed. The daily lives of dialysis patients are also restricted by fatigue, depression, and comorbidities. These disease states have complex effects on adverse events and prognosis in hemodialysis patients.

This Special Issue of the Journal of Clinical Medicine will explore the current state of dialysis, including hemodialysis and peritoneal dialysis. Future challenges and current research will be noted, including, but not limited to, the clinical application of hemodialysis and peritoneal dialysis, dialysis preparation, vascular access function, complications, dialysis membranes and techniques, unfavorable adverse effects, and other topics to related diagnosis, treatment, and management in patients. We welcome you to submit your latest original articles or reviews to provide clinicians with the latest insights related to this field.

Dr. Grazia Maria Virzì
Guest Editor

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Keywords

hemodialysis
peritoneal dialysis
end-stage renal disease
kidney replacement therapy (KRT)
pathophysiology
dialysis membranes
dialysis preparation
dialysis modality
cardiovascular events
vascular access
PD-related peri-tonitis
unfavorable adverse effects
complications
challenges

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Published Papers (8 papers)

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Research

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14 pages, 732 KiB

Open AccessFeature PaperArticle

Cardiovascular and All-Cause Mortality Is Affected by Serum Magnesium and Diet Pattern in a Cohort of Dialysis Patients

by Ioannis Petrakis, Dimitra Bacharaki, Periklis Kyriazis, Olga Balafa, Evangelia Dounousi, George Tsirpanlis, Marios Theodoridis, Ourania Tsotsorou, Anastasia Markaki, Anastasia Georgoulidou, George Triantafyllis, Ioannis Giannikouris, Apostolos Kokkalis, Aristeides Stavroulopoulos and Kostas Stylianou

J. Clin. Med. 2024, 13(14), 4024; https://doi.org/10.3390/jcm13144024 - 10 Jul 2024

Viewed by 1359

Abstract

Background: Hypomagnesaemia is associated with an increased overall mortality in patients with chronic kidney disease on dialysis (CKD-5D). Mediterranean-style diet (MD), having a high magnesium content, can serve as a form of dietary magnesium supplementation. We examined whether there is a potential link between increased Mediterranean Diet score (MDS) and elevated serum magnesium (sMg) to assess its impact on reducing mortality risk in CKD-5D patients. Methods: In this multi-center prospective observational study, 117 CKD-5D patients (66 on hemodialysis and 51 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied for a median follow-up period of 68 months. After baseline assessment, including measurement of sMg and MDS, all patients were followed up for cardiovascular (CV) and all-cause mortality. Results: Forty deaths occurred, 58% of which were cardiovascular. Patients who were above the median value of sMg (2.2 mg/dL) had a 66% reduction in CV (crude HR, 0.34; 95% CI, 0.11–0.70), and 49% reduction in all-cause (crude HR, 0.51; 95% CI, 0.27–0.96) mortality, even after adjustment for age, malnutrition inflammation score, left ventricular mass index, peripheral vascular disease and diabetes. Similar results were obtained when sMg was analyzed as a continuous variable. sMg was associated directly with MDS (r = 0.230; p = 0.012). Conclusions: Higher sMg levels are strongly and independently associated with reduced CV and all-cause mortality in CKD-5D patients. A strong correlation exists between MDS and sMg. Elevated sMg levels, achieved through MD adherence, can significantly reduce CV mortality, implicating MD as a mediator of the association between sMg and CV mortality. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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9 pages, 962 KiB

Open AccessArticle

Serum Calcification Propensity T50 Is Associated with Soluble Thrombomodulin in Patients on Hemodialysis

by Takeshi Tadokoro, Akihiko Kato, Hiromitsu Ohmori, Tomio Matsumoto, Makoto Kuro-O, Tsuyoshi Kobayashi and Hideki Ohdan

J. Clin. Med. 2024, 13(12), 3491; https://doi.org/10.3390/jcm13123491 - 14 Jun 2024

Viewed by 710

Abstract

Background/Objectives: Levels of circulating soluble thrombomodulin (sTM), an anticoagulant factor, are associated with the severity and progression of arteriosclerotic diseases. However, the role of elevated sTM levels remains to be clarified in patients on dialysis. As the calcification propensity time T50 is a novel marker of arterial calcification, we aimed to determine the association between sTM and T50 in patients on hemodialysis (HD). Methods: This cross-sectional study included 49 adult patients on maintenance HD. Correlation analysis was performed to test the association between T50 and patient characteristics. Linear regression was used to evaluate the association between T50 and sTM. Results: Partial correlation analysis showed a strong association between T50 and glycated albumin, phosphorous, and sTM levels (partial correlation coefficient: r [partial] = −0.359, p = 0.023; r [partial] = −0.579, p < 0.001; and r [partial] = 0.346, p = 0.029, respectively). Multivariate linear regression analysis revealed that only sTM level was significantly and positively associated with T50 (β = 0.288; t = 2.27; p = 0.029; 95% confidence interval, 0.082–1.403). Conclusions: sTM is independently and positively associated with the propensity time for calcification, suggesting that sTM could be a good marker of arterial calcification progression in patients on HD. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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10 pages, 1752 KiB

Open AccessArticle

Peritoneal Dialysis-Induced Encapsulating Peritonitis: Diagnostic and Therapeutic Challenges in Women with Benign Gynecological Pathology

by Cristian Iorga, Cristina Raluca Iorga, Iuliana Andreiana, Simona Hildegard Stancu, Traian Constantin and Victor Strambu

J. Clin. Med. 2024, 13(10), 2921; https://doi.org/10.3390/jcm13102921 - 15 May 2024

Viewed by 843

Abstract

Background: Peritoneal sclerosis (PS) and its most severe form, encapsulating PS (EPS), are rare entities that can occur in various procedures (liver transplantation, intraperitoneal chemotherapy) or secondary to medications (beta-blockers); however, PS or EPS typically occur in patients undergoing peritoneal dialysis as a form of renal function substitution. Medical or surgical treatments can be applied, but morbidity and mortality have high rates. This condition typically presents clinically as an intestinal obstruction caused by the inclusion of the intestinal loops in the peritoneal fibrous membrane. Methods: Herein, we present data from a single tertiary surgery center that has dedicated teams for patients receiving dialysis. Over 12 years, we analyzed a group of 63 patients admitted for catheter replacement/removal or for acute surgical pathology. In five cases (7.9%), we diagnosed EPS. Two patients with EPS presented with atypical abdominal pathologies requiring emergency surgery: one case of hemoperitoneum caused by a ruptured ovarian cyst and one case of uterine fibroids and metrorrhagia. Results: The definitive diagnoses were established intraoperatively and by analyzing the morpho-pathological changes in the peritoneum. The possible intraoperative challenges included laborious dissection, difficulties in restoring the correct anatomical landmarks, an increased duration of the surgical intervention and a high rate of incidents and accidents. Conclusions: The aim of the present study was to emphasize the possibility of other surgical pathologies overlapping with EPS, increasing the complexity of the surgical intervention. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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10 pages, 1410 KiB

Open AccessArticle

Immunomodulation Driven by Theranova Filter during a Single HD Session

by Carlotta Caprara, Grazia Maria Virzì, Katia Chieregato, Nicola Marchionna, Valentina Corradi, Alessandra Brendolan, Claudio Ronco and Monica Zanella

J. Clin. Med. 2024, 13(7), 2147; https://doi.org/10.3390/jcm13072147 - 8 Apr 2024

Viewed by 771

Abstract

Background: Patients with end-stage kidney disease (ESKD) have altered immunity. Patients on hemodialysis (HD) present a coexistence of immunodeficiency and activation of the immune system. We evaluated the immunophenotypic profile induced by the medium cut-off of Theranova filter during a single HD session in the same individual. Methods: This pilot observational study explored 11 patients (75 ± 8 years and 73% male). Blood samples were collected prior to (predialytic, PRE) and after 4 h (postdialytic, POST) standard HD session with a medium cut-off, polyarylethersulfone and polyvinylpyrrolidone blend, BPA-free membrane. We performed an immunophenotyping characterization by using flow cytometry. We evaluated eryptosis RBCs and HLA-DR expression on monocytes and Treg cells. Results: The percentages of eryptosis in lymphocytes (CD3+), lymphocyte T helper (CD3+ and CD4+) cells, and monocytes (CD45+ and CD14+) were similar pre- and post-HD. On the contrary, HLA-DR expression and Treg cell numbers significantly decreased after HD. Conclusions: Many studies have focused on the comparison between healthy volunteers and HD patients, but very few have focused on the changes that occur after an HD session in the same individual. With this pilot observational study, we have revealed an immunomodulation driven by HD treatment with Theranova filter. Our preliminary results can be considered to be a hypothesis, generating and stimulating further studies with better designs and larger populations. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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12 pages, 1578 KiB

Open AccessArticle

Relationship between Permanent Catheter Patency and Nutrient Score in Patients Aged >75 Years Requiring Renal Replacement Therapy

by Moo Jun Kim, Yunkyeong Hwang, Jae Wan Jeon, Hae Ri Kim, Suyeon Han, Heewon Park, Eu Jin Lee, Young Rok Ham, Ki Ryang Na, Hyerim Park and Dae Eun Choi

J. Clin. Med. 2024, 13(6), 1562; https://doi.org/10.3390/jcm13061562 - 8 Mar 2024

Viewed by 854

Abstract

Background: Malnutrition is common in patients undergoing hemodialysis and is a powerful predictor of morbidity and mortality. This study aimed to investigate the effect of nutritional status on permanent catheter patency in elderly patients aged >75 years of age undergoing dialysis using tunneled dialysis catheters; Methods: Records of 383 patients whose nutritional factors and body cell mass (BCM) were measured simultaneously at the start of dialysis between 14 January 2020 and 30 September 2023, at Chungnam National University Hospital, were retrospectively reviewed. The relationships between permanent catheter patency at 180 days and BCM parameters and clinical parameters were studied using Kaplan–Meier survival curves and multivariate Cox proportional hazards analysis. Results: Age and sexual differences were significant (p ≤ 0.05), and most of the BCM parameters and BCM were not significant (p ≤ 0.05), except for intracellular water. Permanent catheter patency was superior at low controlling nutritional status (CONUT) scores (p < 0.05). After adjustment for covariates, the CONUT score remained an independent factor associated with permanent catheter-patency survival; Conclusions: CONUT scores measured before the start of dialysis are expected to play an important role in predicting the prognosis of permanent catheter-patency survival in patients aged >75 years. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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11 pages, 1182 KiB

Open AccessFeature PaperArticle

Metabolically Abnormal Non-Obese Phenotype Is Significantly Associated with All-Cause Mortality in Hemodialysis Patients

by Jin Hyeog Lee, Hae-Ryong Yun, Hyung Woo Kim, Jung Tak Park, Seung Hyeok Han, Yong-Lim Kim, Yon Su Kim, Chul Woo Yang, Nam-Ho Kim, Shin-Wook Kang and Tae-Hyun Yoo

J. Clin. Med. 2024, 13(4), 1059; https://doi.org/10.3390/jcm13041059 - 13 Feb 2024

Viewed by 993

Abstract

The association between obesity and all-cause mortality in patients undergoing kidney failure with replacement therapy (KFRT) has shown conflicting results. This study aimed to evaluate whether metabolic abnormalities (MA) increase the risk of all-cause mortality in these patients. Between 2009 and 2015, 1141 patients undergoing KFRT were recruited from the Clinical Research Center for End-Stage Renal Disease dataset. Patients were divided into four groups according to the presence of obesity and MA. Multivariate Cox proportional hazard analysis was performed to determine the association between the phenotypes and all-cause mortality. During a mean follow-up of 4.2 years, all-cause mortality was observed in 491 (43.0%) patients. Obesity had a 24% decreased risk of all-cause mortality compared with non-obesity. In contrast, the presence of MA showed a 1.53-fold increased risk of all-cause mortality. There was a significant interaction between obesity and MA (p = 0.006). In Cox proportional hazard analyses after adjustment of confounding factors, the metabolically abnormal non-obesity (MANO) phenotype showed a 1.63-fold increased risk of all-cause mortality compared with the metabolically healthy non-obesity phenotype. In subgroup analysis, the risk of all-cause mortality was higher in the MANO phenotype; this phenotype was significantly associated with a higher all-cause mortality in patients undergoing KFRT. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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9 pages, 1805 KiB

Open AccessArticle

Self-Reported Physical Inactivity and Mood Disturbances in End-Stage Kidney Disease (ESKD) Patients on Chronic Dialysis Treatment

by Michela Musolino, Pierangela Presta, Paola Cianfrone, Maria Antonietta Errante, Michele Andreucci, Giuseppe Coppolino and Davide Bolignano

J. Clin. Med. 2023, 12(22), 7160; https://doi.org/10.3390/jcm12227160 - 18 Nov 2023

Cited by 2 | Viewed by 1255

Abstract

Background: Physical inactivity and mood disturbances are key issues in individuals with end-stage kidney disease (ESKD) and may lead to poor clinical outcomes. Methods: We performed a pilot, observational study to explore the possible relationships between the self-reported level of physical activity (IPAQ) and the severity of mood disturbances (BDI score) in a cohort of 58 ESKD patients undergoing chronic hemodialysis (HD; n = 30) or peritoneal dialysis (PD; n = 28). Results: Overall, ESKD patients were severely inactive (median METs: 590 [460–1850]) and the intensity of overall and walking physical activity was mostly low to moderate. HD individuals appeared less active than PD (METs 550 [250–1600] vs. 1080 [750–1730]; p = 0.003) and were also less prone to walking (METs 180 ± 90 vs. 320 ± 100; p = 0.01), while a barely statistical difference was noticed for the time spent sitting. ESKD individuals displayed a median BDI score of 17 [12–21], which indicated, on average, the presence of borderline depression, which was apparently more evident among HD individuals. A strong, inverse correlation was found between self-reported METs and BDI scores (R = −0.78; p < 0.0001), while such scores paralleled the time spent sitting during a weekday (R = 0.45; p = 0.0004) and a weekend day (R = 0.40; p = 0.002). Conclusions: In ESKD patients on chronic dialysis, physical inactivity and mood disturbances might be significantly inter-connected, thereby amplifying their relative impact on quality of life, dysautonomia and long-term outcomes. Future studies on larger populations are recommended to confirm these preliminary observations. Promoting strategies to improve fitness, along with greater attention to physiological aspects, should be incorporated into the clinical management of ESKD patients. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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Review

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11 pages, 381 KiB

Open AccessReview

Exploring Health Literacy and Vascular Access Decision Making: A Scoping Review

by Shayna Brathwaite, Olamide Alabi, Lynne Simpson and Nader Massarweh

J. Clin. Med. 2024, 13(13), 3734; https://doi.org/10.3390/jcm13133734 - 26 Jun 2024

Viewed by 972

Abstract

One in seven adults in the United States has chronic kidney disease (CKD) and individuals with the most severe form, end stage kidney disease (ESKD), may require renal replacement therapy with hemodialysis. Despite well-established guidelines indicating that arteriovenous access is the preferred type of vascular access for hemodialysis, in 2021, 85.4% of patients initiated dialysis with a CVC. While the reasons for this evidence–practice gap are unclear, health literacy and patient disease-specific knowledge may play an important role. Importantly, 25% of patients with CKD have limited health literacy. While there is an abundance of research regarding the presence of poor health literacy, poor kidney disease-specific knowledge, and their association with health outcomes in patients with CKD, there is currently a paucity of data about the relationship between health literacy, vascular access-specific knowledge, and vascular access outcomes. The aim of this narrative review is to describe the relationship between health literacy, disease-specific knowledge, and vascular access in patients with CKD. A better understanding of health literacy in this population will help inform the development of strategies to assess patient vascular access-specific knowledge and aid in vascular access decision making. Full article

(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)

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