The most common cause of mortality after a kidney transplant is a cardiovascular event. This is why most patients with poor cardiovascular status are denied a transplant. A 70-year-old male, ESRD from hypertensive nephropathy, was declined renal transplantation in the United States for advanced age, severe coronary disease and abdominal aortic aneurysm. The patient sought a second chance at a possible transplantation here in the Philippines. After a comprehensive cardiovascular evaluation, he underwent coronary artery bypass graft for a three-vessel disease followed by endovascular aneurysm repair (EVAR) which he tolerated well. After four weeks, he underwent a living-related kidney transplantation with immediate allograft function. On postoperative day 5, after catheter removal, the patient was unable to void spontaneously. He was diagnosed with benign prostatic obstruction and underwent transurethral resection of the prostate. He tolerated this and voided freely since catheter removal. One year later, the patient has a functioning allograft and stable cardiac status. High risk patients with cardiovascular disease may be given a chance at kidney transplantation after a meticulous evaluation and optimization.

Human ; Male ; Aged: 65-79 Yrs Old ; Evar ; Allografts ; Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Arteries ; Cardiovascular Diseases ; Catheters ; Coronary Artery Bypass ; Disease ; Coronary Disease ; Endovascular Aneurysm Repair ; Evaluation Studies As Topic ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Mortality ; Patients ; Philippines ; Prostate ; Risk ; Transplantation ; Transplants ; United States

BACKGROUND

Worldwide, kidney transplantation is done as a renal replacement therapy for end-stage kidney disease patients. Lymphocoele is a common complication following renal transplantation, with an incidence varying between 0.6% and 33.9%. The use of the electrothermal bipolar sealing device (LigaSure) has proven superior to other vessel sealing techniques in several reports. As such, LigaSure device is expected to provide an alternative method to the standard silk-tie method during kidney transplantation.

OBJECTIVES

To describe our experience on using Ligasure device in kidney transplantation at the National Kidney and Transplant Institute.

METHODS

A prospective descriptive cross sectional research design among patients who underwent iliac vessel dissection using Ligasure device during kidney transplantation. Clinical outcomes were determined including operative time during iliac vessel dissection using LigaSure device, total and average JP drain output. Incidence of lymphocoele was observed by performing an allograft ultrasound on post operative day 14, 60 and 90.

RESULTS

Ultrasonographically, none of the patients in this study developed a lymphocele. Average use of Ligasure device during iliac vessel dissection was 16.92 minutes. Average daily JP drain output was 123mL and average JP drain output prior to JP drain removal was 25.44mL.

CONCLUSION

We did not observe any incidence of lymphocoele among patients wherein Ligasure device was used during iliac vessel dissection. Routine use of Ligasure device can be done without the risk of lymphocoele formation and can serve as an alternative from the traditional silk-tie method during iliac vessel dissection.

Human ; Kidney ; Kidney Diseases ; Kidney Failure, Chronic ; Kidney Transplantation ; Renal Replacement Therapy

OBJECTIVE: To investigate the effects of using different filters in continuous renal replacement therapy (CRRT) on the mortality, inflammatory mediator level and hemodynamics in patients with sepsis-associated acute kidney injury (SA-AKI). METHODS: A prospective study was conducted. The patients with SA-AKI undergoing first CRRT admitted to the critical care medicine department of General Hospital of Ningxia Medical University from August 2022 to October 2023 were enrolled as the study objects, and they were divided into observation group and control group by random number table method. All patients received routine treatment including anti-infection, optimized volume management and organ function support. On this basis, the observation group was treated with oXiris filter for CRRT, while the control group was treated with ordinary filter for CRRT, and the first treatment time was ≥ 36 hours. General data of the two groups were collected and compared. At the same time, the inflammatory indicators [high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), interleukin-6 (IL-6)], sequential organ failure assessment (SOFA) score, mean arterial pressure (MAP), blood lactic acid (Lac), noradrenaline dosage and other related indicators were collected before CRRT treatment and 24 hours and 48 hours after treatment, and the 7-day and 28-day mortality of patients were recorded. RESULTS: Finally, 65 patients were enrolled, including 30 in the observation group and 35 in the control group. There were no significant differences in baseline data including age, gender, acute kidney injury (AKI) stage and infection source between the two groups. The 7-day mortality of observation group was significantly lower than that of control group [16.7% (5/30) vs. 42.9% (15/35), P < 0.05]. There was no significant difference in 28-day mortality between the observation group and the control group [36.7% (11/30) vs. 54.3% (19/35), P > 0.05]. There were no significant differences in inflammation indicators, SOFA score, MAP, Lac and norepinephrine dosage before treatment between the two groups. After 24-hour and 48-hour treatment, the hemodynamics of the two groups were stable compared with before treatment, the inflammatory indicators, SOFA score, Lac and norepinephrine dosage were reduced to varying degrees, and MAP was significantly increased. In the observation group, hs-CRP, PCT, IL-6, SOFA score, MAP, and norepinephrine dosage showed statistical significance at 24 hours after treatment as compared with before treatment [hs-CRP (mg/L): 125.0 (105.0, 171.2) vs. 280.5 (213.2, 313.8), PCT (μg/L): 51.0 (20.0, 62.8) vs. 71.0 (10.8, 100.0), IL-6 (ng/L): 1 762.2 (300.8, 4 327.5) vs. 4 447.5 (630.4, 5 000.0), SOFA score: 13.0 (12.0, 14.0) vs. 16.0 (15.0, 17.0), MAP (mmHg, 1 mmHg ≈ 0.133 kPa): 79.00±12.87 vs. 65.20±11.70, norepinephrine dosage (μg×kg^-1×min^-1): 0.82±0.33 vs. 1.63±0.51, all P < 0.05]. In the control group, PCT and MAP showed statistical significance after 48 hours of treatment as compared with before treatment. Compared with the control group, hs-CRP, SOFA score and norepinephrine dosage after 48 hours of treatment in the observation group were significantly decreased [hs-CRP (mg/L): 87.2 (74.2, 126.0) vs. 157.0 (88.0, 200.0), SOFA score: 11.0 (10.0, 12.0) vs. 12.0 (10.0, 14.0), norepinephrine dosage (μg×kg^-1×min^-1): 0.51±0.37 vs. 0.81±0.58, all P < 0.05], MAP was significantly increased (mmHg: 82.00±8.71 vs. 77.77±7.80, P < 0.05). CONCLUSION In the treatment of CRRT, oXiris filter can reduce the short-term mortality of SA-AKI patients, lower inflammatory mediators levels and improve hemodynamics, showing therapeutic advantages over conventional filters.
Humans ; Acute Kidney Injury/etiology* ; Sepsis/therapy* ; Prospective Studies ; Interleukin-6 ; Continuous Renal Replacement Therapy/methods* ; C-Reactive Protein ; Male ; Female ; Middle Aged ; Hemodynamics ; Procalcitonin ; Aged

Peritoneal dialysis (PD) is one of the main renal replacement therapy methods for patients with end-stage chronic kidney disease, and peritoneal dialysis belt is a key auxiliary device. However, there are some problems in the existing PD technology, such as the separation of heating system and dialysate system, the inability to continuously heat dialysate and the single function of peritoneal dialysis belt. In order to solve the above problems, the staff of Shanghai Geriatric Medical Center designed an intelligent temperature-controlled peritoneal dialysis belt and obtained the National Utility Model Patent of China (patent number: ZL 2023 2 1815961.9). The intelligent temperature-controlled peritoneal dialysis belt is composed of a double-layer fixed belt, an intelligent temperature control system (including temperature control structure and intelligent control system) and other auxiliary structures. The peritoneal dialysis tube can penetrate into the dissection from the entry of the inner surface of the fixed belt and pass through the exit of the outer surface. The double-layer fixed belt ensures the stable fixation of the dialysis tube. The two ends of the fixing belt are designed with magic stickers to adjust the tightness of the fixing belt to adapt to people with different waist circumferences. The interlayer is equipped with an intelligent temperature control system, which can continuously heat the dialysate through an electric heating plate to maintain a temperature close to the body temperature. Through the display screen and controller on the intelligent control system, medical staff can be allowed to monitor and adjust the temperature, pressure and flow parameters of the dialysate in real time. In addition, a cloth with a pulling chain is designed on the inner surface of the fixed belt, and the cloth is opened to facilitate the medical staff to wear the peritoneal dialysis tube in the temperature control structure or the restraint belt. The intelligent temperature-controlled peritoneal dialysis belt enhances the effectiveness of PD, saves PD resources, improves the convenience of PD, is suitable for family and hospital use, can effectively improve the quality of life of patients with chronic renal failure, and is suitable for clinical promotion.
Peritoneal Dialysis/instrumentation* ; Humans ; Equipment Design ; Temperature ; Kidney Failure, Chronic/therapy* ; Dialysis Solutions

Acute kidney injury (AKI) is one of the most common complications in critically ill patients, and sepsis is the main cause of AKI in the intensive care unit (ICU), which can lead to a poor prognosis in severe cases. For patients with sepsis-associated acute kidney injury (SA-AKI) for whom urgent dialysis is indicated, it is now clear that renal replacement therapy (RRT) can be initiated immediately to control disease progression. However, the optimal timing to initiate RRT in patients whose disease is not severe enough to warrant urgent dialysis remains controversial. Some previous studies were small and heterogeneous, and there was a lack of effective reference indicators for guiding RRT in SA-AKI patients. Therefore, this article reviews the relevant experimental studies on the treatment of critically ill patients with AKI in recent years, and reviews the latest research progress on the optimal timing of RRT initiation, in order to provide an effective reference for clinical practice.
Humans ; Acute Kidney Injury/etiology* ; Renal Replacement Therapy/methods* ; Sepsis/therapy* ; Time Factors ; Intensive Care Units

OBJECTIVE: To investigate the association between fluid balance trajectories within the first 3 days of intensive care unit (ICU) admission and 28-day mortality as well as the incidence of continuous renal replacement therapy (CRRT) in patients with severe acute pancreatitis (SAP). METHODS: Clinical data of SAP patients were extracted from the Medical Information Mart of Intensive Care-IV (MIMIC-IV). Group-based trajectory modeling (GBTM) was used to analyze the daily fluid balance of patients within 3 days of ICU admission, and grouping them accordingly. Univariate and multivariate Logistic regression analyses were performed to assess the association between fluid balance trajectory and 28-day mortality and ICU CRRT in SAP patients. RESULTS: A total of 251 SAP patients were included, with 33 deaths within 28 days, and a 28-day mortality of 13.15%; 49 patients (19.52%) continued to receive bedside CRRT after 3 days of ICU admission. The fluid balance on the 3rd day, cumulative fluid balance within 3 days of ICU admission, and incidence of CRRT in the death group were significantly higher than those in the survival group. According to GBTM groups, there were 127 cases in the moderate fluid resuscitation with rapid reduction (MF group), 44 cases in the large fluid resuscitation with rapid reduction (LF group), 20 cases in the moderate fluid resuscitation with slow reduction (MS group), and 60 cases in the small fluid resuscitation with slow reduction (SS group). The cumulative fluid balance within 3 days of ICU admission of the MF group, LF group, MS group, and SS group were 8.60% (5.15%, 11.70%), 16.70% (13.00%, 21.02%), 23.40% (19.38%, 25.45%), and 0.65% (-2.35%, 2.20%), respectively, and the incidence of CRRT during ICU hospitalization were 11.02%, 29.55%, 85.00%, and 8.33%, respectively, with statistically significant differences among the groups (both P < 0.05); the 28-day mortality were 11.02%, 18.18%, 20.00%, and 11.67%, respectively, with no statistically significant difference among the groups (P > 0.05). Kaplan-Meier survival curve analysis showed there was no statistically significant difference in 28-day cumulative survival rate among groups with different fluid balance trajectories (Log-rank test: χ ² = 2.31, P = 0.509). Multivariate Logistic regression analysis showed that cumulative fluid balance within 3 days of ICU admission was an independent risk factor for 28-day mortality [odds ratio (OR) = 1.071, 95% confidence interval (95%CI) was 1.005-1.144, P = 0.040] and CRRT requirement (OR = 1.233, 95%CI was 1.125-1.372, P < 0.001); early aggressive fluid resuscitation on day 1 reduced CRRT risk (OR = 0.866, 95%CI was 0.756-0.978, P = 0.030). CONCLUSIONS Dynamic fluid management is essential in SAP patients. While early aggressive fluid resuscitation may reduce CRRT demand, excessive cumulative fluid balance is associated with increased 28-day mortality and CRRT incidence.
Humans ; Male ; Female ; Middle Aged ; Water-Electrolyte Balance ; Continuous Renal Replacement Therapy ; Intensive Care Units ; Aged ; Adult ; Pancreatitis/mortality* ; Logistic Models ; Retrospective Studies ; Renal Replacement Therapy

Patients requiring extracorporeal membrane oxygenation (ECMO) often need concurrent continuous renal replacement therapy (CRRT). At present, there are various connection methods between ECMO and CRRT circuits, among which in-series integration is the most common. However, ECMO blood flow and catheter type, pressure changes at the pre-pump, post-pump pre-oxygenator, and post-oxygenator segments frequently result in circuit pressures that exceed the alarm threshold of the device. Excessive negative or positive pressures may compromise blood withdrawal and return within the CRRT circuit, leading to frequent system alarms, interruptions in therapy, filter occlusion, and an increased risk of thrombus formation. To address this issue, the critical care nursing team of Zhongda Hospital Affiliated to Southeast University, developed a novel pressure-regulating clamp for CRRT vascular access in ECMO patient, which has been granted a National Utility Model Patent of China (patent number: ZL 2021 2 1496610.7). The device comprises opposing left and right clamp arms joined at the top by a flexible plastic bridge, with dual internal compression surfaces designed to fit CRRT tubing of various calibers. A locking mechanism and serrated strip at the base enable precise adjustment of the compression distance, thereby modulating the tubing's cross-sectional area. This configuration allows real-time regulation of blood flow and stabilization of pressures at blood withdrawal and return sites within the CRRT circuit. By reducing pressure-related alarms and extending filter life, the device may enhance the safety and efficiency of CRRT delivery during ECMO. It is user-friendly, cost-effective, and well-suited for broad clinical implementation, with the potential to alleviate the overall treatment burden on patients and their families.
Extracorporeal Membrane Oxygenation/instrumentation* ; Humans ; Continuous Renal Replacement Therapy/instrumentation* ; Equipment Design ; Pressure

OBJECTIVE: To analyze the efficacy and access safety of extracorporeal membrane oxygenation (ECMO) in series with continuous renal replacement therapy (CRRT) access for critically ill patients using propensity score matching analysis, and to explore the potential influencing factors of infection. METHODS: A total of 200 critically ill patients who received both ECMO and CRRT treatment in the intensive care unit (ICU) of Huai'an Second People's Hospital from December 2020 to December 2024 were retrospectively selected as the research subjects. They were divided into the independent operation group (72 cases) and the series system group (128 cases) according to the access connection mode of ECMO and CRRT. Propensity score matching analysis was used to perform 1 : 1 matching for patients of the two groups. The general data [age, gender, body mass index (BMI), clinical diagnosis, underlying disease, intubation method, intubation position, disease severity, ECMO support duration, catheter indwelling duration, oxygenation index (PaO₂/FiO₂) at 48 hours after ECMO initiation, serum creatinine (SCr), procalcitonin (PCT), hemoglobin (Hb), white blood cell count (WBC), platelet count (PLT)], treatment status [ECMO initiation duration, ECMO operation duration, ECMO flow, left ventricular ejection fraction (LVEF), CRRT initiation duration, CRRT catheter indwelling duration, inflow and outflow volume of replacement fluid], clinical outcome indicators (28-day survival rate, length of ICU stay, renal function recovery, fluid balance compliance rate), and access safety indicators (incidence of ECMO access thrombosis, incidence of infection, and incidence of bleeding events) of all the patients were collected. Subgroup analysis was conducted based on the occurrence of infection, and multivariate Logistic regression analysis was used to screen the potential risk factors for infection in critically ill patients receiving both ECMO and CRRT treatment. RESULTS: Finally, a total of 120 patients were successfully matched, with 60 patients in both the independent operation group and the series system group. No statistically significant differences were observed in the general data between the two groups, indicating comparability. Compared with the independent operation group, the ECMO flow at 48 hours after ECMO initiation, SCr, and alanine transaminase (ALT) of the patients in the series system group were significantly decreased, while the LVEF at 48 hours after ECMO initiation was significantly increased, additionally, the CRRT initiation duration, CRRT catheter indwelling duration, and the length of ICU stay were significantly shortened, and the inflow and outflow volume of replacement fluid were significantly increased. The incidence of infection and bleeding events in the series system group was significantly lower than that in the independent operation group [infection incidence: 11.67% (7/60) vs. 36.67% (22/60), bleeding event incidence: 8.33% (5/60) vs. 48.33% (29/60), both P < 0.05]. No significant difference was found in the other general data, treatment status, clinical outcome indicators, or access safety indicators between the two groups. Among the 120 patients, 29 cases developed infection (accounting for 24.17%), and 91 cases had no infection (accounting for 75.83%). Compared with the non-infection group, the catheter indwelling duration was significantly prolonged and PCT was significantly increased in the infection group, while the PLT and the proportion of patients with ECMO and CRRT access connected via the series system were significantly decreased. Multivariate Logistic regression analysis showed that catheter indwelling duration [odds ratio (OR) = 1.277, 95% confidence interval (95%CI) was 1.001-1.629, P = 0.049], PCT (OR = 1.529, 95%CI was 1.222-1.914, P < 0.001], PLT (OR = 0.953, 95%CI was 0.926-0.981, P = 0.001), and access connection mode (OR = 0.289, 95%CI was 0.090-0.930, P = 0.037) were potential risk factors for infection in critically ill patients. CONCLUSIONS The ECMO-in-series CRRT access can accelerate the initiation of CRRT, avoid local bleeding, stabilize patients' cardiac, hepatic and renal functions, reduce potential infection risks, and improve the prognosis of patients.
Humans ; Extracorporeal Membrane Oxygenation/adverse effects* ; Critical Illness/therapy* ; Retrospective Studies ; Continuous Renal Replacement Therapy ; Male ; Female ; Intensive Care Units ; Propensity Score ; Middle Aged ; Renal Replacement Therapy ; Adult ; Aged ; Risk Factors

INTRODUCTION

Chronic Kidney Disease (CKD) is a leading cause of morbidity and mortality in the Philippines. Most Filipino CKD patients prefer hemodialysis due to barriers such as cost and availability of Kidney Transplant. End-stage kidney disease (ESKD) patients face high symptom burden and unmet palliative care needs. Even with advancement in dialysis technology, the annual mortality rate of dialysis patients remains between 20% and 25%. While Advance Care Planning (ACP) can help align care with patient preferences by facilitating discussions about values and future decisions, its utilization in dialysis population remains low due to barriers in implementation. There is limited research specifically addressing the preferences and influencing factors of Advance Care Planning among CKD patients on hemodialysis in the Philippines.

OBJECTIVE

This study aimed to determine the ACP preferences of CKD patients undergoing hemodialysis and to identify the clinicodemographic factors associated with these preferences.

METHODS

An analytic cross-sectional study was conducted involving 96 chronic kidney disease (CKD) patients undergoing hemodialysis at Baguio General Hospital and Medical Center (BGHMC) from October to November 2024. Data were collected using validated questionnaires administered either through face-to-face interviews or self-administration, depending on patients’ preferences and capabilities. Descriptive and inferential statistical methods were employed for data analysis.

RESULTS

The study revealed limited awareness of ACP among participants (86.5%), underscoring the need for education. Family-centered decision-making was prominent, with most participants preferring family members as surrogate decision-makers and confidants. Quality of life was prioritized over life extension, and preferences for “Do Not Resuscitate” (DNR) orders were notable. Educational attainment and ethnicity significantly influenced preferences, with higher education linked to greater awareness; and Ethnicity shaping preferences for decision-makers, confidants, timing of discussions, and resuscitation choices. Additionally, duration of dialysis was linked to care setting preferences, while social support systems influenced the preferred place for discussions.

CONCLUSION

The findings highlight critical associations between clinicodemographic factors and ACP preferences among hemodialysis patients. Addressing these associations through targeted education and culturally sensitive approach can promote high-quality end-of-life care, aligned with diverse patient needs, values, and preferences.

Human ; Kidney Failure, Chronic ; End Stage Renal Disease ; Renal Dialysis ; Hemodialysis ; Terminal Care ; End Of Life Care ; Advance Care Planning

BACKGROUND

Chronic Kidney Disease (CKD) patients often face critical treatment decisions that significantly affect their quality of life, making Shared Decision-Making (SDM), a collaborative approach between patients and healthcare providers, an essential component of patient-centered care.

OBJECTIVE

This study aimed to investigate the impact of SDM on decisional readiness and patient satisfaction among CKD patients undergoing hemodialysis (HD) at Southern Isabela Medical Center (SIMC).

METHOD

An analytical cross-sectional design was utilized. The Tagalog Version of SDM Q-9 questionnaire, Decision survey and CSAT survey tool were given to HD patients of SIMC from September – October 2024. Descriptive statistics, Pearson product-moment correlation and chi square test were used to report and analyze data.

RESULTS

One hundred eight (108) CKD patients on HD were included in the study. Shared decision-making score was high and overall satisfaction on health services was outstanding. Higher decisional readiness was associated with greater odds of reporting outstanding satisfaction (OR = 3.47, 95% CI: 2.563–4.688, p = 0.009). There was no significant association between patient satisfaction and SDM (r= 0.111, p =0.253.). Shared decision-making had a significant but weak positive correlation with decisional readiness (r =0.2043, p 0.035).

CONCLUSION

This study showed that fostering SDM positively enhances patients’ preparedness to make healthcare decisions. Decisional readiness is strongly associated with patient satisfaction, as confident patients are more likely to be satisfied with their care. The findings underscore the need for improved patient education to boost decisional readiness and support ongoing SDM practices. Integrating SDM into clinical workflows is essential to advancing patient-centered care and improving health outcomes for CKD patients undergoing hemodialysis.

Human ; Renal Insufficiency, Chronic ; Chronic Kidney Disease ; Renal Dialysis ; Hemodialysis ; Patient Satisfaction