Abstract Background: Important determinants of dialysis adequacy are blood flow rate (BFR) and dialysis time. This study aimed to evaluate the impact of BFR and duration of dialysis session on nutritional status and quality of life (QoL) in hemodialysis (HD) patients. Methods: Real-world evidence studies (RWE) of 3 HD units that differ in BFR and/or dialysis time. Group I, HD 5 hours and BFR 200-250 mL/minute; group II, HD 4 hours and BFR 270-320 mL/minute, and group III, HD 4 hours and BFR 200-250 mL/minute. All HD units use the same dialysate flow and dialysis frequency. The 3-point Subjective Global Assessment (SGA) scale is used to assess nutritional status, while QOL is assessed using the SF-36. Results: There were 291 chronic HD patients with an average age of 51 (12.3) years, 50.5% were male. The proportion of SGA classes between groups did not differ significantly. Group I was associated with significantly higher PF and RP domain scores of PC and VT domain scores of MC compared to Group III. On the other hand, Group II was associated with significantly lower VT and MH domain scores of MC compared to Group I, while the other domains were not significantly different. In general, Group III had the lowest SF-36 scores compared to the other 2 groups. Conclusion: Duration of HD was not associated with nutritional status. Compared with 4-hour HD but with a faster BFR, 5-hour HD was associated with higher Mental Component QOL scores, but not Physical Component scores.
subjective global assessment ; SF-36 questionnaire ; blood flow rate ; dialysis time

BACKGROUND

Hemodialysis access is the lifeline of patients with end-stage renal disease. Factors that can affect access patency needs to be understood further to improve their longevity.

This is a cross-sectional descriptive study that aims to describe the demographic, clinical and duplex scan profiles among patients who have undergone arteriovenous fistula (AVF) or graft duplex scan in a tertiary institution from 2017 to 2023.

There were 133 patients with 139 accesses studied. There were 86 AVFs and 53 arteriovenous grafts. Eighty-one studies were on males and 48 on females. Forty-seven were studies on the young (ageCONCLUSION

Age, gender, type of access and comorbidities can be related to the presence of access flow dysfunction. Larger prospective research is recommended to establish such associations.

BACKGROUND

Hemodialysis access is the lifeline of patients with end-stage renal disease. Factors that can affect access patency needs to be understood further to improve their longevity.

This is a cross-sectional descriptive study that aims to describe the demographic, clinical and duplex scan profiles among patients who have undergone arteriovenous fistula (AVF) or graft duplex scan in a tertiary institution from 2017 to 2023.

There were 133 patients with 139 accesses studied. There were 86 AVFs and 53 arteriovenous grafts. Eighty-one studies were on males and 48 on females. Forty-seven were studies on the young (ageCONCLUSION

Age, gender, type of access and comorbidities can be related to the presence of access flow dysfunction. Larger prospective research is recommended to establish such associations.

Introduction: Severe hypercalcemia is a life-threatening metabolic emergency that necessitates prompt initiation of systemic therapy due to the risk of cardiac arrhythmias. It is frequently linked to squamous cell carcinoma through the production of parathyroid hormone–related protein, which mediates the development of humoral hypercalcemia of malignancy. Case: This is a case of a 38-year-old male who was diagnosed 1 year ago with locally advanced poorly differentiated basaloid squamous cell carcinoma of the lower anterior mandibular alveolus involving cortical, medullary bone, and perineural invasion. He underwent extensive tumor resection with reconstruction, tracheostomy, and bilateral neck dissection, followed by multiple revision surgeries for postoperative complications. He completed adjuvant chemoradiotherapy. He presented with acute confusion without other systemic symptoms. His Glasgow Coma Scale was E4V4M5. Neurological and systemic examinations were unremarkable, and oral cavity assessment showed no evidence of recurrence. Investigations revealed severe hypercalcemia (5.94 mmol/L) with normal phosphate (1.16 mmol/L) associated with shortened QTc. Other tests were unremarkable, with no evidence of infection, uremia, liver dysfunction, or alternative metabolic causes. Lumbar puncture was unremarkable. His parathyroid hormone level was suppressed at 0.50 pg/ mL. Computed tomography brain showed no evidence of meningoencephalitis, hydrocephalus, cerebral oedema, or metastasis. Aggressive hydration was initiated alongside subcutaneous calcitonin, which was subsequently titrated. However, there was no clinical or biochemical improvement after 1 day, with persistent confusion and calcium remaining at 5.87 mmol/L. Subcutaneous denosumab was then administered, and hemodialysis was initiated on alternate days due to refractory hypercalcemia. This resulted in improvement of calcium levels to 3.2–3.6 mmol/L and resolution of confusion Conclusion Refractory hypercalcemia may represent a late manifestation of advanced squamous cell carcinoma and is an ominous prognostic indicator, necessitating prompt evaluation and oncologic management.
Calcitonin ; Denosumab ; Hypercalcemia ; Renal Dialysis ; Neoplasms

BACKGROUND : Peritoneal dialysis is an alternative to hemodialysis in patients with end-stage kidney disease (ESKD). The laparoscopic technique for catheter insertion has been shown to be better than the open method. This study aimed to discuss the results of laparoscopic Tenckhoff catheter insertion by the rectus sheath tunneling (RST) procedure in adult patients with ESKD. METHODS : This retrospective investigation was conducted in an Indonesian tertiary hospital. Data were gathered from the medical records of 18-year-old or older patients with ESKD who underwent laparoscopic Tenckhoff catheter insertion between January 1, 2018 to December 31, 2022. RESULTS : Of 68 patients, 45 (66%) were male and 23 (34%) were female, with a mean age of 45.25 (standard deviation: 13.2) years. The catheter survival rates at 3 months, 1 year, 2 years, and 3 years were 97%, 91%, 82%, and 80%, respectively. The estimated blood loss was 5 (2–100) ml and the median operation time was 70 (40–150) min. The omentopexy maneuver was used in 10 (15%) patients. The most common catheter problems were malfunction (18%), peritonitis (21%), exit-site infection (7%), abdominal herniation (3%), and leakage (1%). Because of uncontrolled complications, 9 (13%) patients underwent revision surgery and 10 (15%) required catheter removal surgery. Catheter migration was not observed in any patient. CONCLUSIONS Laparoscopic Tenckhoff catheter insertion using the RST technique is a practical method for adult patients with ESKD as it has a reasonably low rate of complications.
complications ; laparoscopic ; peritoneal dialysis

BACKGROUND

End-stage renal disease (ESRD) has been increasing in prevalence in recent years. The true prevalence of depression in hemodialysis patients is still not known. Cross-cultural studies showed prevalence ranging from 20-90%. Dimaano translated the Beck’s Depression Inventory Scale into the Visayan language and used this as a screening tool for depression among hemodialysis patients - and this was the first cross-cultural translation of the Beck’s Depression Inventory Scale to the Visayan language (BDI-Visayan).

Determine the accuracy of Beck’s Depression Inventory - Visayan in screening for Major Depressive Disorder (MDD) among Visayan-speaking ESRD patients.

Cross-sectional survey

Adult Visayan-speaking patients, ≥ 18 years old with ESRD, with GFR < 15 ml/min/1.73 m2 and ongoing hemodialysis for at least 3 months at the Chong Hua Hospital Mandaue Renal Unit.

The 73 subjects underwent both the BDI-Visayan and the Structured Clinical Interview for DSM Disorders. Data was gathered to determine the accuracy of the BDI-Visayan in detecting Major Depressive Disorder.

Of the 73 subjects, 19.2% were identified with MDD, based on the SCID, while 37.0% were identified as depressed using the BDI-Visayan. Analyzed data showed that the accuracy of BDI-Visayan to detect MDD was 67.75%, with a sensitivity of 57.14%, and specificity of 67.8%.

BDI-Visayan had an acceptable accuracy in screening for MDD, however, it may tend to have an overdiagnosis in the ESRD population – emphasizing its role as a screening tool for suspected MDD cases.

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.

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

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.

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.

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.

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.

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).

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.

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).

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.

Objective To analyze the risk factors for prolonged length of hospital stay in patients with peritoneal dialysis associated peritonitis(PDAP)and construct a nomogram based on Logistic regression model.Methods A retrospective study was conducted on patients with PDAP who were hospitalized at the Affiliated Hospital of Jiangsu University from January 2013 to December 2023.Using the 75th percentile of hospitalization time as the cutoff(>21 days),the patients were divided into prolonged length of hospital stay group and normal length of hospital stay group.Clinical data were compared between the two groups.Logistic regression analysis was used to analyze the risk factors for prolonged hospital stay in PDAP patients and to construct a nomogram.Results A total of 131 PDAP patients were included in this study,including 40 cases in prolonged length of hospital stay group and 91 cases in normal length of hospital stay group.Multivariate Logistic regression analysis showed that Gram-negative bacteria detected in ascites(OR=6.012,95% CI=1.878-19.248,P=0.003)and elevated platelet count(OR=1.010,95% CI=1.005-1.015,P<0.001)were independent risk factors for prolonged length of hospital stay,while elevated serum chloride(OR=0.885,95% CI=0.802-0.978,P=0.016)was a protective factor.Based on the above three indicators,a nomogram was constructed.The multivariate Logistic regression model showed an area under the receiver operating characteristic curve(AUC)of 0.755,with an internal validation AUC of 0.727 using the Bootstrap method.The calibration curve indicated that the predicted probability was consistent with the actual probability.The decision curve showed that the model was clinically applicable when the threshold probabilities were 9%-10%,13% and 18%-92%.Conclusion A nomogram,based on the detection of gram-negative bacteria in ascites,platelet count and serum chloride,was helpful for clinical screening PADP patients at risk for prolonged length of hospital stay,and can provide a basis for optimizing clinical decision-making.
Humans ; Nomograms ; Risk Factors ; Peritoneal Dialysis/adverse effects* ; Retrospective Studies ; Length of Stay ; Peritonitis/etiology* ; Logistic Models ; Male ; Female ; Middle Aged ; Aged

This study establishes a high-performance liquid chromatography (HPLC) method for the determination of acetate content in hemodialysis solutions and dialysis concentrates. In this study, Synergi Polar-RP column is utilized. Phosphate buffered saline (50 mmol/L, pH=2.5) is used as a mobile phase. The flow rate is 1.0 mL/min. The wavelength of detection is 212 nm. Results show that the linear relationship of acetate is good in the range of 0.1~20 mmol/L, r =0.999 9 and the spike recoveries are from 98.9%~99.5%, RSD<0.5% ( n=3). This method can easily and accurately determine the acetate content in hemodialysis solutions and dialysis concentrates, and can be applied to quality control in the production and use of such products.
Chromatography, High Pressure Liquid/methods* ; Acetates/analysis* ; Hemodialysis Solutions/analysis* ; Dialysis Solutions/analysis* ; Renal Dialysis