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.

Humans ; Transcatheter Aortic Valve Replacement ; Aortic Valve/surgery* ; Heart Valve Prosthesis Implantation ; Renal Dialysis ; Aortic Valve Stenosis/surgery* ; Treatment Outcome ; Heart Valve Prosthesis

Objectives: In the Philippines, patients on chronic hemodialysis with COVID-19 remain admitted in hospitals despite clinical recovery because most free-standing dialysis units require proof of negative conversion via Reverse Transcriptase – Polymerase Chain Reaction (RT-PCR). This study aims to determine the time to negative conversion of COVID-19 RT-PCR testing among adult patients on chronic hemodialysis with COVID-19 admitted at the Philippine General Hospital (PGH) and bring insight in using the symptom or time-based procedure as recommended by local guideline, and ultimately, to ensure delivery of adequate hemodialysis despite being infected with COVID-19, shorten isolation period, and conserve resources especially in resource-limited settings. Methods: This is a retrospective cohort study on all adult patients on chronic hemodialysis who were admitted in PGH after the diagnosis of COVID-19 by RT-PCR between March 2020 and February 2021. Descriptive statistics was used in summarizing the data. Results: A total of 90 patients on chronic hemodialysis who tested positive for COVID-19 via RT-PCR admitted at PGH were included in the study. Most of these patients had moderate COVID-19 at 53.3%. The median number of days from onset of symptoms to clinical recovery was 14.5 days. The median time to first negative conversion was 18 days. Most of these patients had negative conversion at the second week. The correlation coefficient between time to clinical recovery and negative conversion was 0.214. Conclusion Among adult patients on chronic hemodialysis who were admitted in PGH after the diagnosis of COVID-19, the time to negative conversion was longer compared to the time to clinical recovery with a very weak correlation between the two.
COVID-19 ; Renal Dialysis ;

Central venous occlusive disease is commonly seen in patients undergoing hemodialysis and can threaten the viability of the arteriovenous access. Majority of cases are related to central venous catheter placement. This paper reports on three patients on chronic hemodialysis who presented with signs and symptoms of upper extremity venous hypertension and underwent three different therapeutic modalities, all with successful relief of symptoms. A review of the existing literature on past and current treatment options is done.
Renal Dialysis

Objectives: Acute Kidney Injury (AKI) during pregnancy is a complication that poses a serious risk of life for the mother and the fetus. In most cases, the treatment considered in the first instance is pregnancy interruption with subsequent conventional treatment of AKI. The aim of this review is to describe the risks and benefits of using renal replacement therapy [peritoneal dialysis (PD) and hemodialysis (HD)] in pregnant patients with AKI. Methods: A systematic review of pregnant women with AKI/CKD on RRT (pointing out the results of maternal and neonatal morbidity and mortality) in the last three decades was done between January and March 2021 using the databases Pubmed, LILACS, Cochrane, Tripdatabase, AJKD, and Elsevier. Articles in Spanish, English, and French languages were included. A summary of cases of pregnant women on RRT with women and fetus survival percentages was shown in a table. Results: Making a summary of all the included patients, it resulted in 1673 women, 1208 in HD and 170 in PD with 15 maternal deaths and survival percentages for the fetus of 74% in HD and 40% in PD. Conclusion The RRT in pregnant women with AKI/CKD offers a high survival rate for the women and fetus.
Hemodialysis ; Renal Dialysis ; Peritoneal Dialysis ; Pregnancy ; Renal Replacement Therapy

OBJECTIVE: This paper aimed to describe the clinical profile and short-term clinical outcomes of children with Acute Kidney Injury (AKI) requiring hemodialysis in a tertiary pediatric hospital. MATERIALS AND METHODS: A retrospective cohort on in-patients who received hemodialysis treatments at our institution was performed. Medical charts of patients admitted between July 2018 and July 2023 were retrieved. Demographic data, clinical profiles and subsequent outcomes in terms of mortality and recovery or non-recovery from AKI were recorded. RESULTS: After meeting the inclusion and exclusion criteria, 129 patients were included in the study‘s statistical analysis. There was an even distribution between males and females. The average age of treated patients was 10 years old (SD ± 4.3). The average weight of patients was 35kg (SD ± 16.9). The most common diagnosis of patients was severe dengue (21.7%), followed by severe sepsis (14.7%). More than half of patients (51.9%) had an existing co-morbidity, of which Systemic Lupus Erythematosus (22.4%) and solid tumors (22.4%) were most common. The most common indication for hemodialysis was uremia (52.7%). In terms of short-term outcome, majority of patients died during the same admission (56.5%), while 31 patients (24.0%) recovered. CONCLUSION The clinical profile of patients who underwent hemodialysis treatments for AKI were comparable to international data. The study did not differentiate deaths from AKI or underlying illness, but demonstrated a higher mortality rate compared to other existing studies. This study is the first known local paper to describe the profile and outcomes of children who received hemodialysis for AKI.
Hemodialysis ; Renal Dialysis ; Severe Sepsis ; Sepsis ; Severe Dengue

Humans ; Transcatheter Aortic Valve Replacement ; Aortic Valve/surgery* ; Heart Valve Prosthesis Implantation ; Renal Dialysis ; Aortic Valve Stenosis/surgery* ; Treatment Outcome ; Heart Valve Prosthesis

OBJECTIVE: To investigate the high risk factors of failure of autologous arteriovenous fistula (AVF) in hemodialysis patients. METHODS: A retrospective study was conducted, patients with maintenance hemodialysis (MHD) undergoing AVF admitted to General Hospital of Western Theater Command from January 2021 to December 2022 were enrolled, including 107 patients with normal AVF and 168 patients with AVF dysfanction. According to the causes of AVF failure, the patients were divided into AVF stenosis group (n = 103) and AVF thrombosis group (n = 65). Age, gender, body mass index (BMI) and comorbidities (hypertension, diabetes, coronary heart disease) and other clinical data of all patients were collected. Hemoglobin, hematocrit, white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein (CRP), high density lipoprotein, low density lipoprotein, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) within 1 month of AVF use in normal dialysis patients and 1 week before AVF failure. Multivariate Logistic regression was used to analyze the independent risk factors of AVF dysfuction in MHD patients. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of risk factors on AVF dysfuction in MHD patients. RESULTS: (1) There were significant differences in age, BMI, hypertension, hemoglobin, hematocrit, PLR and CRP [age (years): 56.94±14.32, 58.83±14.05, 51.57±13.19; BMI (kg/m²): 22.83±3.10, 21.27±4.98, 23.35±2.72; hypertension: 93.20%, 64.62%, 86.92%; hemoglobin (g/L): 110.82±22.16, 88.70±24.00, 87.95±23.45; hematocrit: 0.350±0.069, 0.282±0.076, 0.275±0.071; PLR: 197.35±113.59, 192.55±138.25, 162.12±73.25; CRP (mg/L): 10.01±4.02, 8.18±5.42, 3.17±1.30, all P < 0.05], among AVF stenosis group, AVF thrombosis group and AVF normal group, there were statistically significant differences no statistically significant difference was found in other indexes among three groups. (2) Multivariate Logistic regression analysis showed that hypertension [odds ratio (OR) = 4.849, 95% confidence interval (95%CI) was 1.278-18.397, P = 0.020], elevated CRP levels (OR = 2.104, 95%CI was 1.533-2.888, P = 0.000) were associated with AVF stenosis. Elevated CRP levels (OR = 1.984, 95%CI was 1.442-2.730, P = 0.000) was an independent risk factor for AVF thrombosis. Analysis of ROC curve showed that the area under the curve (AUC) of AVF dysfunction predicted by CRP was 0.712, 95%CI was 0.637-0.786, P = 0.000; CRP cut-off value was 1.8 mg/L, the sensitivity was 67.0%, the specificity was 83.7%. CONCLUSIONS Elevated CRP is an independent risk factor for AVF failure in hemodialysis patients, which can be used to predict the occurrence of AVF failure.
Humans ; Retrospective Studies ; Constriction, Pathologic ; Renal Dialysis/adverse effects* ; Lymphocytes ; C-Reactive Protein ; Risk Factors ; Hypertension ; Hemoglobins ; Thrombosis ; ROC Curve ; Prognosis

Since end-stage renal disease leads to a variety of problems such as disability,reduced quality of life,and mental and psychological disorders,it has become a serious public health problem around the globe.Renal palliative care integrates palliative care philosophy in the care for patients with end-stage renal disease.As a planned,comprehensive,patient-centered care,renal palliative care focuses on the patient's symptoms and needs,aiming to reduce the suffering throughout the course of the disease,including but not limited to end-of-life care.This study reports the palliative care practice for a patient on maintenance dialysis in the Blood Purification Center of Peking Union Medical College Hospital and reviews the present situation of palliative care in end-stage renal disease.
Humans ; Palliative Care/psychology* ; Quality of Life ; Kidney Failure, Chronic/therapy* ; Terminal Care/psychology* ; Renal Dialysis/psychology*