OBJECTIVES: This study aims to determine the hemodialysis adequacy of dialyzer reuse in pediatric patients undergoing maintenance HD. Specifically, the study aims to determine the median urea reduction ratio (URR) and single pool Kt/V (sp Kt/V) in relation to number of dialyzer reuse, as well as the percentage of patients receiving adequate hemodialysis for each subsequent dialyzer reuse based on the median URR and sp Kt/V. MATERIALS AND METHODS: A total of 17 CKD patients who used 25 dialyzer samples were included in the study. Blood samples for determination of pre- and post-HD blood urea nitrogen were extracted from the hemodialysis access (i.e. central venous access, arteriovenous fistula) prior to initiation and after termination of HD treatment. Additional data such as HD duration (in hours), ultrafiltration volume (in liters), and post-dialysis weight were also noted for the computation of hemodialysis adequacy based on URR and sp Kt/V. RESULTS: There was a marked reduction in adequacy rate based on URR observed at 4th use (78.9%) which further declined until 50% adequacy rate only at 10th use. Moreover, there was a marked reduction in the median URR observed at 4 th use (69.79) which further declined until a median URR of 65.08 at 10th use. There was also a marked reduction in adequacy rate based on sp Kt/V at 4th use (78.9%) which further declined until 50% adequacy rate only at 10th use. In addition, there was a marked reduction in median sp Kt/V observed at 4th use (1.37) which further declined until a median sp Kt/V of 1.30 at 10th use. CONCLUSION Among pediatric patients on HD, the adequacy rates based on URR and sp Kt/V both showed a decline over multiple uses of the dialyzer, particularly after 3rd use and with occasional fluctuations between 6th to 7th use. These findings suggest the need for closer monitoring and potential adjustments to improve dialysis efficiency and patient outcomes. Further studies are needed to explore the factors contributing to the decline in adequacy rates over multiple uses of the dialyzer in this patient population.
hemodialysis ; hemodialysis adequacy ; dialyzer reuse

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.

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

Introduction: Toxoplasma gondii is a protozoan parasite which causes a zoonotic disease called toxoplasmosis. The main purpose of this study was to investigate the seropositivity rate of specific antibodies “anti-T. gondii IgG and IgM antibodies using enzyme-linked immunosorbant assay” in hemodialysis patients attending the Teaching Hospital, Baquba City, Diyala Province, Iraq and to determine the potentially preventable risk factors. Methods: Eighty five hemodialysis patients with kidney failure and 85 healthy volunteers were selected for this study. Results: The percentage of seropositivity for IgG antibodies in patients with hemodialysis was 54.1% while it was 38.2% among the healthy control subjects and the difference was significant between the two groups [Odds Ratio (OR)= 1.8586; 95% Confidence Interval (CI)= 1.0097-3.4212; P= 0.0465]. In contrast, IgM antibodies were not detected in any of the patients or the healthy subjects. Many risk factors were identified, including contact with cats (OR, 2.62; P= 0.0398); eating undercooked meat (OR, 2.6, P= 0.0439); drinking unfiltered water (OR, 2.86, P= 0.0433); and eating outside the home (OR, 5.6, P= 0.0024) as risk factors for toxoplasmosis. However, smoking was not found to be as a risk factor for toxoplasmosis (OR, 2.1, P= 0.1204). Conclusion: The results of the present study revealed a high prevalence of toxoplasma infection in hemodialysis patients and therefore, we recommend monitoring these patients for T. gondii infection to minimize the spreading of toxoplasmosis via treating the seropositive patients with the available commercial drugs.
Hemodialysis

Introduction: Poor nutritional status is prevalent among hemodialysis patients, with limited studies available on how it is being influenced by other factors in the local context. The current study aimed to determine the nutritional status and its associated factors among hemodialysis patients. Methods: This was a study undertaken in a total of 455 hemodialysis patients (256 men and 199 women). The main outcome measure was Malnutrition Inflammation Score (MIS), which was utilized to identify nutritional and inflammatory status of the hemodialysis patients. Other evaluation tools included anthropometry and biochemical measurements as well as dietary assessment. Results: A high proportion of hemodialysis patients were malnourished (64.4%) and presented with inflammation (67.5%). Using multiple linear regression analysis, factors contributing to malnutrition were older age, lower lean body mass, higher interdialytic weight gain (IDWG), inadequate intakes of energy and protein, as well as presence of comorbidities and inflammation. Conclusion: The presence of malnutrition and inflammation were prevalent among hemodialysis patients. Several determinants of poor nutritional status of hemodialysis patients were modifiable and should be recognized while formulating and implementing appropriate intervention plans for this vulnerable group.
Hemodialysis

Introduction: Health-related quality of life (HRQOL) is one of the main indicators of health and wellbeing among dialysis patients which has attracted mounting interest in recent years in the initiation of intervention measures. Thus, this study aimed to determine the correlations between socio-demographic factors and medical characteristics with HRQOL among elderly on maintenance hemodialysis (HD). Methods: A cross-sectional study was conducted in nine HD centers in Selangor. Socio-demographic data and HRQOL were assessed using structured questionnaire and Kidney Disease Quality of Life Instrument (KDQOL-36), respectively whilst medical profile and laboratory data were collected from subjects’ medical record. Results: The mean age of subjects was 67±6 years where majority (57%) of the subjects was on maintenance HD for less than 5 years. The mean physical component summary and mental component summary scores were 33.89±11.83 and 50.23±8.88, respectively. Symptoms/problems subscale, effects of kidney disease on daily life subscale and burden of kidney disease subscale scores were 73.37±17.01, 72.63±19.74 and 54.62±30.42, respectively. There was a significant correlation between serum sodium with physical component summary (r=0.237, p<0.01) and symptoms/problems subscale (r= 0.245, p<0.01). Conclusion: Subjects perceived their mental health better than physical health but felt burdened by kidney disease the most. Serum sodium was found to be positively associated with physical functioning and symptoms/problems subscales. There is a need for routine assessment on HRQOL and appropriate intervention to enhance the quality of life among elderly on HD.
Quality of life ; Hemodialysis

BACKGROUND/AIMS: We investigated which dialysis unit blood pressure (BP) is the most useful for predicting home BP in patients undergoing hemodialysis (HD). METHODS: Patients undergoing HD who had been treated > 3 months were included in this study. Exclusion criteria were hospitalized patients with acute illness and changes in dry weight and anti-hypertensive drugs 2 weeks before the study. We used the dialysis unit BP recording data, such as pre-HD, intra-HD, post-HD, mean pre-HD, and post-HD (pre-post-HD), mean pre-HD, intra-HD, and post-HD (pre-intra-post-HD) BP. Home BP (the same period of dialysis unit BP) was monitored as a reference method during 2 weeks using the same automatic oscillometric device. Patients were asked to record their BP three times daily (wake up, between noon and 6:00 PM, and at bedtime). RESULTS: Significant differences were detected between home systolic blood pressure (SBP) and pre-HD, post-HD, and intra-HD SBP (p = 0.003, p = 0.001, p = 0.016, respectively). In contrast, no differences were observed between home SBP and pre-intra-post-HD and pre-post-HD SBP (p = 0.235, p = 0.307, respectively). Areas under the receiver operating characteristic curve for pre-intra-post-HD and prepost-HD SBP with 2-week home BP as the reference standard were 0.812 and 0.801, respectively. CONCLUSIONS: These results suggest that pre-intra-post-HD and pre-post-HD SBP had similar accuracy for predicting mean 2-week home SBP in HD patients. Therefore, pre-intra-post-HD and pre-post-HD SBP should be useful for predicting home SBP in HD patients if ambulatory or home BP measurements are unavailable.
Antihypertensive Agents ; Blood Pressure* ; Dialysis* ; Hemodialysis Units, Hospital ; Humans ; Hypertension ; Methods ; Renal Dialysis* ; ROC Curve

PURPOSE: In this single repeated measures study, an examination was done on the effects of dialysate flow rate on dialysis adequacy and fatigue in patients receiving hemodialysis. METHODS: This study was a prospective single center study in which repeated measures analysis of variance were used to compare Kt/V urea (Kt/V) and urea reduction ratio (URR) as dialysis adequacy measures and level of fatigue at different dialysate flow rates: twice as fast as the participant’s own blood flow, 500 mL/min, and 700 mL/min. Thirty-seven hemodialysis patients received all three dialysate flow rates using counterbalancing. RESULTS: The Kt/V (M±SD) was 1.40±0.25 at twice the blood flow rate, 1.41±0.23 at 500 mL/min, and 1.46±0.24 at 700 mL/min. The URR (M±SD) was 68.20±5.90 at twice the blood flow rate, 68.67±5.22 at 500 mL/min, and 70.11±5.13 at 700 mL/min. When dialysate flow rate was increased from twice the blood flow rate to 700 mL/min and from 500 mL/min to 700 mL/min, Kt/V and URR showed relative gains. There was no difference in fatigue according to dialysate flow rate. CONCLUSION: Increasing the dialysate flow rate to 700 mL/min is associated with a significant nicrease in dialysis adequacy. Hemodialysis with a dialysate flow rate of 700 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized blood flow rate.
Dialysis* ; Fatigue* ; Hemodialysis Solutions ; Humans ; Prospective Studies ; Renal Dialysis* ; Treatment Outcome ; Urea