• continuous ambulatory peritoneal dialysis
• equation
• residual kidney function
• β2-microglobulin

• Cytokine
• Hemodialysis
• Intradialytic exercise
• Renal disease
• Virtual reality

• Humans
• Renal Dialysis
• Proprotein Convertase 9/blood
• Male
• Tumor Necrosis Factor-alpha/blood
• Female
• Middle Aged
• Virtual Reality
• Aged
• Renal Insufficiency, Chronic/therapy
• Renal Insufficiency, Chronic/blood
• Exercise/physiology
• Exercise Therapy/methods
• Kidney Failure, Chronic/therapy
• Kidney Failure, Chronic/blood
• Adult

• Hemodialysis patients
• dietary potassium intake
• seasonal variations
• serum potassium

• Humans
• Renal Dialysis
• Seasons
• Potassium/blood
• Kidney Failure, Chronic/therapy
• Kidney Failure, Chronic/blood
• Potassium, Dietary/administration & dosage

• gut microbiota
• gut-brain axis
• metabolites
• prebiotic
• probiotic

• Humans
• Gastrointestinal Microbiome
• COVID-19/microbiology
• Bacteria/pathogenicity
• Bacteria/classification
• Bacteria/genetics
• Dysbiosis/microbiology
• SARS-CoV-2/pathogenicity
• Microbial Interactions

• angiotensin receptor blockers (ARB)
• angiotensin receptor-neprilysin inhibitors
• angiotensin-converting enzyme inhibitors (ACE inhibitors)
• dialysis
• end-stage renal disease (ESRD)
• heart failure and reduced ejection fraction

• hemodialysis
• kidney creatinine clearance
• kidney urea clearance
• residual kidney function

• Cardiovascular risk
• Nephrotic syndrome
• Pharmacologic nephrectomy
• Residual renal function

• Humans
• Nephrectomy/adverse effects
• Nephrotic Syndrome/complications
• Kidney/physiopathology
• Renal Dialysis/adverse effects
• Kidney Transplantation
• Male
• Kidney Failure, Chronic/therapy
• Kidney Failure, Chronic/complications
• Middle Aged

• dialysis
• home hemodialysis
• integrated home dialysis
• peritoneal dialysis
• transition

• Baxter Healthcare Corporation

• Dropout
• Haemodialysis
• Peritoneal dialysis
• Systematic review
• Technique failure

• Humans
• Peritoneal Dialysis
• Patient Dropouts/statistics & numerical data
• Renal Dialysis
• Kidney Failure, Chronic/therapy
• Kidney Failure, Chronic/mortality

• Macrocirculation
• central pulse pressure
• microcirculation
• peritoneal dialysis

• Humans
• Blood Pressure
• Microcirculation
• Cross-Sectional Studies
• Pulse Wave Analysis
• Peritoneal Dialysis/adverse effects

• AKI
• Abrupt transition
• Early mortality in ESKD

• Humans
• United States/epidemiology
• Kidney Failure, Chronic/therapy
• Cohort Studies
• Veterans
• Dialysis
• Renal Dialysis
• Acute Kidney Injury
• Retrospective Studies

• K24 DK092291 NIDDK NIH HHS
• K23 DK100468 NIDDK NIH HHS
• R03 DK111881 NIDDK NIH HHS
• National Institutes of Health

• cardiovascular risk
• end stage renal disease
• haemodialysis
• mortality
• residual urine output

• hemodialysis
• non-cardiovascular death
• renal urea clearance
• residual kidney function
• sudden cardiac death
• ultrafiltration rate

• K24 DK091419 NIDDK NIH HHS

• dialysis
• end-stage renal disease
• hemodialysis
• hypotension
• ultrafiltration

• C-reactive protein
• peritoneal dialysis
• peritoneal membrane kinetics
• rapid transporters
• systemic inflammation

• Antioxidants
• Chronic kidney disease
• End-stage renal disease
• Inflammation
• N-Acetylcysteine
• Oxidative stress
• Renal replacement therapy

• Chronic kidney disease
• Cognitive function
• Hemodialysis
• Quality of life
• Residual kidney function

• Cognition
• Disease Progression
• Glomerular Filtration Rate
• Humans
• Kidney
• Kidney Failure, Chronic
• Quality of Life
• Renal Dialysis/adverse effects

• Mansoura University

• Humans
• Kidney Diseases
• Liver Diseases/surgery
• Perioperative Care
• Preoperative Care

• Evidence-based practice
• GRADE approach
• Hemodialysis units, hospital
• Practice guideline

• Humans
• Nephrology
• Renal Dialysis/adverse effects
• Republic of Korea

• end-stage renal disease
• hemodialysis
• initiation
• mortality
• timing

Apparent treatment‐resistant hypertension (aTRH) is the most commonly used term to report resistant hypertension (RH) and is considered as a common problem in dialysis population. However, few reports have focused on peritoneal dialysis (PD) hypertensive patients. The authors conducted a multi‐center cross‐sectional study involving 1789 PD patients from nine centers in Guangdong, China. The prevalence of aTRH was estimated by home blood pressure (BP) monitoring. Evaluating drug adherence through Eight‐item Morisky Medication Adherence Scale (MMAS‐8) and pill counting was performed to assess RH in one PD center. Related factors of aTRH were analyzed using logistic regression analysis. The prevalence of aTRH in PD patients was estimated at 42.2% (755 out of 1789 hypertensive patients) based on home BP. Of those, 91.4% patients were classified as uncontrolled RH, 2.0% as controlled RH, and 6.6% as refractory hypertension. The prevalence of RH was 40.6% and 41.9% among those with medium/high adherence based on the MMAS‐8 scores and the pill counting rate, respectively. PD patients who were younger, with higher body mass index, with lower serum albumin and poorer dialysis adequacy were significantly associated with higher aTRH incident. In conclusion, the present study demonstrates a high prevalence of aTRH in PD population, which occurs in about two in five treated hypertensive patients. Nutritional status and dialysis adequacy might tightly associate with aTRH.

• apparent treatment-resistant hypertension
• dialysis adequacy
• home blood pressure monitoring
• peritoneal dialysis

• chronic kidney disease
• eGFR
• end-stage kidney disease
• glomerular filtration rate

• Acidosis/blood
• Acidosis/physiopathology
• Frailty
• Glomerular Filtration Rate
• Humans
• Kidney/blood supply
• Kidney/physiology
• Phosphorus/blood
• Proteinuria/blood
• Proteinuria/physiopathology
• Renal Dialysis
• Renal Insufficiency, Chronic/blood
• Renal Insufficiency, Chronic/diagnosis
• Renal Insufficiency, Chronic/physiopathology
• Renal Insufficiency, Chronic/therapy

• chronic kidney disease
• cost
• kidney outcomes
• kidney replacement therapies
• low-income and lower-middle-income countries, peritoneal dialysis

• Humans
• Kidney
• Kidney Failure, Chronic/diagnosis
• Kidney Failure, Chronic/therapy
• Quality of Life
• Renal Dialysis/adverse effects
• Renal Replacement Therapy

The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists’ support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient’s condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There is also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).

• Evidence-based practice
• GRADE approach
• Hemodialysis units
• Hospital
• Practice guideline

• cohort studies
• diet
• dietary
• hemodialysis
• mortality
• nutrition
• potassium

• Anomaly detection
• Electronic health records
• Hemodialysis
• LSTM autoencoders
• Mortality prediction

Lower blood pressure (BP) levels are linked to a slower decline of kidney function in patients with chronic kidney disease (CKD) without kidney replacement therapy. However, there are limited data on this relation in peritoneal dialysis (PD) patients. Here we evaluated the association of BP levels with the decline of residual kidney function (RKF) in a retrospective cohort study.

We enrolled 228 patients whose PD was initiated between 1998 and 2014. RKF was measured as the average of creatinine and urea clearance in 24-hr urine collections. We calculated the annual decline rate of RKF by determining the regression line for individual patients. RKF is thought to decline exponentially, and thus we also calculated the annual decline rate of logarithmic scale of RKF (log RKF). We categorized the patients’ BP levels at 3 months after PD initiation (BP_3M) into four groups (Optimal, Normal & High normal, Grade 1 hypertension, Grade 2 & 3 hypertension) according to the 2018 European Society of Cardiology and European Society of Hypertension Guidelines for the management of arterial hypertension.

The unadjusted, age- and sex-adjusted, and multivariable-adjusted decline rate of RKF and log RKF decreased significantly with higher BP_3M levels (P for trend <0.01). Compared to those of the Optimal group, the multivariable-adjusted odds ratios (95% confidence interval) for the faster side of the median decline rate of RKF and log RKF were 4.04 (1.24–13.2) and 5.50 (1.58–19.2) in the Grade 2 and 3 hypertension group, respectively (p<0.05).

Higher BP levels after PD initiation are associated with a faster decline in RKF among PD patients.

• Aged
• Blood Pressure/physiology
• Creatinine/metabolism
• Disease Progression
• Female
• Glomerular Filtration Rate/physiology
• Humans
• Kidney/physiopathology
• Kidney Function Tests/methods
• Male
• Middle Aged
• Peritoneal Dialysis/methods
• Renal Insufficiency, Chronic/metabolism
• Renal Insufficiency, Chronic/physiopathology
• Retrospective Studies

• Heavy metal
• Petrochemical industry
• Renal function

• Alkanes
• Cross-Sectional Studies
• Environmental Exposure/adverse effects
• Humans
• Kidney/physiology

• End-stage renal disease
• hemodialysis
• potassium
• seasonal variation

• Cohort Studies
• Humans
• Potassium
• Renal Dialysis
• Seasons

• adequacy
• goal-directed dialysis
• quality of life
• solutes and cardiovascular control
• volume

• GFR
• MDRD
• dialysis
• hemodialysis
• predialysis

Hemodialysis (HD) is a complex therapy that imposes several changes in the patient's life. Failure to follow therapy recommendations is called non-adherence (NA). The patient's illness perception, severity of chronic kidney disease, and individual strategies for coping with HD can have an impact on NA to the demands of therapy.

This was a cross-sectional study with end-stage renal disease patients on conventional HD in Salvador, Bahia. We evaluated attendance to treatment and interdialytic weight gain (IDWG) as parameters of NA to HD, and investigated its association with clinical aspects and measures of disease perception (illness effects questionnaire - IEQ) and severity of nephropathy (end stage renal disease severity index - ESRD-SI), by analyzing Pearson or Spearman correlation.

79 patients were evaluated, 57% male, aged 53.1 ± 12.3 years, with length of HD of 108 (89 - 131.5) months. Age correlated with ESRD-SI (r = 0.43) and NA parameters: negative correlation with relative IDWG (r = -0.41) and reduction in sessions (r = -0.31) and positive correlation with %HD performed (r = 0.25). The scores on the IEQ and ESRD-SI showed a positive correlation (r = 0.44; p <0.001), but did not show any correlation with the analyzed NA parameters.

We did not find a correlation between illness perception and severity index of advanced nephropathy with the behaviors of NA to chronic HD. In this study, age correlated both with the perception of severity of advanced nephropathy and the parameters of NA to chronic HD.

Chronic volume overload is pervasive in patients on chronic haemodialysis and substantially increases the risk of cardiovascular death. The rediscovery of the three-compartment model in sodium metabolism revolutionizes our understanding of sodium (patho-)physiology and is an effect modifier that still needs to be understood in the context of hypertension and end-stage kidney disease. Assessment of fluid overload in haemodialysis patients is central yet difficult to achieve, because traditional clinical signs of volume overload lack sensitivity and specificity. The highest all-cause mortality risk may be found in haemodialysis patients presenting with high fluid overload but low blood pressure before haemodialysis treatment. The second highest risk may be found in patients with both high blood pressure and fluid overload, while high blood pressure but normal fluid overload may only relate to moderate risk. Optimization of fluid overload in haemodialysis patients should be guided by combining the traditional clinical evaluation with objective measurements such as bioimpedance spectroscopy in assessing the risk of fluid overload. To overcome the tide of extracellular fluid, the concept of time-averaged fluid overload during the interdialytic period has been established and requires possible readjustment of a negative target post-dialysis weight. ²³Na-magnetic resonance imaging studies will help to quantitate sodium accumulation and keep prescribed haemodialytic sodium mass balance on the radar. Cluster-randomization trials (e.g. on sodium removal) are underway to improve our therapeutic approach to cardioprotective haemodialysis management.

• bio-impedance spectroscopy
• cardiovascular disease
• haemodialysis
• sodium metabolism
• time-averaged fluid overload

There are conflicting research results about the survival differences between hemodialysis(HD) and peritoneal dialysis (PD). The present study estimated the survival and the relative mortality hazard for incident HD and PD patients with end stage renal disease (ESRD) in eastern China.

This study examined a cohort of patients with ESRD who initiated dialysis therapy in Zhejiang province between Jan of 2010 and Dec of 2014, followed up until the end of 2015. PD patients were matched in a 1:1 fashion with HD patients, and Kaplan–Meier analysis was used to explore the survival of them. The Cox proportional hazard regression model was applied to identify the factors that predict survival by treatment modality. Subgroup analyses were conducted by stratifying patients according to gender, age, causes of ESRD and comorbidities.

Among a total of 22,379 enrolled patients (17,029 HD patients and 5350 PD patients), 5350 matched pairs were identified, and followed for a median of 29 months (3 ~ 72 months). Kaplan-Meier survival curve revealed that overall mortality rate was significantly higher in HD patients than in PD patients (log-rank test, P < 0.001), after adjusting by gender, age, primary causes of ESRD and comorbidities. HD was consistently associated with an increased risk for morality compared with PD in the matched cohort (adjusted hazard ratio (AHR): 1.140, 95%CI: 1.023 ~ 1.271). In subgroup analyses, male, younger patients, or nondiabetic patients aged less than 65 years after adjustment of covariates, initiating with PD was associated with a significantly lower mortality compared with HD. In the multivariate Cox proportional risks model, age, diabetic nephropathy (DN), other/unknown causes of ESRD, and patients with a history of cardiovascular disease or cancer showed statistical significance in explaining survival of incident ESRD patients.

ESRD patients who initiated dialysis with PD yielded superior survival rates compared to HD. Increased use of PD as initial dialysis modality in ESRD patients could be encouraged in Chinese population.

• End stage renal disease (ESRD)
• Hemodialysis
• Mortality
• Peritoneal dialysis

The number of kidney transplant recipients returning to dialysis after graft failure is steadily increasing over time. Patients with a failed kidney transplant have been shown to have a significant increase in mortality compared with patients with a functioning graft or patients initiating dialysis for the first time. Moreover, the risk for infectious complications, cardiovascular disease and malignancy is greater than in the dialysis population due to the frequent maintenance of low-dose immunosuppression, which is required to reduce the risk of allosensitization, particularly in patients with the prospect of retransplantation from a living donor. The management of these patients present several controversial opinions and clinical guidelines are lacking. This article aims to review the leading evidence on the main issues in the management of patients with failed transplant, including the ideal timing and modality of dialysis reinitiation, the indications for an allograft nephrectomy or the correct management of immunosuppression during graft failure. In summary, retransplantation is a feasible option that should be considered in patients with graft failure and may help to minimize the morbidity and mortality risk associated with dialysis reinitiation.

• allograft nephrectomy
• allosensitization
• dialysis
• graft failure
• immunosuppression
• retransplantation

Intradialytic hypotension (IDH) is a frequent and serious complication of chronic haemodialysis, linked to adverse long-term outcomes including increased cardiovascular and all-cause mortality. IDH is the end result of the interaction between ultrafiltration rate (UFR), cardiac output and arteriolar tone. Thus excessive ultrafiltration may decrease the cardiac output, especially when compensatory mechanisms (heart rate, myocardial contractility, vascular tone and splanchnic flow shifts) fail to be optimally recruited. The repeated disruption of end-organ perfusion in IDH may lead to various adverse clinical outcomes affecting the heart, central nervous system, kidney and gastrointestinal system. Potential interventions to decrease the incidence or severity of IDH include optimization of the dialysis prescription (cool dialysate, UFR, sodium profiling and high-flux haemofiltration), interventions during the dialysis session (midodrine, mannitol, food intake, intradialytic exercise and intermittent pneumatic compression of the lower limbs) and interventions in the interdialysis period (lower interdialytic weight gain and blood pressure–lowering drugs). However, the evidence base for many of these interventions is thin and optimal prevention and management of IDH awaits further clinical investigation. Developing a consensus definition of IDH will facilitate clinical research. We review the most recent findings on risk factors, pathophysiology and management of IDH and, based on this, we call for a new consensus definition of IDH based on clinical outcomes and define a roadmap for IDH research.

• cardiovascular event
• haemodialysis
• intradialytic hypotension
• roadmap
• ultrafiltration

• complications
• hemodialysis
• peritoneal dialysis
• renal replacement therapy
• survival

Although residual urine output (UOP) is associated with better survival and quality of life in dialysis patients, frequent measurement by 24-hour urine collection is burdensome. We thus sought to examine the association of patients’ self-reported residual UOP, as an alternative proxy of measured residual UOP, with mortality risk in a prospective hemodialysis cohort study.

Among 670 hemodialysis patients from the prospective multicenter Malnutrition, Diet, and Racial Disparities in Kidney Disease study, we examined associations of residual UOP, ascertained by patient self-report, with all-cause mortality. Patients underwent protocolized surveys assessing presence and frequency of UOP (absent, every 1–3 days, >1 time per day) every 6 months from 2011 to 2015. We examined associations of baseline and time-varying UOP with mortality using Cox regression.

In analyses of baseline UOP, absence of UOP was associated with higher mortality in expanded case-mix adjusted Cox models (ref: presence of UOP): hazard ratio (HR), 1.78 (95% confidence interval [CI], 1.16–2.72). In analyses examining baseline frequency of UOP, point estimates suggested a graded association between lower frequency of UOP and higher mortality, although estimates for UOP every 1 to 3 days did not reach statistical significance (reference: UOP >1 time per day): HR, 1.29 (95% CI, 0.82–2.05) and HR, 1.97 (95% CI, 1.24–3.12) for UOP every 1 to 3 days and absence of UOP, respectively. Similar findings were observed in analyses of time-varying UOP.

In hemodialysis patients, there is a graded association between lower frequency of self-reported UOP and higher mortality. Further studies are needed to determine the clinical impact of more frequent assessment of residual UOP using self-reported methods.

• end-stage renal disease
• hemodialysis
• mortality
• residual kidney function
• urine output

An immunosuppressant weaning protocol in failing allografts has not yet been established. Maintaining immunosuppressants would preserve residual renal function (RRF) and prevent graft intolerance syndrome and sensitization but would increase the risks of infection and malignancy. In this study, graft failure cases after kidney transplantation in a single center were reviewed retrospectively. The outcome differences in all-cause mortality, infection-related hospitalization, cancer, graft intolerance syndrome, re-transplantation, and RRF duration between the immunosuppressant maintaining and weaning groups 6 months after graft failure were compared. Among the weaning group, the outcome differences according to low-dose steroid use were also compared at 6 and 12 months. In a total of 131 graft failure cases, 18 mortalities, 42 infection-related hospitalizations, 22 cancer cases, 11 graft intolerance syndrome cases, and 28 re-transplantations occurred during the 94-month follow-up. Immunosuppressant maintenance significantly decreased the patient survival rate 6 months after graft failure compared with weaning (log-rank P = 0.008) and was an independent risk factor for mortality, even after adjustments (hazard ratio, 3.01; P = 0.025). Infection-related hospitalization, graft intolerance syndrome development, and re-transplantation were not affected by the immunosuppressant weaning protocol. Among the immunosuppressant weaning group, low-dose steroid maintenance at 6 and 12 months helped preserved RRF (P = 0.008 and P = 0.003, respectively).