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Semin Dial 2019 Feb 8. Epub 2019 Feb 8.

Division of Nephrology, National University Hospital, Singapore, Singapore.

Urgent-start peritoneal dialysis (USPD) is increasingly seen as a viable alternative to hemodialysis through a central venous catheter for late-presenting end-stage renal disease patients. However, concerns remain about starting dialysis early following the surgical implantation of the peritoneal dialysis (PD) catheter; urgent PD is often thought to be a safe option only after minimally invasive percutaneous catheter insertions. Analysis of the cumulative data from published literature presented in this review appears to negate this general perception and shows that compared to the percutaneous catheter insertions, starting PD urgently following surgically placed catheter is not associated with more catheter leaks, dysfunctions, or other complications. Read More

Semin Dial 2019 Jan 28. Epub 2019 Jan 28.

Division of Renal Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.

There is wide variation in clinical practice regarding timing of discontinuation of renal replacement therapy (RRT) in patients with acute kidney injury (AKI). Prolonged, unnecessary RRT treatment can contribute to length of stay, overall hospital costs, and risk of complications associated with RRT. In addition, prolonged RRT can paradoxically lengthen the time for which the patient remains dialysis-dependent. Read More

Semin Dial 2019 Jan 17. Epub 2019 Jan 17.

Maimónides Institute for Biomedical Research (IMIBIC), Córdoba, Spain.

Secondary hyperparathyroidism, characterized by increased PTH synthesis and secretion, is often seen in advanced stages of chronic kidney disease. Excessive proliferation of parathyroid cells leads to the development of diffuse hyperplasia that subsequently progresses to nodular histology. Refractory hyperparathyroidism occurs when parathyroid glands fail to respond to medical therapy. Read More

Semin Dial 2019 Jan 1. Epub 2019 Jan 1.

Division of Hepatology, Department of Medicine, University of Miami, Miami, Florida.

Chronic hepatitis C (CHC) is the most common cause of infection related deaths in USA according to Central Disease Control and Prevention (CDC) report in 2016. Hepatitis C is a blood borne virus and is common in chronic kidney disease (CKD) and in hemodialysis (HD) dependent patients. A majority of patients with CHC could remain asymptomatic and are still undiagnosed. Read More

Semin Dial 2018 Dec 21. Epub 2018 Dec 21.

Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden.

Health-related quality of life (HRQOL) is an important aspect of patients´ health that should be an integral part of the evaluation of patient-centered outcomes, not least because HRQOL associates with patients´ morbidity and mortality. This applies also to chronic kidney disease patients, including those dependent on renal replacement therapies, the type of which may influence patients´ perception of HRQOL. Several studies have addressed HRQOL in chronic kidney disease patients undergoing renal replacement therapies, especially transplanted patients and hemodialysis patients, while publications concerning peritoneal dialysis (PD) patients are scarcer. Read More

Semin Dial 2018 Dec 19. Epub 2018 Dec 19.

Centers for Diseases Control and Prevention, Atlanta, Georgia.

Hepatitis C virus (HCV) infection is more common among hemodialysis patients than the general population and transmission of HCV in dialysis clinics has been reported. In the context of the increased morbidity and mortality associated with HCV infection in the end stage renal disease population, it is important that dialysis clinics have processes in place for ensuring recommended infection control practices, including Standard Precautions, through regular audits and training of the staff. This review will summarize the epidemiology of HCV infection and risk factors for HCV transmission among hemodialysis patients. Read More

Semin Dial 2018 Dec 17. Epub 2018 Dec 17.

Departments of Medicine and Surgery, Yale University, New Haven, Connecticut.

Hepatitis C direct acting antiviral (DAA) therapy has evolved so that infected patients with advanced chronic kidney disease (CKD) can now anticipate the opportunity for sustained virologic response equivalent to that of the broader population of patients with hepatitis C. This has revolutionized the field of transplantation as it relates to renal transplant candidates with hepatitis C and the use of grafts from hepatitis C virus (HCV) viremic donors. In treating this population of patients, special consideration must be given to the timing of anti-viral therapy and drug-drug interactions. Read More

Semin Dial 2018 Dec 13. Epub 2018 Dec 13.

UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, Paris, France.

Hepatitis C virus (HCV) infection has been demonstrated to result in several adverse hepatic outcomes and has been associated with a number of important extrahepatic manifestations. The scope of extrahepatic clinical possibilities includes systemic diseases such as vasculitis and lymphoproliferative disorders, cardiovascular disease, myalgia, arthritis, and sicca syndrome. These end-organ effects of HCV may dominate the clinical course beyond the hepatic complications and significantly worsen the long-term prognosis of infected patients. Read More

Semin Dial 2018 Dec 9. Epub 2018 Dec 9.

Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

The prevalence of hepatitis C virus infection is increased in patients with end stage kidney disease compared to the general population and is an adverse outcome determinant. Direct-acting antiviral therapy for hepatitis C virus is changing the management paradigm of infected kidney transplant candidates and recipients, with potential to reduce patient morbidity and mortality. This review describes the hepatic and nonhepatic manifestations of hepatitis C virus in kidney transplant patients as well as management and treatment strategies to optimize transplant outcomes, highlighting the importance of direct-acting antivirals in this population. Read More

Semin Dial 2018 Dec 9. Epub 2018 Dec 9.

Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milan, Italy.

Liver disease in patients with chronic kidney disease (CKD) is most commonly due to hepatitis C virus (HCV) and contributes to increased rates of mortality. Among the pre-dialysis population, the estimated prevalence of anti-HCV positivity is based on few, limited-size studies. In hemodialysis patients however, HCV remains very prevalent despite large declines in seropositivity rates in dialysis facilities in developed countries after preventive measures were adopted in the 1990s. Read More

Semin Dial 2018 Dec 4. Epub 2018 Dec 4.

Oxford Kidney Unit, Oxford University Hospitals NHS Trust, Oxford, UK.

Hemodialysis has been linked to structural and functional damage to vital organs such as the brain and heart, possibly via repetitive intradialytic organ ischemia. There is increasing recognition that tissue ischemia can occur without changes in standard hemodynamic parameters such as blood pressure, leading to interest in more direct assessment of the adequacy of oxygen delivery to tissues. In this article, we discuss our current understanding of what happens to cellular oxygen delivery during hemodialysis: we review the underlying physiology, potential measurement techniques, and the clinical literature to date. Read More

Semin Dial 2018 Nov 29. Epub 2018 Nov 29.

Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.

Hepatitis C virus (HCV) infection is not only an important cause of chronic liver disease, but extrahepatic manifestations are common and include chronic kidney disease (CKD). HCV is classically associated with cryoglobulinemic glomerulonephritis in the context of mixed cryoglobulinemia syndrome, but other glomerular diseases also occur and may be significantly under-recognized. HCV may cause glomerular disease by immune complex deposition; however, other potential mechanisms by which HCV promotes CKD include a direct cytopathic effect of the virus on renal tissue, and by its association with accelerated atherosclerosis, insulin resistance, and chronic inflammation. Read More

Semin Dial 2018 Nov 29. Epub 2018 Nov 29.

Renal Section, Boston University Medical Center, Boston, Massachusetts.

KDIGO recently updated its clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD). The management of HCV in patients with CKD has dramatically shifted over the past 10 years with the development of direct-acting antiviral (DAA) agents and subsequent demonstration of their efficacy in CKD populations. The opportunity to cure HCV with DAA treatment has impacted all aspects of the KDIGO guideline on HCV in CKD including: (a) HCV diagnosis in CKD populations; (b) HCV treatment in CKD populations; (c) preventing HCV transmission in HD units; (d) management of HCV before and after kidney transplantation; and (e) management of HCV-associated glomerular disease. Read More

Semin Dial 2018 Nov 26. Epub 2018 Nov 26.

Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

HIV infection is a major public health problem worldwide. Due to shared modes of acquisition, many HIV+ patients are coinfected with Hepatitis C. HIV/HCV coinfected patients have an increased burden of chronic kidney disease and are more likely to progress to end-stage renal disease. Read More

Semin Dial 2018 Nov 26. Epub 2018 Nov 26.

Department of Medicine, Division of Infectious Diseases, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.

Hepatitis C is a global health concern, with important implications in chronic kidney disease (CKD) due to its increased prevalence in this population. Patients with advanced CKD have until recently been excluded from the pivotal direct acting anti-viral (DAA) trials, which have demonstrated high virological cure numbers. Sofosbuvir-free DAAs dasabuvir, ombitasvir/paritaprevir/ritonavir with or without ribavirin, and elbasvir/grazoprevir are well-tolerated in patients with genotype 1 and 4 CHC with CKD 4 or 5 (including HD), with virologic cure rates of above 90%, in both single-arm and placebo-controlled studies. Read More

Semin Dial 2018 Nov 26. Epub 2018 Nov 26.

Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida.

The identification of hepatitis C virus (HCV) occurred in 1989, and soon thereafter, it was recognized that there was a higher prevalence of anti-HCV seropositivity in patients with end-stage renal disease (ESRD) when compared to the general population. Multiple extrahepatic manifestations have been associated with HCV infection in patients with ESRD; these include an increased prevalence and risk of cardiovascular complications, insulin resistance, diabetes mellitus, and lymphoproliferative disorders. Infection with HCV has also been associated with an increased relative risk of mortality in the ESRD patient when contrasted to those patients without infection. Read More

Semin Dial 2018 Nov 26. Epub 2018 Nov 26.

Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.

Utilization of kidneys from hepatitis C virus (HCV)-infected deceased donors has the potential to increase the number of kidney transplants by 500-1000 (or more) each year. This increase in the number of kidney transplants offers major opportunities to extend survival and improve quality of life for patients infected with HCV, as well as uninfected recipients. However, due to a lack of prospective safety and efficacy data on a sufficient number of HCV-negative recipients who received a kidney from a HCV-infected donor, as well as key logistical barriers, the practice of transplanting HCV-infected organs into uninfected recipients is not yet ready to be considered as standard of care. Read More

Semin Dial 2018 Nov 21. Epub 2018 Nov 21.

Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand.

Cardiovascular morbidity and mortality remain frustratingly common in dialysis patients. A dearth of established evidence-based treatment calls for alternative therapeutic avenues to be embraced. Sympathetic hyperactivity, predominantly due to afferent nerve signaling from the diseased native kidneys, has been established to be prognostic in the dialysis population for over 15 years. Read More

Semin Dial 2019 01 13;32(1):35-40. Epub 2018 Nov 13.

Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.

The appropriate blood pressure (BP) target for dialysis patients remains controversial. Although there have been remarkable advances in this area in the general population, extrapolation of these data to dialysis patients is not possible. Observational studies in dialysis patients suggest that low BP is associated with worse outcomes. Read More

Semin Dial 2018 Nov 12. Epub 2018 Nov 12.

Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.

Depression is undisputedly common among individuals with End-Stage Kidney Failure and associated with adverse outcomes. It is well recognized that effective treatments for depression are needed within routine dialysis care. But, are we any closer to successfully treating depression in dialysis patients? We consider this question here with respect to two common treatments, antidepressant medication and cognitive behavioural therapy (CBT). Read More

Semin Dial 2019 01 9;32(1):30-34. Epub 2018 Nov 9.

Department of Medicine, Division of Nephrology, Baylor University Medical Center at Dallas, Dallas, Texas.

It has been clearly established that critically ill patients with sepsis require prompt fluid resuscitation. The optimal amount of fluid and when to taper this resuscitation is less clear. There is a growing evidence that fluid overload leads to acute kidney injury, and increased morbidity and mortality. Read More

Semin Dial 2018 11;31(6):535-536

Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.

Semin Dial 2019 01 23;32(1):80-84. Epub 2018 Oct 23.

Department Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina.

The prevalence of end-stage renal disease continues to increase in the United States with commensurate need for renal replacement therapies. Hemodialysis continues to be the predominant modality, though less than 2% of these patients will receive hemodialysis in their own home. While home modalities utilizing peritoneal dialysis have been growing, home hemodialysis (HHD) remains underutilized despite studies showing regression in left ventricular mass, improved quality of life, reduced depressive symptoms, and decreased postdialysis recovery time. Read More

Semin Dial 2019 01 23;32(1):3-8. Epub 2018 Oct 23.

Centre for Kidney Research and Innovation, School of Medicine, University of Nottingham, Nottingham, UK.

Rates of cardiovascular mortality are disproportionately high in patients with end stage kidney disease receiving dialysis. However, it is now generally accepted that patient survival is broadly equivalent between the two most frequently used forms of dialysis, in-center hemodialysis (HD) and peritoneal dialysis (PD). This equivalent patient survival is notable when considering how specific aspects of HD have been shown to contribute to morbidity and mortality. Read More

Semin Dial 2018 11 21;31(6):563-568. Epub 2018 Oct 21.

Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.

The concentration of sodium in dialysis fluid, a major determinant of extracellular fluid volume and blood pressure, plays a major role in the sodium balance in end-stage renal disease patients. A low dialysate sodium concentration (DNa) reduces interdialytic weight gain (IDWG) and blood pressure and might help ameliorate endothelial dysfunction and inflammation. However, low DNa can also increase the incidence of hypotensive episodes and muscle cramps. Read More

Semin Dial 2018 11 11;31(6):633-636. Epub 2018 Oct 11.

Division of Nephrology, Department of Medicine, University of Illinois College of Medicine at Chicago, Chicago, Illinois.

Many dialysis machines can compute dialyzer sodium clearances at multiple time points during a dialysis treatment using conductivity. For a given treatment, the average dialyzer sodium clearance (K), when combined with treatment time (t), and the estimated urea distribution volume (V, usually based on either anthropometry or bioimpedance), can be used to estimate Kt/V, an important measure of hemodialysis adequacy. While this conductivity-derived value for Kt/V correlates moderately with Kt/V calculated from predialysis and postdialysis serum urea nitrogen (SUN) values (urea reduction ratio, URR), the ultrafiltration volume, and session length it is, unfortunately, not sufficiently accurate to replace URR-based Kt/V. Read More

Semin Dial 2019 01 11;32(1):85-86. Epub 2018 Oct 11.

B. Braun Avitum Nusle Dialysis Centre, Prague, Czech Republic.

Semin Dial 2019 01 4;32(1):58-71. Epub 2018 Oct 4.

Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany.

Oxidative stress (OS) is the result of prooxidant molecules overwhelming the antioxidant defense mechanisms. Hemodialysis (HD) constitutes a state of elevated inflammation and OS, due to loss of antioxidants during dialysis and activation of white blood cells triggering production of reactive oxygen species. Dialysis vintage, dialysis methods, and type and condition of vascular access, biocompatibility of dialyzer membrane and dialysate, iron administration, and anemia all can play a role in aggravating OS, which in turn has been associated with increased morbidity and mortality. Read More

Semin Dial 2018 11 21;31(6):607-611. Epub 2018 Sep 21.

Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS, London, UK.

There has been a dramatic, worldwide expansion in life expectancy across the last century. This has resulted in a progressively more elderly and comorbid population. It is increasingly recognized that healthcare in this group needs to move to the concept of "adding life to years". Read More

Semin Dial 2019 01 30;32(1):9-14. Epub 2018 Aug 30.

Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky.

Parathyroid hormone (PTH) 1-84 is the main biologically active hormone produced by the parathyroid cells. Circulating PTH molecules include the whole PTH 1-84 along with amino (N) and carboxyl (C) terminal fragments. While PTH is the best available noninvasive biomarker to assess bone turnover in dialysis patients, the biological roles of individual circulating PTH fragments are still not completely known. Read More

Semin Dial 2018 11 9;31(6):537-543. Epub 2018 Aug 9.

Division of Nephrology, University Health Network, Toronto, ON, Canada.

Since the inception of hemodialysis (HD) for patients with chronic kidney disease, the "perfect" dialysis prescription has remained elusive. Part of this may relate to the heterogeneity among populations, individual patients, and differences in access to health provision. The optimal balance between dialysis frequency and duration to achieve reductions in patient morbidity and mortality continues to be debated. Read More

Semin Dial 2018 11 6;31(6):557-562. Epub 2018 Aug 6.

Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana.

Hypertension among patients on hemodialysis is common, difficult to diagnose and often inadequately controlled. Although specific blood pressure (BP) targets in this particular population are not yet established, meta-analyses of randomized trials showed that deliberate BP-lowering with antihypertensive drugs improves clinical outcomes in hemodialysis patients. BP-lowering in these individuals should initially utilize nonpharmacological strategies aiming to control sodium and volume overload. Read More

Semin Dial 2019 01 22;32(1):72-79. Epub 2018 Jul 22.

Department of Nephrology, Université catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium.

Peritoneal dialysis (PD) effluent is normally transparent. A change in its appearance may be the first indication of an intra- or extraperitoneal abnormality which may or may not be related to the peritoneal dialysis technique itself. What diagnosis should be considered when PD effluent turns on red, orange, cloudy, milky white, green, yellow, purple or black in color? After review of the literature, we propose a differential diagnosis, as well as some management recommendations, for specific abnormal color presentations of the PD effluent. Read More

Semin Dial 2019 01 22;32(1):15-21. Epub 2018 Jul 22.

Renal Consultants of Houston, Houston, TX, USA.

Cardiovascular mortality accounts for most deaths among hemodialysis patients and far exceeds the cardiovascular mortality rate of the general population. One important aspect of cardiovascular risk among dialysis patients is chronic inflammation. Iatrogenic sources of chronic inflammation in the form of failed renal allografts, old clotted arteriovenous grafts, and hemodialysis catheters play important, sometimes, unrecognized roles in this inflammatory state. Read More

Semin Dial 2018 11 19;31(6):569-575. Epub 2018 Jul 19.

Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.

Nephrologists are faced with a difficult dilemma in choosing the ideal dialysis prescription to maintain neutral potassium mass balance. Should potassium mass balance goals prioritize the normalization of serum potassium levels using low potassium dialysate at the expense of provoking intradialytic arrhythmias, or should mass balance goals favor permissive hyperkalemia using higher dialysate potassium to avoid rapid intradialytic fluxes at the risk of more interdialytic arrhythmias? This review examines the factors that determine potassium mass balance among HD patients, the relationships between serum and dialysate potassium levels and outcomes, and concludes by examining currently available approaches to reducing risk of arrhythmias while managing potassium mass balance. Read More

Semin Dial 2019 01 15;32(1):41-46. Epub 2018 Jul 15.

Division of Nephrology, Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA.

Protein-energy wasting (PEW) is a major diet-related complication in hemodialysis (HD) patients. Nutrient-based dietary guidelines emphasize animal-based protein foods for preventing and managing PEW in HD patients. Although dietary protein intake is important for protein anabolism, other dietary factors contribute to PEW. Read More

Semin Dial 2018 09 15;31(5):440-444. Epub 2018 Jul 15.

Division of Nephrology, Hennepin Healthcare Systems, Minneapolis, MN, USA.

Secondary hyperparathyroidism (SHPT), commonly encountered in patients receiving maintenance dialysis, is associated with numerous adverse outcomes, including mortality. Calcimimetics, agents that act on the calcium sensing receptor (CaSR), were designed to overcome limitations in the use of vitamin D sterols to treat SHPT, and have demonstrated efficacy in reducing levels of PTH in randomized trials. Currently available calcimimetics include oral cinacalcet and the recently approved intravenously administered agent, etelcalcetide. Read More

Semin Dial 2019 01 10;32(1):47-57. Epub 2018 Jul 10.

Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Uric acid-mediated biological effects are milieu dependent. In a physiological milieu, serum uric acid serves as an antioxidant; when homeostasis is perturbed, divergent effects are observed depending on the clinical context. Several epidemiologic studies indicated the presence of a direct relationship between higher concentrations of serum uric acid and cardiovascular mortality; yet not all studies support this conclusion. Read More

Semin Dial 2018 07;31(4):313-314

Division of Kidney Diseases and Hypertension, Northwell Health, New Hyde Park, NY, USA.

Semin Dial 2019 01 28;32(1):22-29. Epub 2018 Jun 28.

Ramsay-Générale de Santé, Division of Nephrology and Dialysis, Hôpital Privé Claude Galien, Quincy sous Sénart, France.

Parenteral iron is used to restore the body's iron pool before and during erythropoiesis-stimulating agent (ESA) therapy; together these agents form the backbone of anemia management in end-stage renal disease (ESRD) patients undergoing hemodialysis. ESRD patients receiving chronic intravenous iron products, which exceed their blood loss are exposed to an increased risk of positive iron balance. Measurement of the liver iron concentration (LIC) reflects total body iron stores in patients with secondary hemosiderosis and genetic hemochromatosis. Read More

Semin Dial 2018 09 21;31(5):435-439. Epub 2018 Jun 21.

Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.

Low serum albumin (S-Alb) is a frequent feature of end-stage renal disease (ESRD) that independently predicts mortality. Serum albumin has mainly been considered a biomarker of visceral protein and immunocompetence status, fundamental to nutritional assessment. However, low S-albumin level is associated with persistent systemic inflammation and many bodies of evidence show that S-Alb has a limited role as a marker of nutritional status. Read More

Semin Dial 2018 11 17;31(6):583-591. Epub 2018 Jun 17.

Division of Nephrology, Department of Medicine and Surgery, University of Parma, Parma, Italy.

Protein energy wasting (PEW) is a condition commonly occurring among patients with ESRD on hemodialysis. PEW is characterized by depletion of protein and energy stores and is caused by multiple factors related to chronic kidney disease, acute and chronic comorbidities and by renal replacement therapy itself. Anorexia is central in the pathogenesis of PEW; it is frequently observed in these patients whose protein and energy intakes are typically lower than guidelines recommendations. Read More

Semin Dial 2018 11 17;31(6):599-606. Epub 2018 Jun 17.

Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.

Renal anemia is a serious and common complication in hemodialysis (HD) patients. The introduction of erythropoiesis-stimulating agents (ESAs) has dramatically improved hemoglobin levels and outcomes. Several interventional studies reported that excessive correction of anemia and the massive use of ESA can trigger cardiovascular disease (CVD), and consequently may worsen the prognosis of patients undergoing HD. Read More

Semin Dial 2018 11 13;31(6):592-598. Epub 2018 Jun 13.

Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Osaka, Japan.

Despite the advent of cinacalcet and noncalcium-containing phosphate binders, controlling the progression of vascular calcification (VC) is still challenging. Recent reports demonstrate that carbamylation driven by high urea concentration aggravates VC, suggesting the importance of adequate dialysis in retarding its progression. Theoretically, other promising measures include the use of iron-based phosphate binders, vitamin K, and magnesium supplements, which should be investigated in future randomized controlled trials (RCTs), ideally with hard outcomes. Read More

Semin Dial 2018 11 12;31(6):612-618. Epub 2018 Jun 12.

Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.

Accumulation of amyloid fibrils from β2-microglobulin (β2M) was first recognized as a characteristic osteoarticular complication in long-term hemodialysis (HD) patients and called "HD-related amyloidosis" (HRA). However, this syndrome can also be observed in end-stage renal diseases (ESRD) patients undergoing peritoneal dialysis, and even in patients with chronic renal failure before the initiation of dialytic therapy, suggesting that HD is not a direct cause but that accumulation of β2M or some β2M-associated molecules in the body is a common pathogenesis. Currently the term "dialysis-related amyloidosis" (DRA) is widely used for β2M-amyloid (Aβ2M) amyloidosis associated with ESRD, although DRA patients consist mostly of those undergoing long-term HD. Read More

Semin Dial 2018 09 12;31(5):528-529. Epub 2018 Jun 12.

Instituto de Virología "Dr. Vanella", Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina.

Semin Dial 2018 11 8;31(6):544-550. Epub 2018 Jun 8.

Veterans Administration Health Care System, Minneapolis, MN, USA.

Background: Ultrafiltration rate (UFR) has attracted attention as a modifiable aspect of volume management.

Objective: The objective of this review is to summarize the evidence that links UFR to patient outcomes and discuss UFR cut-offs proposed, and discuss possible consequences of adapting UFR as a quality metric.

Results: Higher UFRs has been associated with younger age, longer dialysis vintage, greater prevalence of comorbidities, higher Kt/V, lower weight, greater interdialytic weight gain, lower residual renal function, and shorter treatment times. Read More

Semin Dial 2018 11 8;31(6):576-582. Epub 2018 Jun 8.

Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy.

Acid-base equilibrium is a complex and vital system whose regulation is impaired in chronic kidney disease (CKD). Metabolic acidosis is a common complication of CKD. It is typically due to the accumulation of sulfate, phosphorus, and organic anions. Read More

Semin Dial 2018 11 6;31(6):551-556. Epub 2018 Jun 6.

Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.

Fluid volume overload is common and is associated with adverse outcomes in hemodialysis patients. Practicing physicians individually manage fluid volume balance in their dialysis patients according to blood pressure, interdialytic weight gain, cardiac function, nutritional status, and other comorbidities. However, accurate assessment of fluid volume status remains a concern. Read More

Semin Dial 2018 11 1;31(6):619-624. Epub 2018 Jun 1.

Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA.

A one-size-fits-all approach to vascular access for dialysis may be prejudicial. Arteriovenous fistulae (AVF) have high primary failure, failure to mature rate, and late-stage complications making them unsuitable choice for many patients. Aging of population with chronic kidney disease (CKD) coupled with venous injury during CKD stages depletes suitable superficial veins for AVF creation. Read More