Introduction : Argatroban is a promising locking solution regarding antithrombotic properties but has rarely been reported before. The objective of this study was to preliminarily verify the safety and effectiveness of argatroban as a catheter lock compared with sodium heparin.

Methods : This was an open-label randomized controlled trial of 50 consenting haemodialysis patients in one dialysis unit. Intervention: 2 weeks of use of 0.5 mg/mL argatroban or 1000 IU/mL heparin locked postdialysis in the dead space of the central venous catheter. Primary outcome of change from baseline (before a dialysis session) in the activated partial thromboplastin time (aPTT) 30 min after locking. Secondary outcomes were changes in aPTT between baseline and before the next dialysis session, catheter thrombosis defined by catheter eradication or the use of urokinase lock and infusion, catheter-related bacteremia and exit-site infection, and bleeding events.

Results: The aPTT measured 30 min after locking was significantly higher in the heparin group than in the argatroban group (P<0.001). In addition, within-group comparisons showed that in the heparin group, the aPTT measured 30 minutes post locking was significantly higher than that measured at baseline and the end of the 1st HD (P<0.001), whereas the argatroban group showed no significant change in aPTT 30 minutes post locking compared to baseline and post HD values (P>0.05). Other secondary end points did not differ.

Conclusion: This study shows that argatroban can provide antithrombotic effects similar to those of heparin without affecting systemic coagulation. Argatroban locking solution is an effective short-term locking solution.

Background : Many patients who start peritoneal dialysis (PD) transition to hemodialysis (HD) after a PD-related complication. Patient psychological factors may influence clinical outcomes. One possible factor is health mindset, or patient belief that their health knowledge and ability can change. The goal of this study is to evaluate the longitudinal associations of baseline health mindset with patient outcomes after one year.

Methods : The Health Mindset Scale (HMS, score 3-18) was administered on paper during clinic to a convenience sample of 100 adult PD patients, to quantify patient mindset along a continuum from fixed mindset (lower scores) to growth mindset (higher scores). Participants were 31% African American, 4% Hispanic, and 64% White American. Demographic and comorbid information were abstracted from medical records. Outcomes assessed at 1 year were death, transition to HD, renal transplant, and maintaining PD.

Results : HMS scores were highest in patients who subsequently received a renal transplant (mean 15, SD 2.1), indicating a growth mindset. HMS scores in patients who died were lower (mean 10, SD 5.2) suggesting a more fixed mindset. Among those who maintained PD, HMS scores were between fixed and growth mindset (mean 12.8, SD 4.2) and similar to those who transitioned to HD (mean 13, SD 4.2). One-way ANOVA for difference in HMS scores by clinical outcome was p = 0.042.

Conclusions : This initial longitudinal study suggests associations between mindset and clinical outcomes. The HMS is a novel and easily administered instrument that quantifies one patient psychological component that could contribute to patient outcomes, and that could also be modified. The HMS may identify individuals who could benefit from specific interventions to favor a growth mindset, with the goal of supporting optimal clinical outcomes.

Objective : To systematically evaluate the effect of peritoneal dialysis and hemodialysis on patients’ quality of life.

Methods : Computer searched the quality of life of patients comparing peritoneal dialysis and hemodialysis in CNKI, Wanfang database, VIP database, the Cochrane Library, PubMed and Web of Science database, searching the database until November 30,2023. Statistical analysis and mapping were performed using the Review Manager 5.3 software.

Results : A total of 26 articles were included for a total of 25501 study subjects. The results of the Meta-analysis showed that, Compared with the hemodialysis patients, The Peritoneal dialysis patients had better quality of life (MD= -9.36, 95%CI =-13.45~-5.26, P<0.001), In the physiological function (MD=2.34, 95%CI =0.134.56, P <0.05), physical pain (MD=3.82, 95%CI=0.836.81, P <0.05), general health (MD=1.57, 95%CI=1.052.08, P <0.05), psychological status (MD=1.94, 95%CI=0.033.85, P <0.05) and the domain differences were significant.

Conclusion: Peritoneal dialysis patients have better quality of life than hemodialysis patients

Individuals with diabetes and hemodialysis present a challenge in metabolic control and nutritional adjustment with high nutrient demand. Traditional blood glucose measurement controls, such as self-monitoring, glycated hemoglobin (A1C), and fructosamine, remain uncertain as they do not present the entire picture of glycemic incursions. This review seeks to collect evidence on the efficacy of continuous glucose monitoring, nutritional adjustment, and adequate metabolic control in people with diabetes and hemodialysis. Currently, continuous glucose monitoring plays an essential role in the metabolic control of these individuals, as well as in glycemic variability. No individual standard is exclusive to these conditions concerning the values of the times in range. However, the American Diabetes Association does allow the identification of the average values for high-risk populations and comorbidities associated with diabetes, such as kidney disease. Synchronous metabolic control and nutritional monitoring go hand in hand in people with diabetes and hemodialysis, this being a pillar in comprehensive management to reduce complications and improve the quality of life of these individuals.

Aim: With an exponential rise in incidence and death over time, chronic kidney disease has become a major hazard to the world. Patients with chronic renal disease who were dependent on dialysis were dying at a rising rate in Ethiopia. The study’s objectives were to ascertain the management outcomes and associated factors for patients with chronic renal disease at selected Ethiopian tertiary hospitals.

Methods: A prospective observational study was carried out in a few Ethiopian tertiary hospitals from June 30, 2022 to March 30, 2023 among patients with chronic kidney disease who were not reliant on dialysis. Consecutively, 170 study participants were enrolled. Data abstraction, interviewer-administered surveys, and phone follow-up formats were used to gather data. Versions 4.6.0 and 25 of the Statistical Packages for Social Science were utilized for data entry and statistical analysis, respectively. Cox regression analysis, both bivariate and multivariate, was used to find the factors that predicted the death from chronic renal disease. A statistically significant p-value was one that was ≤ 0.05.

Result: Over 649.266 person-months, 170 patients were followed. Of these patients, 120(70.6%) were male and the mean (± SD) age of the patients was 45.19 ± 13.86 years. Overall, 71 (41.8%) were died with an estimated 109 deaths per 1000 person-months. The mean survival time was 116.9 days (95% CI:105.3-128.5). Hypertension (90%), anemia (95.8%), and edema (99.4%) were the most frequently prevalent comorbidity and complications. Severe anemia at admission [AHR=3.3, 95% CI,(1.39-7.8)], systolic blood pressure > 159 mmHg [AHR= 4.65, 95%CI(2.07-10.42)], modified Charleston comorbidity index score ≥ 5 [AHR=5.00, 95% CI(2.60-9.64)], and uremic encephalopathy [AHR=2.58, 95% CI,(1.45-4.5)] were predictors of chronic kidney disease patients’ mortality.

Conclusion: Among patients with chronic renal disease, the overall mortality rate was high. Hypertension, anemia, and edema were the common comorbidity and complications. Severe anemia, systolic blood pressure > 159 mmHg, modified Charleston comorbidity index ≥ 5, and uremic encephalopathy were predictors of mortality. As a result, patients with chronic renal disease would likely have a lower death rate if these factors were specifically managed.

Background : Amongst the diverse etiologies of severe acute kidney injury (AKI), Lassa fever (LF) occupies a prominent position in endemic areas of West Africa. However, there is a paucity of studies that compare the characteristics of LF and non-LF-associated cases.
Objectives : To determine the contribution of LF to severe AKI in an endemic area, and compare the illness characteristics and factors associated with mortality in LF versus non-LF-associated AKI.
Methods : We reviewed the records of patients admitted with severe AKI from 1st January 2019 to 30th September 2022 at Irrua Specialist Teaching Hospital (ISTH), and retrieved data on patients’ demography, clinical presentation, treatment, and outcome. We compared the frequencies of categorical data and means of continuous data between patients with LF and those without LF using chi-square test, t-test,and Mann-Whitney U test as appropriate, with the level of statistical significance set at p <0.05.
Results : Fifty-four (41.5%) of 130 patients with severe AKI had LF. LF was associated with a significantly lower mean age (p = 0.013), platelet count (p = 0.010), and mean levels of indices of renal dysfunction (p = 0.02 - <0.001) but there was no significant difference in mortality rates (LF 27.8%; non-LF 39.5%; p = 0.1674). The overall mortality was associated with need for inotropes, requirement for supplemental oxygen, and hemodialysis, and length of admission while the association of mortality with the latter and need for supplemental oxygen was only significant among patients without LF.
Conclusions : LF is a major cause of severe AKI in endemic areas, but it is not associated with any differential risk of mortality perhaps because the associated renal dysfunction is not as severe as in non-LF AKI.

We present the preliminary outcomes of robotic-assisted surgical treatment for bladder neck contracture (BNC), using the innovative Robot-Assisted Laparoscopic Retzius-Sparing Bladder Neck Reconstruction (RAL-RSBNR), technique. Between August and October 2024, three adult male patients underwent RAL-RSBNR at our institution. All patients developed BNC following transurethral resection of the prostate (TURP), for benign prostatic hyperplasia (BPH), and had previously undergone multiple urethral dilation procedures. One patient had experienced recurrent TURP interventions. All RAL-RSBNR procedures were performed using a transperitoneal six-port approach with a four-arm robotic system. No significant intraoperative or postoperative complications were observed. At two weeks postoperatively, all three patients successfully had their catheters removed without notable voiding difficulties. Current literature identifies the RAYV technique as the predominant robotic-assisted approach for treating BNC. In contrast, our novel RAL-RSBNR technique addresses BNC at its root, effectively preventing recurrence often associated with endoscopic surgeries, while maintaining a favorable safety profile with no major complications. These preliminary results indicate that RAL-RSBNR holds significant potential as a promising option for BNC treatment. Nevertheless, given the short study period, further clinical data and extended follow-up are required to thoroughly evaluate the long-term outcomes and efficacy of RALRSBNR.

Diuretics are established fall-risk increasing drugs. However, not all diuretics users experience fall incidents. Due to interindividual
heterogeneity in older populations, it is difficult to identify which older adults are at highest risk of medication-related falls. Therefore, we assessed if diuretic plasma concentrations are associated with fall risk in users. We analyzed plasma samples of 307 hydrochlorothiazide and 110 furosemide users from a cohort of older community-dwelling adults. Cox proportional hazard and logistic regression models were used to analyze associations between diuretic concentration at baseline, changes over time and fall risk. There was no significant association between fall risk and plasma concentration of either hydrochlorothiazide or furosemide at baseline. Nor was a change in concentration over time associated with fall risk. Thus, diuretic plasma concentration is not associated with fall risk in older communitydwelling adults.

Introduction : This study aimed to explore the changes in ferroptosis markers and their relationship with fundus lesion severity in chronic kidney disease (CKD).

Methods : We enrolled 118 CKD patients and collected clinical, renal function, fundus imaging data, and ferroptosis markers. We performed correlation and regression analyses between renal dysfunction and fundus lesions, and assessed the changes and mediating roles of serum iron (Fe), malondialdehyde (MDA), and reduced glutathione (GSH) in CKD deterioration and retinal damage.

Results : Levels of Fe, MDA, and GSH showed significant differences across CKD stages (P<0.001). Logistic regression identified sex, mean arterial pressure, total cholesterol, hemoglobin, ferritin, Fe, MDA, and GSH as significant factors in CKD-related fundus lesions (P<0.05). MDA (β=0.15, 95%CI: 0.03–0.26) and GSH (β=0.33, 95%CI: 0.16–0.54) significantly mediated the link between renal decline and retinal damage (P≤0.001).

Conclusions : Early fundus screening is clinically valuable for managing CKD progression. Fundus damage severity in CKD closely tracks renal decline, with ferroptosis likely playing a key role. MDA and GSH are promising biomarkers for early detection and intervention in CKD-related retinal pathology.