The growing number of prevalent arteriovenous (AV) accesses has been associated with an increase in the incidence of procedures being performed to maintain patency. To reduce the rate of unnecessary procedures, the 2019 Kidney Disease Outcome Quality Initiative guidelines addended the AV access surveillance recommendations, which includes clinical monitoring and assessment of dialysis adequacy alone. Abnormal clinical findings would necessitate follow-up angiography with or without confirmatory duplex ultrasound. Due to poor patency, increased surveillance schedules have been proposed to identify stenosis early and potentially prevent acute thrombotic events and AV access failure. In this review, we outlined current AV access monitoring and maintenance procedure recommendations, as described by the Centers for Medicare and Medicaid Services and 2019 Kidney Disease Outcome Quality Initiative guidelines. In addition, we highlight the findings of recently published randomized controlled trials that have examined increased surveillance schedules.

UNASSIGNED: Currently, several studies have explored the association between the modified creatinine index (mCI) and prognosis in patients on hemodialysis (HD). However, some of their results are contradictory. Therefore, this study was conducted to comprehensively assess the role of mCI in predicting prognosis in HD patients through meta-analysis.
UNASSIGNED: We searched and screened literature from PubMed, Embase, Web of Science, and Cochrane databases from their establishment until March 2024. Relevant data were extracted. The statistical analysis was performed using Stata 15.0, RevMan 5.4, and Meta DiSc 1.4 software.
UNASSIGNED: The results showed a positive association between mCI and nutritional status in HD patients (BMI r = 0.19, 95% CI: 0.1-0.28, p = .000; albumin r = 0.36, 95% CI: 0.33-0.39, p = .000; normalized protein catabolic rate (nPCR) r = 0.25, 95% CI: 0.13-0.38, p = .000). In addition, mCI in deceased HD patients was significantly lower than that in HD survivors (SMD = -0.94, 95% CI: -1.46 to -0.42, p = .000). A low mCI was associated with an increased risk of all-cause death in HD patients (HR = 1.95, 95% CI: 1.57-2.42, p = .000). In addition, a low mCI was significantly associated with decreased overall survival (OS) in HD patients (HR = 3.01, 95% CI: 2.44-3.70, p = .000). mCI showed moderate diagnostic accuracy for sarcopenia in both male and female HD patients (male AUC = 0.7891; female AUC = 0.759).
UNASSIGNED: The mCI can be used as a prognostic marker for HD patients, and monitoring mCI may help to optimize the management of HD and improve overall prognosis in patients.

Cytomegalovirus (CMV) infection is widespread in immunocompromised people, and several cases of CMV infections of the gastrointestinal (GI) tract have been reported in these individuals. We present a case of an immunocompetent patient on hemodialysis (HD) who developed CMV colitis. We also conducted a review of the literature on CMV GI tract infections among patients with chronic kidney disease undergoing dialysis. A 46-year-old man with a history of end-stage renal disease and undergoing HD developed severe diarrhea and hematochezia. A colonoscopy revealed ulcers, and CMV infection was identified in the biopsy sample. We successfully treated the patient with valganciclovir for 2 months. Our review of the literature yielded 21 articles and 24 cases of CMV GI tract infection in patients undergoing dialysis, including the current case. Hematochezia and diarrhea were purported to serve as indicators of CMV GI tract infection among patients on dialysis. Thus, clinicians should suspect CMV infection of the GI tract in dialysis patients, who experience unexplained bloody diarrhea, and promptly perform a GI endoscopy and biopsy.

UNASSIGNED: Patients receiving renal dialysis often experience a wide range of symptoms. These symptoms contribute to a significant symptom burden that significantly affects patients\' quality of life and serves as a significant predictor of healthcare resource utilization and patient prognosis. It is necessary to synthesize existing evidence to draw reliable conclusions to deepen the understanding of symptom burden.
UNASSIGNED: A systematic review and meta-analysis were conducted to identify the relevant factors of symptom burden in patients receiving renal dialysis.
UNASSIGNED: The systematic review and meta-analysis was conducted by searching nine databases for studies reporting the correlates between symptom burden and demographic variables, disease factors, and psychosocial factors from inception to 24 June 2024. After two researchers independently conducted literature search, data extraction, and quality evaluation, meta-analysis was conducted using R Language and Stata 15.1 Software. This study has been registered in the PROSPERO.
UNASSIGNED: Sixty-two studies were included in this review. Results showed that the symptom burden of renal dialysis patients was positively correlated with age, gender, working status, medical cost, dialysis age, quality of sleep, nutritional status, comorbidities, depression, anxiety, disease uncertain, avoidance coping and resignation coping, and negatively correlated with marital status, income, serum sodium, quality of life, social support, subjective well-being, and self-management ability.
UNASSIGNED: Our findings reveal that many factors, including demographic, disease-related, and psychosocial variables, affect symptom burden. The results can supply information for health promotion and relief symptom burden for patients receiving renal dialysis.Registered number: CRD42024507577.

UNASSIGNED: The aim of this study was to determine the strength of the association between frailty and adverse outcomes in patients undergoing maintenance hemodialysis.
UNASSIGNED: A systematic review and meta-analysis.
UNASSIGNED: Patients aged ≥18 years who were undergoing maintenance hemodialysis.
UNASSIGNED: PubMed, Web of Science, Embase, the Cochrane Library, Scopus, the China Knowledge Resource Integrated Database, the Wanfang Database and the Weipu Database were searched from inception until 11 April 2024. The reviewers independently selected the studies, extracted the data and evaluated the quality of the studies. Stata 15.1 software was used to perform the meta-analysis.
UNASSIGNED: A total of 36 articles were included in this study, including 56,867 patients. The primary outcome events in this study were mortality, hospitalization, and vascular access events. The secondary outcomes were depression, cognitive impairment, falls, fracture, sleep disturbances, and quality of life. This study suggested that frailty was associated with mortality in patients undergoing maintenance hemodialysis [hazard ratio (HR), 1.97; 95% CI, 1.62-2.40]. Frailty increased the risk of mortality in patients [odds ratio (OR), 2.33; 95% CI, 1.47-3.68]. In addition, we found that frailty was significantly associated with hospitalization in patients undergoing maintenance hemodialysis (OR, 2.47; 95% CI, 1.52-4.03). Patients who were undergoing maintenance hemodialysis and who were frail had a greater risk of hospitalization [RR, 1.47; 95% CI, 1.05-2.08] and emergency visits (RR, 2.28; 95% CI, 1.78-2.92). The results of this study also suggested that frailty was associated with a greater risk of vascular access events (HR, 1.72; 95% CI, 1.50-1.97). Finally, frailty increased the risk of depression (OR, 4.31; 95% CI, 1.83-10.18), falls and fractures, and reduced quality of life.
UNASSIGNED: The findings of this study suggested that frailty was an important predictor of adverse outcomes in patients undergoing maintenance hemodialysis. In the future, medical staff should regularly evaluate signs of weakness, formulate individual diagnosis and treatment plans, adjust dialysis plans according to the patient\'s condition, and reduce the occurrence of adverse events.
UNASSIGNED: The study protocol was registered on PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, number: CRD42023486239).

BACKGROUND: Radio-cephalic arteriovenous fistulas (RC-AVFs), the preferred vascular access for hemodialysis, have high failure rates. New techniques like the no-touch technique (NTT) and modified no-touch technique (MNTT) have shown promising results. Our objective is to highlight the effectiveness of non-conventional techniques, aiming to address the challenge of AVF failure.
METHODS: We searched Medline, Google Scholar, and Clinicaltrials.gov until April 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five relevant articles were found, all involving human studies on NTT or MNTT for RC-AVF creation. We focused on primary and secondary patency rates, fistula maturation rates, and complications.
RESULTS: We reviewed five studies: two pilot, two prospective, and one retrospective. Three used NTT, and two used MNTT. Among double-arm studies, three out of four showed a significantly improved primary patency with non-conventional techniques. However, one study found no significant difference between non-conventional and conventional methods (90.5% vs. 84.2%; p=0.225). In a single-arm study, non-conventional technique (NTT) displayed 54% primary patency at one year. Secondary patency rates were in three studies. One demonstrated significant secondary patency with non-conventional methods compared to conventional (90% vs. 67.5%; p=0.028), while another found no significant difference (90.5% vs. 84.2%; p=0.803). In the single-arm study, the non-conventional technique (NTT) revealed 80% secondary patency at one year.
CONCLUSIONS: Non-conventional techniques (NTT and MNTT) show promise in improving patency rates, hinting at their potential as alternatives to the conventional technique for RC-AVF creation. Further studies are crucial to confirm their effectiveness and evaluate long-term outcomes.

UNASSIGNED: Chronic kidney disease-associated pruritus (CKD-ap) is a common complication that negatively affects the quality of life. Difelikefalin has emerged as a novel FDA-approved drug to manage CKD-ap. This systematic review and meta-analysis will assess the efficacy and safety of Difelikefalin versus placebo to manage CKD-ap.
UNASSIGNED: PubMed, Scopus, WOS, Central, and Embase were systematically searched until November 2023. RevMan was used to perform meta-analysis. Quality assessment was conducted using the Cochrane RoB 2.0 tool. Results were reported as risk ratio (RR) and mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID: (CRD42023485979).
UNASSIGNED: Five RCTs with a total of 896 participants were included. Difelikefalin significantly decreased the weekly mean WI-NRS score (MD: -0.99 [-1.22, -0.75], p ˂ .00001), 5-D itch scale total score (MD: -1.51 [-2.26, -0.76], p > .0001), and Skindex-10 total score (MD: -7.39 [-12.51, -2.28], p = .005), but showed significantly higher adverse events (RR: 1.26 [1.03, 1.55], p = .03), versus placebo. However, there was no significant difference between both groups in serious adverse events (RR: 1.42 [0.78, 2.57], p = .25) or death (RR: 0.81 [0.19, 3.34], p = .77).
UNASSIGNED: Difelikefalin appears to be a promising agent for the management of CKD-induced pruritus in patients with end-stage renal disease. However, evidence is still underpowered due to the paucity of the current data; therefore, more robust RCTs are required to confirm the benefit of Difelikefalin.

BACKGROUND: Uremic pruritus, one of the most painful symptoms experienced by patients receiving dialysis, seriously affects patient quality of life and health, causes physical and mental damage, and increases hospitalization and mortality rates. Multi-modal therapies with evidence-based healthcare are needed to provide patients receiving dialysis with more convenient and feasible medical resources.
OBJECTIVE: Relevant domestic and international research on the effectiveness and methods of non-invasive acupoint therapy in improving uremic pruritus in dialysis patients was reviewed. Discussing related knowledge can facilitate the evidence-based use of non-invasive acupoint therapy in clinical practice by clinical medical personnel.
METHODS: Based on the PRISMA (preferred reporting items for systematic reviews and meta-analyses) systematic literature review and integrated analysis method, a keyword search of related articles published before September 2023 was conducted in the following databases: PubMed, Cochrane Library, Embase, Web of Science, Airiti Library, Taiwan Master and Doctoral Dissertation System, Chinese Journal Full-text Database and Wanfang Data Knowledge Service Platform. In 2019, the second version of the Risk of Bias Tool for Randomized Controlled Trials was used to evaluate research quality, after which RevMan 5.4 and Stata 14.0 suite software were used for meta-analysis.
RESULTS: Nine of the 112 articles selected, including 10 sets of data and 597 participants, were included in the meta-analysis. The results indicate non-invasive acupoint therapy significantly reduces the degree of uremic pruritus (synthetic effect size = -1.30, 95% confidence interval [-1.67, -0.93], p < .00001). Because the heterogeneity test I² = 76%, showed a high degree of heterogeneity, a subgroup analysis was performed, showing that acupoint massage combined with traditional Chinese medicine fumigation and washing, a general simple itching assessment scale, and the Chinese region achieved better effect sizes.
CONCLUSIONS: Non-invasive acupoint therapy is easy to implement, inexpensive, non-invasive, and associated with few side effects. The authors hope these findings may increase the awareness and understanding of patients with dialysis regarding the practical operation techniques of itching acupoints. According to the results of this systematic review and meta-analysis, massage of the lung and endocrine acupoints at ST-6, SP-10, and LI-11 as well as the relevant points on the ear may be most effective in achieving urinary itching relief. Also, acupoint massage combined with traditional Chinese medicine fumigation, ST-6 far-infrared irradiation, or LI11 transcutaneous acupoint electrical stimulation can further relieve uremic pruritus in this patient population. Based on the results, acupoint massage combined with traditional Chinese medicine fumigation and washing is a complementary method of treatment for uremic pruritus that may be recommended to patients in the future.
BACKGROUND: 非侵入性穴位療法改善透析病人尿毒搔癢成效之系統性文獻回顧暨統合分析.
UNASSIGNED: 尿毒搔癢是令透析病人非常痛苦的症狀之一，嚴重影響其生活品質與健康，導致其身心靈受損，更進而使住院率及死亡率增加，有需要發展具實證健康照護依據的多元療法，以使透析病人取得更方便可行的醫療資源。.
UNASSIGNED: 統合國內外非侵入性穴位療法運用於改善透析病人之尿毒搔癢有效方式的相關研究，以協助臨床醫療人員能更有依據將非侵入性穴位療法運用在臨床實務。.
UNASSIGNED: PRISMA （preferred reporting items for systematic reviews and meta-analyses）系統文獻回顧和統合分析方法，搜尋2023年9月前發表於PubMed、Cochrane Library、Embase、Web of Science、華藝線上圖書館、臺灣博碩士論文知識加值系統、中國期刊全文數據庫及萬方數據知識服務平臺，以2019年隨機對照試驗之偏差風險工具第二版評讀研究品質，再以RevMan 5.4及Stata 14.0套裝軟體進行統合分析。.
UNASSIGNED: 共搜集112篇文獻，最後納入9篇文獻（10組數據），有597名參與者進行分析。結果顯示非侵入性穴位療法可顯著降低透析病人尿毒搔癢程度，綜合效果量（standardized mean difference） = -1.30，95% confidence interval [-1.67, -0.93]，p < .00001。異質性檢定I² = 76%，顯示有高度異質性，故進行次群組分析，顯示穴位按摩配合中藥薰洗、一般簡易的搔癢評估量表及中國地區的綜合效果量較佳。.
UNASSIGNED: 非侵入性穴位療法具有操作簡單、價廉、無創和副作用少的特點，可加強透析病人對搔癢穴位的認知與實際操作手法，依本文獻回顧及統合分析結果顯示可在三陰交、血海和曲池穴位或耳穴的肺及內分泌穴位按摩，或按摩穴位配合中藥薰洗，也可運用紅外線照射三陰交或將經皮穴位電刺激於曲池穴，能達到改善尿毒搔癢程度之效果，而穴位按摩配合中藥薰洗是未來可向病人推薦的另一種方式。.

BACKGROUND: Worldwide, 850 million people suffer from chronic kidney disease (CKD), and in Mexico it is the tenth cause of mortality with 13,167 deaths per year. CKD patients undergoing hemodialysis present challenges in following the prescribed treatment and managing care; Therefore, different health strategies have been proposed to address those challenges, including mobile health applications.
OBJECTIVE: Analyze the scientific evidence available worldwide on mobile health applications for patients with CKD on hemodialysis that have been validated, evaluated, implemented or in the process of development.
METHODS: Systematic review of the literature following the PRISMA statement and search question with the PICOT-D format. Databases with keywords in 12 languages were consulted.
RESULTS: Of 474 manuscripts, seven met the inclusion criteria. Mobile health applications were designed using different methodologies. Mobile health applications were found mainly aimed at self-monitoring and/or self-management, including health literacy, of patients with CKD.

BACKGROUND: Intestinal necrosis in uremic patients has been reported but is rare.
METHODS: A 56-year-old male patient who underwent long-term regular haemodialysis was admitted to the hospital due to involuntary shaking of the limbs and nonsense speech. The patient\'s symptoms improved after continuous blood purification under heparin anticoagulation, rehydration, sedation, and correction of electrolyte disturbances. However, the patient experienced a sudden onset of abdominal pain and a rapid decrease in blood pressure; high-dose norepinephrine were required to maintain his blood pressure. A plain abdominal radiograph performed at bedside showed intestinal dilation. Colonoscopy revealed inflammation and oedema of the entire colon, with purulent secretions and multiple areas of patchy necrosis. The cause of intestinal ischaemia was not clear.
CONCLUSIONS: Although rare, previous causes of uremic colitis have been reported. As the patient developed abdominal pain before the onset of shock and the necrosis was seen on colonoscopy, we suspect that this is a case of fulminant uremic colitis.