Cardiovascular disease is the leading cause of death in patients receiving hemodialysis. Current guidelines define acute myocardial infarction (AMI) by troponin levels above the 99th percentile, accompanied by a ≥ 20% rise or fall. However, troponin concentrations are often elevated, and hemodialysis may influence troponin levels during treatment. This systematic review aims to evaluate whether these factors compromise the diagnostic accuracy of troponin for AMI in patients undergoing hemodialysis. We performed a systematic review including 6359 studies. Inclusion criteria were adult patients and studies reporting predialysis and postdialysis assessment of troponin I. Twenty-eight studies were deemed suitable. Mean troponin I was assessed before and after dialysis. The risk of bias and applicability of the included studies were assessed. The studies were heterogeneous in terms of reporting intradialytic changes of troponin, either in mean or median, which was a problem, along with the lack of reporting dialysis details. The mean troponin predialysis was 68 ng/L, and the mean troponin postdialysis was 73 ng/L. The troponin changes during dialysis were between -100% and +933%. The per se elevated troponin I and the unpredictable changes during dialysis make the use of the current AMI guidelines challenging for patients on dialysis.

Hemodialysis, the most commonly employed renal replacement therapy in end-stage kidney disease, prescriptions have long been standardized as thrice-weekly at full-dose; however, HD implementation is not without major complications. Incremental HD modalities are developed to face such one-size-fits-all approach with hopes for better preservation of residual kidney function, better quality of life and patient compliance, lower complication rates, and improvements in morbidity and mortality. A comprehensive literature search was conducted through PubMed, Scopus, the Cochrane Library, Web of Science, and Ovid MEDLINE to identify relevant clinical studies on the efficacy and safety of incremental HD modalities over standard of care HD approach. We have included a total of 35 clinical studies in our final meta-analysis. Our analysis has revealed that incremental HD approach was not associated with statistically significant improvement in all-cause mortality, hospitalization rates, cardiovascular events, intradialytic hypotension or quality of life including mental, and physical components compared to standardized HD approach. Incremental hemodialysis was associated with better preservation of residual kidney function and lower rates of vascular access complications. Incremental hemodialysis was associated with non-inferior clinical outcomes, better preservation of residual kidney function, and fewer vascular access complications than standard thrice-weekly hemodialysis. Larger prospective studies with longer follow-up are needed to support its widespread clinical use.

Hemodialysis (HD) catheters carry a high risk of life-threatening bloodstream infections and failure. Antimicrobial lock solutions (ALS) are used to reduce this risk, but their overall efficacy on key outcomes like infection rates and catheter survival requires comprehensive evaluation. This systematic review and meta-analysis assess the impact of ALS on preventing catheter-related bloodstream infections (including incidence and density) and on improving catheter survival. A systematic search was conducted across the databases of PubMed, Embase, Scopus, Cochrane Library, and Google Scholar. A meta-analysis was conducted using STATA software. A total of 1183 studies were screened based on title and abstract, and further 282 studies were evaluated in full text. Eventually, 14 studies with 15 treatment arms were included. Key outcomes including central line-associated bloodstream infection (CLABSI), exit infection, and catheter-free survival were conducted separately. ALS demonstrated statistically significant benefits on CLABSI infection and catheter-free survival compared to nonantimicrobial solutions, showing a reduction in CLABSI density with a pooled log odd ratio (logOR) of -1.29 (95% CI: -1.59 to -0.99), lower CLABSI rates (pooled logOR = -1.50, 95% CI: -1.85 to -1.15), and improved catheter-free survival with log hazard ratio (logHR) of -1.11 (95% CI: -1.41 to -0.8). Consistent treatment effects were observed across all lock types with no significant heterogeneity detected. ALS demonstrate statistically significant and clinically important efficacy in reducing CLABSI incidence and density while improving catheter survival in HD patients, establishing them as an essential preventive strategy in clinical practice.

Exit-site granuloma is a frequent and challenging complication in patients undergoing peritoneal dialysis, predisposing to exit-site infections. Recent evidence suggests a potential role for topical timolol in promoting regression of granulomatous tissue. We report two patients on continuous ambulatory peritoneal dialysis who developed exit-site granulomas. Both patients were treated with topical 0.5% timolol maleate ophthalmic solution applied locally to the exit site three times weekly as part of routine exit-site care. Clinical response was monitored using serial photographs. Complete resolution of the granuloma was achieved within 3 weeks in one patient and within 2 months in the other. Neither patient developed local or systemic adverse effects, and no exit-site infections occurred during treatment. Topical 0.5% timolol maleate may represent a safe, non-invasive, and effective treatment option for peritoneal dialysis exit-site granulomas. Larger studies are warranted to establish its efficacy in larger cohorts.

Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis in patients with end-stage renal disease (ESRD), yet high rates of primary failure and suboptimal patency remain significant challenges. The choice of anesthetic technique may influence vascular dynamics and AVF outcomes. This study aims to compare the effectiveness of regional anesthesia (RA) versus local anesthesia (LA) on clinical outcomes following AVF creation in adults with ESRD. A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov were searched from inception to November 2025. Randomized controlled trials and comparative observational studies evaluating RA versus LA in adult AVF creation were included. Primary outcomes included primary patency, functional patency, and primary failure rate. Secondary outcomes included complications, re-interventions, anesthesia time, and vascular parameters. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were pooled using a random-effects model where appropriate. Ten studies involving 1920 patients (RA: 949; LA: 971) were included. RA was associated with significantly higher primary patency (RR = 0.93; 95% CI: 0.87-0.98; p = 0.01) and lower primary failure rates (RR = 1.47; 95% CI: 1.00-2.16; p = 0.05). Complications (RR = 1.49; p = 0.03) and re-interventions (RR = 2.28; p = 0.03) were significantly higher in the LA group. No significant differences were observed in functional patency, anesthesia time, or brachial artery diameter. RA is associated with improved early AVF outcomes, including higher primary patency and reduced failure, complications, and re-interventions, without increasing operative time. These findings suggest that RA may improve early AVF outcomes in selected settings where expertise and resources are available.

We planned a case presentation of right atrial hemodialysis catheter placement via minithoracotomy, an unusually good alternative in cases where venous access is exhausted and there is an associated ascending aortic aneurysm.

The details of four measures of "equivalent" clearances based on urea that have been proposed to monitor hemodialysis adequacy are reviewed. These measures fall into two groups: one based on urea nitrogen generation rate divided by the time-averaged serum urea nitrogen concentration, and the other based on urea nitrogen generation rate divided by the average predialysis serum urea nitrogen concentration. After the original variants were proposed, a potential problem regarding relative weights of dialysis and residual kidney clearances was identified, and revised equivalent urea clearances were proposed that give a higher weight to residual kidney clearance relative to dialysis clearance. These measures suggest that the target dialysis dose should be set to achieve dialysis solute concentrations typically found in patients at the point of needing dialysis, e.g., with a glomerular filtration rate of around 10 mL/min, corresponding to a urea clearance of approximately 6 mL/min and a creatinine clearance of 14. Despite the theoretical attractiveness of equivalent urea clearances to monitor hemodialysis adequacy, their utility has not been conclusively demonstrated in observational studies of incremental or more frequent hemodialysis.