Comparison of blood volume biofeedback hemodialysis and conventional hemodialysis on cardiovascular stability and blood pressure control in hemodialysis patients: a systematic review and meta-analysis of randomized controlled trials.

Background: Despite the improvements in hemodialysis (HD) technology, 20-30% of sessions are still complicated by hypotension or hypotension-related symptoms. Biofeedback systems have proven to reduce the occurrence of such events, but no conclusive findings can lead to wider adoption of these systems. We conducted this systematic review and meta-analysis of randomized clinical trials to establish whether the use of blood volume tracking systems compared to conventional hemodialysis (C-HD) reduces the occurrence of intradialytic hypotension.

A novel double parameters based biofeedback system to prevent intradialytic hypotension in clinical practice: Case report.

Intradialytic hypotension (IDH) still represents the main complication during dialysis treatment. Patient's discomfort, reduced dialysis efficiency, reduced treatment time are only some of the main problems that could derive from the need to stop or temporarily interrupt the treatment because of IDH. Up to now, different types of treatment (HDF, HF, or AFB) have been considered to prevent IDH as well as the use of biofeedback systems (Blood Volume Monitoring, Temperature control, Sodium profiling, Blood Pressure monitoring).

Sotrovimab in SARS-COV-2 chronic hemodialysis patients in the Omicron era. Is intradialytic administration feasible? Report of 4 cases.

Chronic hemodialysis patients are at high risk of morbidity and mortality in case of SARS-CoV-2 infection and they may need to be treated with monoclonal antibodies, either because they have not been vaccinated, or because they have a low anti spike antibody titer. Administration of Sotrovimab has recently been proposed for hemodialysis patients, but data are on the results lacking. We report on four cases of chronic dialysis patients who received Sotrovimab during intermittent dialysis sessions.

Flash Glucose Monitoring to Assess Glycemic Control and Variability in Hemodialysis Patients: The GIOTTO Study.

Flash glucose monitoring (FGM) is a technology with considerable differences compared to continuous glucose monitoring (CGM), but it has been scarcely studied in hemodialysis patients. Thus, we aimed assessing the performance of FGM in such patients by comparison to self-monitoring of blood glucose (SMBG). We will also focus on estimation of glycemic control and variability, and their relationships with parameters of glucose homeostasis.

COVID-19 incidence and mortality in non-dialysis chronic kidney disease patients.

Many studies reported a higher risk of COVID-19 disease among patients on dialysis or with kidney transplantation, and the poor outcome of COVID-19 in these patients. Patients in conservative management for chronic kidney disease (CKD) have received attention only recently, therefore less is known about how COVID-19 affects this population. The aim of this study was to provide evidence on COVID-19 incidence and mortality in CKD patients followed up in an integrated healthcare program and in the population living in the same catchment area.

Ramipril and Cardiovascular Outcomes in Patients on Maintenance Hemodialysis: The ARCADIA Multicenter Randomized Controlled Trial.

Background And Objectives: Renin-angiotensin system (RAS) inhibitors reduce cardiovascular morbidity and mortality in patients with CKD. We evaluated the cardioprotective effects of the angiotensin-converting enzyme inhibitor ramipril in patients on maintenance hemodialysis.

Design, Setting, Participants, & Measurements: In this phase 3, prospective, randomized, open-label, blinded end point, parallel, multicenter trial, we recruited patients on maintenance hemodialysis with hypertension and/or left ventricular hypertrophy from 28 Italian centers.

Clinical, electromyographical, histopathological characteristics of COVID-19 related rhabdomyolysis.

Rhabdomyolysis is an uncommon complication of the coronavirus disease 2019 (COVID-19) infection. Previous reports have described its management and treatment in medical units, but have not discussed confirmatory tests or differential diagnosis. We report a case of a 58 year-old male patient, who was admitted for COVID-19 pneumonia and subsequently developed severe weakness, inability to move limbs, acute renal failure, significantly elevated myoglobin and creatinine kinase, and was diagnosed with rhabdomyolysis.

Central venous catheter management prior to the start of the dialysis session: a new device to improve a critical procedure.

Background: Central venous catheter (CVC) preparation for a haemodialysis (HD) session is a critical non-standardized manoeuvre.

Methods: We compared the procedure in use at our centre (C) versus the use of Haemocatch® (H), a device recently presented for the management of CVC, in 12 patients, with C during 7 dialysis sessions and H during the subsequent 7 sessions.

Results: Out of 75 HD sessions with C and 75 with H, both the number of connections and disconnections of the CVC via a syringe and the amount of blood wasted during the manoeuvres proved significantly lower with H (2.

Sodium concentration measurement during hemodialysis through ion-exchange resin and conductivity measure approach: in vitro experiments.

Sodium measurement during hemodialysis treatment is important to preserve the patient from clinical events related to hypo- or hyper-natremia Usually, sodium measurement is performed through laboratory equipment which is typically expensive, and requires manual intervention. We propose a new method, based on conductivity measurement after treatment of dialysate solution through ion-exchange resin. To test this method, we performed in vitro experiments.

The prevalence of peripheral neuropathy in hemodialysis patients.

Background/aims: Uremic Neuropathy (UN) highly limits the individual self-sufficiency causing near-continuous pain. An estimation of the actual UN prevalence among hemodialysis patients was the aim of the present work.

Methods: We studied 225 prevalent dialysis patients from two Italian Centers.

[Arterial hypertension in dialysis: up to what point should it be corrected? It depends].

It is well known that blood pressure values <130/80 mmHg in high-risk patients (diabetics, heart patients) reduces the cardiovascular risk, and it is equally well known that the same target is advised for patients with renal insufficiency. In view of the elevated prevalence of postural hypotension, autonomic dysfunction and peripheral, cerebral and cardiac vasculopathy in kidney patients, the maintenance of this pressure target can, however, be harmful in this category of patients. Indeed, some studies have shown that lower pressure values are associated with more cardiovascular events in dialysis patients.

Severe ticlopidine-induced cholestatic syndrome.

A patient with chronic renal insufficiency undergoing dialysis treatment presented with a clinical picture of acute intrahepatic cholestasis and alterations in liver function indices. Liver biopsy showed a histological picture of hepatitis with cholestatic signs. A causal correlation with the recent administration of ticlopidine was hypothesized, which led to the drug being discontinued.

A continuous and non-invasive arterial pressure monitoring system in dialysis patients.

Background: As symptomatic intradialytic hypotension in the hemodialysis (HD) patient is often a sudden event whose onset cannot be predicted by means of extemporary measures, continuous blood pressure (BP) measurement would be far more useful. We tested a new continuous noninvasive BP monitoring system, Harmonized Alert Sensing Technology (HASTE), which, by means of the analysis of the finger pulse wave, obtained from an O2 sensor, estimates a beat-to-beat systolic pressure value (Esys) and supplies a continuous read-out. The study aim sought to verify the reliability of this non-invasive instrument in continuously providing systolic pressure values during HD.

Prevention of dialysis hypotension episodes using fuzzy logic control system.

Background: Automatic systems for stabilizing blood pressure (BP) during dialysis are few and only control those variables indirectly related to BP. Due to complex BP regulation under dynamic dialysis conditions, BP itself appears to be the most consistent input parameter for a device addressed to preventing dialysis hypotension (DH).

Methods: An automatic system (ABPS, automatic blood pressure stabilization) for BP control by fluid removal feedback regulation is implemented on a dialysis machine (Dialog Advanced, Braun).

Biofeedback in dialysis.

The traditional control of the dialysis session comes about by means of an open-loop system. At the beginning of the session some parameters are set, such as the kind of dialyzer, the blood flow, the ultrafiltration rate, the dialysate conductivity and the dialysate temperature. Generally speaking, these parameters are not modified unless there occur complications in the patient that call for adjustments to be made.

Thermal balance in convective therapies.

Among the factors causing intradialytic haemodynamic instability, dialysate temperature has been shown to play a relevant role. An improved cardiovascular response during isolated ultrafiltration or with cooled dialysate has been described in the past. Cold dialysate may increase the external heat loss compensating for the increase in core temperature, thus avoiding vasodilatation, but it also increases myocardial contractility.