High-normal albuminuria is strongly associated with incident chronic kidney disease in a nondiabetic population with normal range of albuminuria and normal kidney function

Background: Pruritus in patients undergoing hemodialysis reduces quality of life via insomnia and depression, and negatively affects prognosis. For diagnosing pruritus, selecting therapeutic strategies, and determining therapeutic outcomes, methods are needed for objectively quantifying the degree of itchiness. In 2015, the Japanese version of the 5-D itch scale (5D-J), originally developed in the USA in 2010, was developed as a simple self-administered questionnaire; it evaluated the degree of itchiness based on five components: (1) duration of itchiness, (2) degree of itchiness, (3) direction of itchiness, (4) disability caused by itchiness, and (5) distribution of itchiness. 5D-J is useful for comprehensively assessing multiple elements related to itchiness. We used 5D-J to assess the degree of itchiness experienced by patients undergoing hemodialysis to investigate its clinical usefulness. Methods: Subjects were 336 patients undergoing maintenance hemodialysis at our facility in October 2016; they were selected from 383 patients, of whom 20 were excluded because their itchiness had a dermatologic origin and 27 were excluded because their localized itchiness was related to vascular access, respectively. The status of itchiness (duration, degree, direction, disability, and distribution) of the patients was surveyed in October 2016 using 5D-J; total scores were calculated and used for assessing the itchiness experienced by patients. We additionally investigated whether 5D-J scores correlated with visual analog scale (VAS) and Shiratori severity scores for pruritus. Results: Degree was reported as "not present" by 124 patients (36.9%), "mild" by 164 (48.8%), "moderate" by 46 (13.7%), "severe" by 2 (0.6%), and "unbearable" by 0 (0%). Total score was 5 points in 55 patients (16.4%), 6-9 in 176 (52.4%), 10-14 in 95 (28.3%), 15-19 in 9 (2.7%), 20-24 in 1 (0.3%), and 25 in 0 (0%). The 5D-J total and VAS scores were strongly correlated (r = 0.7159; p < 0.001). The 5D-J total score correlated with "daytime itchiness" (r = 0.6441; p < 0.001) and "nighttime itchiness" (r = 0.6352; p < 0.001) on the Shiratori severity score. Conclusions: 5D-J may be useful for objectively assessing itchiness experienced by patients undergoing hemodialysis.

Aim β2‐Microglobulin (β2‐MG) and α1‐microglobulin (α1‐MG) have molecular weights of 11,800 and 33,000 Da, respectively. We studied the α1‐MG and β2‐MG reduction ratios (RRs) and survival in patients on predilution online haemodiafiltration (Pre‐OL‐HDF). Methods Participants were 247 Pre‐OL‐HDF patients. α1‐MG and β2‐MG RRs were assessed at baseline. Kaplan–Meier survival and Cox proportional hazard analyses were used. Results In 247 patients, the median age was 67 (56–73) years, the dialysis duration was 77 (46–150) months, and the diabetes prevalence was 47.4%. Twenty‐two patients died over the 450‐day study period. The mortality cut‐off values using receiver‐operating characteristic curves for the α1‐MG and β2‐MG RRs were 20% and 80%, respectively. Survival rates were significantly (p < 0.05) higher in patients with α1‐MG RRs ≥20% (n = 134) compared with patients with α1‐MG RRs <20% (n = 113) and in patients with β2‐MG RRs ≥80% (n = 87) compared with patients with β2‐MG RRs <80% (n = 160). Cox models adjusting for diabetes and dialysis duration showed that α1‐MG RR, β2‐MG RR, and pre‐ and postdialysis β2‐MG were risk factors for all‐cause mortality; however, after additional adjustment for age, sex, and serum albumin, only β2‐MG RR and pre‐ and postdialysis β2‐MG were significant predictors of mortality (p < 0.05). α1‐MG RRs were significantly correlated with β2‐MG RRs (ρ = 0.73, p < 0.0001) and serum albumin levels (ρ = 0.13, p < 0.05). Conclusion In patients on Pre‐OL‐HDF, α1‐MG RRs ≥20% and β2‐MG RRs ≥80% were associated with better survival, β2‐MG RR ≥80% and pre‐and postdialysis β2‐MG levels were significant predictors of all‐cause mortality, and α1‐MG RR ≥20% may predict mortality.

Aim: The effect of convection volume (CV) in patients on pre-dilution online haemodiafiltration (Pre-OL-HDF) was evaluated.Methods: We conducted a retrospective, cross-sectional study in 126 patients on Pre-OL-HDF. Dialysis conditions, laboratory data, and same day post-dialysis body composition measurements using bioimpedance spectroscopy were assessed.Patients were divided into two groups according to their CV: ≥ median value and < median value. Linear regression analyses for reduction ratios (RRs) of β2-microglobulin and α1-microglobulin, and body composition, were conducted.Results: Age, dialysis vintage, and CVs of the study patients were 64 ± 12 years, 81 (48-154) months, and 43.2 (38.5-55.9) L/session, respectively. The higher CV (≥ 43 L/session) group (n = 66) had significantly higher RRs of β2-microglobulin and α1-microglobulin, lean tissue index, body cell mass index, total body water (TBW), extracellular water (ECW), and intracellular water (ICW) compared with the lower CV (< 43 L/session) group (n = 60, p < .01). Serum albumin and fat tissue index were not significantly different between the groups. CV/ECW, CV/TBW, and CV/ICW but not un-adjusted CV, were significant determinants for β2-microglobulin and α1-microglobulin RRs (p < .05). Lean tissue and body cell mass indexes, but not the fat tissue index, showed significant associations with CV, and RRs of β2-microglobulin and α1-microglobulin (p < kb.05).Conclusions: Among patients on Pre-OL-HDF, higher values in the lean tissue index and body cell mass index were observed in those with higher CV versus lower CV, and CV adjusted to body water may be useful to prescribe individualized conditions for Pre-OL-HDF.

The pH after the first PMX-DHP session is an independent risk factor for mortality in patients receiving PMX-DHP for sepsis and septic shock.