Short-term administration of oral nutritional supplements can improve the nutritional status of hemodialysis patients. However, such treatment is associated with high cost. The aim of the present trial was to evaluate the benefits of the short-term administration of a low-cost, intradialytic, protein-rich meal on selected parameters of the nutritional status in Chinese patients undergoing hemodialysis. Methods: This was a 6-month single-center, prospective interventional study. Stable hemodialysis patients aged $18 years with a concentration of serum albumin ,40 g/L were eligible for inclusion in this study. Patients allocated to the intervention group (IG) received nutritional counseling plus a low-cost, intradialytic, protein-rich meal thrice weekly over a period of 3 months, followed by a treatment-free period of 3 months. Patients allocated to the control group (CG) received nutritional counseling alone. Changes in serum albumin and body composition were investigated. Results: At the start of the study, both groups were similar except for the levels of C-reactive protein (P 5 .034) and hemoglobin (P 5 .003). At the end of the study period, the level of serum albumin (P 5 .001) was significantly increased with increased protein intake in the IG (P 5 .048). However, this difference was not sustained during the follow-up period after termination of therapy. In the IG, the levels of serum albumin were significantly decreased between months 3 and 6 (P , .001), whereas those in the CG remained unchanged. There were no statistically significant differences observed between the two groups in the levels of C-reactive protein and body composition. Conclusion: The short-term administration of a low-cost, intradialytic, protein-rich meal (i.e., 200 mL milk plus two egg whites) resulted in a significant improvement in the levels of serum albumin versus nutritional counseling alone. This inexpensive nutritional intervention was feasible for the treatment of Chinese patients undergoing hemodialysis.

The continuous emergence of SARS-coronavirus 2 (SARS-CoV-2) variants, especially the variants of concern (VOC), exacerbated the impact of the coronavirus disease 2019 (COVID-19) pandemic. As the key of viral entry into host cells, the spike (S) protein is the major target of therapeutic monoclonal antibodies (mAbs) and polyclonal antibodies elicited by infection or vaccination. However, the mutations of S protein in variants may change the infectivity and antigenicity of SARS-CoV-2, leading to the immune escape from those neutralizing antibodies. To characterize the mutations of S protein in newly emerging variants, the proteolytic property and binding affinity with receptor were assessed, and the vesicular stomatitis virus (VSV)-based pseudovirus system was used to assess the infectivity and immune escape. We found that some SARS-CoV-2 variants have changed significantly in viral infectivity; especially, B.1.617.2 is more likely to infect less susceptible cells than D614G, and the virus infection process can be completed in a shorter time. In addition, neutralizing mAbs and vaccinated sera partially or completely failed to inhibit host cell entry mediated by the S protein of certain SARS-CoV-2 variants. However, SARS-CoV-2 variant S protein-mediated viral infection can still be blocked by protease inhibitors and endocytosis inhibitors. This work provides a deeper understanding of the rise and evolution of SARS-CoV-2 variants and their immune evasion.

Background: Many studies suggested that the optimal cephalic vein diameter for wrist radio-cephalic arteriovenous fistula construction should be at least 2 mm to predict successful maturation and primary patency. However, our experience has shown that many patients with smaller cephalic vein diameter (≤2 mm) in the neutral state (without a tourniquet) also have good clinical outcomes. The aim of this study was to identify predictors that affect primary survival of new wrist radio-cephalic arteriovenous fistula in patients with cephalic vein diameter ≤2 mm. Methods: We performed a retrospective review of 50 patients with preoperative cephalic vein diameters ≤2 mm in the neutral state who underwent wrist radio-cephalic arteriovenous fistula construction between September 2016 and October 2019. Internal diameters of the cephalic vein and radial artery, venous distensibility, peak systolic velocity, and resistance index of the radial artery were determined by ultrasound examination before wrist radio-cephalic arteriovenous fistula placement. Patients were divided into two groups: failure and survival. Results: The radio-cephalic arteriovenous fistula survival rate was 68% from the time of radio-cephalic arteriovenous fistula creation until the end of the study. Univariate analysis showed that larger venous distensibility (p < 0.001), non-diabetic kidney disease (p = 0.009), and slower peak systolic velocity of the radial artery (p = 0.033) were predictive factors for primary radio-cephalic arteriovenous fistula survival. Multivariate regression analysis revealed good venous distensibility (odds ratio = 9.637, 95% confidence interval = 1.893–49.050, p = 0.006) and non-diabetic kidney disease (odds ratio = 0.148, 95% confidence interval = 0.033–0.660, p = 0.012) to be independent predictors for primary radio-cephalic arteriovenous fistula survival. Receiver operating characteristic analysis showed that venous distensibility >0.52 mm (sensitivity: 70.6%, specificity: 68.8%) was the best cut-off value to predict primary radio-cephalic arteriovenous fistula survival. Conclusion: When cephalic veins with diameter ≤2 mm are found, venous distensibility should be used to aid in the surgery decision-making process. The outcome of wrist radio-cephalic arteriovenous fistula survival would be significantly improved through the use of cephalic vein with venous distensibility >0.52 mm.

PurposeFluid management using a body composition monitor (BCM) based on bioimpedance spectroscopy has been found to be beneficial for maintenance hemodialysis (MHD) patients. Our purpose was to provide a management procedure for the adjustment of post-dialysis overhydration (OHpost) and to evaluate whether this approach could improve blood pressure.MethodsPost-dialysis fluid status was assessed weekly using the BCM. The reference value of OHpost and the flow procedure for post-dialysis target weight (PDTW) adjustment were established via measurements of OHpost in 60 normotensive MHD patients. In the interventional study, we adjusted the PDTW of hypertensive patients to the optimal OHpost range, with a 0.2–0.5 kg change in PDTW per week.ResultsThis observational study included 130 anuric MHD patients, of whom 60 were in the pre-dialysis systolic blood pressure (sBPpre) < 140 mmHg group. On multivariate logistic regression analysis, we found that only OHpost was significantly associated with sBPpre ≥ 140 mmHg (odds ratio = 2.293, p = 0.000). Patients in the OHpost < −1.8 L group were mainly male and younger, and had higher post-dialysis diastolic blood pressure, ultrafiltration volume, levels of nutrition markers (serum albumin and creatinine), body mass index, and lean tissue index (LTI). On multiple stepwise regression analysis, only the change in LTI was found to be an independent predictor of OHpost [R2 0.208, β = −0.196, 95% CI (−0.296, −0.095), p < 0.001]. The reference value of OHpost was found to deviate by − 2.5–0.5 L from that of normotensive patients. At the end of the study, the systolic blood pressure of 38 patients was less than 140 mmHg after PDTW adjustment. The changes in OHpost from the initial to last adjustment were significant (t = 5.431, p <  0.001), with a substantial decrease in the sBPpre (t = 11.208, p <  0.001).ConclusionsAssessment of OHpost and LTI using a BCM with a patient-specific optimal PDTW adjustment flow can lead to significantly better control of hypertension in anuric MHD patients.

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