Fresenius Medical Care (India)

Prior to the Omicron variant of SARS-CoV-2, COVID-19 was characterized by a severe course and unfavorable prognosis, including fatal outcomes, in a significant proportion of patients with end-stage chronic kidney disease undergoing renal replacement therapy via programmed hemodialysis. Since January 2022, the Omicron variant of SARS-CoV-2 has been the dominant strain in Russia and is associated with a low incidence of viral pulmonary lesions in infected individuals. Objective. To identify clinical and laboratory predictors of viral pulmonary lesions caused by the Omicron variant of SARSCoV-2 in patients with end-stage chronic kidney disease. Material and methods. A retrospective analysis was conducted on 33 medical records of patients with end-stage chronic kidney disease undergoing programmed hemodialysis who contracted COVID-19 between January 2022 and February 2024. Results. Laboratory markers associated with viral pulmonary lesions in patients with end-stage chronic kidney disease and COVID-19 included hemoglobin ≤ 115 g/L, neutrophil count > 65%, monocyte count < 8%, absolute and relative eosinophil counts < 0.1 × 10⁹/L and < 2%, respectively, reduced albumin values, AST > 20 U/L, CRP > 50 mg/L, prothrombin activity < 100% (according to Quick’s method), and APTT ≥ 30 seconds. It was demonstrated that a body temperature of ≥ 37.2 °C during the first three days of hospitalization, an absolute eosinophil count < 0.1 × 10⁹/L, and a relative eosinophil count < 2% increased the risk of viral pulmonary lesions by 9 times. Conclusion. Considering that COVID-19 caused by the Omicron variant of SARS-CoV-2 remains a significant threat to patients undergoing programmed hemodialysis, it is essential to predict the development of a generalized form of SARS-CoV-2 infection with pulmonary involvement in patients with end-stage chronic kidney disease. Early prediction will facilitate timely therapeutic adjustments and the planning of additional diagnostic evaluations.

<title>Abstract</title> Background Health-Related Quality of Life (HRQoL) is a critical outcome in end-stage kidney disease care. The Kidney Disease Quality of Life-36 (KDQoL-36) is widely used but presents limitations in length and personalization, which may reduce its clinical utility. We evaluated the psychometric performance of a multidimensional Item Response Theory (IRT) model for KDQoL-36 and simulated a Computerized Adaptive Testing (CAT) version in a large European dialysis cohort. Methods We included 8,325 KDQoL-36 responses from chronic dialysis patients in 170 NephroCare clinics across six countries. Psychometric properties were assessed using confirmatory factor analysis and bifactor IRT modeling. CAT simulations were conducted to evaluate reliability and burden reduction. Construct and criterion validity were assessed using hospitalization outcomes and known-group comparisons. Results Bifactor models demonstrated superior fit for both SF12 and disease-specific KDQoL-36 domains, with excellent reliability (ω &gt; 0.90). IRT-based scores showed high agreement with classical test theory (R²: 0.75–0.98) and differentiated patient groups by hospitalization risk. CAT simulations showed strong agreement with full-length scores (R²: 0.93–0.99), reduced item count by 22–36% and saved up to 10 workdays per survey cycle. CCAT administered 7.67 ± 2.58 items per patient in SF12 domain and 18.75 ± 4.09 for KDQoL-36 diseases specific domain while preserving measurement precision. Conclusion Multidimensional IRT modeling supports the KDQoL-36 as a reliable, valid measure of HRQoL in dialysis care. CAT implementation offers substantial efficiency gains with minimal loss of information, reducing patient and staff burden while enhancing integration of HRQoL into routine clinical practice.

Abstract Background and Aims End-stage kidney disease (ESKD) patients receiving dialysis often experience a diminished health-related quality of life (QoL) [1], making the collection of patient-reported outcome measures (PROMs) essential for identifying key to enhance dialysis effectiveness and patients’ experiences. Our study aims to explore the association between haemodialysis (HD) treatment related factors and PROMs. Method In this cross-sectional study, we analysed electronic-PROM survey results, targeting 1,485 patients at Fresenius Medical Care (FMC) Singapore clinics from August to December 2024. The study was approved by the local Institutional Review Board. Patients enrolled for ≥90 days, provided consent, and completed the survey were included in the analysis. The survey comprised 3 questionnaires: Kidney Disease (KD) QoL-36 [2], Itch-5D, and intradialytic symptom questionnaire. We also analysed hospitalisation outcomes in this cohort. The KDQoL-36 includes 36 multiple-choice questions that assess five domains, generating scores (0 to 100), with higher scores indicating better QoL. Only patients who reported they were ‘very much bothered’ by itching on the KDQoL were asked to fill in the Itch-5D questionnaire (score: 5—mild impact to 22—severe impact) and only those patients who experienced symptoms during the previous dialysis were asked to rate the severity (1—not at all to 5—severe) of the 12 common intradialytic symptoms. Patients who received haemodiafiltration (HDF) for ≥75% of all treatments were classified as HDF group. We used linear and logistic regression models for numerical and binary outcomes, respectively and Poisson regression for hospitalisation. We analysed the results using R (version 4.1.1) and considered a two-sided p-value of &amp;lt;0.05 as significant. Results In total, 1,023 patients agreed to participate in the ePROM survey, yielding a response rate of 69%. Of the 681 patients who completed the survey and met the inclusion criteria, 122 used central venous catheter (CVC), 555 used arteriovenous fistulas (AVF) or grafts (AVG) (non-CVC), and VA was not reported for 4 patients. Three hundred and two patients (44%) were in the HDF group and 56% in the conventional HD group. The characteristics of patients by VA type and dialysis modality are presented in Tables 1 and 2, respectively. Ninety-seven patients (14%) reported experiencing intradialytic symptoms during the last dialysis session, with the most common being tiredness (13%) and muscle cramping (10%). The CVC group had significantly higher odds of experiencing intradialytic symptoms, including dizziness [OR: 2.10, (95% C.I.: 1.06, 4.03)], tiredness [OR: 1.97, (95% C.I.: 1.14, 3.40)], and shivering [OR: 2.50, (95% C.I.: 1.29, 4.76)] compared to the non-CVC group (Table 3). Furthermore, CVC group reported more severe vomiting, dizziness, tiredness, and shivering (P &amp;lt; 0.05) albeit with small effect size. Tiredness and shivering are common symptoms of catheter infection, and we observed that CVC use was associated with higher risk of infection-related hospitalisation [Incidence rate ratio: 3.16 (95% C.I.: 1.46, 6.70)] in our cohort. The HDF group was significantly associated with lower occurrence of muscle cramps [OR: 0.57, (95% C.I.: 0.32, 0.98)], headache [OR: 0.51, (95% C.I.: 0.25, 0.98)], and tummy pain [OR: 0.31, (95% C.I.: 0.09, 0.87)] (Table 3). Headache was also reported to be less severe in the HDF group (P &amp;lt; 0.05) albeit with a small effect size. We observed no significant relationships between CVC use and HDF and the five KDQoL domain scores, Itch-5D score, or recovery time. Conclusion Our results demonstrate that the use of AVF or AVG as VA and HDF modality are associated with fewer and less severe patient-reported intradialytic symptoms in our stable prevalent HD cohort.

Introducción: El cáncer como una enfermedad que se caracteriza por la proliferación descontrolada de células, pudiendo asi invadir otros tejidos y la multiplicación de manera autónoma; así, existen hace algunos años una amplia gama de alternativas en materia de anticuerpos monoclonales para el tratamiento del cáncer, entre estos rituximab que se dirige contra el antígeno CD20 de los linfocitos B, siendo su mecanismo de acción la disminución de la célula B, apareciendo como una opción dentro del tratamiento en niños con enfermedades autoinmunitarias graves y resistentes dando buenos resultados Objeto: determinar la eficacia del Rituximab en pacientes con leucemia linfoblástica durante su primer año de tratamiento . Metodología: se realizó una búsqueda no sistemática de artículos originales, reportes de caso y revisiones bibliográficas publicadas en SciElo, ScienceDirect, UpToDate; descriptores: Rituximab; anticuerpos monoclonales; protocolos antineoplásicos. Se incluyó trabajos con antigüedad menor a 5 años, idioma inglés y/o español. Resultados: Se construyó un documento científico de fácil lectura y que aborda los principales tópicos para el conocimiento del personal de todos los niveles de atención. Conclusión: Para mejorar los resultados se deberían de administrar vacunas antes de la terapia con rituximab debido a que puede producir una hipogammaglobulinemia lo que representaría un aumento en el riesgo de infecciones. En casos donde existen pacientes con infecciones recurrentes después de la terapia con rituximab se sugiere una profilaxis antibiótica o incluso un reemplazo de inmunoglobulina. Área de estudio general: medicina. Área de estudio específica: oncología. Tipo de estudio: revisión narrativa.

Introducción: Los trastornos del sueño son la alteración en el ciclo de sueño – vigilia, que afecta la consolidación y el mantenimiento del sueño y por lo tanto el funcionamiento humano, se asocian a diversos factores que pueden coexistir en un mismo sujeto y se asocian al incremento de riesgo de patologías cardiometabólicas y peor calidad de vida. Objeto: abordar las generalidades de los trastornos del sueño, de forma sintética orientado principalmente a constituir un recurso de fácil acceso para el personal de salud del primer nivel de atención. Metodología: se realizó una búsqueda no sistemática de artículos originales, reportes de caso y revisiones bibliográficas publicadas en PubMed, ScienceDirect, Redalyc, y SciELO; descriptores: trastornos del sueño; trastornos sueño-vigilia; hipersomnolencia; parasomnias. Se incluyó trabajos con antigüedad menor a 5 años, idioma inglés y/o español y encontrarse disponible de forma libre. Resultados: Se construyó un documento científico de fácil lectura y que aborda los principales tópicos para el conocimiento del personal del primer nivel de atención. Conclusión: Los trastornos del sueño son entidades patológicas complejas, cuyo abordaje integral implica el conocimiento de factores incidentes, clínica y principios del tratamiento, previa valoración por especialidad que oferte tratamiento avanzado, cuando el caso lo necesite. Área de estudio general: medicina. Área de estudio específica: psiquiatría. Tipo de estudio: original.

In this presentation we will investigate how Kansei Engineering and user experience design come together to solve real problems in a large healthcare organization, transcending the boundaries between physical and digital solutions and contexts. We will investigate examples from industry and various methodology for driving collaboration and culture change. We will also discuss the value and, perhaps more importantly, the responsibilities that come with participating in the engineering of sticky and infectious experiences. Organizational structures and other enabling details will also be explored.

Abstract Background: We developed machine learning models to understand the predictors of shorter-, intermediate-, and longer-term mortality among hemodialysis (HD) patients affected by COVID-19 in four countries in the Americas. Methods: We used data from adult HD patients treated at regional institutions of a global provider in Latin America (LatAm) and North America who contracted COVID-19 in 2020 before SARS-CoV-2 vaccines were available. Using 93 commonly captured variables, we developed machine learning models that predicted the likelihood of death overall, as well as during 0–14, 15–30, &gt; 30 days after COVID-19 presentation and identified the importance of predictors. XGBoost models were built in parallel using the same programming with a 60%:20%:20% random split for training, validation, &amp; testing data for the datasets from LatAm (Argentina, Columbia, Ecuador) and North America (United States) countries. Results: Among HD patients with COVID-19, 28.8% (1,001/3,473) died in LatAm and 20.5% (4,426/21,624) died in North America. Mortality occurred earlier in LatAm versus North America; 15.0% and 7.3% of patients died within 0–14 days, 7.9% and 4.6% of patients died within 15–30 days, and 5.9% and 8.6% of patients died &gt; 30 days after COVID-19 presentation, respectively. Area under curve ranged from 0.73 to 0.83 across prediction models in both regions. Top predictors of death after COVID-19 consistently included older age, longer vintage, markers of poor nutrition and more inflammation in both regions at all timepoints. Unique patient attributes (higher BMI, male sex) were top predictors of mortality during 0–14 and 15–30 days after COVID-19, yet not mortality &gt; 30 days after presentation. Conclusions: Findings showed distinct profiles of mortality in COVID-19 in LatAm and North America throughout 2020. Mortality rate was higher within 0–14 and 15–30 days after COVID-19 in LatAm, while mortality rate was higher in North America &gt; 30 days after presentation. Nonetheless, a remarkable proportion of HD patients died &gt; 30 days after COVID-19 presentation in both regions. We were able to develop a series of suitable prognostic prediction models and establish the top predictors of death in COVID-19 during shorter-, intermediate-, and longer-term follow up periods.