Anaesthesia in chronic dialysis patients:A narrative review

The provision of anaesthesia for individuals receiving chronic dialysis can be challenging.Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room.This narrative review summarizes the important principles of sedation and anaesthesia for individuals on long-term dialysis,with reference to the best available evidence.Topics covered include the pharmacology of anaesthetic agents,the impacts of patient characteristics upon the pre-anaesthetic assessment and critical illness,and the fundamentals of dialysis access procedures.

Application of Dorzagliatin in peritoneal dialysis patients with type 2 diabetes mellitus:A case report

BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female patient with a 30-year history of type 2 diabetes(T2DM)who had struggled to control her blood sugar for more than a year.She had a history of high blood pressure for 30 years,had undergone continuous ambulatory peritoneal dialysis for more than two years,was 163 cm tall,weighed 77 kg,and had a body mass index of 28.98 kg/m2.Despite intensive insulin therapy at a daily dose of 150 units,adding Dorzagliatin at a dosage of 75 mg orally twice daily led to immediate blood sugar improvement and a gradual reduction in insulin dosage.After one month of follow-up,the fasting plasma glucose was 6-8 mmol/L,and the 2-hour postprandial glucose was 8-12 mmol/L.CONCLUSION To our knowledge,this report is the first to use Dorzagliatin to treat type 2 diabetes peritoneal dialysis patients with challenging glucose control.Dorzagliatin,a novel glucokinase activator primarily metabolized by the liver,exhibits no pharmacokinetic differences among patients with varying degrees of chronic kidney disease.It has a high plasma protein binding rate and may not be cleared by peritoneal dialysis,potentially offering a new glycemic control option for Type 2 diabetic patients on peritoneal dialysis.

Factors Associated with Mortality in Diabetic Patients with End-Stage Renal Failure Starting Emergency Hemodialysis

Background: Diabetic nephropathy is the leading cause of end-stage chronic kidney disease with poor prognosis in resource-limited settings. This study aimed to determine factors associated with mortality in patients starting dialysis treatment for end-stage chronic renal disease in an emergency context. Patients and Methods: This was a retrospective study from January 2020 to December 2022 at CHU-B. Data from 79 diabetic patients requiring emergency dialysis were compared with those of 79 non-diabetic patients with an end-stage renal disease requiring emergency dialysis. Data were collected from the Nephrology Department registry. We studied their initial clinical and biological profiles and factors related to mortality. Results: Out of 545 compiled records, 79 diabetic chronic kidney disease patients needing dialysis were included (group 1). A control group of 79 non-diabetic chronic kidney disease patients requiring emergency dialysis was also included (group 2). The average age of patients was 53.5 ± 17 years, and the duration of diabetes at dialysis initiation was 14.8 ± 4.3 years. Twenty-three percent were hypertensive. Fifty-two percent of patients experienced intra-dialytic hypotension. Death occurred in 22% of patients. Results show that age (adjusted OR 1.955;CI: 1.025 - 1.086;p-value: Conclusion: Emergency dialysis in diabetics is associated with unfavorable outcomes in terms of mortality. Despite follow-up, renal involvement remains poorly explored, emphasizing the need for physician awareness.

Causes and Prognosis of Cases of Acute Obstructive Renal Failure Managed at the Donka National Hemodialysis Center

Introduction: Acute obstructive renal failure (AORF) is a frequent clinical situation, secondary to obstruction of the urinary excretory tract. Whatever the cause, urinary tract obstruction suddenly opposes glomerular filtration and is responsible for tubulointerstitial lesions. It accounts for 10% of acute renal failure (ARF). The aim of this study was to identify the causes and prognosis of cases of acute obstructive renal failure managed at the Centre National d’hémodialyse Donka. Material and Methods: This was a prospective descriptive study lasting 6 months, from September 1, 2022 to February 29, 2023. All patients undergoing haemodialysis for acute obstructive renal failure who agreed to participate in the study and whose medical records were complete were included. Results: During the course of the study, we registered 97 haemodialysis patients, including 20 cases (20.62%) of acute obstructive renal failure. The mean age of the patients was 57.8 ± 10.54 years, with a male predominance of 11 cases (55%) and a sex ratio of 1.22. The reasons for consultation were dominated by physical asthenia 11 cases (55%), lumbar pain 9 cases (50%), vomiting 6 cases (30%) and acute urine retention 6 cases (30%). Arterial hypertension 16 cases (80%) and urinary tract infection 10 cases (50%) were the most common antecedents. The etiologies of RAOI were dominated by lithiasis 10 cases (50%), neoplasia 6 cases (30%) and benign prostatic hypertrophy 3 cases (15%). mean creatinine was 1267.60 ± 710.76 μmol/l with extremes of 243 μmol/l and 2822 μmol/l, mean urea was 39.56 ± 18.36, hyperkalemia in 14 cases (70%) and hyponatremia in 8 cases (40%). After hemodialysis, 9 cases (45%) recovered renal function, 4 cases (20%) became chronic and 7 cases (35%) died. Conclusion: The frequency of AKI remains non-negligible in our department, and early detection and prompt management would considerably reduce the morbidity and mortality associated with this pathology.

Outcomes of Hemodialysis Patients in Public Centres in Abidjan from September 2018 to October 2021: Data from the Renal Registry of Cote d’Ivoire

Background: Hemodialysis is the most widely used renal replacement therapy in developing countries such as Cote d’Ivoire. Objective: To study the outcome of chronic hemodialysis patients in public centres in Abidjan using data from the Renal Registry of Cote d’Ivoire (2RCI). Method: This was a prospective analytical cohort study of End Stage Kidney Disease (ESKD) patients undergoing iterative hemodialysis in the network of public hemodialysis centres in Abidjan and who had been registered in the 2RCI register by September 2018. Results: Our study involved 363 cases out of 379 patients registered in the 2RCI registry database in 2018. The mean age of the patients was 47.3 ± 12.1 years, with a male predominance (sex ratio 1.97). In 70.24% of cases, they had no health insurance. The average duration of dialysis for our patients was 6.94 ± 4.1 years, with extremes of 2 and 28 years. This duration was less than 5 years in 44.3% of cases, between 6 and 10 years in 42.9% and more than 10 years in 12.6% of cases. The comorbidities found were hypertension in 95.6% of cases, diabetes in 7.8% and HIV in 4.6%. Anemia was found in 68% of cases and stroke in 8.6%. During the study period, 161 deaths were observed, representing a mortality rate of 44.35%. Acute lung oedema (29.8%), stroke (6.8%) and other cardiovascular diseases (19.3%) were the main causes of death. In multivariate analysis, factors such as age ≥ 65 years (HR = 3.66;CI 95% = 1.55 - 8.67;p = 0.003), “married/coupled” status (HR = 2.02;CI 95% = 1.24 - 3.31;p = 0.005) and normal weight at the start of dialysis (OR = 9.59, CI95% = 4.19 - 21.95;p = 0.001) were associated with the risk of death. Conclusion: Hemodialysis is performed in Abidjan on young patients. The mortality rate after three years of dialysis is very high. Hence the need to pursue the policy of decentralizing public centres and optimizing access to dialysis in terms of quality and quantity in order to improve patient survival.

Quality of life and psychological distress in end-stage renal disease patients undergoing hemodialysis and transplantation

BACKGROUND Among diverse profound impacts on patients’quality of life(QoL),end-stage renal disease(ESRD)frequently results in increased levels of depression,anxiety,and stress.Renal replacement therapies such as hemodialysis(HD)and transplantation(TX)are intended to enhance QoL,although their ability to alleviate psychological distress remains uncertain.This research posits the existence of a significant correlation between negative emotional states and QoL among ESRD patients,with varying effects observed in HD and TX patients.AIM To examine the relationship between QoL and negative emotional states(depression,anxiety,and stress)and predicted QoL in various end-stage renal replacement therapy patients with ESRD.METHODS This cross-sectional study included HD or TX patients in the Eastern Region of Saudi Arabia.The 36-item Short Form Survey and Depression Anxiety Stress Scale(DASS)was used for data collection,and correlation and regression analyses were performed.RESULTS The HD and TX transplantation groups showed statistically significant inverse relationships between QoL and DASS scores.HD patients with high anxiety levels and less education scored low on the physical component summary(PCS).In addition,the results of the mental component summary(MCS)were associated with reduced depression.Compared with older transplant patients,TX patients’PCS scores were lower,and depression,stress,and negative working conditions were highly correlated with MCS scores.CONCLUSION The findings of this study revealed notable connections between well-being and mental turmoil experienced by individuals undergoing HD and TX.The PCS of HD patients is affected by heightened levels of anxiety and lower educational attainment,while the MCS of transplant patients is influenced by advancing age and elevated stress levels.These insights will contribute to a more comprehensive understanding of patient support.

Selection of dialysis methods for end-stage kidney disease patients with diabetes

The increasing prevalence of diabetes has led to a growing population of endstage kidney disease(ESKD)patients with diabetes.Currently,kidney transplantation is the best treatment option for ESKD patients;however,it is limited by the lack of donors.Therefore,dialysis has become the standard treatment for ESKD patients.However,the optimal dialysis method for diabetic ESKD patients remains controversial.ESKD patients with diabetes often present with complex conditions and numerous complications.Furthermore,these patients face a high risk of infection and technical failure,are more susceptible to malnutrition,have difficulty establishing vascular access,and experience more frequent blood sugar fluctuations than the general population.Therefore,this article reviews nine critical aspects:Survival rate,glucose metabolism disorder,infectious complications,cardiovascular events,residual renal function,quality of life,economic benefits,malnutrition,and volume load.This study aims to assist clinicians in selecting individualized treatment methods by comparing the advantages and disadvantages of hemodialysis and peritoneal dialysis,thereby improving patients’quality of life and survival rates.

Analysis of current status of and barriers to exercise participation among patients on maintenance hemodialysis

Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method.The data of patients on MHD were collected using the general information questionnaire,Physical Activity Rating Scale,Exercise Benefits/Barriers Scale(EBBS),and Exercise Self-Efficacy Scale(ESES).The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models.Results:Patients on MHD had a low exercise volume score of 13.71±0.68 points and a medium EBBS score of 63.36±0.40 points.Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects,including low monthly household income per capita(odds ratio[OR]=86.741,95%confidence interval[CI][1.164-6.465],P=0.042),primary underlying disease of diabetic nephropathy(OR=45.993,95%CI[1.353-1.564],P=0.033),the belief that“fatigue in lower extremities hinders exercise”(OR=4.697,95%CI[1.127-19.585],P=0.034),and the belief that“physical exercise bringing optimistic and positive life attitude”(OR=0.074,95%CI[0.007-0.830],P=0.035).Conclusions:Since patients on MHD had low physical exercise volume,the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD.Therefore,feasible and effective intervention measures can be formulated based on ESES in clinical nursing.

Residual renal function in peritoneal dialysis with failed allograft and minimum immunosuppression

Immunosuppression(IS) is often withdrawn in patients with end stage renal disease secondary to a failed renal allograft, and this can lead to an accelerated loss of residual renal function(RRF). As maintenance of RRF appears to provide a survival benefit to peritoneal dialysis(PD) patients, it is not clear whether this benefit of maintaining RRF in failed allograft patients returning to PD outweigh the risks of maintaining IS. A 49 year-old Caucasian male developed progressive allograft failure nine years after living-donor renal transplantation. Hemodialysis was initiated via tunneled dialysis catheter(TDC) and IS was gradually withdrawn. Two weeksafter IS withdrawal he developed a febrile illness, which necessitate removal of the TDC and conversion to PD. He was maintained on small dose of tacrolimus(1 mg/d) and prednisone(5 mg/d). Currently(1 year later) he is doing exceedingly well on cycler-assisted PD. Residual urine output ranges between 600-1200 m L/d. Total weekly Kt/V achieved 1.82. RRF remained well preserved in this patient with failed renal allograft with minimal immunosuppressive therapy. This strategy will need further study in well-defined cohorts of PD patients with failed allografts and residual RRF to determine efficacy and safety.

Dental implant treatment for renal failure patients on dialysis:a clinical guideline

Chronic kidney disease （CKD） is a worldwide public health problem that is growing in prevalence and is associated with severe complications. During the progression of the disease, a majority of CKD patients suffer oral complications. Dental implants are currently the most reliable and successful treatment for missing teeth. However, due to complications of CKD such as infections, bone lesions, bleeding risks, and altered drug metabolism, dental implant treatment for renal failure patients on dialysis is more challenging. In this review, we have summarized the characteristics of CKD and previous publications regarding dental treatments for renal failure patients. In addition, we discuss our recent research results and clinical experience in order to provide dental implant practitioners with a clinical guideline for dental implant treatment for renal failure patients undergoing hemodialysis.

Peritoneal dialysis for chronic cardiorenal syndrome:Lessons learned from ultrafiltration trials

The current models of cardiorenal syndrome(CRS) are mainly based on a cardiocentric approach; they assume that worsening renal function is an adverse consequence of the decline in cardiac function rather than a separate and independent pathologic phenomenon. If this assumption were true,then mechanical extraction of fluid(i.e.,ultrafiltration therapy) would be expected to portend positive impact on renal hemodynamics and function through improvement in cardio-circulatory physiology and reduction in neurohormonal activation. However,currently available ultrafiltration trials,whether in acute heart failure(AHF) or in CRS,have so far failed to show any improvement in renal function; they have reported no impact or even observed adverse renal outcomes in this setting. Moreover,the presence or absence of renal dysfunction seems to affect the overall safety and efficacy of ultrafiltration therapy in AHF. This manuscript briefly reviews cardiorenal physiology in AHF and concludes that therapeutic options for CRS should not only target cardio-circulatory status of the patients,but they need to also have the ability of addressing the adverse homeostatic consequences of the associated decline in renal function. Peritoneal dialysis(PD) can be such an option for the chronic cases of CRS as it has been shown to provide efficient intracorporeal ultrafiltration and sodium extraction in volume overloaded patients while concurrently correcting the metabolic consequences of diminished renal function. Currently available trials on PD in heart failure have shown the safety and efficacy of this therapeutic modality for patients with chronic CRS and suggest that it could represent a pathophysiologically and conceptually relevant option in this setting.

Effectiveness of Ultrasound-Guided Arteriovenous Fistulas Cannulation in Difficult Hemodialysis Arteriovenous Access: A Meta-Analysis of Randomised Controlled Trials

Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guided cannulation may improve successful cannulation and reduce complications associated with unnecessary punctures. The study aims to conduct the meta-analyze to examine the effectiveness of renal nurse-performed US-guided cannulation to improve successful cannulation and reduce AVF-related complications in difficult AVF access. Design: A meta-analysis of randomised controlled trials. Methods: A systemic search was performed on electronic databases including CINAHL Plus, Web of Science, and PubMed from inception to October 2023. Risk ratios (RR) and standardized mean differences (SMD) were estimated using random-effect models for considerable homogeneity, and the Scottish Intercollegiate Guidelines Network (SIGN) methodology was adopted for critical appraisal. Results: Four RCTs were included. The results showed US-guided AVF cannulation had a significant effect in improving successful cannulation (RR: 0.19, 95% CI: 0.06 to 0.63, p = 0.007), and was favorable in reducing cannulation-associated complications (RR: 0.44, 95% CI: 0.10 to 1.93, p = 0.28), compared with blind needle cannulation. Conclusion: US-guided cannulation performed by renal nurses has the potential to improve successful cannulation, and fewer complications in hemodialysis patients with difficult arteriovenous access. Relevance to Clinical Practice: The results suggest the value of further training for renal nurses in US-guided cannulation, and broader implementation of US-guided cannulation to improve patient outcomes. Future studies could explore the optimal nursing training and longer-term benefits of US-guided cannulation by renal nurses in difficult AVF access. Patient or Public Contribution: No Patient or Public Contribution as this is a meta-analysis using the secondary data published in the RCTs.

Efficacy of roxadustat in treatment of peritoneal dialysis patients with renal anaemia

BACKGROUND There are no studies on the use of roxadustat in patients on regular peritoneal dialysis in China.AIM To observe the efficacy and safety of roxadustat in treating renal anaemia in peritoneal dialysis patients.METHODS Patients with renal anaemia who were regularly followed at the Peritoneal Dialysis Center of the First Affiliated Hospital of China Medical University from November 1,2019 to June 30,2020 were selected.A before-and-after self-control design was performed to retrospectively analyse the treatment effects on anaemia in patients treated with recombinant human erythropoietin(EPO)and roxadustat.RESULTS A total of 31 patients with renal anaemia on long-term peritoneal dialysis treated with roxadustat were included.Haemoglobin(Hb)levels were maintained or increased in all patients(100%),and no patients had a decrease in Hb compared with the previous phase.Patients had a mean Hb of 86.2±14.8 g/L with Hb compliance(Hb≥110 g/L)of 16.1%during the EPO phase and a mean Hb of 112.4±18.5 g/L with Hb compliance of 67.7%during the roxadustat phase.No major adverse cardiovascular events occurred in any patient.CONCLUSION The application of roxadustat in peritoneal dialysis patients with renal anaemia can effectively improve the Hb compliance rate.

What is the optimal dialysis method for diabetic patients with end stage kidney disease?

Diabetes is one of the most catastrophic diseases ruling every corner of the world,and this has led to elevated incidents of end-stage kidney disease(ESKD).The standard treatment for ESKD is kidney transplantation/replacement,which is limited due to a deficiency of donors.Hence,dialysis has become the second-best option for treating patients with ESKD.Patients with ESKD with underlying diabetes have an additional risk of complications and infections over non-diabetic ESKD patients.Furthermore,these patients also experience variations in blood glucose levels and are more liable to develop malnutrition.This article elaborates on the different dialysis methods for ESKD patients.This editorial highlights the evidence-based studies that include randomized clinical trials,cohort studies,retrospective studies and case-control studies and suggests the most suitable type of dialysis under the following components.

Impact of anxiety symptoms on dialysis adherence and complication rates:A longitudinal observational study

BACKGROUND Anxiety is a common psychological comorbidity in patients undergoing dialysis,yet its impact on treatment adherence and complication rates remains understudied.We designed a longitudinal observational study to investigate these relationships,based on the hypothesis that higher anxiety symptoms would be associated with increased complication rates and negatively associated with adherence to the dialysis regimen.AIM To investigate the relationship between anxiety symptoms,dialysis adherence,and complication rates in patients undergoing dialysis over a 24-month period.METHODS This observational study analyzed data from 250 adult patients who underwent hemodialysis or peritoneal dialysis at three Affiliated Hospitals of Youjiang Medical University for Nationalities over a period of 24 months.Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale at baseline and every 6 months.Dialysis adherence was evaluated through attendance records,interdialytic weight gain,and patientreported medication adherence.We recorded complications(infections,cardiovascular events,and hospitalizations)and used mixed-effects models and survival analyses to infer associations between anxiety symptoms,adherence measures,and complication rates.RESULTS Higher anxiety symptoms were significantly associated with poorer dialysis adherence,including increased missed sessions[incidence rate ratio=1.32,95%confidence interval(CI):1.18-1.47,P<0.001],greater interdialytic weight gain(β=0.24,95%CI:0.15-0.33,P<0.001),and lower medication adherence(odds ratio=0.85,95%CI:0.78-0.93,P<0.001).Patients with clinically significant anxiety(Hospital Anxiety and Depression Scale-Anxiety subscale≥8)had a higher risk of complications[hazard ratio(HR)=1.68,95%CI:1.32-2.14,P<0.001],particularly infections(HR=1.89,95%CI:1.41-2.53,P<0.001)and cardiovascular events(HR=1.57,95%CI:1.18-2.09,P=0.002).The relationship between anxiety and complications was partially mediated by adherence measures.CONCLUSION Anxiety symptoms in patients undergoing dialysis are associated with poorer treatment adherence and increased complication rates.Regular screening and targeted interventions to address symptoms may improve adherence and clinical outcomes.

Systemic oncological therapy in breast cancer patients on dialysis

The advancement of renal replacement therapy has significantly enhanced the survival rates of patients with end-stage renal disease(ESRD)over time.How-ever,this prolonged survival has also been associated with a higher likelihood of cancer diagnoses among these patients including breast cancer.Breast cancer treatment typically involves surgery,radiation,and systemic therapies,with ap-proaches tailored to cancer type,stage,and patient preferences.However,renal replacement therapy complicates systemic therapy due to altered drug clearance and the necessity for dialysis sessions.This review emphasizes the need for opti-mized dosing and administration strategies for systemic breast cancer treatments in dialysis patients,aiming to ensure both efficacy and safety.Additionally,ch-allenges in breast cancer screening and diagnosis in this population,including soft-tissue calcifications,are highlighted.

Study on the occurrence and influencing factors of gastrointestinal symptoms in hemodialysis patients with uremia

BACKGROUND Gastrointestinal symptoms are common in patients with uremia undergoing hemodialysis,and these symptoms seriously affect patients'prognosis.AIM To assess the occurrence and factors influencing gastrointestinal symptoms in patients with uremia undergoing hemodialysis.METHODS We retrospectively selected 98 patients with uremia who underwent regular hemo-dialysis treatment in the blood purification center of our hospital from December 2022 to December 2023.The gastrointestinal symptoms and scores of each dimension were evaluated using the Gastrointestinal Symptom Grading Scale(GSRS).Patients were divided into gastrointestinal symptoms and no gastrointestinal symptom groups according to whether they had gastrointestinal symptoms.The factors that may affect gastrointestinal symptoms were identified by single-factor analysis.Multiple logistic regression analysis was performed to identify independent risk factors for gastrointestinal symptoms.RESULTS Gastrointestinal symptoms included indigestion,constipation,reflux,diarrhea,abdominal pain,and eating disorders,and the total average GSRS score was 1.35±0.47.This study showed that age,number of tablets,dialysis time,glucocorticoid,parathyroid hormone(PTH),combined diabetes mellitus and C-reactive protein(CRP)were independent risk factors for gastrointestinal symptoms in patients with uremia undergoing hemodialysis,whereas body mass index(BMI),hemoglobin(Hb),and urea clearance index were independent protective factors(P<0.05).CONCLUSION Gastrointestinal symptoms are mostly mild in patients with uremia undergoing hemodialysis,most commonly including dyspepsia,eating disorders,and gastroesophageal reflux.The independent influencing factors mainly include the BMI,age,number of pills taken,dialysis time,urea clearance index,Hb,use of glucocorticoids,and thyroid hormone level.PTH,CRP,and diabetes are clinically related factors influencing the occurrence of gastrointestinal symptoms,and targeted prevention can be performed.

When to initiate renal replacement therapy: The trend of dialysis initiation

The timing of renal replacement therapy for patients with end-stage renal disease has been subject to considerable variation. The United States Renal Data System shows an ascending trend of early dialysis initiation until 2010, at which point it decreased slightly for the following 2 years. In the 1990s, nephrologists believed that early initiation of dialysis could improve patient survival. Based on the Canadian-United States Peritoneal Dialysis study, the National Kidney Foundation Dialysis Outcomes Quality Initiative recommended that dialysis should be initiated early. Since 2001, several observational studies and 1 randomized controlled trial have found no beneficial effect when patients were placed on dialysis early. In contrast, they found that an increase in mortality was associated with early dialysis initiation. The most recent dialysis initiation guidelines recommend that dialysis should be initiated at an estimated glomerular filtration rate （eGFR） of greater than or equal to 6 mL/min per 1.73 m2. Nevertheless, the decision to start dialysis is mainly based on a predefned eGFR value, and no convincing evidence has demonstrated that patients would benefit from early dialysis initiation as indicated by the eGFR. Even today, the optimal dialysis initiation time remains unknown. The decision of when to start dialysis should be based on careful clinical evaluation.

Symptom burden amongst patients suffering from end-stage renal disease and receiving dialysis: A literature review

Patients suffering from end-stage renal disease and receiving dialysis experience a high symptom burden,which leads to an impaired quality of life and is associated with an increased risk of future hospitalisation and mortality.However,the symptom burden amongst patients undergoing dialysis was often underrecognised by clinical staff.In this paper,related works on symptom burden amongst patients with end-stage renal disease receiving dialysis,its concepts,assessment tools,status,and influencing factors were reviewed to draw clinical staff's attention for the relief of symptom burden amongst these patients and provide a reference for further research.

Single self-leading suture technique for iridodialysis repairment

Dear Editor,We described an innovative“single self-leading suture technique”for repairing iridodialysis.Instead of moving the needle forth and back,our method is easier to manipulate in the narrow surgical space between the cornea and lens,which will decrease the unnecessary complications related to iatrogenic injury.We provide an economical friendly and less time-taking method,which improves the suture accuracy.