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Background: Haemodialysis access patterns differ internationally. This can not only be explained by differences in patient cohorts. What is considered the right access for the right patient is debated and it is unclear which patient-related factors affect the choice of access. The aim of the study was to investigate how patient-specific factors as body size and comorbidities influenced the choice of haemodialysis access in a real-life setting.

Methods: Retrospective cohort study including all patients receiving a haemodialysis access in Sweden between 2013 and 2022. Data from the Swedish Renal Registry (SNR) and the National Patient Register (NPR) was used. Data regarding age, sex, cause of kidney failure, previous kidney replacement therapy, height and weight (after dialysis), were collected from SNR. Data on comorbidities were extracted both from SNR and the NPR. AV-accesses were grouped into four categories depending on location of artery. Changes in arteriovenous access creation over time and patient-related factors affecting the choice of first access were analysed.

Results: Of 10,170 patients, 9706 with 17,709 accesses were included. The creation of upper-arm fistulas (p = 0.042) and arteriovenous grafts (p = 0.007) increased. Small body size, female sex, diabetes mellitus, vintage, previous haemodialysis treatment (all p < 0.001), age (p = 0.002) and peripheral arterial disease (p = 0.031) led to more central venous catheters. Small body size, female sex, peripheral arterial disease, vintage, previous haemodialysis treatment (all p < 0.001) and diabetes mellitus (p = 0.023) decreased the probability for selecting a forearm fistula. Upper-arm fistulas were preferred over arteriovenous grafts for those with small body size (p < 0.001 for body surface area), female sex (p = 0.003) and previous haemodialysis (p < 0.001).

Conclusions: The use of upper-arm fistulas and arteriovenous grafts is increasing, while forearm arteriovenous fistulas remain the primary access modality. Patient-related factors influencing the choice of access seemed to be related to vessel size and quality, rather than age and cardiovascular comorbidities.

In most patients with heart disease, kidney function is maintained, but in those with late-stage heart failure the kidney function plays an important role in optimum treatment in adjusting medical treatment for control of symptoms and even survival. The commonest disease that impacts the heart and the kidney is hypertension, a condition that might progress into chronic kidney disease, then kidney failure requiring dialysis.

Microbubbles (MBs) of air occur in the hemodialysis (HD) extracorporeal circuit and may enter the bloodlines of the patient. The aim of the present study was to investigate possible sites of contamination. Seventeen patients performed 20 HD (Baxter AK200S n = 5 and Artis n = 15) and 930 ultrasound measurements of MBs/min (Hatteland CMD10 device). Detection ranges were diameters between 2.5 and 50 µm. Hemodiafiltration with postdilution (HDF-post) was performed in 14 dialyses, predilution (HDF-pre) in 1 dialysis, and HD using hemocontrol (HDhc) in 5 dialyses. Measurement points were M1—after the blood access, M2—before the dialyzer, M3—after the dialyzer, and M4—after the venous chamber. At each point, 10 measures of MBs were performed. MB contamination of the blood was larger at all points when the access was an arteriovenous fistula compared to a central dialysis catheter (p < 0.001). MB levels with the AK200 versus the Artis were lower at M1, higher at M2 (p ⩽ 0.005), and were similar at M3 and M4. HDF-pre had fewer MBs than HDF-post, whereas HDhc had more MBs than HDF-post (p < 0.001). An increase of MBs was seen at M2 during an internal “Autotest.” No air alarms were induced during dialyses. MBs were detected in the extra corporeal circuit at all points investigated. The venous chambers used did not significantly reduce contamination. The detected MBs did not induce air alarms when the blood returned to the patient.

Objective: The antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides are heterogeneous disorders. The aim of this study was to identify and characterize subgroups of patients based on sex, ANCA, age at diagnosis, and organ involvement.

Methods: In total, 1,167 patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) were retrospectively recruited to the study. Data including cumulative involvement of 10 different organ systems, end-stage kidney disease (ESKD), sex, proteinase (PR) 3–ANCA, myeloperoxidase (MPO)-ANCA, age at diagnosis, disease duration, and relapse were obtained from medical records. Clinical variables were analyzed for associations with sex, age at diagnosis, and relapse using logistic regression analysis. Thirteen clinical variables were included in hierarchical cluster analyses using the Ward method.

Results: In patients with GPA, PR3-ANCA, renal and pulmonary involvement, and ESKD were significantly associated with male sex, whereas MPO-ANCA was associated with female sex. Patients with GPA who were younger than 32 years of age at diagnosis were significantly more often females and had more ear–nose–throat involvement than patients older than 32 years. In patients with MPA, female patients were significantly younger at diagnosis than male patients. Relapse was significantly associated with young age at diagnosis and pulmonary involvement in GPA and with musculoskeletal involvement in MPA. Hierarchical cluster analyses identified five and seven patient clusters among individuals with GPA and MPA, respectively. PR3-/MPO-ANCA defined the largest clusters, whereas heart, gastrointestinal, and central nervous system involvement were hallmarks for three clusters for both patients with GPA and MPA.

Conclusion: Sex, age at diagnosis, and specific organ involvements define clinically relevant subgroups among patients with ANCA-associated vasculitides.

Background and Aims: Covid-19 is a multiorgan disease affecting the kidney. However, the risk of kidney injury after infection remains unknown. Therefore, this study aimed to determine the risk and time of first ever diagnosed kidney injury following Covid-19, and determine the impact of Covid-19 disease severity on this risk.

Research Questions:

• Is the risk of a first ever kidney injury increased following Covid-19 in a nationwide Swedish whole population setting?
• If so, which patients are at higher risk?

Method: The total Swedish adult population were included in the study from January 1, 2020, to July 26, 2022. Nationwide multi-registry data was used and cross-linked with Personal Identification Numbers. Data was retrieved from the Swedish Inpatient, Outpatient, Covid-19 (SmiNet), Vaccination, Intensive Care, Cancer and Cause of Death Registries. Covid-19 date (exposure) was defined as the first SARS-CoV-2 related date registered in SmiNet based on the date of symptom onset, sample date, diagnosis date or date of report. All ICD-codes (IDC9 and ICD10) used for kidney injury registered since 1987 and 2000 respectively were identified to exclude patients with previous kidney injury. Outcome was defined as all first-time events of kidney injury diagnosis (acute, non-specified and chronic) reported with ICD10 codes post Covid-19 date, during the study period. We used the Self-Controlled Case Series (SCCS) method to determine the incidence rate ratio (IRR) of kidney injury during risk periods up to 6 months after infection. In the SCCS analysis, all individuals with reported Covid-19 (exposure) and first time diagnosed kidney injury (outcome) were included. The adjusted SCCS model was used, which considers deaths in the model.

Results: Among the total 2 426 423 Covid-19 cases, there were 10 351 first kidney injury events diagnosed. In a preliminary analysis, the risk of developing kidney injury after Covid-19 was increased up to 90 days post infection with the highest IRR during the first week (day 1–7) of Covid-19 onset being 56.1 (95% CI 52.5–60). The highest risk was day 0 with nearly 200-fold increased risk, however, due to risk of selection bias (Fonseca-Rodriguez O., 2021) when including day 0, this data is excluded from the first week and should be considered with caution. The IRR was elevated for a longer time for men than for women. For women, the IRR was elevated up until 60 days post infection, compared to 90 days for men. Stratified by age groups, the IRRs were highest in the group aged 51–74 years, compared with those ≤50 years and >74 years. Individuals with higher Covid-19 disease severity were also at higher risk than those with mild infection.

Conclusion: Covid-19 is associated with an increased risk of kidney injury according to this nationwide preliminary analysis, including more than two million Covid-19 cases in Sweden. The risk of a first ever diagnosed kidney injury is elevated up to 90 days after Covid-19, which is later than previously shown. The risk was higher for men than for women and was highest for age group 51–74 years. These results highlight the importance of vaccination to prevent severe Covid-19, and if diseased by Covid-19, follow up to detect kidney injury post Covid-19.

Patients with acute kidney disease (AKD) may need treatment by hemodialysis and/or apheresis, which is often started in haste due to the life-threatening condition. To illuminate patients' lived experiences of being in acute need of such therapy due to AKD, we performed semi-structured interviews analyzed with qualitative content analysis. Eleven patients out of 104 were eligible and completed interviews. Six main categories were found - shock and emotional chaos, loneliness in an unfamiliar situation, a need for tailored information, emotional support from next of kin, the dialysis and/or apheresis experience varied, and the disease-conditioned life. An overarching theme emerged as, 'Will I survive? Will I be cured?' Clear and repeated information and personalized contact were requested to reduce anxiety and give hope during a time of crisis.

In this study we analyzed 12 years of adverse events, (AE) data from the World Apheresis Association, (WAA) Registry specific to the Spectra Optia Apheresis System. We queried WAA Registry data, (2012–2023) on apheresis procedures performed exclusively on the Spectra Optia Apheresis System. We categorized AEs by severity, (mild, moderate, and severe), and ordered them by year. We then analyzed and presented AEs associated with the following variables: diagnosis, procedure type, vascular access, and replacement fluid type, and causes of procedural interruption. We identified 51 567 apheresis procedures specific to the Spectra Optia Apheresis System within the data set. AE rates from 2012 to 2023 for mild, moderate, and severe were 1.43%, 2.81%, and 0.21%, respectively. Procedures associated with the lowest AE rates include red blood cell exchange and therapeutic plasma exchange. The most common mild and moderate AEs include tingling and hypotension and AEs related to vascular access. The highest rates of mild and moderate AEs were associated with cellular collections. The highest rate of severe AEs was associated with the use of 3.5% albumin as replacement fluid. Other variables impacting patient safety are identified. AE rates could not be compared to the median length of procedure since this time variable is not currently collected in the Registry. This is the first device-specific analysis of the WAA Registry data, bringing prior safety reporting into even sharper focus. Device-specific safety analysis like this will help practitioners better understand potential safety concerns associated with a commonly used apheresis device, including various separation modalities and accessories, thus supporting improved procedure management.

Apheresis is used for the treatment of many different diseases, especially when conventional therapy lacks efficacy. There are however some diseases in which apheresis is accepted as first line therapy. The aim of this analysis was to investigate the use of apheresis for the treatment of neurological diseases and the changes over two decades in the World Apheresis Association registry. During the period 2003–2023, a total of 23,699 apheresis procedures in 2963 patients with a neurological disease were performed. Data were collected during different periods by 44 centers, out of which 22 centers had been registering continuously over the latest 10 years. An increase in the proportion of neurological diseases developed over the period (p < 0.001) while the overall apheresis procedures remained stable (p = 0.46). Most procedures were due to myasthenia gravis (MG; n = 11,049 (31 % of patients), Guillain-Barré Syndrome (GBS; n = 3247 (30 %), multiple sclerosis (MS; n = 2665 (18 %)), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP; n = 2367 (3 %)), and neuromyelitis optica (NMO; n = 650 (2 %)). A change in the proportion of these diseases was noted over time. Adverse events (AEs) differed significantly between the diseases. Patients with GBS had most moderate and severe AEs. Hypotension was the most common severe AE. The panorama of different neurological diseases may cause different AEs based on the variation in neurological response to the apheresis procedure and replacement fluid. It is important to expand this knowledge among those who are prescribing and those performing the apheresis procedures.

The WAA registry has been active since 2002. It allows bed side registration of safety and efficacy data. The data each center enters is accessible for its own use but also used for merged analysis. Most types of procedures are represented. Treatments of many severe diseases as well as the collection of autologous and donor cells for therapeutic use especially in oncologic diseases are recorded. Previous reports have shown a successive reduction in adverse events (AE) over the years. The aim of the present report is to update data of the risk for AE during the years from 2013 to Oct 2024. Contributions of 44 centers from 20 countries were analysed. Over these years, more than 169,000 apheresis procedures have been registered in more than 26,000 patients. During the study period the mean incidence of AE, merged for all types of procedures, was 1.6 /100 procedures for mild, 2.0/100 for moderate and 0.20/100 for severe AE, and reduced since 2013. Since 2002, death due to apheresis could not be excluded in one patient. There was an increased risk of hypotension during apheresis in patients with neurological diagnoses (ICD-10 chapter G) versus those with diseases of the musculoskeletal or connective tissue (ICD-10 chapter M) and vice versa for urticaria and tingling. In conclusion, the present data show the risk for various degrees of AE in apheresis procedures. Many patients suffer from severe illness and apheresis is often offered as a rescue therapy. Although the risk of death due to the apheresis procedure is extremely rare the concomitant severe disease itself poses a risk for severe events.