Ukrainian Journal of Nephrology and Dialysis

Effect of the combination of stretching exercise and warm compress on leg cramps and discomfort in hemodialysis patients: A randomized clinical study

2026-07-14T10:55:38+03:00

Patients undergoing hemodialysis have a variety of negative effects on their quality of life, health, and comfort, including physical dysfunction, alterations to their diet, and limits on fluid intake. This study aimed to determine the effects of intradialytic exercise and heat compression on alleviating discomfort and leg cramps in individuals receiving hemodialysis.

Methods. A multicenter randomized clinical study was conducted in Iraqi hemodialysis facilities. A total of 205 patients receiving hemodialysis were randomized into four groups: warm compress group (n = 53), stretching exercise group (n = 43), combined warm compress and exercise group (n = 57), and control group (n = 52). The intervention was applied during hemodialysis sessions over four weeks. Comfort was assessed using the Hemodialysis Comfort Scale, while leg cramps were evaluated using the Cramp Questionnaire Chart. Pre- and post-intervention scores were compared using paired-sample t-tests and repeated-measures ANOVA.

Results. The combined intervention group demonstrated the greatest improvement in comfort scores, increasing from 61.74 ± 20.24 before the intervention to 100.99 ± 7.21 after the intervention (p < 0.001). The exercise group also showed a significant increase in comfort scores, from 62.30 ± 25.17 to 85.19 ± 3.92 (p < 0.001), whereas no significant change was observed in the warm compress group (66.43 ± 21.20 to 67.38 ± 18.26; p = 0.816) or the control group (61.15 ± 21.88 to 60.62 ± 18.39; p = 0.902). Repeated-measures ANOVA showed significant effects of time, group, and time × group interaction on comfort scores (F = 148.62, 96.13, and 192.39, respectively; p = 0.001; partial η² = 0.64). Cramp scores decreased significantly in the warm compress group (9.23 ± 2.76 to 3.66 ± 4.98; t = 7.567; p < 0.001), exercise group (8.35 ± 3.61 to 5.44 ± 2.67; t = 5.839; p < 0.001), and combined intervention group (9.37 ± 2.46 to 3.68 ± 0.73; t = 17.544; p < 0.001), while no significant improvement was observed in the control group (8.13 ± 2.44 to 8.81 ± 2.42; p = 0.171). Repeated-measures ANOVA confirmed significant time, group, and time × group effects for cramp scores (F = 112.47, 28.90, and 134.21, respectively; p = 0.001; partial η² = 0.57).

Conclusions. The combination of warm compresses and stretching exercise was the most effective non-pharmacological nursing intervention for reducing leg cramps and improving comfort among hemodialysis patients. These procedures are safe, non-invasive, cost-effective, and may be incorporated into routine nursing care during hemodialysis.

Trial registration: WHO International Clinical Trials Registry Platform / TrialSearch, Main ID: IRCT20240828062892N1.

Determinants of nutritional risk assessed by the geriatric nutritional risk index in Vietnamese maintenance hemodialysis patients: A cross-sectional study

2026-07-14T10:55:44+03:00

Malnutrition is prevalent and strongly predicts adverse outcomes in maintenance hemodialysis (MHD) patients. The Geriatric Nutritional Risk Index (GNRI) is a validated nutritional risk screening tool for this population. This study determined the prevalence of nutritional risk and identified independent factors associated with GNRI scores in Vietnamese MHD patients.

Methods. A cross-sectional study enrolled 125 end-stage kidney disease (ESKD) patients on MHD for ≥ 3 months at the Dialysis Unit of the Rehabilitation and Occupational Disease Hospital, Ho Chi Minh City, Vietnam, from January to June 2025. Nutritional risk was assessed using the GNRI, calculated from serum albumin, actual body weight, and ideal body weight, and classified into four categories (no risk: GNRI > 98; low risk: 92–98; moderate risk: 82–<92; major risk: < 82). For binary prevalence reporting, patients were dichotomised as at any nutritional risk (GNRI ≤ 98) versus no risk (GNRI > 98), consistent with the original Bouillanne classification. Univariate analysis used Spearman’s correlation and the Mann–Whitney U test. Multivariable linear regression with backward elimination identified independent factors associated with GNRI scores.

Results. The mean GNRI score was 94.74 ± 6.75. Overall, 77 patients (61.6%) had any nutritional risk (GNRI ≤ 98), including 38 (30.4%) with low risk, 32 (25.6%) with moderate risk, and 7 (5.6%) with major risk. Multivariable regression identified five independent associated factors of lower GNRI scores: advanced age (B = −0.142; 95% CI: −0.216, −0.069; p < 0.001), diabetes mellitus (B = −2.229; 95% CI: −4.714, −0.085; p = 0.042), active hepatitis C virus (HCV) infection (B = −3.055; 95% CI: −5.847, −0.263; p = 0.032), higher epoetin alfa dose (B = −0.020; 95% CI: −0.033, −0.006; p = 0.005), and elevated parathyroid hormone (PTH) levels (B = −0.002; 95% CI: −0.003, −0.0001; p = 0.027). The final model explained 32.4% of the variance (adjusted R² = 0.324).

Conclusions. Nutritional risk is prevalent in Vietnamese MHD patients, affecting 61.6% of the cohort. Malnutrition severity is independently associated with advanced age, diabetes mellitus, active HCV infection, ESA hyporesponsiveness, and secondary hyperparathyroidism. Targeted interventions, including HCV treatment, optimisation of anaemia management, and mineral-bone disorder control, are essential to improve nutritional outcomes in this population.

Apixaban versus warfarin in nephrotic syndrome: thromboembolic events, bleeding risk and changes in profibrotic and inflammatory cytokines

2026-07-14T10:55:18+03:00

Nephrotic syndrome (NS) is associated with a high risk of thromboembolic complications and activation of inflammatory and profibrotic pathways. The optimal anticoagulation strategy in NS remains uncertain.

Objective. To compare the efficacy and safety of apixaban versus warfarin in patients with NS and to explore their effects on inflammatory, profibrotic, and coagulation biomarkers.

Methods. In this prospective observational cohort study, 67 adults with biopsy-proven primary glomerulonephritis and newly diagnosed NS were followed for 6 months. Patients received either warfarin (n=33) or apixaban (n=34) for thromboprophylaxis. Primary endpoints were thromboembolic and bleeding events. Secondary endpoints included longitudinal changes in serum and urinary IL-6, TNF-α, TGF-β₁, thrombin, proteinuria, and estimated glomerular filtration rate (eGFR).

Results. No thromboembolic events occurred in either group. Bleeding events were more frequent with warfarin (33.3%) than with apixaban (8.7%) (OR 5.17, 95% CI 1.28–20.9; p=0.021); all were minor. Both treatments were associated with reductions in inflammatory and profibrotic markers; however, apixaban demonstrated earlier and more pronounced decreases in serum and urinary IL-6, TNF-α, TGF-β₁, and urinary thrombin (all p<0.05 at 6 months vs warfarin). Proteinuria declined in both groups but was significantly lower in the apixaban group at 6 months (p=0.026). Decline in eGFR was less pronounced with apixaban (p=0.035 between groups).

Conclusions. Apixaban provided effective thromboprophylaxis with fewer bleeding events than warfarin and was associated with greater reductions in inflammatory and profibrotic biomarkers, alongside more favorable changes in proteinuria and eGFR. These findings suggest potential beneficial pleiotropic effects for apixaban requiring confirmation in randomized studies.

Plasma PCSK9 and its correlation with serum lipid profile in patients undergoing peritoneal dialysis: A cross-sectional study

2026-07-14T10:56:04+03:00

Peritoneal dialysis (PD) is a widely practiced treatment option for patients with chronic kidney disease (CKD). Patients undergoing PD have lipid abnormalities that pose a significant cardiovascular risk. Elevated Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) levels in these patients may worsen their lipid dysregulation. However, limited data are available on PCSK9 concentration in PD patients. The present study aimed to examine the correlation between plasma PCSK9 and serum lipid profile in patients on PD.

Methods. In this cross-sectional study, a total of 160 participants were included following the selection criteria. Of them, 80 were CKD patients on PD (Group A) and rest 80 were apparently healthy subjects as controls (Group B). Fasting serum lipid profile, serum albumin, serum creatinine, urinary protein creatinine ratio (UPCR), and plasma PCSK9 levels of all participants were measured. Additionally, PD adequacy parameters (Kt/V urea, creatinine clearance, residual renal function, transport status) were recorded for PD patients.

Results. PD patients had significantly high levels of total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) compared to controls (p<0.001). PD patients exhibited a significantly elevated level of PCSK9 than controls (p<0.001). In PD patients, PCSK9 had a significant positive correlation with TC (r= 0.713, p<0.001) and LDL cholesterol (r= 0.747, p<0.001). TC (>200 mg/dL) and LDL cholesterol (>130 mg/dL) were significant predictors of elevated PCSK9 levels. A cut-off value of PCSK9 >125.3 ng/ml was significantly associated with dyslipidemia in PD patients, with a sensitivity and specificity were 85.0% and 87.5%.

Conclusions. Serum TC, LDL cholesterol, and TG levels are considerably higher in PD patients compared to healthy controls. Patients receiving peritoneal dialysis also had significantly elevated plasma PCSK9 levels. Plasma PCSK9 was positively associated with TC and LDL cholesterol. TC and LDL cholesterol were independent predictors of elevated plasma PCSK9 levels in patients undergoing peritoneal dialysis.

Multimodal assessment of early kidney allograft complications: Role of renal scintigraphy and laboratory biomarkers

2026-07-14T10:55:25+03:00

Early post-transplant complications remain a major challenge in kidney transplantation. It reveals an overlap of clinical manifestations and the limited specificity of routine laboratory markers may delay diagnosis. Functional renal scintigraphy provides a quantitative assessment of graft perfusion and function and may improve early detection of allograft dysfunction.

Objective. To evaluate the predictive value of scintigraphy, clinical and laboratory parameters for early post-transplant complications in kidney transplant recipients.

Methods. This single-center observational study included 65 kidney transplant recipients who underwent 99mTc-DTPA renal scintigraphy within 1-7 days after transplantation. Conventional laboratory markers (serum creatinine, blood urea, white blood cell count, erythrocyte sedimentation rate, platelet count) and scintigraphy indices, including perfusion index (PI), functional index (FI), and glomerular filtration rate (GFR), were analyzed. Patients were classified into stable graft function and complication groups. Statistical analysis included multivariable logistic regression, receiver operating characteristic (ROC) analysis, and principal component analysis (PCA).

Results. Thirty-three patients (50.8%) developed early post-transplant complications. Serum creatinine and platelet count were significantly higher in the complication group (p < 0.05). Multivariable regression identified serum creatinine, ESR, PI, FI and GFR as independent predictors of complications, with GFR demonstrating the strongest inverse association (p<0.0001). ROC analysis showed good diagnostic performance for PI (AUC 0.78-0.82), FI (AUC 0.75-0.80), and GFR (AUC 0.73-0.78). PCA demonstrated clustering of scintigraphy indices with markers of graft dysfunction and inflammation, supporting their complementary diagnostic value.

Conclusions. Functional renal parameters, particularly PI, FI and GFR, provide significant predictive value for early kidney allograft complications and outperform routine laboratory markers when used in isolation. An integrated approach combining laboratory and scintigraphy assessment may improve early risk stratification and guide timely clinical interventions in the post-transplant period.

Association of TNF-α and microRNAs expression with immune cell profiles and kidney function in women with urinary tract infection: A cross-sectional study

2026-07-14T10:55:31+03:00

Urinary tract infection (UTI) is associated with inflammatory activation involving cytokines and microRNAs (miRNAs). However, the relationship between tumor necrosis factor-alpha (TNF-α), miRNA expression, immune cell profiles, and renal function remains unclear. The present study aimed to evaluate TNF-α, miR-125, and miR-155 expression in women with UTI and assess their association with immune cell profiles and kidney function.

Methods. This cross-sectional study included 123 women with culture-confirmed UTI and 40 healthy controls. Hematological and biochemical parameters were measured, and expression levels of TNF-α, miR-125, and miR-155 were assessed using qRT-PCR. Correlation analysis was performed to evaluate associations between molecular markers, immune cell profiles, and kidney function.

Results. TNF-α, miR-125, and miR-155 expression levels were all significantly higher in UTI patients compared with controls (all p < 0.05). TNF-α expression was positively correlated with miR-155 (r = 0.515, p = 0.01) and miR-125 (r = 0.459, p = 0.024), while a strong correlation was observed between miR-125 and miR-155 (r = 0.734, p < 0.0001). miR-125 was associated with lymphocytes (r = 0.545, p = 0.0058), eosinophils (r = 0.406, p = 0.049), and monocytes (r = 0.406, p = 0.049), while miR-155 was correlated with lymphocytes (r = 0.462, p = 0.023). No significant correlations were found between TNF-α or miRNAs and renal function markers (p > 0.05).

Conclusions. TNF-α is associated with microRNA expression in UTI. microRNAs show stronger relationships with immune cell profiles, while neither TNF-α nor microRNAs is associated with kidney function.

Hospital care indicators for patients with pyelonephritis in Ukraine (2018–2023): Regional characteristics

2026-07-14T10:55:06+03:00

The public health monitoring system is an important component for resource planning, with a particular focus on analyzing inpatient care indicators in the country and regions, especially during periods of emergencies in society (epidemics, military actions, etc.).

The aim of the study is to analyze indicators of hospital morbidity among the adult and pediatric populations, as well as regional and provincial characteristics of dynamics in patients with acute (AP) and chronic (CP) pyelonephritis over the last 6 years (2018-2023).

Materials and methods. The source of data was statistical compilations for the analysis of epidemiological indicators of inpatient medical care for patients with AP and CP. The data obtained were considered both for Ukraine as a whole with regions, and for each of the 5 regions – Western, Central, North-Eastern, South-Eastern, Southern – and for the regions that comprise them, as well as for the city of Kyiv. For statistical processing using the software packages “SPSS for Windows, Version 11” and “MedStat,” the chi-square criterion was used, comparing the proportions for two groups using Fisher's angular transformation (with Yates' correction); a difference of p<0.05 was considered significant.

Results. It has been shown that the number of adults and children per 100,000 population treated in hospitals for AP and CP has been declining since 2018, reaching a minimum in 2020-2021, and then slowly increasing; the same, but reverse dynamics of adult mortality (p=0.008), which in these two years increases by 84% in patients with AP and by 100% in patients with CP, and both indicators do not reach the initial observation levels in 2022-2023. A direct link between this and the peak of the COVID-19 epidemic and subsequent military actions cannot be ruled out.

Regional differences in the number of patients treated (per 100,000) were identified, with the highest numbers in the Central region and the lowest in the Southern region and the Donetsk and Luhansk oblasts, as well as in the Kharkiv oblast for adults and the Zakarpattia and Chernihiv oblasts for children. The levels of hospital treatment for AP and CP in adults and children have been steadily increasing since 2022 in the Central and Western regions due to a decrease in the South-East and South, which correlates with the start of hostilities in Ukraine, as well as lower rates of treated patients and higher mortality rates in 2022-2023 compared to 2018-2019.

The duration of inpatient treatment for adults and children with AP and CP will decrease by an average of 20% between 2018 and 2023, and by 30% for children with CP. In adults and children, the longest average duration of inpatient treatment (respectively, >10 and >12) is in the South-East region, with a notable spike in Kyiv in 2020 (and in children in 2021) during the coronavirus epidemic.

Conclusions. The identified dynamics of inpatient care indicators for adults and children with AP and CP, which correlate with the peculiarities of emergencies in the country (COVID-19 epidemic, military actions), allow for the timely adoption of appropriate administrative decisions to maintain the current level of effective in patient medical care for urological and nephrological patients.

Methods of renal replacement therapy and the course of the early postoperative period in patients with acute kidney injury following cardiac surgery involving cardiopulmonary bypass

2026-07-14T10:55:12+03:00

Acute kidney injury (AKI) following cardiac surgery involving cardiopulmonary bypass is associated with increased mortality and prolonged intensive care unit (ICU) stays. The optimal choice of modality and regimen for renal replacement therapy (RRT) remains a matter of debate.

The aim of the study was to assess the incidence of AKI in patients following cardiac surgery and the impact of different RRT methods on the course of the early postoperative period in this patient group.

Methods. A total of 5,289 patients who underwent cardiac surgery between 2022 and 2025 were included in the retrospective study. AKI was defined according to KDIGO criteria. All adult patients requiring dialysis treatment were divided into groups based on the modality and regimen of RRT: intermittent haemodialysis (IHD, n=20), slow low-efficiency dialysis (SLED, n=21) and continuous renal replacement therapy (CRRT, n=17). The primary endpoint of the study was in-hospital mortality.

Results. Of the total number of patients who underwent cardiac surgery, acute kidney injury (AKI) developed in 1,358 cases (25.7%), of whom 58 (4.27%) required treatment with continuous renal replacement therapy. The patient groups were representative in terms of demographic, laboratory and intraoperative characteristics. In the CRRT group, compared with the IHD and SLED groups, a significantly faster normalisation of creatinine and lactate was observed (p<0.05 on days 1–14), more stable mean arterial pressure (p=0.032–0.041), lower requirement for invasive support (12.9±5.8 vs 21.3±7.5 in the IHD group and 18.1±6.8 in the SLED group; p=0.013) and duration of mechanical ventilation (CRRT – 34 [24–60] hours vs 68 [42–110] in IHD and 52 [36–88] in SLED; p=0.018). Furthermore, patients in the CRRT group had shorter lengths of stay in the ICU (10 [4–15] days; p=0.048) and overall hospitalisation (19 [11–29] days; p=0.028).

In the CRRT group, in-hospital mortality was 23.5% compared with 45.0% in the IHD group and 38.1% in the SLED group (p=0.372); however, in multivariate analysis, CRRT treatment was significantly associated with a reduced risk of death (OR 0.50; 95% CI 0.23–0.99; p=0.048). Independent predictors of mortality were lactate, MODS, duration of mechanical ventilation, sepsis and maximum VIS.

Conclusions. The incidence of acute kidney injury (AKI) in patients following cardiac surgery involving cardiopulmonary bypass was 25.7%; one in every four to five (4.27%) patients with AKI required renal replacement therapy. Compared with other methods, CRRT is associated with better early outcomes regarding the course of the early postoperative period and a reduced risk of mortality after adjustment for disease severity, particularly in haemodynamically unstable patients.

Physical activity and exercise training in patients with chronic kidney Disease: A narrative review

2026-07-14T10:55:50+03:00

Physical activity (PA) is a non-pharmacological intervention that may improve cardiovascular risk, functional capacity, muscle strength, inflammation, and quality of life in patients with chronic kidney disease (CKD). However, practical use of PA remains limited because exercise prescription should differ according to CKD stage, dialysis status, comorbidity burden, and baseline physical capacity.

The aim of this narrative review was to summarize mechanisms linking PA and CKD, evaluate clinical evidence for aerobic, resistance, balance, and low-intensity exercise, and formulate practical recommendations for non-dialysis and dialysis patients.

The reviewed evidence supports regular aerobic activity, resistance and balance training, and reduction of sedentary time in clinically stable non-dialysis CKD. Expected benefits include better cardiorespiratory fitness, muscle performance, endothelial function, inflammatory profile, and physical functioning.

For dialysis patients and patients with advanced CKD, individualized low-intensity activity, especially a home-based walking program with gradual progression, is a reasonable and safer starting strategy. Exercise should be prescribed as part of CKD care, monitored by symptoms, Borg scale, heart-rate response, gait speed, and the six-minute walk test.

Predictive models for assessing kidney allograft survival: A narrative review

2026-07-14T10:55:57+03:00

This review aimed to provide a clinically oriented evaluation of predictive models, scores, indices, nomograms and online calculators used for kidney allograft function and graft survival.

Methods. A targeted search was performed in PubMed/MEDLINE, Scopus, Embase, Web of Science Core Collection, Cochrane Library and Google Scholar. Priority was given to original model-development and validation studies, clinically used calculators, consensus documents and reviews addressing applicability, calibration and limitations of prognostic tools.

Results. Predictive instruments are most useful when applied according to the clinical time point: donor and recipient indices before transplantation; early functional markers and delayed graft function calculators during the perioperative period; eGFR, proteinuria, biopsy and immunological markers during the first year; and composite or dynamic models after the first year.

Conclusions. No single calculator can replace clinical judgment. The most practical strategy is a stepwise risk-oriented approach combining simple routine markers with validated and dynamically updated models.