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RESULTSCompared with matched controls, GLP-1RA users demonstrated reductions in systemic inflammation, characterized by lower neutrophil-to-lymphocyte ratio (3.97 vs 4.64, with a mean difference of -0.67 [95% CI, -0.89 to -0.45]) and white blood cell counts at 12 months, alongside greater improvements in serum albumin level (3.92 vs 3.86 g/dL, with a mean difference of 0.06 [95% CI, 0.04-0.08]). Although hemoglobin levels remained comparable between groups (10.9 vs 10.84 g/dL, with a mean difference of 0.06 [95% CI, -0.004 to 0.12]), GLP-1RA users had lower cumulative ESA exposure (1,881.9 vs 2,005.8 μg; mean difference of -123.9 μg, [95% CI, -201.7 to -46.1] μg) and a modestly reduced rate of erythropoietin resistance index compared with nonusers. Additionally, iron stores (ferritin level and transferrin saturation value) were consistently higher in the GLP-1RA group.Patients receiving hemodialysis often experience inflammation and anemia, which can make treatment more difficult and affect outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), commonly used for diabetes and weight management, may also have anti-inflammatory effects. We studied whether starting GLP-1RA therapy in patients on hemodialysis was associated with changes in markers of inflammation, nutrition, and anemia over 1 year, compared with similar patients not receiving these medications. We found that patients using GLP-1RAs showed consistent improvements in inflammatory markers and indicators of iron use, along with lower requirements for anemia medications, while maintaining similar hemoglobin levels. These findings suggest that GLP-1RAs may have benefits beyond glucose control, though further studies are needed to confirm their clinical impact.RATIONALE & OBJECTIVEGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for diabetes and obesity but have not been studied in patients with kidney failure with replacement therapy receiving hemodialysis in prospective trials. GLP-1RAs may influence inflammatory pathways relevant to anemia, although their effects in hemodialysis patients remain unclear.CONCLUSIONSIn patients receiving maintenance hemodialysis, GLP-1RA agonist use was associated with reductions in inflammatory markers and lower ESA requirements; however, as an observational study, causality cannot be inferred. These findings suggest GLP-1RAs may have potential benefits in managing inflammation and inflammation-mediated anemia in kidney failure.STUDY DESIGNRetrospective matched cohort study.ANALYTICAL APPROACHLinear mixed models were used to compare longitudinal trajectories between matched groups.SETTING & PARTICIPANTSData were derived from a large US dialysis provider (Fresenius Kidney Care). We identified 2,468 adult patients who initiated GLP-1RA therapy between January 1, 2023, and November 1, 2024, and matched 1:1 to nonusers using propensity scores based on demographic characteristics, comorbidities, and baseline laboratory values.OUTCOMESLongitudinal changes over 12 months in inflammatory markers (neutrophil-to-lymphocyte ratio, white blood cell count, and albumin level) and anemia parameters (hemoglobin level, ferritin level, transferrin saturation value, erythropoiesis-stimulating agent (ESA) dose, and erythropoietin resistance index).EXPOSUREInitiation of GLP-1RA therapy.

Background Ports have traditionally been inserted in hospitalized inpatients; however, there has been an increasing transition to outpatient placement by interventionalists in hospital imaging suites. To our knowledge, port implantation in nonhospital settings has not been reported in peer-reviewed literature. Here, we report our experience with port placement in freestanding outpatient vascular centers. Methodology The electronic medical record for 47 centers was retrospectively searched to identify port placements between January 1, 2012, and December 31, 2018. Data included indications, platelet inhibitor/anticoagulants, American Society of Anesthesiologists (ASA) classification, port type, site, tip position, peri-procedure medications, procedure time, and pain scores. Complications were determined by phone calls at 48-72 hours. Results No short-term malfunctions were reported. In total, 5,890 ports were placed for chemotherapy (n = 5,531), IV therapy (n = 77), antibiotics (n = 74), hyperalimentation (n = 19), phlebotomy (n = 7), medications (n = 4), miscellaneous (n = 74), and unknown (n = 104). Regarding ASA classifications, 1% (n = 65) were categorized as Class I, 20% (n = 1,203) as Class II, 78% (n = 4,592) as Class III, and 0.5% (n = 30) as Class IV. Overall, 3,712 were single-lumen power ports, 341 dual-lumen, 19 unknown, 7 arm, 1 other, and 1,810 were unspecified. There were 5,855 chest, 19 arm, 1 thigh, and 15 unspecified ports. Tips were positioned in the superior vena cava (n = 1,582), superior vena cava-right atrium (n = 497), right atrium (n = 272), inferior vena cava (n = 2), inferior vena cava-right atrium (n = 1), or not specified (n = 3,536). The mean procedure time was 29 minutes (range = 6-137). The mean peak pain score was 0.86 (range = 0-10). Complications (n = 33) included 16 emergency/hospital admissions <24 hours for port-site bleeding (2), infection (1), pneumothorax (1), EKG changes (1), respiratory symptoms (3), tachycardia (2), unconfirmed infection (1), fall (1), chest pain (1), syncope (1), pain (1), or other (1). Furthermore, 17 Other complications included unrelated/unconfirmed infection (4), death <30 days (1), shortness of breath (1), infection (1), reversal agent (1), hypoglycemia (1), fall (1), and other (7). No leaks were reported. Conclusions According to the study findings, port placement in outpatient centers appears to be safe and provides short-term effectiveness.

RESULTSApollo captures data from January 2018 to March 2021 from 40 countries and 543,169 patients worldwide (4.6% in Asia-Pacific [AP], 13.9% in Europe, Middle East, and Africa [EMEA], 7.0% in Latin America [LA], and 74.5% in North America [NA]). It contains demographic data, 35,874,039 laboratory, and 140,016,249 treatment observations as well as frequently recorded medication information, and clinical outcomes (e.g., hospitalization and mortality). Several regional differences can be observed using these data, such as age, treatment modality, and treatment time.CONCLUSIONCreating a robust multinational dialysis database offers vast opportunities to conduct real-world research and data analytics, including the development of artificial intelligence models. These activities hold promise of advancing the understanding of kidney disease and dialysis therapies. It can serve as comparative resource for the nephrology community.INTRODUCTIONLarge amounts of data are captured during dialysis, yet multinational datasets are scarce because of challenges in harmonizing and integrating clinical data, as well as complying with data protection regulations across the world. A global kidney care provider, Fresenius Medical Care, approached this challenge and finalized the creation of an anonymized dialysis database, coined ApolloDialDb (Apollo). We report on the approach used for database creation and detail dialysis patient characteristics globally.METHODSTo create this globally distributed multinational database, data from different electronic clinical systems were extracted, covering routinely collected medical information from dialysis clinics worldwide. This data were harmonized, and then anonymized following a reidentification risk assessment conducted by the external company Privacy Analytics, Ontario, Canada. The data was consolidated and is stored in a central cloud environment and will be updated periodically.