Background: Dialysis adequacy (Kt/V) remains an essential marker of hemodialysis quality; however, it does not fully capture patients’ overall well-being. Growing evidence underscores the need for a more holistic, patient-centered approach that integrates clinical efficiency with factors affecting daily functioning and quality of life (QoL). Objectives: This study aimed to identify the key determinants of health-related quality of life (HRQoL) among Polish patients undergoing hemodialysis. Methods: Seventy hemodialysis patients from a single center completed the KDQOL-36 questionnaire and provided demographic and clinical data. Statistical analyses included Pearson’s and Spearman’s correlations, as well as multiple linear regression, to determine predictors of HRQoL. Results: The mean (SD) KDQOL summary score was 60.9 (17.3). Pain (B = −15.9, p < 0.001) and the need for additional dialysis sessions (B = −10.2, p = 0.008) were the strongest independent predictors of poorer HRQoL, collectively accounting for 28.6% of variance. Longer dialysis-related transportation time (r = −0.238, p = 0.03) and longer hemodialysis vintage (r = −0.254, p = 0.03) were also significantly associated with lower HRQoL, while dialysis adequacy showed no significant effect. Conclusions: Pain, additional dialysis sessions, and longer dialysis-related transportation time are key, modifiable contributors to reduced HRQoL in Polish hemodialysis patients. These findings underscore the importance of a patient-centered approach that supplements clinical measures with interventions targeting comfort, education, and accessibility. Incorporating structured pain management and improved transport into routine nephrology practice can meaningfully improve patient QoL.

Introduction and objective: The SARS-CoV-2 virus has triggered a global pandemic, particularly affecting individuals with comorbidities and those on renal replacement therapy. Vaccination has become a critical strategy, although evidence indicates suboptimal immunity in these groups compared to the general population. Material and methods: The study assessed the post-vaccination response in 121 patients undergoing renal replacement therapy and 104 control individuals. IgG antibody levels against glycoprotein S were measured twice: the first sample was collected 4–8 months after two vaccine doses, and the second sample 6–8 months after third dose. Results: In both groups, antibody titres significantly increased after the third vaccine dose, with no notable difference between the control and study groups after two vaccine doses (p < 0.001). The findings revealed no statistically significant difference in antibody levels between the two groups. Furthermore, there was no significant difference in infection frequency after three vaccine doses (p = 0.072). Patients who contracted COVID-19 after the third vaccination had lower antibody levels during the first blood draw, suggesting a potential impact on immunity. Among dialysis patients, a correlation was found between IgG antibody titres (in the first blood draw) and a longer time interval between the first and second vaccine doses (p = 0.021). The regression analysis indicated that a 1-unit increase in antibody level resulted in a 0.1% reduction in the risk of infection. Conclusions: The results imply that achieving immunity comparable to the general population is possible among patients undergoing renal replacement therapy more than half a year after receiving three vaccine doses. The study also introduces the hypothesis of a delayed antibody response.

Background: Alagille syndrome is an autosomal dominant disorder usually caused by pathogenic variants of the JAG1 gene. In the past, cholestasis was a condition sine qua non for diagnosis of the syndrome. However, recent advancements in genetic testing have revealed that clinical presentations vary from lack of symptoms, to multiorgan involvement. Tetralogy of Fallot, the most frequent complex congenital heart defect in Alagille Syndrome, very rarely leads to renal failure requiring dialysis – there are only single reports of such cases in the literature, with none of them in Alagille Syndrome. Case presentation: A 41-year-old woman suffering from cyanosis, dyspnea and plethora was admitted to the hospital. The patient suffered from chronic kidney disease and tetralogy of Fallot and had been treated palliatively with Blalock-Taussig shunts in the past; at admission, only minimal flow through the left shunt was preserved. These symptoms, together with impaired mental status and dysmorphic facial features, led to extensive clinical and genetic testing including whole exome sequencing. A previously unknown missense variant c.587G > A within the JAG1 gene was identified. As there were no signs of cholestasis, and subclinical liver involvement was only suggested by elevated alkaline phosphatase levels, the patient was diagnosed with incomplete Alagille Syndrome. End-stage renal disease required introduction of renal replacement therapy. Continuous ambulatory peritoneal dialysis was chosen and the patient’s quality of life significantly increased. However, after refusal of further treatment, the patient died at the age of 45. Conclusions: Tetralogy of Fallot should always urge clinicians to evaluate for Alagille Syndrome and offer patients early nephrological care. Although tetralogy of Fallot rarely leads to end-stage renal disease requiring dialysis, if treated palliatively and combined with renal dysplasia (typical of Alagille Syndrome), it can result in severe renal failure as in the presented case. There is no standard treatment for such cases, but based on our experience, peritoneal dialysis is worth consideration. Finally, clinical criteria for the diagnosis of Alagille Syndrome require revision. Previously, diagnosis was based on cholestasis – however, cardiovascular anomalies are found to be more prevalent. Furthermore, the criteria do not include renal impairment, which is also common.

Wstęp: Zapalenie osierdzia jest jedną z przyczyn bólu w klatce piersiowej, szczególnie u młodych mężczyzn. Jego powikłaniem może być tamponada serca, wymagająca pilnej interwencji. Etiologia ostrego zapalenia osierdzia bywa trudna do ustalenia. Możliwe przyczyny obejmują infekcje wirusowe i bakteryjne, choroby reumatologiczne, rozwarstwienie aorty i inne. Jedną z nich jest również mocznicowe zapalenie osierdzia, występujące głównie u pacjentów dializowanych, rzadziej w przewlekłej chorobie nerek przed rozpoczęciem dializ.Opis przypadku: 65-letni pacjent został przyjęty do szpitala z powodu pogorszenia stanu ogólnego i duszności. Na podstawie obrazu klinicznego podejrzewano tamponadę serca w przebiegu zapalenia osierdzia, co potwierdzono w badaniach obrazowych. W trybie ostrego dyżuru przeprowadzono perikardiocentezę. Diagnostyka różnicowa obejmowała etiologię mocznicową i wirusową. Włączono codzienne zabiegi hemodializ oraz terapię glikokortykosteroidami uzyskując poprawę stanu pacjenta.Omówienie: Mocznicowe zapalenie osierdzia występuje głównie u pacjentów z przewlekłą chorobą nerek i może rozwijać się zarówno przed dializoterapią, jak i podczas niej, niezależnie od stężenia mocznika. Intensyfikacja dializ, jak w opisanym przypadku, często przynosi poprawę. Leki stosowane w ostrym zapaleniu osierdzia o etiologii wirusowej mają ograniczone zastosowanie u pacjentów z przewlekłą chorobą nerek, co sprawia, że steroidoterapia często pozostaje jedyną opcją terapeutyczną.Wnioski: U dializowanych pacjentów z ostrym zapaleniem osierdzia należy zawsze uwzględniać zarówno etiologię mocznicową, jak i inne potencjalne przyczyny. W przypadku pojawienia się tamponady serca kluczowe jest wczesne rozpoznanie i przeprowadzenie perikardioc entezy.