Background: End-stage renal disease (ESRD) is the last stage of chronic kidney disease, mainly caused by type 2 diabetes mellitus and characterized by an increased mortality risk related to cardiovascular disease. Low-dose aspirin (acetylsalicylic acid or ASA) seems to effectively prevent cardiovascular events in patients with ESRD. However, the number of interventional studies in this population remains limited and the mechanisms of aspirin-related bleeding remain poorly understood. Aspirin’s efficacy and safety may be modified by the presence of type 2 diabetes mellitus or platelet hyperreactivity. Objective: The overall objective of this protocol is to (1) evaluate aspirin’s safety and efficacy in reducing the risk of thrombotic events in patients with ESRD on hemodialysis and (2) examine whether aspirin’s efficacy is modified by the presence of type 2 diabetes mellitus or platelet hyperreactivity. Specifically, the primary objective is to compare the 12-month rate of any thrombotic event (cardiac death, nonfatal myocardial infarction, nonfatal stroke, arteriovenous fistula thrombosis) and Thrombolysis in Myocardial Infarction (TIMI) major bleeding in patients treated with aspirin compared to those on placebo. Secondary objectives are to test for effect modification of treatment by the presence of type 2 diabetes mellitus or platelet hyperreactivity and compare the rate of TIMI minor bleeding between treatment groups. Methods: We developed a protocol for a phase 2 randomized, single-center, placebo-controlled, triple-blind, superiority clinical trial to assess the prophylactic efficacy and safety of aspirin in patients with ESRD and on hemodialysis. It follows the ethical principles of the Declaration of Helsinki of the World Medical Association. A total of 342 participants would be enrolled over 12 months at a large dialysis center. Patients will be randomized in a 1:1 ratio and stratified by presence of type 2 diabetes mellitus and platelet hyperreactivity to receive either oral aspirin (100 mg/d) or placebo for a treatment period of 12 months. An intention-to-treat statistical analysis will be performed. Results: The randomized clinical trial will be performed after approval by the ethical committee of the participating center and registration at ClinicalTrials.gov. Conclusions: We provide a protocol for a randomized controlled trial to evaluate the safety and efficacy of treatment with aspirin to reduce the risk of thrombotic events. In addition, such a study would further our understanding of the mechanism of aspirin-related bleeding and help identify subgroups of best-responders and patients with a higher risk of adverse events. Registered Report Identifier: RR1-10.2196/10516

Background: Pharmacologic therapies to prevent decompensation in cirrhosis remain limited. Aim: To evaluate the association between aspirin use and cirrhosis‐related outcomes and mortality. Methods: This retrospective cohort study utilized deidentified electronic health records from a global federated network (January 2013–July 2025). Adults with cirrhosis without decompensation in the preceding 12 months and without prior HCC were included. Following 1:1 propensity score matching, outcomes were assessed at 12, 24, and 36 months. The primary outcome was a composite of cirrhosis‐related decompensation (ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatorenal syndrome, encephalopathy). Secondary outcomes included hepatocellular carcinoma (HCC), mortality, and gastrointestinal bleeding. Results: Among 458 165 patients, matching yielded 25 782 patients (12 891 per group; mean age 63.3 years). Aspirin was associated with a lower risk of the composite outcome at 12 (HR, 0.75; 95% CI, 0.67–0.83), 24 (HR, 0.76; 95% CI, 0.70–0.84), and 36 months (HR, 0.77; 95% CI, 0.68–0.84), driven by reduced variceal bleeding, spontaneous bacterial peritonitis, and ascites. Absolute risks were 17.8% vs. 22.7% at 12 months, 20.4% vs. 24.7% at 24 months, and 22.0% vs. 25.7% at 36 months. At 12 months, the NNT was 21 for the composite outcome and 20 for mortality. Despite an increased risk of nonvariceal bleeding (NNH 143 at 12 months), serving as a positive control outcome, aspirin demonstrated a net clinical benefit, with more pronounced benefits in high cardiovascular risk patients ( p _interaction < 0.05). Conclusions: Aspirin use is associated with reduced cirrhosis complications, HCC, and mortality, suggesting a potential role in the management of compensated cirrhosis.

Objective: Clinical monitoring remains central to vascular access care, while surveillance of vascular access blood flow (Qa) provides information for detecting dysfunction. Ultrasound dilution (UD), such as Transonic ^® , is widely used for Qa measurement but may be limited by workflow, personnel, and time constraints. Alternatively, conductivity-based approaches integrated into dialysis machines enable automated intradialytic estimation of Qa without interrupting treatment. This bicentric study evaluated agreement between an automated ionic dialysance–based method, AFM ^® , and UD, and assessed its clinical performance across prespecified Qa ranges. Methods: We conducted an observational method-comparison study in two Italian hemodialysis centers. Paired Qa measurements were obtained in 64 patients during routine hemodialysis sessions using AFM ^® and Transonic ^® . Agreement and association were assessed using Spearman correlation, Passing–Bablok regression, Bland–Altman analysis, Lin’s concordance correlation coefficient, and weighted Cohen’s kappa. Clinical performance was evaluated across prespecified Qa ranges: ⩽600, >600 to <2000, and ⩾2000 mL/min. Results: Median Qa was 1145 (IQR, 807-1536) mL/min with AFM and 1436 (IQR, 947-1980) mL/min with UD. The two methods showed strong correlation (ρ = 0.849, p < 0.001) and moderate-to-good concordance (CCC = 0.73). Bland–Altman analysis revealed a systematic underestimation at higher flows, with magnitude-dependent variability. Overall categorical agreement was 84% (weighted κ = 0.72). Performance was highest in the clinically relevant ranges of ⩽600 and >600 to <2000 mL/min, with 100% and 93% sensitivities, and F1-scores of 0.89 and 0.88, respectively. Agreement declined in the high-flow range (⩾2000 mL/min), where sensitivity dropped to 53%. Conclusion: AFM ^® showed strong correlation and substantial clinical agreement with UD, particularly in the low- and intermediate-flow ranges most relevant to routine vascular access surveillance. Its automated intradialytic implementation supports its use as a practical screening tool for Qa surveillance. However, high-flow measurements should be interpreted cautiously and further evaluated when clinically indicated.

BACKGROUND End-stage renal disease (ESRD) is the last stage of chronic kidney disease, mainly caused by type 2 diabetes mellitus and characterized by an increased mortality risk related to cardiovascular disease. Low-dose aspirin (acetylsalicylic acid or ASA) seems to effectively prevent cardiovascular events in patients with ESRD. However, the number of interventional studies in this population remains limited and the mechanisms of aspirin-related bleeding remain poorly understood. Aspirin’s efficacy and safety may be modified by the presence of type 2 diabetes mellitus or platelet hyperreactivity. OBJECTIVE The overall objective of this protocol is to (1) evaluate aspirin’s safety and efficacy in reducing the risk of thrombotic events in patients with ESRD on hemodialysis and (2) examine whether aspirin’s efficacy is modified by the presence of type 2 diabetes mellitus or platelet hyperreactivity. Specifically, the primary objective is to compare the 12-month rate of any thrombotic event (cardiac death, nonfatal myocardial infarction, nonfatal stroke, arteriovenous fistula thrombosis) and Thrombolysis in Myocardial Infarction (TIMI) major bleeding in patients treated with aspirin compared to those on placebo. Secondary objectives are to test for effect modification of treatment by the presence of type 2 diabetes mellitus or platelet hyperreactivity and compare the rate of TIMI minor bleeding between treatment groups. METHODS We developed a protocol for a phase 2 randomized, single-center, placebo-controlled, triple-blind, superiority clinical trial to assess the prophylactic efficacy and safety of aspirin in patients with ESRD and on hemodialysis. It follows the ethical principles of the Declaration of Helsinki of the World Medical Association. A total of 342 participants would be enrolled over 12 months at a large dialysis center. Patients will be randomized in a 1:1 ratio and stratified by presence of type 2 diabetes mellitus and platelet hyperreactivity to receive either oral aspirin (100 mg/d) or placebo for a treatment period of 12 months. An intention-to-treat statistical analysis will be performed. RESULTS PLEASE WRITE RESULTS. CONCLUSIONS We provide a protocol for a randomized controlled trial to evaluate the safety and efficacy of treatment with aspirin to reduce the risk of thrombotic events. In addition, such a study would further our understanding of the mechanism of aspirin-related bleeding and help identify subgroups of best-responders and patients with a higher risk of adverse events.

Introduction: Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19. Methods: ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients. Results: We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12–84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002). Conclusions: In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19.