The Use of Nocturnal Home Hemodialysis in Sickle Cell Disease
Bibliographic record
Abstract
INTRODUCTION: Despite being a rare cause of end-stage kidney disease (ESKD), sickle cell disease has broad kidney implications. Patients with both sickle cell disease and ESKD are at a greater risk of adverse events including mortality; while these patients can be managed with hemodialysis (HD), the use of nocturnal HD in sickle cell disease has not been previously described. METHODS: Here, we report a patient with sickle cell disease and ESKD who transitioned from conventional HD to nocturnal home HD. FINDINGS: Following the initiation of extended HD, we observed a significant improvement in her blood pressure (BP) parameters, serum potassium levels, and volume status. We describe the importance of nitric oxide (NO) in maintaining normal endothelial function, and how NO bioavailability is disrupted in both the sickle cell disease and ESKD populations. We speculated that our patient had significant vasoconstriction secondary to NO depletion causing uncontrolled hypertension and intravascular hemolysis (leading to recurrent hyperkalemia), and theorized that extended HD could have enhanced the bioavailability of NO, restoring the vasodilatory capability of her endothelium. DISCUSSION: Having a dialysis modality that counters the negative pathophysiologic endothelial changes in sickle cell disease and ESKD could result in fewer complications in this vulnerable population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".