Dialysis Research Articles

Frailty in kidney transplant recipients.

Kidney transplantation is the treatment of choice even for the elderly, as it improves quality of life and life expectancy, lowering the financial burden to the health care system compared to dialysis therapy. In Japan, kidney transplant recipients have become older due to the shift in demographics. Compared to community-dwelling elderly adults, elderly kidney transplant recipients undergoing immunosuppressive therapy have a higher risk of age-related outcomes including hospital readmissions, infections, dementia, malignancies, and fractures. In frailty, patients become vulnerable to adverse events after stressors due to a lack of physiologic reserve. Although it is often associated with aging, frailty can also occur in younger individuals with certain chronic illnesses or conditions including chronic kidney disease. Limited compensatory mechanisms result in functional impairment and adverse health outcomes, such as disability, falls, decreased mobility, hospitalization, and death. Although kidney transplant recipients can restore their kidney function after transplantation, most of them still have chronic kidney disease, as well as a gradual decline in graft function as a result of chronic allograft nephropathy. Wait-listed candidates for kidney transplantation with frailty are more likely to experience wait-list removal or death. Frailty at the time of transplantation is associated with complications after kidney transplantation such as delayed graft function, longer hospital stays, rehospitalizations, immunosuppression intolerance, surgical complications, and death. Nevertheless, kidney transplantation can be a viable intervention for frailty in dialysis patients.

Correlates of self-reported distress in end-stage kidney dialysis patients using the distress thermometer score

IntroductionHaemodialysis patients self-report increased levels of anxiety and depression. We wished to determine the prevalence of distress in a multi-ethnic dialysis population and patient factors associated with distress.MethodsWe reviewed self-reported distress thermometer (DT) scores from 971 haemodialysis patients with corresponding laboratory investigations, bioimpedance body composition and hand grip strength (HGS).ResultsThe median age was 66.0 (55–75) years, 62.9% were male, 46.5% were of white ethnicity and 45.4% were diabetic. The results showed that 57.4% were classified as having no/minimal, 34% moderate, and 8.7% severe distress. Frailty increased from 31.5% to 47.9% and 56%, in the none/minimal, mild to moderate and severe distress groups (χ2 17.6, p = 0.001), as did smoking (12.9% versus 16.7% versus 25%, χ2 12.5, p = 0.001), and more patients reporting severe distress had suffered a previous myocardial infarction (MI) (17.4% versus 16.7% versus 27.4%, χ2 7.1, p = 0.029). Haemoglobin decreased (109.6 ± 14.6 versus 107.6 ± 14.2 versus 103.5 ± 14.4 g/L, p < 0.001) as did HGS (18.9 (12.8–26.5) versus 17.1 (11.8–23.9) versus 15.4 (11.1–22.6) kg, p < 0.05). On ordinal multivariable analysis, increasing distress was associated with smoking (β 0.55, 95% confidence interval (CI) (0.17–0.92), p = 0.004), previous MI (β 0.47 (0.09–0.83), p = 0.015), serum calcium (β 1.11, (0.3–1.9), p = 0.007), lower age (β −0.016, (−0.03 to −0.005), p = 0.003), haemoglobin (β −0.014 (−0.02 to −0.004), p = 0.008) and HGS (β −0.12 (−0.04 to −0.005), p = 0.013).ConclusionYounger age, higher calcium, lower haemoglobin and muscle strength, previous MI and smoking were associated with increasing levels of distress in this multi-ethnic dialysis population. Thus, both psychological and physical treatments are required to reduce stress levels for haemodialysis patients.

The effectiveness of a cognitive behavioral counseling program to alleviate future anxiety among patients with diabetes Kidney failure at Al-Kamelin Hospital

This scientific paper based on scientific research to investigate a cognitive behavioral counseling program to reduce the cognitive distortions and future anxiety of kidney failure patients at Dr. Dalal Kidney Dialysis Center, Al Kamline Hospital, the researcher used the experimental method single group design including a sample size of (30) patients who were selected on purposeful method. The two researchers implemented the future anxiety scale, prepared by Dr. Zainab Shugair, and the data has been processed using the Statistical Package for Social Sciences (SPSS) program using: Pearson's correlation coefficient, Cronbach's alpha coefficient, one-sample ttest, one-way variance (ANOVA). The researcher concluded the following results: The anxiety of the future of kidney failure patients at Al-Kamline Hospital, Dr. Dalal Center for Kidney Dialysis is high. There are also statistically significant differences in the effectiveness of the behavioral guidance program among the members of the experimental group between the pre-measurement and the post-measurement in favor of the post-measurement. There are also no statistically significant differences between the members of the experimental group, attributed to the age variable. There are no statistically significant differences between the members of the experimental group attributed to the educational level variable, and there are no statistically significant differences between the members of the experimental group attributed to the social status variable. At the end of the research, the researcher presented a number of recommendations, the most important of which is the need to prepare psychological treatment programs to treat cognitive distortions for psychiatric patients in general and kidney patients in particular.

Prevalence and management of anemia and impact of treatment burden on health-related quality of life in chronic kidney disease and dialysis patients.

Anemia management in chronic kidney disease (CKD) is a significant challenge for healthcare professionals worldwide. The extensive management of CKD and its complications is directly linked with a substantial treatment burden, which impacts quality of life (QoL). This study aimed to assess the prevalence and management of anemia and to evaluate the treatment burden and its impact on the QoL of CKD and dialysis patients in Pakistan. A multicenter prospective observational study was conducted in three hospitals. A total of 170 patients were enrolled, with 156 available for follow-up after six months. Their prior consent was obtained. Each participant was interviewed in person and received a data collection form. At baseline, the prevalence of anemia among CKD (stage 3-5) and dialysis patients was 78.7% and 94.7%, respectively. Patients on dialysis used more erythropoietin stimulating agents (ESAs), with 38.6% at baseline and 40.8% by month six, compared to non-dialysis CKD patients. Oral iron was used by 6.2% of stage 3, 25% of stage 4, 20% of stage 5 patients, and 6.6% of dialysis patients at baseline. At the six-month follow-up, 42.8% of CKD and 33.8% of dialysis patients achieved the target hemoglobin level. Dialysis patients had a higher treatment burden compared to CKD at baseline (77.4±10.6 vs 59.3±13.3) and at six-month visit (79.3±11.1 vs 59.1±14.5). The multiple regression analysis showed that treatment burden had a significant association with age, disease duration, and comorbidity at baseline. There was a significant negative correlation between overall treatment burden and QoL, indicating that QoL decreases as treatment burden increases. Anemia was prevalent, and its management was suboptimal in this study. The overall treatment burden score was high in dialysis patients, negatively affecting the QoL.

Severe uterovaginal prolapse and start of peritoneal dialysis: Role of colpocleisis surgery. Report of two cases.

Utero-vaginal prolapse is a common condition in the female population. In addition to well-known predisposing risk factors malnutrition, autosomal dominant polycystic kidney disease (ADPKD) and dialysis technique may favour its occurrence or aggravation, especially in patients with end-stage kidney disease (ESKD). Depending on severity, a relative contraindication to peritoneal dialysis (PD) could be considered. We report the cases of two patients with a grade IV utero-vaginal prolapse who successfully started PD after obliterative surgery (partial colpocleisis by Le Fort).

Impact of kidney transplantation vs. dialysis waiting for deceased donor on left ventricular diastolic dysfunction.

Left ventricular (LV) diastolic dysfunction is frequently observed in patients with end-stage kidney disease (ESKD) and a significant risk factor for the development of cardiovascular events in those patients. We hypothesized that the ratio of early diastolic peak mitral flow velocity to early mitral annulus velocity (E/e' ratio), the widely used non-invasive LV diastolic dysfunction index, would show improvements following kidney transplantation (KT). A total of 192 KT recipients who underwent echocardiography before KT and 2 years after KT were included this analysis. Moreover, 137 patients with ESKD on dialysis, waiting for deceased donor were included as a control group. Multiple linear regression analysis was used to identify the factors related to changes in the E/e' ratio. The median duration between conducting the two echocardiographies was 809 days for the KT recipients and 798 days for the controls. The mean E/e' ratio showed a significant decrease in KT recipients (10.9 vs. 9.8, respectively; p=0.002), but not in the controls (11.7 vs. 11.9, respectively; p=0.605). In multiple linear regression, KT (standardized β (SB) = -0.156; p=0.009) and administration of β blocker (BB) at enrollment (SB = -0.130; p==0.034) and at 2 years (SB=0.206, p=0.001) were significant predictors of the change in the E/e' ratio. LV diastolic dysfunction showed a noticeable improvement in the patients after KT compared to those on the waiting list and undergoing dialysis. Further studies, including patients with volume status and major cardiovascular events, may be helpful for validating these findings.

Home Dialysis for Latinx Individuals Living with Kidney Failure: A Qualitative Study of Interdisciplinary Dialysis Clinicians.

Latinx individuals experience 2 times the incidence of kidney failure compared to non-Latinx individuals and are less likely to utilize home dialysis therapies. In this qualitative study, interdisciplinary home dialysis clinicians were interviewed to understand the key factors and strategies used by clinicians to improve home dialysis uptake among the Latinx community. One-to-one, semi-structured interviews were conducted between November 2021 and March 2023 with 25 home dialysis interdisciplinary clinicians in Denver, Colorado and Houston, Texas. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. We identified three themes that focus on different levels of clinician advocacy in home dialysis uptake for the Latinx community: (1) Individual patient-level advocacy (helping patients overcome social challenges to home dialysis, cultivating personalized relationships, educating patients with in-person versus phone language interpretation, understanding cultural differences in communication), (2) Understanding patient influences on modality decision-making (acknowledging the importance of cultural concordance with clinician educator and patient peers, incorporating the patient lived experience, connecting with a patient's social support network, highlighting greater flexibility for employment, underscoring flexibility with culturally concordant foods) and (3) Changes to education at the dialysis facility level (standardizing routine and repeated modality education, promoting early and patient-centered education). Clinicians outlined efforts to improve access to home dialysis for Latinx groups on the patient and system level; in particular, individual and system level advocacy was grounded in trusting relationships and personalized education. A future intervention that improves the quality and personalization of dialysis modality education incorporating Latinx cultural values may improve access to home dialysis for Latinx people with kidney disease.

Participation in eHealth Communication Interventions Among Patients Undergoing Hemodialysis: Scoping Review.

eHealth communication interventions have been shown to offer individuals with chronic kidney disease the opportunity to embrace dialysis therapies with greater confidence, the potential to obtain better clinical outcomes, and an increased quality of life. eHealth is an emerging field that offers diverse, flexible designs and delivery options. However, existing evidence on eHealth communication among patients undergoing hemodialysis is sparse and scattered and lacks systematization. This scoping review aims to identify and map the current evidence on patient participation in eHealth communication interventions. We aimed to map the associations between interventions and electronic health records, the participative role of individuals living with chronic kidney disease and undergoing hemodialysis, and the barriers to and facilitators of patient involvement in eHealth communication with health care professionals. This study used the Joanna Briggs Institute methodology for conducting a scoping review. Studies eligible for inclusion were those that included adult patients (aged >18 y) undergoing all types of hemodialysis, including prescheduled in-center hemodialysis and conventional home-based hemodialysis. Systematic searches were completed in Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL with Full Text, Scopus, and ProQuest Dissertations and Theses. Extracted data from the included studies were presented in figures and tables along with descriptions that responded to the research questions. This review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. In total, 9 peer-reviewed studies were included. The main result was a low participative patient role and a vaguely described link to electronic health records. The key participative facilitators were availability of and access to the intervention; security, trust, and confidence; patient knowledge of their health situation and use of self-care; and patient preparedness for an uncertain future health situation and the ability to relate to family and friends about it. The key participative barriers were lack of availability of and access to information, mistrust and lack of safety, lack of knowledge of health situation and self-care, and relational issues. All barriers and facilitators were related to health literacy. This scoping review summarizes 4 specific and 3 nonspecific eHealth communication interventions developed and evaluated in various studies involving patients receiving hemodialysis. A knowledge gap exists between low levels of patient participation in eHealth communication and patients' limited access to electronic health records. eHealth communication interventions should implement patient participation and focus on the fact that different modalities of eHealth communication can complement face-to-face communication. RR2-10.2196/38615.

ZIF‐8 as Potential Vector for Enhanced Target Delivery of Sulfathiazole for the Treatment of Bovine Ruminal Acidosis

AbstractThe aim of this paper is enlarging the potential use of ZIF‐8 MOF as drug delivery system (DDS) for antimicrobial molecules, in particular for sulfathiazole, to be employed for the treatment of Sub‐Acute Ruminal Acidosis (SARA) in dairy cows. We therefore optimized (from milligrams to grams) the synthesis methodology for ZIF‐8 MOF, moving from organic solvents to aqueous solution, deeply characterizing the prepared material with X‐ray diffraction (XRD), surface area analyses (BET), electron microscopy (SEM), and thermogravimetric analyses (TGA). Once proved that the synthesis is also reproducible, we tested the stability of the material at physiological and acid pH, controlling material stability over time by checking their crystallinity with XRD. We then optimized sulfathiazole entrapment method to obtain the best material, checking the effective loading with UV‐Vis spectroscopy. Afterwards, we checked the effective entrapment vs physical mixture by means of XRD, SEM and ATR‐MIR spectroscopy. Finally we tested the pH‐responsive drug release by dialyzing the sulfathiazole@ZIF‐8 by UV spectroscopy on the dialysis solution, confirming the strong pH‐dependence of release time of sulfathiazole.

Iatrogenic Carotid Injury Following Jugular Vein Cannulation: A Case Report

Central Venous Catheterization (CVC) through the internal jugular vein is a routine procedure conducted in critically ill patients for hemodynamic monitoring, medication administration, and fluid management both in preparation for and during major surgery and for possible dialysis therapy. We present a case of an 80-year-old patient who went to hospital due to a sudden increase in creatinine levels. Subjected to an attempted CVC placement procedure, she suffered damage to the right common carotid artery with perforation and hemorrhage of the carotid artery. Taken immediately to the operating room, it was decided to repair the common carotid artery endovascularly using a covered stent with an immediate stop to the bleeding.

TOXIC ALCOHOL POISONING: A CASE REPORT

During the COVID-19 pandemic, toxic alcohol poisoning, notably from methanol, has emerged as a significant concern due to increased consumption of illicit liquor amidst lockdown restrictions. We present a case of a middle-aged man who developed altered consciousness, metabolic acidosis, and shock two days after ingesting hospital spirit. Although initial qualitative tests only detected ethanol, subsequent MRI findings showed classical signs of methanol poisoning, including basal ganglia abnormalities. Prompt management with dialysis, ventilatory support, and adjunctive therapy successfully addressed the acute phase despite the patient remaining delirious for seven days. This case underscores the importance of considering methanol toxicity even in the absence of direct evidence, necessitating comprehensive diagnostic approaches. Awareness and incorporating point-of-care assessments such as arterial blood gas analysis and osmolar gap evaluation in suspected cases are crucial, especially in resource-limited settings. Recognizing unexplained high anion gap metabolic acidosis with a high osmolar gap and characteristic MRI findings can aid in the early diagnosis and management of toxic alcohol poisoning

Predictive values of four nutritional indices for adverse outcomes in patients with hypertension.

Malnutrition, evaluated by nutritional indices, is reportedly related to a poor prognosis in patients with hypertension. However, clinical evidence on which index is more suitable for predicting a kidney prognosis is limited, and it has not been evaluated in hypertension. The aim of the present study was to investigate and compare the predictive values of four nutritional indices: Geriatric Nutritional Risk Index (GNRI); Prognostic Nutrition Index (PNI); Triglycerides × Total cholesterol × Body weight Index (TCBI); and the controlling nutritional status (CONUT) score. A retrospective, cohort study of 1255 hypertensive patients under care in the Fukushima Cohort Study was conducted. The primary outcome was kidney events, defined as a combination of a 50% decline in eGFR from baseline and renal failure requiring dialysis therapy or kidney transplantation. Kaplan-Meier analyses and multivariate Cox regression analyses were conducted to examine associations between the four nutritional indices and kidney events. The area under the curve (AUC) values of the receiver-operating characteristic curves were also examined to compare the predictive values of these nutritional indices. Lower GNRI, lower PNI, and higher CONUT score were significantly related to a higher risk of kidney events. GNRI (AUC = 0.729, 95% confidence interval 0.681-0.777) and PNI (AUC = 0.710, 95% confidence interval 0.665-0.756) had significantly higher AUCs for kidney events than the TCBI and CONUT score. GNRI and PNI showed greater predictive values for kidney events than other nutritional indices in patients with hypertension.

Central Line-Associated Bloodstream Infection Reduction in Hemodialysis Patients Across 9 Hospitals and 3 States.

This quality improvement project was initiated to reduce hospital-acquired catheter-associated bloodstream infections (CLABSI) in hospitalized patients receiving dialysis. A team dedicated to reducing hospital-acquired infections led the implementation of evidence-based interventions across all the included hospitals. This innovative approach demonstrated substantial enhancements in outcomes for patients on hemodialysis. To enhance patient safety in patients receiving hemodialysis, new strategies were implemented, including (1) transitioning from a vendor model to an internal model, enabling dialysis program standardization, (2) empowering intensive care nurses with increased autonomy and ownership, (3) transitioning to a standardized dialysis machine, and (4) introducing chlorhexidine gluconate (CHG) impregnated caps and CHG pads. To reduce CLABSI in hemodialysis lines, a multidisciplinary team was formed comprising physicians, nurses, a dialysis technician, pharmacists, the dialysis director, the chief medical officer, the chief nursing officer, the assistant chief nursing officer, the infection preventionist, and the quality director. The team implemented a standardized approach to caring for hemodialysis lines, provided just-in-time education to staff, and standardized policies simultaneously at 8 hospitals. Initially, 1 facility served as the pilot facility for facility-owned dialysis services, totaling 9 facilities providing in-house standardized dialysis services. Data was reported back for monthly evaluation. Overall, there was an 88% reduction in CLABSI occurrences in hemodialysis lines from pre-intervention (n = 8) to post-intervention (n = 1), X2 (1, N = 4112) = 4.181, P = .0408. Collaboration on these initiatives improved communication and enhanced quality care and patient safety across the entire spectrum of care. Implementing innovative tracking of standardized approaches to patient care and infection prevention and evidence-based interventions resulted in decreased CLABSI rates, improving outcomes in vulnerable patients. An unintended benefit of this project was the increase in multidisciplinary collaboration.

Discrete Joint Random Variables in Fréchet-Weibull Distribution: A Comprehensive Mathematical Framework with Simulations, Goodness-of-Fit Analysis, and Informed Decision-Making

This paper introduces a novel four-parameter discrete bivariate distribution, termed the bivariate discretized Fréchet–Weibull distribution (BDFWD), with marginals derived from the discretized Fréchet–Weibull distribution. Several statistical and reliability properties are thoroughly examined, including the joint cumulative distribution function, joint probability mass function, joint survival function, bivariate hazard rate function, and bivariate reversed hazard rate function, all presented in straightforward forms. Additionally, properties such as moments and their related concepts, the stress–strength model, total positivity of order 2, positive quadrant dependence, and the median are examined. The BDFWD is capable of modeling asymmetric dispersion data across various forms of hazard rate shapes and kurtosis. Following the introduction of the mathematical and statistical frameworks of the BDFWD, the maximum likelihood estimation approach is employed to estimate the model parameters. A simulation study is also conducted to investigate the behavior of the generated estimators. To demonstrate the capability and flexibility of the BDFWD, three distinct datasets are analyzed from various fields, including football score records, recurrence times to infection for kidney dialysis patients, and student marks from two internal examination statistical papers. The study confirms that the BDFWD outperforms competitive distributions in terms of efficiency across various discrete data applications.

Effect of renal dialysis session on novel echocardiographic parameters of left and right ventricle in patients with end-stage renal disease

Abstract Introduction Chronic heart disease is among the leading causes of end-stage renal disease (ESR). On the other hand, patients with ESR undergoing dialysis demonstrate often subclinically impaired left and/or right ventricular function according to small studies, and higher prevalence of chronic heart disease. However, data regarding the effect of renal dialysis on novel echocardiographic parameters among renal dialysis patients remain limited.The purpose of our study, was to study the effect of renal dialysis on novel echocardiographic parameters of left and right ventricle. Methods All 50 patients (14 females) of mean age 62.9 years undergoing renal dialysis in our kidney unit regularly were included in our study. Blood pressure, heart rate and weight measurements and heart echocardiogram with measurement of LV GLS, RV GLS, RV FWS, LA ResS, E/e’ ratio, Right Ventricular Systolic pressure (PASP) and inferior vena cava (IVC) diameter, before and after renal dialysis session, were carried out. Results Mean values of body weight (79,9 vs 77,6 kg), heart rate (74,2 vs 73,5 bpm) and blood pressure (131,5/80,6 vs 123,5/76,9 mmHg) were as expected statistically significant reduced after renal dialysis (p&amp;lt;0,001). Values of PASP (36,1 vs 27,8 mmHg), E/e’ ratio (14 vs 12,5) and IVC diameter (1,6 vs 1,3 cm), were statistically significant reduced after renal dialysis (p&amp;lt;0,001). Furthermore, values of RV GLS (-19,3 vs -20,3 %), RV FWS (-21,2 vs -22,6 %) and LA ResS (29,6 vs 30,7%), were statistically significant improved after renal dialysis session (p &amp;lt;0,001), while LV GLS depicted a minor improvement (-17,9% vs 18,2%) not statistically significant. Conclusion In conclusion, renal dialysis session had a beneficial effect on novel echocardiographic parameters of left and right ventricle (RV GLS, RV FWS, LA ResS) due to improvement of hemodynamic parameters (blood pressure, heart rate, PASP and IVC diameter) and intravascular volume reduction. Larger clinical studies should be organized to further investigate the effect of renal dialysis on those parameters and the underlying mechanisms in the chronic setting of hemodialysis.

The prognostic interplay of heart failure and chronic kidney disease in atrial fibrillation, focus on cardiorenal outcomes

Abstract Background Heart failure (HF) and chronic kidney disease (CKD) create a mutually reinforcing cycle, escalating disease development, and increasing morbidity and mortality rates. Both are common comorbidities promoting atrial fibrillation (AF) and contributing to heightened symptom burden and poorer outcomes in AF. Purpose To investigate the relationship of HF and CKD with cardiorenal outcomes in patients with AF. Methods For this analysis we included patients with known AF, treated at a tertiary centre between 01/2005 and 07/2019. The primary endpoint was a composite of cardiovascular (CV) death and hospitalization for HF (HHF). Secondary outcomes were renal death and dialysis. The multivariate model has been adjusted for age, sex, body mass index, HF, diabetes mellitus, CKD, coronary artery disease, previous myocardial infarction, and C-reactive protein. Results We included in total 7412 patients (median age 70 years, 39.7% female) with AF and followed them over a median of 4.5 years. A total of 1668 patients (22.5%) were diagnosed with HF, 806 (10.9%) with CKD and 372 (5.0%) were suffering from both conditions. Both CKD (adjusted HR 1.87, 95% CI 1.55-2.25) and HF (adjusted HR 2.57, 95% CI 2.22-2.98) were significantly associated with the composite of CV death/ HHF after multivariable adjustment. There was a significant stepwise increase in 5-year’s event rates of CV death/ HHF (no CKD &amp; no HF: 23%, HF: 61%, CKD: 63%, CKD &amp; HF: 82%; P-logrank &amp;lt;0.001). These results remained significant in the multivariate analysis, showing the highest increase in risk in patients with both HF and CKD with an adjusted HR of 3.96 (95% CI 3.34-4.68), followed by patients with only HF (adjusted HR 2.53, 95% CI 2.26 to 2.84) and only CKD (adjusted HR 2.22, 95% CI 1.87-2.63, p-value of &amp;lt;0.001, respectively). Regarding renal death/ dialysis we could observe a similar distribution of the 5-year’s event rates (no CKD &amp; no HF: 1.5%, HF: 4.0%, CKD: 11.8%, CKD &amp; HF: 17.7%; P-logrank &amp;lt;0.001). Both conditions, CKD and HF, remained independently associated with the combined endpoint of renal death/ dialysis after multivariable adjustment (only HF: adjusted HR of 2.80, 95% CI 1.84 to 4.25; only CKD: adjusted HR of 5.31, 95% CI 3.22 to 8.76; CKD &amp; HF: adjusted HR of 7.47, 95% CI 4.70 to 11.87; Figure 1). Conclusions Both CKD and HF significantly increase the risk of CV death and HHF, as well as renal death and dialysis in patients with AF. Risk assessment should expand beyond stroke and bleeding to cardiorenal complications including HHF, CV and renal death, as well as kidney failure in an unselected AF patient population.

Mortality and patient stratification 30 days after Staphylococcus aureus bacteraemia in patients with cardiac implantable electronic devices - a Danish nationwide cohort study

Abstract Background Staphylococcus aureus bacteraemia (SAB) is a high-risk condition with a reported 30-day mortality of up to 25% even with timely and correct treatment. Patients with cardiac implantable electronic devices (CIEDs) are at increased risk of a complicated course of disease due to the risk of device infection. Purpose We aimed to estimate the 30-day mortality rate following SAB among adult Danish patients with a de novo CIED. Furthermore, we aimed to identify patients with low, intermediate, and high mortality risk following SAB. Methods Using The National Danish Staphylococcus Aureus Bacteriemia Database and The Danish Pacemaker and ICD Register, we identified all Danish patients aged 18 to 99 years with a de novo CIED implantation between 2000 and 2020, and subsequently positive Staphylococcus aureus blood culture. The primary outcome was 30-day all-cause mortality from date of SAB. Clinical variables significantly associated with increased 30-day mortality following SAB were identified (p&amp;lt;0.05 and 95% CI not including 1) using adjusted multivariable Cox regression modelling. We tested variables related to age, sex, calendar year of SAB, device type, timing of infection, previous SAB, concomitant medication, and clinically relevant pre-existing co-morbidities including valvular replacement, recent surgery, and renal dialysis. Patients were awarded 1 point for each of the significant variables present, and the sum was used to stratify into low-, intermediate-, and high-risk groups. The cut-offs between the groups were set at 0 and 2 points (0 points = low risk, 1-2 points = intermediate risk, ≥3 = high risk). Results We identified 1,393 patients with de novo CIED (pacemaker: n=983, implantable cardioverter defibrillator: n=230, cardiac resynchronization therapy w/wo defibrillator capacity: n=180) and subsequent SAB (median time to SAB from CIED implantation: 679 days [IQR 168-1,525]). Median age at the time of SAB diagnosis was 77 years [IQR 68-84] with 72.4% being males. In total, 469 patients died within the first 30 days from SAB, equivalent to an overall 30-day mortality rate of 33.7% (95% CI 31.2-36.2). We identified high age, left sided valvular disease, use of systemic corticosteroids, and SAB occurring &amp;gt;6 months from CIED implantation to be associated with an increased hazard of 30-day mortality following the SAB diagnosis (Fig. 1). The median total sum obtained from the stratification model was 2 points [IQR 1-2]. 30-day all-cause mortality was estimated to 16.2%, 31.6% and 54.9% for the low-, intermediate- and high-risk groups, respectively (Fig. 2). Conclusions In patients with a de novo cardiac implantable electronic device and subsequent Staphylococcus aureus bacteraemia the overall 30-day mortality from date of SAB was 33.7%. Patients with high age, recent surgery, left sided valvular disease, and use of systemic corticosteroids were particularly at risk.Fig. 1.Simplified stratification modelFig. 2.30-day mortality following SAB

Correlation between postdialysis blood pressure assessed at different time points and home blood pressure monitoring

Abstract Background Hemodialysis patients undergo blood pressure (BP) measurements during the predialysis, intradialytic and postdialysis (POSBP) periods at the dialysis sessions. However, there is no consensus regarding the time point when POSBP measurement should be performed. Purpose This study investigated the relationship of POSBP measurements performed at different time points with home blood pressure monitoring (HBPM). Methods This prospective study included 98 long-term dialysis patients (67% men; age=59.4 ±17.7 years; 79% using antihypertensive medications). During one week, POSBP measurements were obtained in sitting patients by trained health staff using oscillometric BP monitors lodged in the dialysis machines at all dialysis sessions in three different periods: 1) immediately after the dialysis period ended (POSBP1); 2) after returning the patient's blood (POSBP2) and 3) after hemostasis of the fistula or catheter sealing (POSBP3). In the same week, HBPM was performed using validated devices and was calculated as the mean of BP measurements obtained on six consecutive days, comprising three readings in the morning and in the evening after at least 3 min of rest, before antihypertensive medications were taken, with the patients seated. Abnormal BP was defined as HBPM≥135/85 mmHg. Based on the optimal cut-point values derived from ROC curves analysis, we built cutoffs for POSBP1 (143/79 mmHg), POSBP2 (153/78 mmHg) and POSBP3 (151/80 mmHg) corresponding to HBPM values of 135/85 mmHg. Results The values of POSBP1, POSBP2, POSBP3 and HBPM were 138±21/72±13, 143±24/73±13, 142±22/72±13 and 128±19/76±13 mmHg, respectively. Systolic HBPM showed greater correlation with systolic POSBP3 (r=0.71), followed by POSBP1 (r=0.68), POSBP2 (r=0.67), while diastolic HBPM showed greater correlation with diastolic POSBP2 and POSBP3 (both r=0.56), followed by POSBP1 (r=0.49) (all p&amp;lt;0.05). The POSBP3 cutoff showed the highest association (odds ratio [95% CI]= 8.06 [3.21, 20.27]), accuracy (area under the curve [95% CI]= 0.74 [0.65, 0.83]) and concordance (kappa coefficient=0.47) to identify elevated BP at HBPM in comparison with the POSBP1 and POSBP2 cutoffs (Figure). Conclusion(s) POSBP3 exhibited the strongest correlation with HBPM and had the highest accuracy to detect elevated HBPM in dialysis patients and may be a potentially preferable POSBP measurement in clinical practice.

Outcomes of infective endocarditis in patients with end-stage renal disease and dialysis in Spain: a population-based study

Abstract Background Patients with end-stage renal disease (ESRD), particularly those undergoing dialysis, have a significantly higher risk of developing infective endocarditis (IE) compared to the general population. ESRD is not only related to a higher risk of infection, but also to a worse prognosis in IE. However, most data regarding the epidemiology and outcomes of patients with ESRD and IE is derived from noncontemporary population-based studies with limited clinical variables and lack of complete microbiological information, or from retrospective single-center cohorts. Purpose The aim is to describe the clinical characteristics and outcome of patients with IE and ESRD in Spain, compared to patients without ESRD, and to investigate potential differences between patients undergoing dialysis and the rest of patients with ESRD. Methods Retrospective observational population-based study. A total of 9,008 episodes of IE between 2016 and 2019 were analysed using information from the Spanish Minimum Basic DataSet. 428 patients had ESRD, of whom 332 were undergoing dialysis. A multivariable and multilevel logistic model was developed to evaluate the association of different variables with in-hospital mortality in ESRD patients. Results Compared to patients without ESRD, those with ESRD were younger, had more comorbidities, and had a higher incidence of Staphylococcus aureus (31.8% vs. 18.4%; p &amp;lt;0.001) and coagulase-negative staphylococci infections (19.2% vs. 14%; p =0.006). In terms of in-hospital complications, septic shock was more frequent in patients with ESRD (12.1% vs. 8.9%; p=0.007). Furthermore, ESRD patients underwent cardiac surgery less frequently than patients without ESRD (12.6% vs. 19.6%; p &amp;lt;0.001) and had significantly higher in-hospital mortality (33.4% vs. 26.9%; p =0.003). When comparing patients undergoing dialysis with the rest of ESRD patients, it was observed that those on dialysis had more comorbidities and a higher proportion of Staphylococcus aureus infections (36.1% vs. 16.7%; p &amp;lt;0.001). No differences were found in observed in-hospital mortality between patients on dialysis and the rest of ESRD patients. The multilevel analysis revealed that dialysis was not an independent risk factor for in-hospital mortality in patients with ESRD. Cardiac surgery was also not independently associated with higher in-mortality in ESRD patients. Conclusions Patients with ESRD and IE have a different clinical and microbiological profile than other patients with IE. Moreover, they undergo cardiac surgery less frequently and have significantly higher in-hospital mortality. Dialysis treatment and cardiac surgery were not independent risk factors for mortality in ESRD patients with IE.

Treatment of Renal Capsule Lesion in a Transplanted Kidney: A Case Report and Literature Review

Expanded donor criteria have been established to reduce organ wastage, as various factors can lead the disposal of kidneys, such as anatomical abnormalities, traumatic injuries, and iatrogenic injuries during organ retrieval surgery. We report a case of kidney transplantation in which a capsular lesion was identi!ed and repaired during organ preparation (back table) and review of the literature regarding transplant kidney injuries. A diabetic and hypertensive 52-year-old patient with chronic kidney disease undergoing dialysis therapy for 2 years was admitted for a deceased donor kidney transplant. "e donor was a 35-year-old man with brain death secondary to traumatic brain injury in a car accident. During the kidney preparation on the back table, a capsular lesion was visualized on the upper pole of the right kidney. Continuous suture of the renal capsule was performed using a 3-0 CatGut suture to correct the defect and reconstruct the renal surface. After renal reperfusion, no active bleeding was observed from the sutured area. "e patient had a good postoperative course with no complications. "e main complications associated with capsular lesions and complete capsular denudation are bleeding and hematoma formation, as well as urinary and lymphatic extravasation through the exposed renal parenchyma. Treatment may involve direct cauterization using electrocautery or argon plasma, or the use of hemostatic agents. Successful repair of capsular lesions not only prevents complications such as bleeding during reperfusion and urinary !stulae but also plays a crucial role in expanding the pool of organs available for transplantation.