Hemodialysis-dependent Patients Research Articles

#3076 A UK parallel cohort study on renal ANCA associated vasculitis outcomes for avacopan exposed and matched unexposed cohorts

Abstract Background and Aims Avacopan was approved in the UK for severe ANCA associated vasculitis (AAV) in December 2022. The ADVOCATE trial found the differential effect of avacopan on kidney function was greatest in patients with the lowest estimated glomerular filtration rate (eGFR), at highest risk of progression to end stage kidney disease (ESKD). Patients with an eGFR <15 ml/min/1.73 m2, pulmonary haemorrhage requiring invasive ventilation, under 12 months prognosis, use of plasma exchange and dual therapy with cyclophosphamide (CYC) and rituximab (RTX) were excluded from ADVOCATE; all common scenarios in real life practice. We aim to provide further information on these subgroups and evaluate 6 month renal outcome data in the UK. Method Parallel cohort study on renal AAV outcomes for avacopan exposed and matched unexposed cohorts, with severe, active GPA or MPA. 120 patients on avacopan from 7 UK centres have been recruited to date. Controls matched by renal function and age will be presented. Comparisons of ESKD, delta eGFR, eGFR recovery, reduction in proteinuria/haematuria, remission, relapse and mortality will be presented, with subgroup analyses for eGFR<15 ml/min/1.73 m2. Steroid exposure will be presented. Results Baseline characteristics of the avacopan cohort are below. Most received oral prednisolone at avacopan initiation (89%, n = 107) and 54% received intravenous methylprednisolone (n = 65). The majority received RTX alone (44%, n = 53) or RTX and CYC combination therapy (43%, n = 52). Fewer received CYC alone (9%, n = 11) and 3% were initiated on alternative immunosuppression (n = 4). 26% (n = 31) underwent plasma exchange and 13% required haemodialysis (n=16). 3% of patients have died. Excluding dialysis dependent patients at presentation, median eGFR was 22ml/min/1.73 m2 (IQR 10-36). eGFR at the time of avacopan initiation was 21ml/min/1.73 m2 (IQR 11-34). Conclusion Avacopan is commonly being used to treat nephritis in patients with a low eGFR, including haemodialysis dependent and elderly patients. Avacopan is frequently used with RTX and CYC combination therapy. 6 month outcome data will provide new data on important patient subgroups excluded from the ADVOCATE trial.

A pilot study on Paxlovid therapy for hemodialysis patients with severe acute respiratory syndrome coronavirus 2 infections.

We aimed to investigate the safety and efficacy of nirmatrelvir/ritonavir (Paxlovid) therapy for hemodialysis-dependent patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Thirteen hemodialysis patients infected with the Omicron variant of SARS-CoV-2 from April 3 to May 30, 2022, were recruited. Laboratory parameters and chest CT (computed tomography) imaging were analyzed. The treatment group included six patients who received 150 mg/100 mg of Paxlovid orally once daily for 5 days, whereas the control group included seven patients who received basic treatment. No serious adverse reactions or safety events were recorded. Four control patients progressed to moderate disease, and none in the treatment group showed progression of chest CT findings (P < 0.05). Paxlovid therapy tended toward early viral clearance and low viral load on Day 8. Moreover, 83.3% of the patients in the treatment group and 57.1% of the patients in the control group turned negative within 22 days. In the Paxlovid treatment group, we found significantly increased levels of lymphocytes (P=0.03) and eosinophils (P=0.02) and decreased levels of D-dimer on Day 8 compared with those on Day 1. Paxlovid therapy showed a potential therapeutic effect with good tolerance in hemodialysis patients. The optimal dose and effectiveness evaluation must be further investigated in a largeer cohort.

Features of nephrectomy hemodialysis dependent patients. Experience of the regional center

Background. A feature of the postoperative period of patients with end-stage chronic kidney disease (ESKD) after nephrectomy is the need to continue hemodialysis sessions, taking into account the high risk of developing hemorrhagic complications. A significant place in the literature devoted to organ removal surgery is devoted to a discussion of the video endoscopic method, which, as medicine develops, is constantly being improved, modified and noted as one of the promising areas. Open surgical interventions are accompanied by a more severe course. In this connection, the issue of choosing the timing and method of surgical intervention for this group of patients remains relevant.&#x0D; Aim. To evaluate the results of nephrectomy of hemodialysis patients for the period from 2013 to 2023, performed at the Krasnoyarsk Regional Clinical Hospital.&#x0D; Materials and methods. An analysis of 68 cases of nephrectomy was carried out to evaluate the effectiveness of the protocol adopted in the clinic for the management of nephrectomy in hemodialysis patients. The group included 31 (44.6%) men and 37 (55.4%) women. Nephrectomy through the lumbotomy approach was performed in 31 (45.6%) patients, laparoscopic unilateral nephrectomy – in 23 (33.8%) patients, and bilateral laparoscopic nephrectomy – in 14 (20.6%) patients.&#x0D; Results. Patients with ESKD who underwent nephrectomy were divided into 3 groups – emergency, elective open and laparoscopic nephrectomy. The end-stage of chronic kidney disease and the need for hemodialysis sessions are aggravating factors in the peri- and postoperative treatment of patients with a higher risk of developing complications, in order to minimize which the clinic has adopted a specialized protocol for the management of this category of patients, consisting of preoperative preparation, intraoperative and postoperative stages, applied in 89.7% of cases. Open surgical interventions were performed in 31 patients. Laparoscopic bilateral nephrectomy was performed in 14 patients and was carried out exclusively as planned. Laparoscopic monolateral nephrectomy was performed in 23 patients. Indications for surgical intervention in most patients were the presence of a complicated infection against the background of impaired urodynamics of the upper urinary tract, planned kidney transplantation in patients with polycystic disease, diagnosed malignant tumors of the kidney and ureters. The analysis indicates a greater number of hemorrhagic complications during open interventions. The introduction of endovideosurgical nephrectomy and patient management according to a specialized protocol leads to a significant reduction in the incidence of postoperative complications.&#x0D; Conclusion. Surgical minimally invasiveness and the use of a specialized protocol for the management of hemodialysis-dependent patients makes it possible to reasonably expand the indications for planned interventions, reducing the peri- and postoperative risks of a complicated course.

Risk of Subdural Hematoma Expansion in Patients With End-Stage Renal Disease: Continuous Venovenous Hemodialysis Versus Intermittent Hemodialysis.

Subdural hematoma (SDH) patients with end-stage renal disease (ESRD) require renal replacement therapy in addition to neurological management. We sought to determine whether continuous venovenous hemodialysis (CVVHD) or intermittent hemodialysis (iHD) is associated with higher rates of SDH re-expansion as well as morbidity and mortality. Hemodialysis-dependent patients with ESRD who were discovered to have an SDH were retrospectively identified from 2016 to 2022. Rates of SDH expansion during CVVHD vs iHD were compared. Hemodialysis mode was included in a multivariate logistic regression model to test for independent association with SDH expansion and mortality. A total of 123 hemodialysis-dependent patients with ESRD were discovered to have a concomitant SDH during the period of study. Patients who received CVVHD were on average 10.2 years younger ( P < .001), more likely to have traumatic SDH (47.7% vs 19.0%, P < .001), and more likely to have cirrhosis (25.0% vs 10.1%, P = .029). SDH expansion affecting neurological function occurred more frequently during iHD compared with CVVHD (29.7% vs 12.0%, P = .013). Multivariate logistic regression analysis found that CVVHD was independently associated with decreased risk of SDH affecting neurological function (odds ratio 0.25, 95% CI 0.08-0.65). Among patients who experienced in-hospital mortality or were discharged to hospice, 5% suffered a neurologically devastating SDH expansion while on CVVHD compared with 35% on iHD. CVVHD was independently associated with decreased risk of neurologically significant SDH expansion. Therefore, receiving renal replacement therapy through a course of CVVHD may increase SDH stability in patients with ESRD.

Clinical characteristics and outcomes of COVID-19 patients with varying renal functions statuses during the Omicron pandemic in Shanghai

ObjectiveThis study aims to provide an academic summary of the clinical characteristics, outcomes and risk factors associated with prolonged hospital stays among the patients with varying renal function statuses during the Omicron pandemic in Shanghai.MethodsClinical data was collected from COVID-19 patients admitted to Shanghai Jiaotong University School of Medicine Ruijin Hospital Northern District. Based on their baseline eGFR, the patients were divided into three groups: Group A (eGFR > = 90ml/min/1.73m2, n = 384), Group B (15ml/min/1.73m2 < = eGFR < 90ml/min/1.73m2, n = 220), and Group C (Hemodialysis-dependent patient, n = 92). Clinical characteristics and laboratory data were compared among the three groups. The cumulative hazards of ICU admission were compared using the Kaplan-Meier method. Univariate and multivariate linear regression analyses were conducted to identify the factors influencing the duration of positive nucleic acid test.ResultsBetween March 25, 2022, and May 31, 2022, a total of 696 COVID-19 patients were included in the study. Among the dialysis patients, 92% (85) of dialysis patients had not received any COVID-19 vaccination, and 14.1%(13) of hemodialysis (HD) patients eventually progressed to severe or critical cases. A total of 13 (2.15%) patients were admitted to the ICU, with 8 (61.5%) were HD patients. The duration of nucleic acid positivity showed a negative correlation with eGFR (B: -0.048, 95%CI: -0.059~-0.037, P = 0.000), platelet counts (B: -0.011, 95%CI: -0.017~-0.005, P = 0.001) or lymphocyte counts (B: -0.658, 95%CI: -1.229~-0.086, P = 0.024).ConclusionsThe majority of Omicron patients have a favorable prognosis, while HD patients experience relatively poorer outcomes and higher rates of ICU admission. Decreased eGFR and low lymphocyte/platelet counts are the important risk factors associated with prolonged Omicron infection.

Depression Among Dialysis Dependent end-Stage Renal Disease Patients: A Study from Tertiary Care Hospital in Bahawalpur

Objective: To determine the frequency of depression among dialysis dependent end-stage renal disease patients, associated factors and effect on patients’ compliance and clinical performance parameters. Study Design: Cross-sectional study Place and Duration of Study: Department of Nephrology, Bahawal Victoria Hospital, Bahawalpur Pakistan, from Apr 2017 to Mar 2018. Methodology: End-stage renal disease patients above 16 years of age who were on maintenance haemodialysis for more than 6 months were requested to complete the questionnaire of Urdu version of Patient Health Questionnaire 9. The information about missed treatments, shortened sessions, fluid overload and monthly laboratory data was obtained from medical records. Patient Health Questionnaire 9 score was calculated for all the patients and categorized as mild (5), moderate (10), moderately severe (15) and severe (20) depression. Results: There were 146 dialysis dependent end-stage renal disease patients (95 males, 51 females) with mean age of 45.1±14.3 years. Duration of dialysis dependence was significantly higher among females (p=0.022). Out of 146 patients, 116 had depression and 27(18.5%) had severe depression. Patients with depression were younger (p=0.037) and lack of social support was significantly associated with depression (p=0.018). Severe depression was significantly more frequent among females (p=0.041). Serum albumin was significantly low among patients with depression (p=0.044). Conclusion: Depression is common among haemodialysis dependent end-stage renal disease patients. It is common among young patients and those who lack social support and it is associated with hypoalbuminemia.

#5906 THE PROGNOSTIC VALUE OF DIFFERENT HISTOPATHOLOGIC MODELS OF ANCA-ASSOCIATED VASCULITIDES: A PROSPECTIVE STUDY

Abstract Background and Aims Renal histology in ANCA-associated vasculitides-glomerulonephritis (AAV/GN) is characterized by active (inflammation, necrosis, crescents) and chronic lesions (sclerosis, fibrosis), and lately classified by Berden Classification (BC), ANCA renal risk (RRS) and Mayo Chronicity score (MCCS). We aimed to prospectively compare predictive ability of the three classification models in AVV. Method 27 AVV/GN patients, 17 females, were estimated at time of diagnosis (T0), based on renal biopsy, commenced on the same treatment protocol, cyclophosphamide+steroids, and followed for 6 months. BC, RRS and MCCS Classification models were initially applied on renal biopsies and results were correlated to renal function at T0, and accordingly, 3 (T3) and 6 (T6) months. Results Patients’ median age at presentation was 61.9(18-82) years, ratio of MPO/PR3/ANCA- was 17/7/3, eGFR was 19(19)mg/ml/1.73m2, and 11/27(40.7%) patients were hemodialysis-dependent (HD) at T0. Based to BC model, 5(18,5%), 9(33,3%), 8(29,7%), 5(18,5%) were classified as Focal, Crescentic, Mixed, Sclerotic, respectively, while according to RRS 7(26%), 10(37%), 10(37%) as Low, Medium, High, respectively and to MCCS 3(11%), 13(48%), 6(22%), 5(19%) as Minimal, Mild, Moderate, Severe, respectively. During follow up eGFR significantly increased from T0 towards T3 and T6, 19(19), 34(21), 38.5(26)mg/ml/1.73m2, respectively, p&amp;lt;0.0001. In RRS model, significant improvement was noticed in patients classified as low, eGFR from 37.5(55) vs. 57.5(39) vs. 57(22)mg/ml/1.73m2, p = 0.019) or medium risk group, 31(24) vs. 39(18) vs. 40(10)mg/ml/1.73m2, p = 0.047), at T0, T3, T6, respectively. In BC, a significant increase of eGFR was evident in sclerotic class, 18(9) vs. 32(17) vs. 38(21)mg/ml/1.73m2, respectively p = 0.05. RRS showed important results regarding HD dependence. At T0, from the 11 HD patients 1/3/7 were classified as low/medium/high risk, p = 0.04, the ratio changed to 0/1/5, respectively, p = 0.02 at T3 and 0/1/4, p = 0.04 at T6. No patient with low risk RRS remained on HD, while, 7/10 patients with high RRS, were still on HD at T6. BC and MCCS could not predict end stage renal function either at 3 or 6 months of follow up. Conclusion In the short term follow up, ANCA renal risk could better predict renal function outcome compared to Berden Classification and Mayo Chronicity Score, with high RRS frequently leading to HD. Instead, the sclerotic class in BC was not predictive of poor outcome.

Sewing a Silk Purse from a Sow’s Ear: Performance Goals for Thoracic Central Vein Obstruction

Objective Performance Goals Based on a Systematic Review and Meta-Analysis of Outcomes for Bare Metal Stents and Angioplasty for Hemodialysis-related Central Venous ObstructionJournal of Vascular and Interventional RadiologyPreviewTo use safety and efficacy outcomes following treatment with percutaneous transluminal angioplasty (PTA) and/or stent placement for thoracic central venous obstruction (TCVO) in hemodialysis-dependent patients to establish objective performance goals (OPGs). Full-Text PDF

Are We on the Right Track for HCV Micro-Elimination? HCV Management Practices in Dialysis Centers in Poland-A National Cross-Sectional Survey.

Chronic hepatitis C (CHC) is prevalent in the hemodialysis-dependent population. Currently, all patients with CHC should be considered for treatment; however, many hemodialysis-dependent patients are still left untreated. Following HCV cure, accurate surveillance is mandatory to reduce liver-related mortality and prevent reinfection. We aimed to establish HCV management practices and barriers to HCV elimination in dialysis centers in Poland. Polish dialysis centers were surveyed via email. The HCV management strategies were investigated. Representatives of 112 dialysis centers responded, representing 43.1% of all dialysis centers in Poland and 43.4% of hemodialysis-dependent patients' volume. Most respondents were Heads of hemodialysis centers and board-certified nephrologists. The study demonstrated that in the vast majority of hemodialysis centers (91.6%), subjects are considered for antiviral treatment (AVT); however, many obstacles preventing patients from being prescribed AVT were identified; patients' reluctance to undergo AVT was most reported (60%). The majority of dialysis units neither evaluate patients with CHC for liver fibrosis (60.4%) nor screen them for hepatocellular carcinoma (53.5%). In conclusion, the presented study demonstrates that HCV management practices across Polish dialysis centers vary substantially. There is a need to optimize and streamline the HCV management infrastructure in the hemodialysis population in Poland.

Factors Affecting On Dialysis Patients to Choose or Refuse Kidney Transplantation as Renal Replacement Therapy

Kidney transplantation (KT) is the most successful treatment for end-stage renal disease patients. But objective data about patients' willingness to undergo kidney transplant is still lacking in Pakistan. Objective: To assess barriers to KT and identify factors which could influence the willingness regarding KT among hemodialysis dependent patients. Methods: This cross-sectional study carried out at Dialysis Unit, Dept. of Urology and Kidney transplantation Lahore General Hospital, Lahore on 100 hemodialysis dependent patients by completion of structured questionnaire about their knowledge and attitudes toward KT and how satisfied they were with dialysis. Results: The mean age of the patients was 42.8 ± 10.6 years with 55% male and 45% female patients. The percentage of patients who were willing to get a kidney transplant was 60%. The main reason of unwillingness to undergo KT was lack of donor (83.3%). Motivating factors in patients to choose KT were vascular access constraints 75%, studies or work difficulties 70%, fluid and dietary restrictions account for 63.3%. The percentage of patients who wanted a deceased kidney for transplant was 50%, whereas the percentage of patients who preferred a living kidney for transplant was 25% (17 % relatives and 8% non-relatives) and 25% of patients had no preference. Conclusion: Willingness to get kidney transplant is relatively low in Pakistan. Lack of donor, fear of surgery and financial problems are the main barriers for KT in ESRD patient

Prevalence and Susceptibility of Staphylococcus aureus Nasal Carriage Strains Isolated from Haemodialysis Patients

Introduction: Staphylococcus aureus is part of the normal human flora that can commonly be found on the skin and mucous membranes of the nasal area. However, in immunosuppressed patients such as those with kidney failures, colonization can potentially lead to infection. There is a concern of increasing antibiotic resistance in S. aureus. This study aimed to determine the prevalence of S. aureus nasal colonization and its antimicrobial susceptibility among haemodialysis-dependent populations. Methods: A cross-sectional study at the Nephrology Unit, Hospital Canselori Tuanku Mukhriz (HCTM) was conducted among haemodialysis-dependent patients between February 2017 to February 2018. Nasal swabs were obtained and cultured on mannitol salt agar. S. aureus isolates were identified by gram staining, tube coagulase and Deoxyribonuclease (DNase). Cefoxitin disc (30 µg) were used to identified the presence of MRSA (methicillin-resistance S. aureus). The S. aureus colonies were further tested against six antibiotics using Kirby Bauer disc diffusion. Result: A total of 134 patients were recruited. S. aureus isolates were detected from 27 patients (20.1%). All S. aureus were phenotypically identified as methicillin-sensitive S. aureus (MSSA) based on the cefoxitin disc. Teicoplanin and linezolid were the most effective with 100% susceptibility. S. aureus exhibited a high resistance rate towards erythromycin (29.6%). No MRSA was isolated in this study. Conclusion: This study highlighted the high prevalence of S. aureus nasal colonization in haemodialysis patients. Teicoplanin and linezolid were found to be the most effective antibiotics against isolated S. aureus.

Serum Free T4/Free T3 Ratio as a Predictor of Subclinical Hypothyroidism in Non- Hemodialysis Dependent Chronic Kidney Disease Patients

Serum Free T4/Free T3 Ratio as a Predictor of Subclinical Hypothyroidism in Non- Hemodialysis Dependent Chronic Kidney Disease Patients

Risk assessment of vasoplegic syndrome after cardiac surgery in chronic hemodialysis-dependent patients: a single-center retrospective study

【目的】維持透析患者の心臓手術における血管麻痺症候群（vasoplegic syndrome, VPS）の発症率とリスク因子を検討すること。【方法】2013年4月1日から2020年1月31日までに定期開心術を受けた維持透析患者106例を対象とし，後方視的にVPSの発症率を調査するとともに，過去の報告でVPSの発症と関連があると報告された，①糖尿病，②駆出率（ejection fraction, EF）40％未満，③透析歴，④β遮断薬の内服，の4つの因子において，VPS発症の独立因子を決定する多重ロジスティック回帰分析を実行した。【結果】106例のうち，5例をデータ不足のため除外した。5例を除いた101例のうち，39例（39%）がVPSを発症した。VPSと独立した関連を認めた因子はEF 40％未満であった。【結論】透析患者におけるVPSの発症率は39％であり，中でもEF 40％未満の患者群は独立したVPSの発症リスク群であることが示唆された。特に心機能低下例において，心臓手術を行う場合，VPSの発症を念頭に周術期管理を行う必要があると考えられた。

Outcomes of Infrapopliteal Bypass for Chronic Limb-Threatening Ischemia are Worse in Renal Transplant Patients than in Hemodialysis-Dependent Patients

Comparisons of distal bypass outcomes between hemodialysis-dependent (HD) and renal transplant (RT) patients have been reported, but the influences of immunosuppressive therapy on the outcomes remain unclear because of the limited number of RT patients who underwent distal bypass or cohort heterogenicity. We compared outcomes of distal bypass for chronic limb-threatening ischemia (CLTI) with homogenous ischemic limb pathology. Between January 2014 and December 2019, we performed 334 infrapopliteal bypass procedures using vein grafts for 275 consecutive CLTI patients with tissue loss. Among them, there were 130 HD patients (47.3%) (163 limbs) and 11 RT patients (4%) (15 limbs), and 30-day mortality, 5-year primary and secondary patency (PP and SP), limb salvage (LS), amputation-free survival rates, and wound healing (WH) status were compared between the HD and RT patient groups. Nine HD patients died within 30days after surgery (7%), whereas no deaths were observed among the RT patients. Five-year PP and SP rates in the RT group 39% and 41%, which were significantly worse compared to 64% and 82% in the HD group (P<0.01). Unsuccessful rate of revision surgery including hemodynamically failed grafts after revision reached over 80% in the RT group, which was technically unfeasible pathology for graft salvage (vs. 3% in the HD group), and WH, and LS rates were significantly worse in the RT group. In comparison with HD patients, RT patients showed a lower LS rate for CLTI. The lower LS rate was associated with a lower SP rate, which was caused by disease progression of distal arteries in the foot.

Prevalence of Depression and Anxiety in Chronic Kidney Disease Patients on Hemodialysis

Introduction: Depression and anxiety disorders are common among hemodialysis (HD) dependent chronic kidney disease (CKD) patients. This study determined the prevalence of depression and anxiety in HD-dependent CKD patients. Methods: 146 HD-dependent patients were selected from the dialysis unit, between 20 and 60 years of age. CKD patients not on hemodialysis were excluded from the study. Depression and anxiety were assessed using the hospital anxiety and depression scale (HADS) questionnaire. Patients’ demographic data such as gender, age, and socioeconomic status were recorded. The socioeconomic status was defined as lower class; patients having a monthly income of 5000 to 12000 PKR, middle class; patients having a monthly income of 12000 to 30000 PKR, and upper middle class; patients having a monthly income of &gt; 30000 PKR. Results: A total of 146 CKD patients were enrolled. The mean age was 39.67±12.42 years. There were 82 (56.2%) males and 64 (43.8%) females in our study. The frequency of depression and anxiety in CKD patients in our study was 32.2% and 19.2%, respectively.. The frequency of depression and anxiety in CKD patients in our study was 32.2% and 19.2%, respectively. Depression and anxiety were stratified among age, gender, and socioeconomic status, and the association was statistically significant (P &lt; 0.05). Practical implications: After this research we can easily find the anxiety and depression factor among HD dependent CKD patients. Conclusion: Depression and anxiety are common disorders among HD-dependent CKD patients. Anxiety and depression were observed in 19.2% and 32.2 % of the CKD patients in our study. Keywords: Depression, Anxiety, Hemodialysis, Chronic Kidney Disease, Prevalence, Mortality.

Urinary tract infections in hemodialysis patients—The controversy of antimicrobial drug urine concentrations

Major infectious diseases societies recommend the use of antimicrobials that achieve high-urinary concentrations to treat urinary tract infection (UTI), which is a concept of little relevance to the oliguric and anuric hemodialysis (HD) dependent population. Outcome studies in this population are more relevant, but unfortunately scarce. We sought to investigate the impact of different antimicrobials on clinical and microbiologic outcomes in HD dependent population. A retrospective observational study conducted at our quaternary care hospital between May 2015 and December 2019. We included all HD dependent adults diagnosed with UTIs. Our primary end points were clinical and microbiologic cure. Our secondary end points were 90-day recurrence and mortality. Fifty-six patients were included in the study with 33 (58.9%) females, mean age of 69.9± 11.6 years, and mean body mass index of 27.7± 7.8kg/m2 . Thirty-six subjects of the sample (64.3%) were anuric. Ninety-one percent of the patients achieved clinical cure. Out of those who had repeat cultures, 90.7% achieved microbiologic cure. Clinical and microbiologic cure rates were not significantly different between the oliguric and anuric groups. The 90-day recurrence rate was 11.1% and mortality was 19%, none of them was related to UTI. Our findings demonstrate high rate of clinical and microbiologic cure in the treatment of oliguric and anuric HD dependent patients. We suggest that drug development and treatment societies to consider clinical and microbiologic outcomes in conjunction with achievable urinary concentration when making recommendations for the treatment of UTI.

Raw oyster consumption causing vibrio vulnificus bacteremia in ESRD patient

Vibrio is gram negative bacteria found in warm salty water [1]. Vibrio vulnificus is one of the most common species causing vibriosis in the United States [2]. It is associated with primary sepsis, skin infections as well as gastrointestinal tract infection. Here we present a case of Vibrio vulnificus bacteremia in a hemodialysis dependent ESRD patient [3], with h/o treated colon carcinoma, and liver cirrhosis presenting as bilateral leg edema rapidly escalating to septic shock.

Protocol for a qualitative study exploring haemodialysis dependent patients’ arteriovenous fistula experience, values and concerns in Sydney, Australia

IntroductionThe experiences of patients from culturally and linguistically diverse backgrounds, with chronic mental illness, disabilities or who identify as sexual or religious minorities are under-represented in clinical research on arteriovenous...

Reverse Epidemiology for Lipid Disorders in Hemodialysis-Dependent Patients: Role of Dilutional Hypolipidemia.

Introduction:Atherosclerotic cardiovascular disease is a major cause of mortality and morbidity in dialysis patients. Compared to general population, dialysis patients have lower lipid levels and higher vascular events. This paradox is popularly known as reverse epidemiology. Present study is an attempt to understand reasons for low lipids in dialysis patients.Subjects and Methods:This was a prospective observational multicentric study involving three stages across six dialysis units with Care Hospitals, Hyderabad. Maintenance hemodialysis patients were studied with fasting lipid profiles [TC, LDL-c, HDL-c, and TG], pre- and post-dialysis blood lipids and effluent water lipid profiles. Other parameters studied were use of statins, interdialytic weight gain, and ultrafiltration. All patients had uniform dialysis protocols regarding filter used and dialysis duration.Results:Of the 91 patients studied, we observed significant rise in post-dialysis TC, LDL, and HDL [P < 0.01] and lower lipids [P < 0.01] just before the next dialysis. Lipids were least filtered across the membrane except HDL, which was found in effluent water for more than 60% of patients. Single use of dialyser was associated with higher rise in post dialysis lipids as well as HDL getting filtered in effluent [P = 0.24]. Rosuvastatin was associated with lower lipid values [P = 0.08] and BMI [P = 0.19].Conclusions:Low lipid levels in dialysis patients are due to dilutional hypolipidemia and needs correction with an equation proposed in present study. Corrected lipids should be used for risk stratification and deploying treatment.

Postoperative Complications and Survival Rate in Hemodialysis-Dependent Patients Undergoing Cervical Spine Surgery.

Introduction Spine surgery is challenging in hemodialysis (HD)-dependent patients owing to their poor general condition. However, postoperative complications and the mortality and survival rates have not been specifically evaluated in a wide series. This study aimed to elucidate postoperative complications and the survival rate in cervical spine surgery in HD patients. Methods This study included 109 HD patients (70 men, 39 women) who had undergone cervical spine surgery between July 1996 and May 2018. Based on radiological diagnosis, we divided them into the destructive spondyloarthropathy (DSA) and non-DSA groups. We investigated the causes of hemodialysis, postoperative complications, postoperative inpatient mortality rate, and survival rate. Results The DSA and non-DSA groups included 100 surgeries in 89 patients and 21 surgeries in 20 patients, respectively. The mean age at surgery was 62.9 years for the DSA and 55.9 years for the non-DSA group (P=0.97). The DSA group had a shorter hemodialysis period at surgery compared with the non-DSA group (21.7 vs. 26.5 years, P<0.05). The two most common causes of HD in both groups were chronic glomerulonephritis (DSA, 45%; non-DSA, 57.1%) and diabetes (DSA, 11%; non-DSA, 14.5%). Postoperative complications were observed in 23% (23/100) and 19% (4/21) of surgeries in the DSA and non-DSA groups, respectively (P=0.782). The total in-hospital mortality rate was 2.5% (3/121). The 1-, 3-, 5-, and 10-year postoperative survival rates of all patients were 89.6%, 75.5%, 67.1%, and 44.7%, respectively. The survival rates did not depend on the group (DSA vs. non-DSA), pre- and postoperative Japanese Orthopedic Association score for cervical myelopathy, hemodialysis period, sex, and age (P>0.05). However, significantly low survival rates were observed in HD caused by diabetes compared with that by chronic glomerulonephritis (P<0.001) and other causes (P<0.001). Conclusions Cervical spine surgery in HD patients is associated with postoperative complications. The postoperative survival rate was found to be low if the cause of hemodialysis was diabetes.