Hospitalization In Hemodialysis Patients Research Articles

National Estimates of Direct Health Care Costs Associated with Catheter-Related Bloodstream Infection among Hospitalized Hemodialysis Patients in Australia

National Estimates of Direct Health Care Costs Associated with Catheter-Related Bloodstream Infection among Hospitalized Hemodialysis Patients in Australia

#1874 Comparative analysis of rehabilitation outcomes in hospitalized hemodialysis vs. non-hemodialysis patients: a retrospective cohort study

Abstract Background and Aims The hospitalization rate of patients undergoing hemodialysis (HD) is high, due to complications related to renal failure and hemodialysis treatment. Therefore, it is crucial to provide rehabilitation for hospitalized HD patients to improve their activities of daily living (ADL) and physical functions, so as to enable them to be discharged home, resume outpatient dialysis, and avoid re-hospitalization. However, the effectiveness of rehabilitation to improve the ADL and physical functions may differ between hospitalized patients undergoing HD (HD patients) and hospitalized patients not undergoing HD (non-HD patients), depending on their pathological conditions and influence of the HD treatment. The aim of the present study was to compare the outcomes of rehabilitation between hospitalized HD patients and non-HD patients. Method This was a retrospective cohort study. The inclusion criteria were hospitalized patients who received rehabilitation between April 2017 and February 2023. The exclusion criteria were patients who discontinued rehabilitation, were transferred to other hospitals, or died during the rehabilitation period. Rehabilitation consisted of physical therapy and/or occupational therapy provided six times a week, for both hospitalized HD and non-HD patients. The rehabilitation program comprised balance training, aerobic exercises, resistance training, and ADL training to prepare the patients for discharge to their homes. We measured several outcomes in the study, including the daily duration of rehabilitation (min/day), length of hospital stay (days), Barthel index (BI), as the ADL index, at the time of admission and discharge, grip strength and isometric knee extension strength (IKES) as muscle strength indices, and the 10-meter walking speed, timed up and go test (TUG), and short physical performance battery (SPPB) as mobility function indices. For the statistical analysis, missing values were completed by using multiple imputation methods. The inverse probability weighting (IPTW) method was used to match the HD group and non-HD group to adjust for confounding factors. The outcomes between the groups were then compared using a generalized linear model analysis. All procedures in the present study were conducted with the approval of the ethics committee of Seirei Christopher University. Results Of 1002 patients who were registered for the study, 100 patients who discontinued rehabilitation, were transferred to other hospitals, or died were excluded, and the data of the remaining 902 patients (765 of the non-HD group and 137 of the HD group) were included in the analysis in this study. The results of the generalized linear model analysis revealed a lower daily duration of rehabilitation [43.3(0.6) vs. 38.8(1.2) min/day, p=0.0003] and longer length of hospital stay [48.5(0.5) vs. 58.1(2.3) days, p=0.0108] in the HD group. In addition, the 10-meter walking speed [0.75(0.02) vs. 0.66(0.03) m/s, p=0.003] and scores on the TUG [20.8(0.7) vs. 24.3(1.0) sec, p=0.0021] and SPPB [6.3(4.57) vs. 4.7(0.6) points, p=0.0415] at discharge were also significantly lower in the HD group as compared with the non-HD group. There was no difference in the ability for ADL or muscle strength at discharge between the two groups. Conclusion This study was the first to demonstrate a lower daily duration of rehabilitation and longer hospital stay in hospitalized HD patients. Furthermore, rehabilitation had a lower impact on the mobility indices in HD patients as compared with non-HD patients. Although there was no difference in the ability for ADL or muscle strength at discharge between the two groups, HD patients exhibited a significantly lower ability for mobility functions, including a lower gait speed and lower scores on the TUG, and SPPB assessments. Therefore, rehabilitation efforts in HD patients need to be improved by securing more time for inpatient rehabilitation and promoting mobility function improvement.

Ankle-brachial index associates with arteriovenous fistula stenosis.

Arteriovenous fistula (AVF) stenosis is associated with pre-existing arterial atherosclerosis of AVF and results in significant morbidity and hospitalization for hemodialysis patients. The ankle brachial index (ABI) is a noninvasive method of assessing atherosclerosis. This study was to examine whether ABI is a significant predictor for AVF stenosis. This was a retrospective, longitudinal cohort study. Patients with hemodialysis between 1 January 2016 and 31 December 2022 were reviewed. ABI was assessed in January 2016. AVF stenosis was diagnosed by fistulography. A total of 82 patients were included. Forty-two patients experienced AVF stenosis. The univariate logistic regression analysis showed that AVF stenosis was associated with age (OR: 1.045, p = 0.033), DM status (OR: 5.529, p = 0.013), 7-year averaged cholesterol level (OR: 1.018, p = 0.034), 7-year averaged triglyceride level (OR: 1.007, p = 0.017), and ABI (OR: 0.011, p < 0.001). In multivariate logistic regression analysis, ABI was a strong predictor for AVF stenosis (OR: 0.036, p = 0.023). Then, a cut-off point of ABI with optimal sensitivity and specificity for AVF stenosis was 1.01. An analysis of time to events with adjustment for other variables showed that patients with ABI < 1.01 were significantly associated with AVF stenosis (HR: 3.859, p < 0.001). ABI below 1.01 was associated with AVF stenosis. This finding may be useful in tailoring surveillance programs for monitoring AVF function.

Economic assessment of hemodialysis patients in tertiary and charitable hospitals: A prospective multicenter study in India

End-stage renal disease (ESRD) is becoming more common in India, and the treatment options for ESRD are, e.g., hemodialysis (HD) or kidney transplantation. In the current situation, many individuals can only afford HD. More research is needed to estimate the exact cost of HD because it varies across the country. The study aims to investigate the cost of HD in a tertiary and charitable hospital in South India. A multicentric prospective observational study was conducted in tertiary care hospitals. The study included patients who are on HD regularly at these hospitals. Patients’ data and cost information were collected for 1 year. Overall cost evaluation of HD patients was done. Cost categories were calculated based on their cost of HD per session, monthly expense, and cost per annum. This includes HD cost per session, ward cost, consultation physician cost, overall medication cost, laboratory cost, the cost for blood transfusion, transportation cost, accompanying person’s cost, and food costs. More studies on costs and outcomes are required to examine the benefits and drawbacks of renal replacement treatment and improve the quality of life of ESRD patients. As the treatment costs are higher, the government can develop schemes that provide insurance or compensation to needy people.

Factors Affecting Sleep Pattern Disturbance for Hemodialysis Patients in Port Said Hospitals

Factors Affecting Sleep Pattern Disturbance for Hemodialysis Patients in Port Said Hospitals

Lung Ultrasound, Bioimpedance Spectroscopy, and Physical Examination for Volume Assessment in Hospitalized Hemodialysis Patients: A Diagnostic Test Study

Lung Ultrasound, Bioimpedance Spectroscopy, and Physical Examination for Volume Assessment in Hospitalized Hemodialysis Patients: A Diagnostic Test Study

Improving Medication Errors in Hospitalized Hemodialysis Patients

Improving Medication Errors in Hospitalized Hemodialysis Patients

The Effect of Sleep Hygiene Education on Sleep Quality, Depression, and Fatigue of Hemodialysis Patients

Background: One of the conservative treatment methods for patients with end-stage renal failure is hemodialysis. Although hemodialysis contributes to patients’ lives, it has adverse emotional and psychological effects, including sleep problems, fatigue, and depression. Objectives: The present study aimed to examine the effect of sleep hygiene education on sleep quality, depression, and fatigue among hemodialysis patients admitted to hospitals affiliated with Zahedan University of Medical Sciences in 2021. Methods: This quasi-experimental study was conducted on 80 hemodialysis patients in Khatam Al-Anbia and Ali Ibne Abi Talib hospitals affiliated with Zahedan University of Medical Sciences in 2021. The participants were selected through convenience sampling and randomly assigned to intervention and control groups using permuted block randomization. The data were collected using a demographic information form, Pittsburgh sleep quality index (PSQI), Multidimensional Fatigue Inventory (MFI), and Beck Depression Inventory-II (BDI-II). The patients in the control group received routine care, and the patients in the intervention group attended a sleep hygiene education program in three consecutive face-to-face dialysis sessions using educational pamphlets for 40 to 60 minutes, depending on the patient’s tolerance. Two months after the training program, the quality of sleep, fatigue, and depression were measured for patients in both groups. The patients’ data were analyzed with SPSS software (version 25) using the paired samples t-test, independent samples t-test, chi-square test, and analysis of covariance (ANCOVA) at a significant level of 0.05 (P &lt; 0.05). Results: The mean scores of sleep quality for the patients in the intervention and control groups changed from 12.05 ± 2.18 to 10.85 ± 2.00 and from 10.28 ± 1.85 to 10.45 ± 1.85, respectively, and the paired samples t-test showed significant differences in both groups before and after the intervention, but the sleep quality scores increased for the patients in the intervention group (P = 0.001). Moreover, the mean fatigue scores for the patients in the intervention and control groups changed from 57.98 ± 13.48 to 52.25 ± 13.23 and from 48.88 ± 8.97 to 52.20 ± 8.80, respectively. The paired samples t-test showed significant differences in both groups before and after the intervention, but fatigue scores increased for the control group (P = 0.001). The data also indicated that the mean depression scores for the patients in the intervention and control groups changed from 24.20 ± 6.26 to 22.28 ± 5.26 and from 25.18 ± 7.70 to 25.68 ± 7.54, respectively. The independent samples t-test showed significant differences in both groups before and after the intervention (P = 0.001). By controlling the pre-test effect, the analysis of covariance (ANCOVA) revealed significant differences in the mean scores of sleep quality (P = 0.001), fatigue (P = 0.001), and depression (P = 0.001) in hemodialysis patients in both intervention and control groups after two months. Conclusions: The study’s findings indicated that sleep hygiene education significantly improves sleep quality, depression, and fatigue in hemodialysis patients. Given that sleep hygiene education is a simple and easy-to-use method, sleep hygiene training courses need to be organized and held for dialysis patients.

#6864 IMMUNE RESPONSES OF PATIENTS ON MAINTENANCE HEMODIALYSIS AFTER INFECTION BY SARS-COV-2: A PROSPECTIVE OBSERVATIONAL COHORT STUDY

Abstract Background and Aims We aimed to study the immune response of maintenance hemodialysis (HD) patients to Corona Virus Disease-19 (COVID-19) since it is not fully elucidated. Method In this prospective study, hospitalized HD patients with moderate-to-severe COVID-19 and matched non diseased HD comparators were analyzed for their absolute counts of lymphoid cells (flow cytometry) and circulating inflammatory mediators (ELISA). Blood samples were collected at the start and at of the end of the first in hospital HD session; dialysate samples at the end of the first half hour session. Results 59 HD patients with acute COVID-19 HD and 20 comparators were enrolled. Circulating median (range) of interferon-gamma (IFNγ) at the start of HD was 125 (125-1777) pg/ml in comparators and 810 (125-4000) pg/ml in SARS-CoV-2 (p&amp;lt;0.00001) and 125 (125-1278) pg/ml and 738 (125-4000) pg/ml at the end of HD (p&amp;lt;0.0001). Respective concentrations of platelet derived growth factor-A were 8286 (4600-28150) and 27938 (8285-99256) pg/ml (p&amp;lt;0.0001) and 7779 (5055-28128) and 27410 (6836-87887) pg/ml respectively. Similar increases were found for tumor necrosis factor-alpha (TNFα) only at the start of the HD whereas no differences were found for interleukin (IL)-6, IL-10 and IL-38. Respective mean (SD) CD4-counts were 881.3 (407.6) and 461.6 (365.4) per microliter (p&amp;lt;0.0001) and 839.4 (509.7) and 483.6 (329.9) per microliter (p&amp;lt;0.0001). Respective mean (SD) CD19-counts were 199.0 (154.5) and 76.4 (78.6) per microliter (p&amp;lt;0.0001) and 144.9 (110.3) and 98.3 (70.8) per microliter (p&amp;lt;0.0001). The respective mean (SD) MFI expression of HLA-DR on CD14-monocytes was 97.2 (28.2) and 67.4 (44.7) (p: 0.013) and 87.3 (26.7) and 63.3 (36.3) (p: 0.009). MFI of HLA-DR on CD14-monocytes before the first HD session less than 44 was associated with 100% sensitivity for unfavorable outcome (defined as respiratory failure or death) after 28 days. An absolute CD19-count more than 40 per microliter before the first HD session was associated with 8.70 odds ratio for cure favorable outcome after 28 days. Conclusion HD patients develop an inflammatory reaction to Severe Acute Respiratory Syndrome Coronavirus 2 characterized by increase of the inflammatory mediators IFN-γ, PDGF-A and TNF-a and decrease of circulating T helper lymphocytes. Decreased expression of HLA-DR on CD14-monocytes is a hallmark of unfavorable prognosis.

Clinical Characteristics of Hemodialysis Patients with COVID-19 Referred to Hemodialysis Centers Affiliated with the Shahrekord University of Medical Sciences Between 2020 and 2021

Background: The coronavirus pandemic (COVID-19) seriously threatens the health and life of people with underlying diseases, such as patients undergoing hemodialysis. Objectives: This study aimed to determine the clinical characteristics of COVID-19 patients with chronic kidney disease undergoing hemodialysis referring to hemodialysis centers affiliated with the Shahrekord University of Medical Sciences between 2019 and 2021. Methods: This was a retrospective descriptive-analytical study with a sample size of 144 hemodialysis patients with COVID-19. The data were collected by a demographic questionnaire, a checklist based on the presence of underlying diseases, the cause of the kidney failure, drugs received during hemodialysis, medications used for COVID, the result of COVID-19 treatment, and outpatient or inpatient treatment, and the checklist of laboratory indices extracted from the patient’s medical records. Data were analyzed by SPSS version 20 and descriptive and analytical statistical tests. Results: The average age was 57.2 ± 14.42 years, and 64.6% were men, 35.4% were women, 64.6% recovered, and 35.4% died, although 42.4% of patients were treated on an outpatient basis, and 57.6% needed hospitalization. Also, 93.7% of patients were vaccinated. The average duration of hemodialysis treatment was 6.44 years, and diabetes accounted for 31.1% of the causes of kidney failure, and these people had a higher chance of mortality. Positive c-reactive protein (CRP) results were found in 72.2% of patients, and 54.2% had a positive erythrocyte sedimentation rate (ESR). In addition, 22.2% of patients used mechanical ventilation, and 88.2% had positive PCR results. Iron, ferritin, albumin, and hemoglobin index were lower than normal in all patients. Patients with positive hepatitis B antigens were treated with sofosbuvir. In outpatient treatment, 65.6% used remdesivir, and 70.5% used dexamethasone. Regarding inpatient treatment, 75.9% used methylprednisolone, 56.6% used tocilizumab, and 54.2% used pirfenidone. Conclusions: The rate of death and hospitalization in hemodialysis patients with COVID-19 was higher than that of normal people. Diabetes increases the chance of morbidity and mortality of COVID-19 in hemodialysis patients. The reduction of hemoglobin, iron, ferritin, and albumin weakened the therapeutic response of hemodialysis patients to COVID-19 and increased the chance of death. Although various drugs were used in the treatment of COVID-19 hemodialysis patients, the patients did not follow a single regimen.

COVID-19: Clinical Course and Outcome of hospitalized Hemodialysis Patients: Single-center Experience.

There is a paucity of data regarding the consequences of coronavirus disease 2019 (COVID-19) infection in patients with maintenance hemodialysis (MHD). Our objective was to identify the clinical manifestations and prognostic factors and to assess the impact of treatment schemes on the outcomeMaterials and methods: Here we present retrospectively collected data from medical records of patients on MHD hospitalized with COVID-19 infection from 1st June to 30th November 2020Result: Around 69 patients were admitted with a median age of 51 years. About 81% had hypertension, 41% had diabetes, and 24% had body mass index (BMI) ≥ 23 kg/m2 . Of all who died, 73.33% had dialysis vintage of &lt;12 months (p = 0.06). Common presenting symptoms were fatigue (67%), fever (58%), cough (42%), and dyspnea (35%). Milder, severe, and critical disease was found in 35, 45, and 20% of patients, respectively. About 54 patients were living 4 weeks after discharge. Around 15 patients died, that includes all who received invasive ventilatory support. Nonsurvivors were older and had lower oxygen saturation on admission, lower hemoglobin (Hb), and worst lactate dehydrogenase (LDH), interleukin (IL)-6, and D-dimer values than survivors, which were statistically significant. Use of remdesivir and anticoagulant improves chances of survival (p-value 0.035 and 0.034, respectively) Conclusion: About one-third of patients had mild disease. Those with critical disease displayed high mortality. Older age, male gender, short dialysis vintage, lower oxygen saturation on admission, anemia, leucocytosis, higher inflammatory markers [except C-reactive protein (CRP)], bilateral lung opacity, and requirement of the mechanical ventilator are poor prognostic factors. CRP, ferritin, and lymphopenia are not good prognostic markers unlike in the general population. These findings need to be verified in larger cohorts.

The predictive markers of severity and mortality in hospitalized hemodialysis patients with COVID-19 during Omicron epidemic.

Predictive markers and prognosis remain unclear in hospitalized hemodialysis (HD) patients with coronavirus disease 2019 (COVID-19) during the Omicron epidemic. We evaluated characteristics, laboratory parameters, and outcomes in hospitalized HD patients with COVID-19 (n=102) at two centers between January and April 2022. The 30-day mortality rate was higher in moderate-critical group (n=43) than mild group (n=59) (16.3% vs. 1.7%; p=0.007), and higher in patients with lower CC chemokine ligand 17 (CCL17) levels (<95.0pg/mL) compared with normal CCL17 levels (19.0% versus 4.9%; p=0.03). In multivariate analyses, a low CCL17 level (p=0.003) was associated with moderate-critical conditions, and moderate-critical conditions (p=0.04) were associated with 30-day mortality, whereas CCL17 was not associated with 30-day mortality. COVID-19 remains a fatal complication, and CCL17 was a predictive marker of severity in hospitalized HD patients during the Omicron epidemic.

Clinical characteristics and short-term mortality of 102 hospitalized hemodialysis patients infected with SARS-CoV-2 omicron BA.2.2.1 variant in Shanghai, China

BackgroundThe aim of this study was to analyze clinical features and short-term mortality in hemodialysis (HD) patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) omicron BA.2.2.1 variant. MethodsIn a retrospective single-center case series, 102 consecutive hospitalized HD patients infected with the coronavirus omicron variant were assessed at Pudong Hospital in Shanghai, China, from April 6 to April 18, 2022; the final date of follow-up was May 16, 2022. Clinical, laboratory, chest CT, and treatment data were collected and analyzed. The association between these factors and all-cause mortality was studied using univariate and multivariate analyses. The relationship between lymphocyte count and short-term mortality was based on receiver operating characteristic (ROC) curve analysis. Kaplan–Meier analysis was used to assess overall survival. ResultsIn total, 102 patients were included in this study. The patients were divided into two groups: HD patients with pneumonia (N = 46) and without pneumonia (N = 56). Of the 102 patients, 12 (11.8%) died. Multivariate regression analysis revealed that all-cause mortality was correlated with lymphocyte counts and type B natriuretic peptide (BNP), C-reactive protein (CRP), and D-dimer levels (P < 0.05). The cut-off value of lymphocyte counts was 0.61 × 109/L for all-cause mortality. The overall survival rate was significantly different between HD patients with and without pneumonia (P < 0.05). ConclusionsLymphocyte counts are important for the prediction of short-term mortality in HD patients with SARS-CoV-2 infection. HD patients with lung involvement have poorer survival rates than those without lung involvement.

SARC-F is a Weaker Predictor Compared to Muscle Strength and a Stronger Predictor Compared to Muscle Mass for Mortality and Hospitalization in Hemodialysis Patients

SARC-F is a Weaker Predictor Compared to Muscle Strength and a Stronger Predictor Compared to Muscle Mass for Mortality and Hospitalization in Hemodialysis Patients

Temporal Changes in Electrolytes, Acid-Base, QTc Duration, and Point-of-Care Ultrasound during Inpatient Hemodialysis Sessions.

Of the more than 550,000 patients receiving maintenance hemodialysis (HD) in the United States, each has an average of 1.6 admissions annually (>880,000 inpatient HD sessions). Little is known about the temporal changes in laboratory values, ECGs, and intravascular and extravascular volume during inpatient HD sessions. In this prospective cohort study of hospitalized HD patients, we assessed intradialytic laboratory values (metabolic panels, blood gases, ionized calcium levels), ECGs, and sonographic measures of volume status. Among 30 participants undergoing HD (mean age 62 years; 53% men, 43% Black) laboratory values had the largest changes in the first hour of HD. There was no significant change in ionized calcium levels pre- to post-HD (change: -0.01±0.07, P=0.24); 12 of 30 and 17 of 30 patients had levels below the lower reference limit at the beginning and end of HD, respectively. The mean pH increased pre- to post-HD (change: 0.06±0.04, P<0.001); 21 of 30 had a pH above the upper reference limit post-HD. There was a trend toward longer median QTc duration from pre- to post-HD (change: 7.5 msec [-5 msec, 19 msec], P=0.07). The sum of B lines on lung ultrasound decreased from pre- to post-HD (median decrease: 3 [1, 7], P<0.01). The collapsibility index of the inferior vena cava increased pre- to post-HD (median increase: 4.8% [1.5%, 13.4%], P=0.01), whereas internal jugular vein diameter did not change (P=0.24). Among hospitalized patients undergoing HD, we found dynamic changes in laboratory values, QTc duration, and volume status. Further research is required to assess whether HD prescriptions can be tailored to alter these variations to potentially improve patient outcomes.

The efficacy and safety of niacin on hyperphosphatemia in ESRD patients undergoing hemodialysis: randomized controlled trial

BackgroundHyperphosphatemia is a common complication of end-stage renal disease (ESRD) and particularly affects hemodialysis (HD) patients. Elevated serum phosphorus contributes to the development of secondary hyperparathyroidism, chronic kidney disease–mineral bone disorder (CKD-MBD), metastatic calcifications and calcific uremic arteriolopathy. There is a significant association between hyperphosphatemia and increased morbidity and mortality in ESRD patients including cardiovascular morbidity and mortality, and it is also associated with prolonged hospitalization of HD patients. This study aim to evaluate the serum phosphorus lowering effect of niacin in HD patients.ResultsThere was a decrease in phosphate values during the first 3 months of the study in the niacin group, with a significant change in phosphate level at the third month (5.90 ± 0.52 vs. 6.42 ± 0.65 (mEq/l); P < 0.001) and at the sixth month (5.12 ± 0.41 vs. 5.76 ± 0.47 (mEq/l); P < 0.001) compared to the control group. It was noted that both groups had an insignificant difference regarding baseline parathormone (PTH), though the PTH showed a significantly lower level at the third month (192.39 ± 78.85 vs. 388.27 ± 263.10 pg/ml; P < 0.001) and at the sixth month (127.56 ± 90.87 vs. 249.85 ± 97.69 pg/ml; P < 0.001) in the niacin group.ConclusionNiacin caused a statistically significant decrease in levels of phosphate and PTH in dialysis patients.Trial registrationRegistered at ClinicalTrials.gov NCT03163576. Trial registration date: 22 May 2017. Date of first patient’s enrolment: 1 October 2018. Date of the ethical committee approval: 29 March 2017. Number of the ethical committee approval: 17100040.

Effects of intravenous iron therapy on mortality and hospitalization of hemodialysis patients: Aprospective cohort study in Korea.

Iron replacement therapy is necessary for anemia treatment in patients with advanced chronic kidney disease. Intravenous (IV) iron therapy is an efficient method for iron replacement. However, there are concerns regarding its considerable side effects, including increased risks of infection or major adverse cardiovascular events (MACE). This is a longitudinal study from a multicenter prospective cohort study conducted in the Korean end-stage renal disease population. All-cause mortality, death due to infection or MACE, hospitalization due to infection or MACE, and all adverse event of death or hospitalization due to infection or MACE were compared according to the iron replacement methods during the first 3 months of enrollment. Among 1,680 hemodialysis patients, 29.3% of patients received IV iron therapy, and 38% of patients received oral iron therapy. During the median 632 days follow-up, all-cause mortality, mortality or hospitalization due to infection or MACE, and all adverse events did not differ among iron replacement groups. There were significant differences related to the risk of all adverse events among iron replacement therapies in the log-rank test and univariate Cox regression analysis only in the prevalent dialysis patients; however, the significance was lost in multivariate Cox regression analysis. Similar results were observed in the 1-year short-term outcome analysis. High-dose IV iron did not increase adverse outcomes. All-cause mortality or all adverse events due to infection or MACE were not higher with the current clinical regimen of IV iron replacement therapy than with oral or no iron therapy in Korean hemodialysis patients.

Predictors of Mortality in Hemodialyzed Patients after SARS-CoV-2 Infection.

Introduction: The determinants of COVID-19 mortality are well-characterized in the general population. Less numerous and inconsistent data are among the maintenance hemodialysis (HD) patients, who are the population most at risk of an unfavorable prognosis. Methods: In this retrospective cohort study we included all adult HD patients from the Pomeranian Voivodeship, Poland, with laboratory-confirmed SARS-CoV-2 infection hospitalized between 6 October 2020 and 28 February 2021, both those who survived, and also those who died. Demographic, clinical, treatment, and laboratory data on admission, were extracted from the electronic medical records of the dedicated hospital and patients’ dialysis unit, and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with 3-month all-cause mortality. Results: The 133 patients (53.38% males) aged 73.0 (67–79) years, with a median duration of hemodialysis of 42.0 (17–86) months, were included in this study. At diagnosis, the majority were considered to have a mild course (34 of 133 patients were asymptomatic, another 63 subjects presented mild symptoms), while 36 (27.07%) patients had low blood oxygen saturation and required oxygen supplementation. Three-month mortality was 39.08% including an in-hospital case fatality rate of 33.08%. Multivariable logistic regression showed that the frailty clinical index of 4 or greater (OR 8.36, 95%CI 1.81–38.6; p < 0.01), D-Dimer of 1500 ng/mL or greater (6.00, 1.94–18.53; p < 0.01), and CRP of >118 mg/L at admission (3.77 1.09–13.01; p = 0.04) were found to be predictive of mortality. Conclusion: Very high 3-month all-cause mortality in hospitalized HD patients was determined mainly by frailty. High CRP and D-dimer levels upon admission further confer mortality risk.

Causes and Risk Factors of Hemodialysis Catheter Infection in Dialysis Patients: A Prospective Study

Objectives: Infectious central venous catheter (CVC) complications, including mortality and care and hospitalization costs, are still a major clinical concern. This study aimed to determine the prevalence of hemodialysis catheter infection and its risk factors among hemodialysis patients. Methods: The present research was a descriptive, prospective cross-sectional study on hemodialysis patients in Babol hospitals during 2020 - 21. The participants' demographic information and some relevant data on clinical variables (namely underlying diseases, cause of dialysis, and cause of catheter removal) and catheter-related variables (namely catheter location, frequency of catheter placement, and apparent signs of catheter site) were collected and recorded directly and systematically during surgery post-surgery. Results: One hundred and twenty-two patients with temporary double-lumen acute hemodialysis catheters for dialysis, including 56 women (45.9%), were included in this study, the mean age of whom was 58.9 ± 16.4 years. Twenty-two patients (18%) developed a catheter-induced systemic infection. There was no significant relationship between the catheter site and its removal inducing infection (P &gt; 0.05). The frequencies of microorganisms causing catheter infection included gram-positive Staphylococcus epidermis (59%) and Staphylococcus aureus (31.8%). Moreover, there was no significant correlation between demographic variables and clinical history with systemic infection induced by catheterization. Conclusions: The rate of catheter-induced infection is relatively high among patients since sterile instructions were observed during catheterization; therefore, it is recommended to pay more attention to the care and dressing of the catheter site.

Outbreak of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in hospitalized hemodialysis patients: An epidemiologic and genomic investigation.

We performed an epidemiological investigation and genome sequencing of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) to define the source and scope of an outbreak in a cluster of hospitalized patients. Lack of appropriate respiratory hygiene led to SARS-CoV-2 transmission to patients and healthcare workers during a single hemodialysis session, highlighting the importance of infection prevention precautions.