Infection In Dialysis Patients Research Articles

MO850OUTCOMES OF COVID-19 INFECTION IN DIALYSIS PATIENTS IN QATAR: A NATIONWIDE COHORT STUDY

Background and AimsPatients on maintenance dialysis are more susceptible to COVID-19 and its severe complications. We studied outcomes of COVID-19 infection in dialysis patients in the state of Qatar. Our primary outcome was to determine the mortality rate of dialysis patients with COVID-19 infection and associated risk factors. Our secondary outcomes were to assess the severity of COVID-19 in dialysis patients and its related complications such as the incidence of hypoxia, critical care unit admission, need for mechanical ventilation or inotropes, incidence of acute respiratory distress syndrome (ARDS), and length of hospital stay.MethodThis was an observational, analytical, retrospective, nationwide study. We included all adult patients on dialysis who tested positive for COVID-19 (PCR assay of nasopharyngeal swab) during the period from February 1, 2020 to July 19, 2020. Patient demographics and clinical features were collected from a national electronic medical record. Laboratory tests were evaluated upon diagnosis and on day 7.ResultsThere were 76 out of 1068 dialysis patients who were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). Eleven patients (15%) died during study period. Mortality due to COVID-19 among our dialysis cohort was 100 times higher than that in the general population for the same period (15% vs. 0.15%; OR 114.2 [95% CI: 1.53 to 2.44]; p<0.001). Univariate analysis for risk factors associated with COVID-19-related death in dialysis patients showed minor but statistically significant increases in risks with age (OR 1.07), peak WBC peak level (OR 1.189), AST level at day 7 (OR 1.04), fibrinogen level at day 7 (OR 1.4), D-dimer level on day 7 (OR 1.94), and peak CRP level (OR 1.01). A major increase in the risk of death was noted with atrial fibrillation (OR, 8.7; p=0.008) and hypoxia (OR: 28; p=0.001). High severity of COVID-19 illness in dialysis manifested as 25% of patients required admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes for intractable hypotension or shock. The mean length of hospital stay was 19.2±10.4 days. Laboratory tests were remarkable for severely elevated ferritin, fibrinogen, CRP, and peak IL-6 levels and decreased albumin levels on day 7.ConclusionThis is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high mortality rate of COVID-19 infection compared to the general population. Dialysis patients had severe COVID-19 course complicated by prolonged hospitalization and high need for critical care, mechanical ventilation and inotropes. Special care should be done to prevent COVID-19 in dialysis patients to avoid severe complications and mortality.

The retrospective analysis of urinary tract infection in renal transplant recipients

Infection is the most common reason for admission to the emergency department in the early period after transplantation. Urinary tract infections (UTIs) in adult kidney transplant patients are common. Their incidence is significantly higher than in the general population.1 The majority of sepsis cases in this period are composed of UTIs.2 While mild UTIs generally do not affect graft function, acute pyelonephritis observed in the post-transplant period causes a decrease in graft function and an increase in mortality.3 In the literature, a small amount of data has been published regarding the incidence, epidemiological features, and risk factors of UTIs in kidney transplant recipients. In this retrospective study, we evaluated the data of 550 patients who underwent kidney transplantation between January 2006 and May 2019 at our center and analyzed UTIs' characteristics.&#x0D; Among 550 recipients, 633 episodes were detected in 200 patients (36.4%). Recurrent infection was encountered in 74 (37%) of 200 patients. We determined 1 episode in 63 (31.5%), 2 episodes in 39 (19.5%), 3 episodes in 31 (15.5%), 4 episodes in 14 (7%), 5 episodes in 10 (5%), 6 episodes in 8 (4%), and 7 or more episodes in 35 (17.5%). While 48.3% (n=306) of 633 episodes were asymptomatic bacteriuria, 51.6% (n=327) was symptomatic. The risk factors for UTI were female gender, the advanced age of transplant and advanced donor age, long-term dialysis period before transplant, prolonged urinary catheterization and hospitalization time after transplant, cytomegalovirus infection, vesicoureteral reflux, and neurogenic bladder history. At the survival analysis, a transplant from living donor, female gender, use of tacrolimus, mycophenolate mofetil and corticosteroid combination as maintenance immunosuppressive therapy, preemptive transplant compared to patients receiving peritoneal dialysis was found to be associated with longer survival; advanced age of transplant, obesity, delayed graft function, acute rejection, diabetes mellitus and a history of cytomegalovirus infection was also associated with a shorter life span. Escherichia coli (64.9%) and Klebsiella pneumonia (51.6%) were the most common causative microorganisms, and ESBL (Expanded Spectrum Beta-Lactamase) was positive in 19.9% and 67.5% of them, respectively. &#x0D; Similarly, female gender, the advanced age of transplant, prolonged catheterization time, history of vesicoureteral reflux, neurogenic bladder, acute rejection, and deceased donor were dependent risk factors for developing of UTI in transplant recipients in other studies,4-6 but not body mass index, history of diabetes mellitus, dialysis type and duration, primary kidney disease, donor type, delayed graft function, and history of acute rejection in another study.7 UTI frequency in the female gender increases due to anatomical differences such as the shorter urethra compared to men and its relative proximity to the perianal region and vulva, as in the general population. Age-related changes in the urinary tract and existing additional diseases are important factors that predispose to bacterial colonization. Prolonged urinary catheterization and hospitalization durations facilitate pathogen entry into sterile body parts in the post-operative period. Immunosuppression, frequent hospitalizations, and surgical interventions increase the risk of nosocomial infections in dialysis patients. A history of vesicoureteral reflux facilitating bacterial invasion and a neurogenic bladder causing urinary stasis poses a UTI risk. &#x0D; Hospitalizations for septicemia are most commonly associated with UTI.8 In our cohort, antibiotics in the carbapenem group, started in more than half of the episodes. There is an increase in trimethoprim/sulfamethoxazole, ciprofloxacin and ceftazidime resistance in Klebsiella species.9 Although the microorganism spectrum in the studies is similar all world, ESBL positivity is noticeably higher than the average in UTI episodes is an observation in parallel with the increasing antibiotic resistance both in our country and in the world in recent years. This observation was considered as a cautionary finding for the review of antibiotic selection preferences in our clinic. Finally, UTIs being a threat to graft and patient survival in the post-transplant period should be treated effectively by carefully evaluating risk factors.

National Epidemiological Study about Hepatitis C Virus Infection among Dialysis Patients.

The World Health Organization estimates that 3% of the general population is infected with this virus. Hepatitis C remains the main viral infection in dialysis patients, and the severity of this infection is the risk of developing cirrhosis or hepatocarcinoma. We aim to determine the prevalence of hepatitis C in dialysis patients, to calculate the rate of hepatitis C virus (HCV) seroconversion, and to identify the risk factors for seroconversion. This is a nationwide multicenter observational study including all dialysis patients regardless of age and gender. Those with acute renal failure and vacationers were excluded from the study. We included 185 centers including 176 hemodialysis (HD) centers and nine peritoneal dialysis (PD) centers with a total number of patients at 11,238, a number of HCV-positive patients at 402, and a number of functional machines at 3139. The mean age of a patient was 55.6 years (range: 18-65), and sex ratio was 0.9. The prevalence of HCV-positive patients is 3.6%; it is higher in private centers with an average of 2.7 compared to 1.18 in public centers with a significant difference (P = 0.009). The prevalence of HCV-positive patients was significantly higher in HD centers compared to PD centers, in centers where the number of generators was >15 and when the number of patients per center is >70. One hundred and fifty-six patients seroconverted after dialysis, i.e., a prevalence of seroconversion at 1.3% with a mean delay of 6.052 ± 5.3 years. Our study shows a lower prevalence of HCV seroconversion than that reported in the literature; this requires a national survey to be carried out by homogenizing virological diagnostic kits and treating infected patients to eradicate this infection in dialysis patients.

Dialysis access as a source of infective endocarditis in dialysis patients

The incidence of Infective Endocarditis (IE) is higher in dialysis patients compared to the general population. A major risk factor for IE in this group stems from bacterial invasion during repeated vascular access. Previous studies have shown increased risk of bacteremia in patients with indwelling dialysis catheters compared to permanent vascular access. However, association between the development of IE and the type of dialysis access is unclear. We aimed to examine the associated types of intravascular access and route of infection in dialysis patients who were admitted with infective endocarditis at our center.All patients admitted to Albert Einstein Medical Center in Philadelphia with a diagnosis of infective endocarditis who were on chronic hemodialysis were identified from the hospital database for the period of 1/1/07 to 12/31/18. Modified Duke criteria was used to confirm the diagnosis of infective endocarditis. A total of 96 cases were identified. Of those, 57 patients had an indwelling dialysis catheter while the other 39 had permanent dialysis access. In 82% of patients with dialysis catheters, their dialysis access site was identified as the primary source of infection compared to 30% in those with permanent dialysis access (p<0.001). The number of dialysis catheters placed in the preceding 6 months was strongly associated with endocarditis resulting from the dialysis access site (OR = 3.202, p=0.025). Dialysis catheters are more likely to serve as the source of infection in dialysis patients developing IE compared to permanent dialysis access. Increased awareness of risk of IE associated with dialysis catheters is warranted.

SARS-CoV-2 infection in dialysis patients in northern Italy: a single-centre experience.

BackgroundDialysis patients are considered at high risk for COVID-19 and the infection can easily spread in dialysis units.MethodsWe conducted an observational single-centre cohort study to describe clinical characteristics, treatments and outcomes of dialysis patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We tested patients who presented symptoms or had contact with a confirmed case. We enrolled 15 patients positive for SARS-CoV-2.ResultsWe tested 37 of 306 dialysis patients. Patients with SARS-CoV-2 infection were older (mean age 75.96 ± 11.09 years) and all had comorbidities. At presentation, most had interstitial infiltrates on chest X-ray, three-quarters had leucopenia and none had respiratory insufficiency. During follow-up, there was an increase in serum C-reactive protein and interleukin-6. Eighty percent of patients received supplemental oxygen; none received non-invasive ventilation, one was intubated. Most patients (80%) were treated with oral hydroxychloroquine for a median time of 6.5 days [interquartile range (IQR) 5–14.5] and 40% received azithromycin; two patients received a short course of antivirals and one received a single dose of tocilizumab. Only two patients did not require hospitalization. Of the nine survivors, eight still tested positive for SARS-CoV-2 a median of 19 days (IQR 9.25–23) after diagnosis. Six patients died (case fatality rate 40%) a median of 5.5 days (IQR 1.75–9.75) after diagnosis. The main reported cause of death was respiratory failure related to COVID-19 (five patients).ConclusionsWe report a single-centre experience of SARS-CoV-2 infection in dialysis patients. The disease showed a high case fatality rate and most patients required hospitalization. Survivors show prolonged viral shedding.

Screening strategies for the diagnosis of asymptomatic Leishmania infection in dialysis patients as a model for kidney transplant candidates

Despite being considered a tropical disease, visceral leishmaniasis (VL) caused by L. infantum is also endemic in the Mediterranean Europe and represents an increasing cause of morbidity and mortality in solid organ transplant (SOT) recipients. VL occurring in kidney transplant recipients is a severe event, often worsening the renal damage and leading to poor outcome. It is believed that most of VL cases in transplant recipients are caused by reactivation of a pre-existent, dormant leishmanial infection induced by the immunosuppressive drugs. Nevertheless, the prevalence of asymptomatic Leishmania infection in candidates to kidney transplant residing in or visiting endemic areas is unknown. As L. infantum is highly circulating in northeastern Italy, we aimed to examine the occurrence of this parasitic infection in 119 dialysis patients living in the mentioned area, 71 of whom were potential candidates to kidney transplant. By employing a combination of sensitive serological and molecular methods, we observed a prevalence of 15.9% asymptomatic Leishmania infection in the study cohort. This finding emphasizes the need of further evaluating potential screening strategies for Leishmania infection in solid organ transplant candidates residing in or visiting endemic areas.

The use of 3.15% chlorhexidine gluconate/70% alcohol hub disinfection to prevent central line-associated bloodstream infections in dialysis patients.

Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality. An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection. The 5-year preintervention period (2008-2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013-2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period. A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable. This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG.

Comparison of serological and molecular methods in the diagnosis of cytomegalovirus infections in dialysis patients

Introduction. Cytomegalovirus is the most common cause of infections in the post-transplantation period. A reliable and timely laboratory diagnosis of cytomegalovirus infection in patients on dialysis and in the post-transplantation period is significant because of the possibility of preventing or mitigating the effects of cytomegalovirus disease. The main objective of this study was to compare serological and molecular polymerase chain reaction methods to determine the presence of cytomegalovirus in the blood of dialysis patients. Material and Methods. The study included 28 dialysis patients, potential renal transplant recipients. All patients were evaluated for the presence of cytomegalovirus in the blood by a quantitative polymerase chain reaction method as well as in the serum for the presence of anti-cytomegalovirus Immunoglobulin G and Immunoglobulin M antibodies. Results. According to the comparative enzyme-linked immunosorbent assay for detecting antibodies in dialysis patients, 96.4% were once exposed to the virus, while 7.1% showed current infection not confirmed by polymerase chain reaction test. No statistically significant association was found between the positive finding of anti-cytomegalovirus Immunoglobulin M antibodies and the findings of the polymerase chain reaction cytomegalovirus method when Chi-square (?2) and Fisher?s correlation tests were conducted (p &gt; 0.05). Conclusion. Due to 7.1% false positives results for the presence of anti-cytomegalovirus Immunoglobulin M antibodies in the serum of immunocompromised dialysis patients, not confirmed by polymerase chain reaction test, serological techniques are not reliable in detecting active cytomegalovirus infection causing positive finding of anti-cytomegalovirus Immunoglobulin M, so confirmation of cytomegalovirus deoxyribonucleic acid by polymerase chain reaction method is required.

Fused Deposition Modelling as a Potential Tool for Antimicrobial Dialysis Catheters Manufacturing: New Trends vs. Conventional Approaches

The rising rate of individuals with chronic kidney disease (CKD) and ineffective treatment methods for catheter-associated infections in dialysis patients has led to the need for a novel approach to the manufacturing of catheters. The current process requires moulding, which is time consuming, and coated catheters used currently increase the risk of bacterial resistance, toxicity, and added expense. Three-dimensional (3D) printing has gained a lot of attention in recent years and offers the opportunity to rapidly manufacture catheters, matched to patients through imaging and at a lower cost. Fused deposition modelling (FDM) in particular allows thermoplastic polymers to be printed into the desired devices from a model made using computer aided design (CAD). Limitations to FDM include the small range of thermoplastic polymers that are compatible with this form of printing and the high degradation temperature required for drugs to be extruded with the polymer. Hot-melt extrusion (HME) allows the potential for antimicrobial drugs to be added to the polymer to create catheters with antimicrobial activity, therefore being able to overcome the issue of increased rates of infection. This review will cover the area of dialysis and catheter-related infections, current manufacturing processes of catheters and methods to prevent infection, limitations of current processes of catheter manufacture, future directions into the manufacture of catheters, and how drugs can be incorporated into the polymers to help prevent infection.

Association between duration of dialysis and Helicobacter pylori infection in dialysis patients: a meta-analysis.

The association between Helicobacter pylori (HP) infection and duration of dialysis in dialysis patients is conflicting, this meta-analysis was conducted to elucidate the association between duration of dialysis and HP infection status in dialysis patients, and subgroup study was conducted to explore its influencing factors. Furthermore, our study aims to provide advice on the treatment of dialysis patients. Articles published up to 30 September 2018 were searched from PubMed, Embase, Sinomed, Medline, China Knowledge Resource Integrated Database (CNKI) and Wang fang database. Two researchers independently identified whether studies met the eligibility criteria. The adjusted relative risk (RR) or the weighted mean difference (WMD) and their 95% CI were estimated. I2 was performed to evaluate the statistical heterogeneity. Publication bias was evaluated using Egger's test and a funnel plot. Fourteen studies were included involving 2087 dialysis patients, 815 of them were HP positive, 1272 of them were HP negative. Quantitative data and qualitative data were analyzed, respectively. For quantitative data, statistical differences were observed in the association between HP infection and duration of dialysis (P = 0.008), also in the hemodialysis subgroup (P = 0.006). After stratifying by detection methods, differences still existed in groups with different detection methods (P = 0.001, P = 0.033). For qualitative data, there was no statistical difference in the association between HP infection rate and duration of dialysis (P = 0.295). Furthermore, we found that the age was higher in HP positive patients than in HP negative patients (P < 0.001). Our meta-analysis found that HP infection rate was negatively correlated with accumulative dialysis time, and methods of HP detection did not influence the association between HP infection and accumulative dialysis time. We also found that age was the risk factor of HP infection in dialysis patients. Further studies need to be performed to elucidate the mechanism of the correlation between HP infection and duration of dialysis, to explore which timing period of dialysis is most susceptible to HP infection, then, improve the prognosis of patients with renal diseases.

Seroprevalence of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among hemodialysis patients in a Tertiary Care Teaching Hospital in a developing country.

Background:Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) prevalence in hemodialysis patients varies geographically, both within and between countries. High prevalence of these infections in dialysis patients reflects the increased presence of common risk factors for their acquisition, including transfusion, transplantation, history of drug abuse, plus susceptibility to nosocomial transmission during dialysis.Objective:The aim of this study is to investigate the seroprevalence and clinical profile of HIV, HBV, and HCV patient's on hemodialysis.Materials and Methods:Clinical and epidemiological data of patients undergoing maintenance hemodialysis in the dialysis unit of a teaching institution were obtained and analyzed over a 5 years' period.Results:A total of 127 males and 69 females were studied. Their mean age was 50.45 years. Out of the total 196 dialysis-dependent patients, 2 (1.02%) were seropositive for HIV antibodies, 6 (3.06%) were hepatitis B surface antigen positive, and 30 (15.30%) were anti-HCV antibody positive. There was no coexistence of HIV, HBV, and HCV markers. The major primary renal diseases in hemodialysis patients included diabetes mellitus (42%), hypertension (22%), chronic nephritis (15%), urologic diseases (6%), cystic renal diseases (4%), and others (11%).Conclusion:Prevalence of transfusion-transmissible viral infections was higher among hemodialysis patients, especially HCV infection which was an alarming situation and therefore strict adherence to infection control strategies, barrier precautions, and preventive measures, including routine hepatitis B vaccination and regular virological follow-up were recommended along with regular education and training programs of technical and nursing personnel's involved with dialysis patients.

Development of a risk-prediction model for Middle East respiratory syndrome coronavirus infection in dialysis patients.

Introduction The Middle East respiratory syndrome coronavirus (MERS‐CoV) infection can cause transmission clusters and high mortality in hemodialysis facilities. We attempted to develop a risk‐prediction model to assess the early risk of MERS‐CoV infection in dialysis patients. Methods This two‐center retrospective cohort study included 104 dialysis patients who were suspected of MERS‐CoV infection and diagnosed with rRT‐PCR between September 2012 and June 2016 at King Fahd General Hospital in Jeddah and King Abdulaziz Medical City in Riyadh. We retrieved data on demographic, clinical, and radiological findings, and laboratory indices of each patient. Findings A risk‐prediction model to assess early risk for MERS‐CoV in dialysis patients has been developed. Independent predictors of MERS‐CoV infection were identified, including chest pain (OR = 24.194; P = 0.011), leukopenia (OR = 6.080; P = 0.049), and elevated aspartate aminotransferase (AST) (OR = 11.179; P = 0.013). The adequacy of this prediction model was good (P = 0.728), with a high predictive utility (area under curve [AUC] = 76.99%; 95% CI: 67.05% to 86.38%). The prediction of the model had optimism‐corrected bootstrap resampling AUC of 71.79%. The Youden index yielded a value of 0.439 or greater as the best cut‐off for high risk of MERS infection. Discussion This risk‐prediction model in dialysis patients appears to depend markedly on chest pain, leukopenia, and elevated AST. The model accurately predicts the high risk of MERS‐CoV infection in dialysis patients. This could be clinically useful in applying timely intervention and control measures to prevent clusters of infections in dialysis facilities or other health care settings. The predictive utility of the model warrants further validation in external samples and prospective studies.

When and how can nephrologists treat hepatitis C virus infection in dialysis patients?

Hepatitis C virus (HCV) infection, a major cause of end-stage liver disease, is a common comorbidity in patients on dialysis and causes increased morbidity and mortality. Historically HCV has been extremely difficult to cure with interferon and ribavirin-based therapies, which are also associated with significant side effects, and few dialysis patients ever received HCV treatment. However, in the last 4years, interferon-free direct-acting antiviral therapies have been approved, and several combinations have been studied in dialysis patients. A recently approved, pan-genotypic, direct-acting antiviral regimen, glecaprevir and pibrentasvir, may simplify prescribing. The simplicity of these new therapies, with few side effects, makes it possible for nephrologists to treat HCV infection in their patients on dialysis. We review the workflow and motivation behind nephrology-led management of HCV infection. We highlight the importance of identifying which patients need referral to a hepatologist or HCV specialist prior to treatment and which can be managed by their nephrologist. Nephrologist involvement would lead to improved access to treatment and ensure that appropriate patients are referred for HCV treatment. In this paper, we review the background of HCV infection, its effect on dialysis patients, and impact on kidney transplantation. In addition, we outline the therapy options for each genotype of HCV, and we discuss the benefits and barriers to nephrology-led HCV treatment.

Spectrum of hepatitis B and renal involvement.

Renal involvement in hepatitis B occurs in various spectrums and its knowledge is important for clinicians in management of patients. The renal diseases most commonly associated with hepatitis B virus (HBV) infection include membranous nephropathy, membranoproliferative glomerulonephritis and Polyarteritis nodosa. The widespread use of hepatitis B vaccination has decreased the incidence of HBV-related renal diseases. The incidence of HBV infection in dialysis patients has significantly decreased over the past few decades because of screening of blood products for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody, implementation of infection control measures and hepatitis B vaccination. The definition of acute kidney injury has been recently modified in cirrhotic population, helping in prognosis and prediction of mortality. The most common etiologies of acute kidney injury in this cirrhotic population, which account for 80% to 90% of all cases, include volume depletion, acute tubular necrosis and hepatorenal syndrome. Treatment with oral nucleoside/tide analogues (NA) brought a new paradigm in the management of HBsAg positive glomerulonephritis, kidney transplant recipients and dialysis patients, resulting in effective viral suppression, reduced hepatic complications and improved patient survival, without compromising renal allograft outcome. NAs are cleared by the kidneys and therefore their dosage has to be adjusted in all patients with impaired renal function. This article reviews the recent knowledge of the pathogenesis and treatment of HBV-related glomerulonephritis and discusses the management of hepatitis B in patients on dialysis, kidney transplant recipients and cirrhotics, which is continuously evolving.

Main determinants of tunneled cuffed catheters infection in hemodialysis patients

Introduction: Despite all efforts to prevent tunneled-cuffed catheter (TCC) infection, the incidence of this infection has remained considerably high. Objectives: The present study aimed to assess risk determinants affecting TCC infection in hemodialysis patients. Patients and Methods: This case-control study was performed on 165 consecutive patients as known cases of end-stage renal disease on maintenance hemodialysis through double-lumenTCC. The patients were assigned into two groups as the case group with the clinical evidences of TCC infection and the control group with noninfectious condition. Results: In the group with TCC infection, the most common microorganisms cultured in the medium included Staphylococcus aurous and Staphylococcus epidermidis with the overall prevalence of 17.6% and 15.3% in blue lumen and 14.1% and 14.1% in red lumen, respectively. Overall, 75.3% of the lumens were positive for infection, while 52.9% of blood cultures were positive. Multivariable logistic regression modeling showed that female gender, insertion catheter through jugular vein, higher C-reactive protein (CRP) level, lower serum iron level and higher serum ferritin level could predict TCC infection in dialysis patients. According to ROC curve analysis, measuring CRP level, serum iron and serum ferritin could effectively discriminate TCC infection from noninfectious condition. Particularly, serum CRP >16 mg/ dL, ferritin > 200 ng/mL and serum iron <40 mg/dL could predict TCC infection. Conclusion: Around 75% of samples extracted from catheter lumens are positive for TCC infection. The main determinants of TCC infection included female gender, insertion catheter by jugular vein, higher CRP level, lower serum iron level, and higher serum ferritin level.

Virological response to daclatasvir and asunaprevir combination therapy for chronic hepatitis C virus genotype 1b infection in dialysis patients: a prospective, multicenter study

BackgroundThe introduction of direct-acting antiviral agents (DAAs) for the treatment of chronic hepatitis C virus (HCV) infection in patients undergoing hemodialysis (HD) has improved sustained virological response (SVR) rates. Our aim was to assess the characteristics of the virological response to daclatasvir (DCV) and asunaprevir (ASV) combination therapy for HCV in HD patients.MethodsA multicenter prospective study was conducted at eight centers in Japan. Patients on HD with chronic genotype 1b HCV infections were orally administered DCV and ASV for 24 weeks at doses of a 60-mg capsule once daily and a 100-mg tablet twice daily, respectively. The primary endpoint of this trial was the proportion of patients with a sustained virological response at 24 weeks after the treatment ended (SVR24). We also investigated the characteristics associated with the virological response to combination therapy.ResultsThirty patients were enrolled in this study, and the proportion that achieved an SVR24 after treatment was 83.3% (25/30). Virological failure was observed in 4 patients (13.3%). Two exhibited virological breakthrough at weeks 16 and 20 of drug administration, and viral relapse occurred in 2 patients at weeks 4 and 8 after the end of treatment. Virological failure was defined as HCV-RNA levels exceeding 5.5 log10 IU/mL, and resistance-associated variants (RAVs) NS5A-L31M/V and Y93H were not exhibited at baseline.ConclusionsDCV and ASV therapy for chronic HCV on HD was significantly effective. Most importantly, patients with the low viral loads undergoing HD demonstrated a higher response to combination therapy regardless of RAV.Trial registrationUMIN Clinical Trials Registry UMIN000016181

Diagnostic Dilemmas in Hepatitis C Virus Infection for Hemodialysis Patients.

Hepatitis C virus (HCV) is a leading cause of chronic hepatitis in dialysis patients. The diagnosis of HCV infection in these patients is predominantly based on laboratory tests because of the specificity of the clinical course of the disease. The present prospective study aimed at determining very accurately the prevalence rate of HCV infection in patients on dialysis by simultaneously testing them for anti-HCV and for HCV RNA levels. For the present cross-sectional longitudinal study we recruited and followed up 93 patients from St George University Hospital Hemodialysis Unit between July 2013 and December 2014. All patients were tested for anti-HCV and HCV RNA. The anti-HCV negative patients were tested for anti-HCV and HCV RNA at least twice at intervals of 6 months or more (up to 12 months). Anti-HCV antibodies were identified using a third generation ELISA assay. Commercial kits for real-time polymerase chain reaction (RT-PCR) were used to detect HCV RNA in the plasma and mononuclear cells. Aminotransferase and gammaglutamyl transpeptidase levels were studied to find if liver inflammation was present. The total seroprevalence in 68 patients was 20.6% (14). Of these, 10 patients were viremic (HCV RNA+/anti-HCV+), and 4 patients (5.9%) had discordant results (anti-HCV+/HCV RNA-). Acute hepatitis was detected in one patient. Duration of dialysis in HCV viremic patients was longer than that in aviremic patients (p=0.005). The present study suggests that HCV infection in dialysis patients can be diagnosed more accurately if these patients are tested using two diagnostic methods - a serological test and a biomolecular assay. Further studies with larger sample size may prove the feasibility of such approach for all dialysis patients in this country.

Bacterial infections in the dialysis

AIMS: Our study focused on bacterial infections in dialysis patients (under peritoneal dialysis or hemodialysis). Method: this study was carried out for six months, from January to June 2017 at the bacteriology laboratory of the renal clinic of Daksi of Constantine. The analysis was carried out on strains isolated from different pathological samples. The identification of bacteria was achieved by the conventional methods used in the laboratory, namely the study of their morphological, biochemical API cropping and galleries (analytical index profile). The detection of resistance phenotypes was studied by the conventional method of dissemination of antibiotic disks on medium agar Mueller Hinton and reading and interpretation criteria recommended by the Clinical and Laboratory Standard Institute (CLSI). Results: 200 cases of infectious were analyzed. Results showed that the majority of patients are treated by peritoneal dialysis with a higher frequency (63.80%) than those treated with hemodialysis (36, 19). 112 bacterial strains were isolated from various samples. Analysis of dialysate samples showed a clear predominance of Gram-positive Cocci (75%) versus Gram-negative bacilli (25%). First there are the staphylococci with a frequency of 62, 5% followed Enterobacteriaceae with a predominance of E. coli to 17, 85%, 12.5% of Streptococcus, and gram negative bacilli not fermenting with predominance of Pseudomonas aeruginosa, with a percentage of 7,14%. Conclusion: In this study we have identified the organisms responsible for infections in dialysis patients and their antibiotic resistance. The frequency of these infections is significant. The diagnosis of infections has identified the main germs in question. The isolated bacteria show resistance to several antibiotics tested which aggravates the situation of this immune- suppressed population and diminishes the therapeutic possibilities. The best treatment remains the prevention by the early detection of these infections. Compliance with hygiene measures, individual and collective cleanliness and maintenance of the hospital environment

Clostridium difficile infection in dialysis patients

Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhea. Patients with end-stage renal disease (ESRD) may be at increased risk for CDI. Patients with ESRD with CDI...

Trends in Infections in Dialysis Patients

Trends in Infections in Dialysis Patients