Renal Disease Research Articles

Trends in Antidiabetic Drug Use and Safety of Metformin in Diabetic Patients with Varying Degrees of Chronic Kidney Disease from 2010 to 2021 in Korea: Retrospective Cohort Study Using the Common Data Model.

This study aimed to investigate trends in antidiabetic drug use and assess the risk of metformin-associated lactic acidosis (MALA) in patients with chronic kidney disease (CKD). A retrospective observational analysis based on the common data model was conducted using electronic medical records from 2010 to 2021. The patients included were aged ≥18, diagnosed with CKD and type 2 diabetes, and had received antidiabetic medications for ≥30 days. MALA was defined as pH ≤ 7.35 and arterial lactate ≥4 mmol/L. A total of 8318 patients were included, with 6185 in CKD stages 1-2 and 2133 in stages 3a-5. Metformin monotherapy was the most prescribed regimen, except in stage 5 CKD. As CKD progressed, metformin use significantly declined; insulin and meglitinides were most frequently prescribed in end-stage renal disease. Over the study period, the use of SGLT2 inhibitors (13.3%) and DPP-4 inhibitors (24.5%) increased significantly, while sulfonylurea use decreased (p < 0.05). Metformin use remained stable in earlier CKD stages but significantly decreased in stage 3b or worse. The incidence rate (IR) of MALA was 1.22 per 1000 patient-years, with a significantly increased IR in stage 4 or worse CKD (p < 0.001). Metformin was the most prescribed antidiabetic drug in CKD patients in Korea with a low risk of MALA. Antidiabetic drug use patterns varied across CKD stages, with a notable decline in metformin use in advanced CKD and a rise in SGLT2 inhibitor prescriptions, underscoring the need for further optimized therapy.

Nano-based perivascular intervention sustains a nine-month long-term suppression of intimal hyperplasia in vein grafts

Open vascular reconstructions (OVR), including bypass grafts and dialysis access, are standard treatments for cardiovascular and renal diseases. Unfortunately, OVR often fail largely due to intimal hyperplasia (IH), and there are no clinical methods to prevent this complication. Perivascular drug administration during OVR presents a promising strategy for IH suppression. However, durations of drug release from carriers are generally short whereas sustained efficacy is essential for clinical success. This raises a critical question in clinical translation: can IH suppression be realistically maintained long-term (e.g., over 6 months) with short-term perivascular interventions? To address this question, we modified a rat vein-graft model to prolong IH progression. We then applied Pericelle, a nanoparticle/hydrogel hybrid system that we developed for perivascular delivery of rapamycin, an established IH-inhibitory drug. Surprisingly, despite short (∼3-month) drug release, Pericelle demonstrated IH suppression throughout 3, 6, and 9 months with IH reduced from 115.58 ± 27.89 to 40.34 ± 5.18 at 9 months (P < 0.05, n = 6 rats), as indicated by morphometric analysis. Live animal ultrasonography showed the same trend. Consistently, histone-3 lysine-27 trimethylation, an epigenetic mark associated with IH progression, was decreased at 6 months after Pericelle treatment. Moreover, Pericelle exhibited promising efficacy in mitigating IH in a porcine model of arteriovenous fistula that mimics dialysis access. These results suggest that Pericelle-mediated suppression of IH in rat vein-grafts extends much beyond drug release, offering potential solutions to longstanding translational challenges in reducing OVR failure.

Prevalence, risk factors and effect of curative parathyroidectomy on nephrocalcinosis in Asian-Indian patients with symptomatic primary hyperparathyroidism.

Primary hyperparathyroidism (PHPT) is characterized by inappropriate secretion of parathyroid hormone, causing hypercalcemia and hypercalciuria, leading to renal stone diseases and nephrocalcinosis. The frequency, risk factors, and curative effect on nephrocalcinosis in post-parathyroidectomy have not been identified yet. Therefore, the present study evaluated the clinico-biochemical, radiological parameters and curative effect on nephrocalcinosis. A total of 583 PHPT patients were analysed in four groups viz. Group 1 (PHPT with nephrocalcinosis-98; 16.8%); Group 2 (PHPT with nephrolithiasis-227; 38.9%); Group 3 (PHPT with both nephrolithiasis and nephrocalcinosis-59; 10.1%); and Group 4 (PHPT without renal diseases-199, 34.1%). In the sub-group analysis, younger age(p ≤ 0.05), male gender(p ≤ 0.05), and hematuria(p ≤ 0.005) were significant in Group 1 vs. Group 4. Dysuria and low eGFR were significant in Group 1 vs. Group 2(p ≤ 0.0005; p ≤ 0.05) and Group 1 vs. Group 4(p ≤ 0.0005; p ≤ 0.0005). Polyuria (p ≤ 0.05; p ≤ 0.05, p ≤ 0.005), and gravluria (p ≤ 0.05; p ≤ 0.0005, p ≤ 0.005) were frequent in Group 1 vs. other groups. A significant difference was observed in S.Ca and, 24-hrs U.Ca in Group 1 vs. Group 2 {(12.2 (10.8-13.4) vs. 11.2 (10.7-12.4), p ≤ 0.05; 301 (189.5-465) vs. 180 (92.5-323.1), p ≤ 0.05} and Group 1 vs. Group 4 {(12.2 (10.8-13.4) vs. 11.4 (10.7-12.5), p ≤ 0.05 ; 301 (189.5-465) vs. 213 (110-360), p ≤ 0.0005}. Multivariate logistic regression showed gravluria [aOR = 9.2, p = 0.0001], S.Ca (aOR = 1.30, p = 0.003) and, 24-hrs U.Ca (aOR = 1.02, p = 0.042) to be independent predictors of nephrocalcinosis. Pre and post-operative assessment revealed decreased S. Ca levels [(11.9 ± 1.9) vs. (10.5 ± 1.0) mg/dL; p = 0.04] and complete radiological resolution (10.4%) in PHPT with nephrocalcinosis. Therefore, serum calcium, 24-hrs Urinary calcium, and gravluria were independent predictors of nephrocalcinosis with 10.4% showing complete radiological resolution post-operatively.

Chronic kidney disease and risk factors among Type 2 Diabetic patients in selected hospitals in Dhaka, Bangladesh

Chronic kidney disease (CKD) may be defined as abnormalities of kidney function or structure present for more than 3 months. Around 10% of people worldwide have CKD. The data about chronic kidney disease among diabetics in Bangladesh is inadequate, and very few studies have been done on specific populations, i.e., male or female. Thus, the study aims to determine the prevalence of CKD and its risk factors among diabetic patients in selected hospitals in Dhaka city. The specific objectives of the study were to assess the participants through physical and laboratory evaluations, categorize them into the different stages of CKD, analyze their socio-demographic characteristics, and determine the association between CKD and various risk factors. This is a cross-sectional study. The study population consisted of different outpatient diagnostic centers and outpatient and indoor patients of Shaheed Suhrawardy Medical College and Hospital. The sample size of the study is 369. The Modification of Diet in Renal Disease equation was used to calculate eGFR. This study revealed that in Dhaka, 18.2% of Type 2 Diabetic patients had CKD. Most of the participants were between 46 and 65years old. Most of the CKD patients had a low education level and a lower family income. Having diabetes for more than 3 years and hypertension for more than 5 years were associated with a higher risk of developing CKD, especially among individuals who consumed added salt in their diet.

All-cause mortality and factors associated with it in Finnish patients with type 1 diabetes

AimsTo assess the effect of comorbidities, risk classification for chronic kidney disease (CKD) according to albuminuria and eGFR, HbA1c and LDL-cholesterol levels on all-cause mortality in patients with type 1 diabetes (DM1). MethodsThe study included all 45,801 DM1 patients from the Finnish Diabetes Registry during 2018–2022. Mortality of patients with DM1 was compared with mortality in non-diabetic population in Finland by estimating standardized mortality rates (SMRs). Poisson regression model was used to estimate the effect of risk factors on the SMR. ResultsA total of 2469 patients died during follow-up. SMR for the total cohort was 1.84 (95 % CI 1.77–1.92) peaking at the age of 30–49 years. The coverage of HbA1c values was 98 %, that of LDL-cholesterol 94 %, and U-ACR and eGFR 80 %. In a multivariate analysis, assessing the effect on mortality, the rate ratio for end-stage renal disease was 2.66, cardiovascular diseases 1.92, mental and behavioural disorders 1.64, foot complications 1.51, high or very high risk for CKD 3.64, LDL-cholesterol ≥2.6 mmol/l 1.33, and HbA1c ≥8 % (64 mmol/mol) 1.27. ConclusionsThere's substantial excess mortality due to DM1 in Finland. Interventions should focus on addressing both renal and cardiovascular risk factors but also pay more attention to mental health.

Daily Versus Conventional Dialysis for COVID-19 Patients: A Randomized Controlled Trial

Background: Hemodialysis patients have high mortality and morbidity in COVID-19 due to different causes, thus the current study evaluates the difference between the effect of conventional and daily hemodialysis on mortality in End-Stage Renal Disease (ESRD) patients with COVID-19. Methods: This study was designed as a single-center, parallel, randomized and un-blinded clinical trial that chronic hemodialysis patients with confirmed COVID-19 infection enrolled. The study group was dialyzed daily for a week and the control group was on three sessions per week of dialysis. The primary outcome was estimation of mortality rate and secondary outcome was considered as ICU admission rate during hospitalization. Results: A total of 47 patients with the diagnosis of ESRD were included. The mean age of the included patients was 57.1±14.2 years in daily hemodialysis and 58.8±17.4 years in the conventional hemodialysis, and 36(76.6%) were male. From the 47 included patients, 18(38.3%) were admitted to the ICU, and 12(25.5%) were deceased during their hospital stay. The prevalence of the two main outcomes of the study, ICU admission and mortality, was not different between the two groups of the study. Conclusion: In this study, daily hemodialysis was beneficial in reducing mortality in COVID-19 infected patients, but this difference was not statistically significant. Studies with higher sample sizes may show this difference significantly.

Particularities of a Cardiac Amorphous Left Ventricular Tumor in a Patient with Coronary Artery Disease—Diagnostic and Therapeutic Challenges: A Case Report and Literature Review

Background: Cardiac calcified amorphous tumors (CATs) are rare non-neoplastic formations containing amorphous fibrinous material and calcifications. In our research, we present the case of a 42-year-old male patient who developed, during his 6-months monitoring for coronary artery disease, a left ventricular (LV) CAT raising diagnostic challenges. Methods: To gather additional information on CATs, we researched the international medical literature for scientific articles published with the full text in English, on PubMed, ResearchGate, Clarivate, and Google Scholar between 2020 and 2024. Results: Compared to most described cases, our patient was a young male, without mitral annular calcification or chronic renal disease, but he was suffering from chronic peripheral and coronary artery disease, and genetic testing revealed a higher risk for thromboembolic events. During 6 months, he developed a LV CAT of 4.5/3.5/3 cm. Although we found in the medical literature 16 case reports of patients with CAT, only six authors could specify a precise postoperative evolution of the CAT, most of them sustaining that if completely removed, it would not relapse, an aspect observed also in our patient during 3 years of follow-up. Conclusions: CATs are rare heart tumors with slow growth, but with a high embolization risk that raises diagnostic and therapeutic challenges.

An anti-Shiga toxin VHH nanobody multimer protects mice against fatal toxicosis when administered intramuscularly as repRNA.

Hemolytic uremic syndrome (HUS) is a systemic sequelae from gastrointestinal infection with Shiga toxin (Stx) producing Escherichia coli (STEC) that can result in acute kidney injury, lasting renal disease, and death. Despite a window for intervention between hemorrhagic diarrhea and onset of HUS, no specific therapies exist to prevent or treat HUS following STEC infection. Furthermore, there is no way to predict which patients with STEC will develop HUS or any rapid way to determine which Stx variant is present. To address this, we have broadened the therpay to neutralize additional toxin variants. It contains a multimer of nanobodies derived from camelid heavy chain antibody fragments (VHHs). An improved VHH-based neutralizing agent (VNA2) is delivered intramuscularly as RNA combined with LION nanoparticles rather than mRNA, that replicates on administration (repRNA), resulting in a rapidly circulating VNA that can bind systemic toxin. The RNA/VNA2-Stx administered intramuscularly prevents toxicity and death in a mouse model of acute Stx toxicity.

Hepatitis C virus infection increases risk of peripheral arterial disease in end‐stage renal disease patients receiving maintenance hemodialysis therapy

AbstractBoth hepatitis C virus (HCV) infection and end‐stage renal disease are associated with an increased risk of developing peripheral arterial disease (PAD). Our objective was to explore the relationship between HCV infection and PAD in hemodialysis patients, using brachial‐ankle pulse wave velocity (baPWV) as the assessment method. Since 2016, we have actively been recruiting patients undergoing regular hemodialysis three times a week. All baPWV assessments for our patients were performed before the implementation of direct‐acting antiviral treatment. Furthermore, none of the uremic patients with HCV infection had received interferon‐based treatment in the past. An elevated baPWV measurement surpassing 2100 cm/s is indicative of an increased susceptibility to potential PAD. Our analysis utilized multivariate linear and logistic regression analysis. Individuals with HCV infection exhibited higher baPWV levels compared with those without HCV infection (2006.0 ± 687.4 vs. 1809.3 ± 466.1 cm/s, p = .039). The presence of HCV infection (β = 199.56, 95% CI: 10.56–388.56, p = .039) demonstrated a significantly positive correlation with baPWV levels. In the multivariate logistic regression analysis, HCV infection (OR = 2.67, 95% CI: 1.07–6.68, p = .036) significantly associated with baPWV &gt;2100 cm/s. Furthermore, individuals with a higher viral load (HCV RNA ≥60 × 103 IU/mL) (OR = 4.45, 95% CI: 1.12–17.68, p = .034) demonstrated a significant association with baPWV ≥2100 cm/s when compared with non‐HCV infection patients. Additionally, patients with genotype I exhibited a significant association with baPWV ≥2100 cm/s (OR = 8.13, 95% CI: 2.04–32.42, p = .003) in comparison to non‐HCV patients. The presence of HCV infection has been demonstrated to markedly increase baPWV levels. Particularly, HCV infection with higher viral load and genotype I is significantly linked to an elevated risk of PAD. It emphasizes the importance of HCV elimination in the specific population.

Home hemodialysis

Chronic kidney disease (CKD) is a public health problem with increasing prevalence worldwide and is associated with significant morbidity and mortality . According to 2022 data, there are a total of 13725 patients receiving renal replacement therapy (RRT) for end-stage renal disease (ESRD) in Turkey. Hemodialysis (HD) accounts for a large proportion of patients receiving RRT with 10287 patients . Although kidney transplantation is the best treatment option for patients with ESRD, the majority of patients do not have access to this treatment for various reasons. Most patients are treated with HD and peritoneal dialysis (PD), which are traditional methods of RRT. HD has two modalities: conventional HD and home hemodialysis (HHD).

Kidney function in newly diagnosed myeloma patients: factors associated with kidney impairment and recovery

Kidney disease is a common complication of multiple myeloma (MM) and a risk factor for increased morbimortality. In this retrospective cohort study based on medical records, we analyzed the kidney function of patients with renal disease related to MM during the first year of treatment. All patients included were consecutively admitted to the outpatient services of two hospitals between January 2009 and January 2019 and met the diagnostic criteria for MM regardless of the reason for seeking medical help. We excluded patients who had kidney disease or who were on dialysis before MM diagnosis. We investigated the factors associated with renal function recovery using multivariate analysis. We evaluated 167 patients (median age of 66 ± 11.49 years). Almost half of the patients had arterial hypertension (76; 45.5%). The majority had International Staging System (ISS) grades 3 (73; 43.7%) or 2 (60; 35.9%). Seventy-four (44%) patients had an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² at the time of MM diagnosis. Fifty-two patients (31%) underwent hematopoietic stem cell transplantation (HSCT). After 12 months, 4 (2.3%) patients needed dialysis, and 18 (10.7%) died. The factors associated with an eGFR < 60 ml/min/1.73 m² were anemia, hyperuricemia, 24-hour proteinuria > 1.0 g, and extramedullary plasmacytoma. However, only baseline renal function (eGFR > 60 ml/min/1.73 m2) and HSCT were associated with greater recovery of renal function at 12 months of follow-up.

Relationship of body mass index and kidney outcomes in patients with primary glomerulonephritis: A systematic review and meta-analysis.

Primary glomerulonephritis, is a major contributor to the development of chronic kidney disease and end-stage renal disease. Previous studies on the relationship between overweight/obesity with primary glomerulonephritis in the chronic kidney disease was inconsistent. This study aimed to systematically review and meta-analyze the relationship between body mass index and adverse kidney outcomes in patients with primary glomerulonephritis. PubMed, Embase, the Cochrane Library, and the China National Knowledge Infrastructure were searched. Patients were divided into an overweight/obesity group (group O) and a non-overweight/obesity group (group N) according to their body mass index values. Twenty-six studies with 11,038 patients were selected. Patients in group O had deteriorated baseline characteristics, including worse baseline estimated glomerular filtration rate (weighted mean differences [WMD] = -5.99), higher Scr (WMD = 7.34), uric acid (WMD = 47.53), 24-hour proteinuria (WMD = 0.40), and a higher prevalence rate of hypertension (odds ratio, OR = 2.70) and diabetes mellitus (OR = 2.644). On the histopathologic level, patients in group O had a significantly lower total glomerular number (WMD = -2.30); however, no difference was observed in mesangial cell proliferation, endocapillary hypercellularity, crescents, sclerosis, and tubular atrophy/interstitial fibrosis between the 2 groups. The incidence of adverse renal outcomes in the 2 groups was similar (OR = 0.96). The meta-analysis of hazard ratios from Cox regressions indicated a strong association between overweight/obesity and poor renal outcomes in glomerulonephritis (HR = 1.17). Overweight/obesity glomerulonephritis patients had remarkably poor baseline clinicopathological characteristics. Being overweight or obesity would likely impact the progression of primary glomerulonephritis but not serious enough to contribute to significant poor renal outcomes, which could be prevented by aggressive therapy.

A retrospective study of the safety and efficacy of peritoneal dialysis catheter placement under combined local infiltration anesthesia and monitored anesthesia care

ObjectiveGiven the lack of global consensus on anesthesia selection for peritoneal dialysis catheter (PDC) placement via open surgery, this study investigates the safety and efficacy of combining local infiltration anesthesia (LIA) with monitored anesthesia care (MAC) in patients with end-stage renal disease (ESRD).MethodsThis retrospective analysis of ESRD patients who underwent open surgical placement of PDC in the Department of Nephrology, the First Affiliated Hospital of the Army Medical University from 1 August 2020 to 31 May 2022. Patients were categorized into two groups based on anesthesia method: LIA group and LIA + MA group. MA was defined as preoperative sedation (0.2–0.7 µg/kg/h) with dexmedetomidine injection (Huidrican trade name, DEX), and intraoperative analgesia with dexrazoxane injection (Garonin trade name, DEZ) as appropriate according to the patients’ pain scores. We compared the general clinical data of the two groups of patients, the changes in blood pressure and heart rate during the whole operation, the intraoperative and postoperative pain, the total duration of the operation and the immediate postoperative complications.ResultsThe study included 123 patients (59 in the LIA + MAC group and 64 in the LIA group). The LIA + MA group exhibited lower pain scores measured by Visual Analogue Scale(VAS) during surgery (skin incision, subcutaneous adipose tissue dissection, anterior fascia, muscle traction, posterior fascia, peritoneum, and catheterization) compared to the LIA group(p<0.05). In terms of surgical incisions, to intraoperative pain scores (VRS), the LIA + MA group showed higher score level I and lower score level II compared to the LIA group (p = 0.002, 0.004, respectively). The LIA + MA group experienced lower postoperative resting pain (NRS) and VAS than the LIA group (p = 0.001,0.003, respectively). The surgical duration for the LIA + MA group was shorter than that of the LIA group (p<0.001). Preoperative systolic and diastolic blood pressures (SBP and DBP) were higher in the LIA + MA group compared to the LIA group (p<0.001,<0.001, respectively). Postoperative heart rate and DBP were lower in the LIA + MA group (p<0.001, 0.004, respectively). The LIA + MA group exhibited greater changes in heart rate, SBP, and DBP during and after surgery compared to the LIA group (p = 0.009, <0.001,<0.001, respectively). In terms of immediate postoperative complications, the proportion of patients requiring analgesics within 24 h post-surgery was significantly lower in the LIA + MA group (p = 0.031).ConclusionOpen surgery for PDC placement under LIA + MAC is both safe and effective.

COVID-19 Vaccination Recommendations for Immunocompromised Patient Populations: Delphi Panel and Consensus Statement Generation in the United States.

The United States Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control (CDC) recommend COVID-19 vaccines for all immunocompromised individuals. Certain disease groups are at increased risk of comorbidity and death for which disease-specific recommendations should be considered. The objective of the Delphi panel of experts was to summarize expert consensus on COVID-19 vaccinations for patients with rheumatologic disease, renal disease, hematologic malignancy and solid organ transplant (SOT) in the US. A two-stage Delphi panel method was employed, starting with qualitative interviews with key opinion leaders (KOLs) in the four disease areas (n = 4 KOLs, n = 16 total) followed by three rounds of iterative revision of disease-specific COVID-19 vaccine recommendations. Final consensus was rated after the third round. Statements addressed primary and booster dosing (e.g., number and frequency) and other considerations such as vaccine type or heterologous messenger ribonucleic acid (mRNA) vaccination. Following the Delphi Panel, an online survey was conducted to assess physician agreement within the disease areas (n = 50 each, n = 200 total) with the consensus statements. Moderate to strong consensus was achieved for all primary series vaccination statements across disease groups, except one in hematology. Similarly, moderate to strong consensus was achieved for all booster series statements in all disease areas. However, statements on antibody titer measurements for re-vaccination considerations and higher dosages for immunocompromised patients did not reach agreement. Overall, approximately 62%-96% of physicians strongly agreed with the primary and booster vaccine recommendations. However, low agreement (29%-69%) was found among physicians for time interval between disease-specific treatment and vaccination, recommendations for mRNA vaccines, heterologous mRNA vaccination, antibody titer measurement and higher vaccine dosage for immunocompromised groups. Consensus was achieved for disease-specific COVID-19 vaccine recommendations concerning primary and booster series vaccines and was generally well accepted by practicing physicians.

Abnormal US findings of the shoulders in Mexican patients with end-stage renal disease: association with long-term hemodialysis

Abnormal US findings of the shoulders in Mexican patients with end-stage renal disease: association with long-term hemodialysis

Research progress on measurement methods and evaluation of the hemodialysis adequacy index Kt/V.

The most common form of replacement therapy for end-stage renal disease (ESRD) is hemodialysis, and the adequacy of hemodialysis is strongly associated with the quality of life and long-term survival of patients. Kt/V is currently one of the most important indicators for evaluating the adequacy of hemodialysis. There are many methods for measuring Kt/V, such as blood collection and measurement, dialysate measurement, bioresistive resistance, WinNonlin software analysis, and artificial intelligence. There are different views on the importance of Kt/V as an indicator of the adequacy of hemodialysis. This article provides a literature review of the various methods of measuring Kt/V and on different perspectives on Kt/V as an evaluation of hemodialysis adequacy.

Cardiac Implantable Electronic Device Infections in Patients with Renal Insufficiency: A Systematic Review and Meta-Analysis.

(1) Background: Renal insufficiency is a risk factor for cardiac implantable electronic device (CIED) infection. (2) Methods: A comprehensive search was conducted from multiple electronic databases to identify studies. Using the random effects model, we calculated the pooled rates of CIED infection and their 95% confidence intervals. We also calculated the pooled odds ratios to determine the risk of CIED infections due to chronic kidney disease (CKD) and end-stage renal disease (ESRD). We utilized the Cochran Q and I2 statistics to detect and quantify heterogeneity. (3) Results: A total of 17 studies comprising 359,784 patients with renal insufficiency were added to the meta-analysis. Out of these, 263,819 were CKD patients and 89,617 were ESRD patients. The pooled rate of CIED infection in patients with CKD was 4.3% (95% CI: 2-8.8; I2: 95.7), and in patients with ESRD, it was 4.8% (95% CI: 2.6-8.7; I2: 99.4). The pooled risk of CIED infection in the CKD population was OR 2.5 (95% CI: 1.9-3.3; p < 0.001; I2: 21.1), and in the ESRD population, it was OR 2.4 (95% CI: 1.01-5.7; p = 0.046; I2: 88.8). ESRD was associated with higher mortality, OR 2.5 (95% CI: 1.4-4.4.8; p = 0.001; I2: 95). (4) Conclusions: The presence of renal insufficiency increases the number of CIED infections. In particular, patients with ESRD have an increased risk of mortality.

Delphi Panel Consensus Statement Generation: COVID-19 Vaccination Recommendations for Immunocompromised Populations in the European Union.

The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare systems globally. The lack of quality guidelines on the management of COVID-19 in rheumatologic disease, renal disease, hematological malignancy, and solid organ transplant recipients has resulted in a wide variation in clinical practice. Using a Delphi process, a panel of 16 key opinion leaders developed clinical practice statements regarding vaccine recommendations in areas where standards are absent or limited. Agreement among practicing physicians with consensus statements was also assessed via an online physician survey. The strength of the consensus was determined by the following rating system: a strong rating was defined as all four key opinion leaders (KOLs) rating the statement ≥ 8, a moderate rating was defined as three out of four KOLs rating the statement ≥ 8, and no consensus was defined as less than three out of four KOLs provided a rating of ≤ 8. Specialists voted on agreement with each consensus statement for their disease area using the same ten-point scoring system. Key opinion leaders in rheumatology, nephrology, and hematology achieved consensuses for all nine statements pertaining to the primary and booster series with transplant physicians reaching consensus on eight of nine statements. Experts agreed that COVID-19 vaccines are safe, effective, and well tolerated by patients with rheumatological conditions, renal disease, hematologic malignancy, and recipients of solid organ transplants. The Delphi process yielded strong to moderate suggestions for the use of COVID-19 messenger ribonucleic acid (mRNA) vaccines and the necessity of the COVID-19 booster for the immunocompromised population. The expert panel had mixed feelings concerning the measurement of antibody titers, higher-dose mRNA vaccines, and the development of disease-specific COVID-19 guidance. These results confirmed the necessity of COVID-19 vaccines and boosters in immunocompromised patients with rheumatologic disease, renal disease, hematological malignancy, and solid organ transplant recipients. Statements where consensus was not achieved were due to absent or limited evidence.

Big data analysis reveals significant increases in complications, costs, and hospital stay in revision total knee arthroplasty compared to primary TKA.

Despite significant advancements in total knee arthroplasty (TKA), some patients require revision surgery (R-TKA) due to complications such as infection, mechanical loosening, instability, periprosthetic fractures, and persistent pain. This study aimed to explore the specific causes leading to R-TKA, associated complications, including infection, mechanical failure, and wound issues, as well as costs, mortality rates, and hospital length of stay (LOS) using data from a large national database. Data from the nationwide inpatient sample (NIS), the largest publicly available all-payer inpatient care database in the United States were analysed from 1 January 2016 to 31 December 2019. The study included 44,649 R-TKA cases, corresponding to 223,240 patients, with exclusions for nonelective admissions. Various statistical analyses were used to assess clinical outcomes, including in-hospital mortality, postoperative complications, LOS, and hospitalization costs. Among 2,636,880 TKA patients, 8.4% underwent R-TKA. R-TKA patients had higher rates of chronic conditions, including mental disorders (36.4%) and renal disease (9.9%). Additionally, these patients often experienced instability, necessitating revision surgery. Infection (22.3%) was the primary reason for R-TKA, followed by mechanical loosening (22.9%) and instability. Compared to primary TKA patients, R-TKA patients exhibited higher in-hospital mortality (0.085% vs. 0.025%), longer LOS (3.1 vs. 2.28 days), and higher total charges ($97,815 vs. $62,188). Postoperative complications, including blood transfusion (4.6% vs. 1.3%), acute kidney injury (4.4% vs. 1.8%), venous thromboembolism (0.55% vs. 0.29%), infection, and wound problems, were significantly higher in R-TKA patients. This study provides detailed insights into t LOS, costs, and complications associated with specific etiologies of revision TKA. Our findings emphasize the need for targeted preoperative optimization and patient education. This approach can help reduce the incidence and burden of R-TKA, improve patient care, optimize resource allocation, and potentially decrease the overall rates of complications in revision surgeries. Level III.

Sex- and age-specific differences in the use of antiarrhythmic therapies among atrial fibrillation patients: a nationwide cohort study.

Atrial fibrillation (AF) patients frequently require active rhythm control therapy to maintain sinus rhythm and reduce symptom burden. Our study assessed whether antiarrhythmic therapies (AATs) are used disproportionately between men and women after new-onset AF. The nationwide Finnish anticoagulation in atrial fibrillation (FinACAF) registry-based linkage study covers all patients with new-onset AF in Finland during 2007-2018. Study outcomes included initiation of AATs in the form of antiarrhythmic drugs (AAD), cardioversion, or catheter ablation. The study population constituted of 229 565 patients (50% females). Women were older than men (76.6 ± 11.8 vs. 68.9 ± 13.4 years) and had higher prevalence of hypertension or hyperthyroidism, but lower prevalence of vascular disease, diabetes, renal disease, and cardiomyopathies than men. Overall, 17.6% of women and 25.1% of men were treated with any AAT. Women were treated with AADs more often than men in all age groups (adjusted subdistribution hazard ratio (aSHR) 1.223, 95%-CI 1.187-1.261). Cardioversions were also performed less often on women than on men aged <65 years (aSHR 0.722, 95%-CI 0.695-0.749), more often in patients ≥75 years (aSHR 1.166, 95%-CI 1.108-1.227), while no difference between the sexes existed in patients aged 65-74 years. Ablations were performed less often in women aged <65 years (aSHR 0.908, 95%-CI 0.826-0.998) and ≥75 years (aSHR 0.521, 95%-CI 0.354-0.766), whereas there was no difference in patients aged 65-74 years. Women used more AAD than men in all age groups but underwent fewer cardioversion and ablation procedures when aged <65 years.