Recovery of dialysis patients with COVID-19 : health outcomes 3 months after diagnosis in ERACODA

Background. Coronavirus disease 2019 (COVID-19)-related short-term mortality is high in dialysis patients, but longer-term outcomes are largely unknown. We therefore assessed patient recovery in a large cohort of dialysis patients 3 months after their COVID-19 diagnosis. Methods. We analyzed data on dialysis patients diagnosed with COVID-19 from 1 February 2020 to 31 March 2021 from the European Renal Association COVID-19 Database (ERACODA). The outcomes studied were patient survival, residence and functional and mental health status (estimated by their treating physician) 3 months after COVID-19 diagnosis. Complete follow-up data were available for 854 surviving patients. Patient characteristics associated with recovery were analyzed using logistic regression. Results. In 2449 hemodialysis patients (mean ± SD age 67.5 ± 14.4 years, 62% male), survival probabilities at 3 months after COVID-19 diagnosis were 90% for nonhospitalized patients (n = 1087), 73% for patients admitted to the hospital but not to an intensive care unit (ICU) (n = 1165) and 40% for those admitted to an ICU (n = 197). Patient survival hardly decreased between 28 days and 3 months after COVID-19 diagnosis. At 3 months, 87% functioned at their pre-existent functional and 94% at their pre-existent mental level. Only few of the surviving patients were still admitted to the hospital (0.8-6.3%) or a nursing home (∼5%). A higher age and frailty score at presentation and ICU admission were associated with worse functional outcome. Conclusions. Mortality between 28 days and 3 months after COVID-19 diagnosis was low and the majority of patients who survived COVID-19 recovered to their pre-existent functional and mental health level at 3 months after diagnosis

Peritoneal sclerosis--aetiology, diagnosis, treatment and prevention

Peritoneal selerosis (PS) is a rare, but potentially life-threatening complication in peritoneal dialysis (PD). The annual incidence increases with the duration of PD treatment and the mortality rate is high. Aetiology of PS is probably multifactorial and in most cases not exactly known. One import factor of PS is the bioincompatibility of the glucose-based PD solutions. Diagnosis is mainly based on clinical suspicion and radiological findings. Early detection is important to institute preventive strategies and development of therapeutic strategies has reduced mortality

Influence of icodextrin on plasma and dialysate levels of N(epsilon)-(carboxymethyl)lysine and N(epsilon)-(carboxyethyl)lysine

RATIONALE: Standard peritoneal glucose solutions may induce the formation of advanced glycation end products (AGEs). Preliminary data suggest that AGE formation may be less with the use of polyglucose solutions (icodextrin). Therefore, we investigated whether the use of icodextrin for the long dwell would result in a reduction in plasma and dialysate levels of the AGE products N(epsilon)-(carboxymethyl) lysine (CML) and N(epsilon)-(carboxyethyl) ysine (CEL). PATIENTS AND METHODS: 40 patients were randomized to treatment with standard glucose solutions (1.36%) and icodextrin for the long dwell during a 4-month study period; 32 patients completed the study. CML was assessed by stable isotope dilution/tandem mass spectrometry. RESULTS: CML levels in plasma increased significantly in patients treated with icodextrin (0.146 +/- 0.056 at start vs 0.188 +/- 0.069 micromol/mmol Lys at the end of the study, p < 0.0001) but did not change in the control group (0.183 +/- 0.090 vs 0.188 +/- 0.085 micromol/mmol Lys). The same held true for CML levels in dialysate (0.28 +/- 0.09 at start vs 0.33 +/- 0.11 micromol/mmol Lys at the end of the study, p < 0.025). No change was observed in patients treated with the control solutions (0.31 +/- 0.11 at start vs 0.31 +/- 0.07 micromol/mmol Lys). CONCLUSION: Contrary to the hypothesis, plasma and dialysate levels of CML increased in patients treated using icodextrin for the long dwell

Moderate elevations of high-sensitivity cardiac troponin I and B-type natriuretic peptide in chronic hemodialysis patients are associated with mortality

BACKGROUND: Several biomarkers are associated with mortality in hemodialysis patients. In particular, elevated cardiac troponin T and B-type natriuretic peptide (BNP) are strong predictors of mortality; however, less is known about cardiac troponin I (cTnI). Elevated troponin I is detected in many hemodialysis patients, but the association of moderate elevations with mortality is unclear. METHODS: The relation between mortality and cTnI, using a high-sensitivity cTnI assay, as well as BNP and C-reactive protein (CRP) was evaluated in 206 chronic hemodialysis patients. RESULTS: Median follow-up was 28 months with a total mortality of 35%. Mortality was significantly associated with elevated cTnI, BNP and CRP. Even patients with only moderate elevation of cTnI (0.01-0.10 µg/L) showed 2.5-fold increased mortality. Interestingly, hazard ratios for mortality for single (random) measurements were comparable to those for mean/median measurements. Subsequently, subgroup analysis based on combined markers was performed. Patients with both cTn

Is there a competition between urine volume and peritoneal ultrafiltration in peritoneal dialysis patients?

Many peritoneal dialysis patients are overhydrated. Overhydration may lead to hypertension and left ventricular hypertrophy, and may be related to inflammation and malnutrition. The presence of overhydration is not always detected by clinical examination. Especially patients with peritoneal ultrafiltration failure and/or negligible residual renal function are prone to overhydration. Treatment consists of a combination of sodium and fluid restriction, in combination with increased peritoneal ultrafiltration and loop diuretics in patients with residual diuresis. Peritoneal ultrafiltration can be enhanced by the use of hypertonic glucose solutions or icodextrin. In some, but not all, studies, residual renal function or diuresis declined with an increase in peritoneal ultrafiltration. At least in a subset of patients, underhydration might have played a role in this phenomenon. We propose to treat overhydration using both clinical criteria and objective techniques such as vena cava echography or bioimpedance measurements