Peritoneal defense in continuous ambulatory versus continuous cyclic peritoneal dialysis

Peritoneal defense in continuous ambulatory peritoneal dialysis versus continuous cyclic peritoneal dialysis. Several centers have reported a lower rate of peritonitis among adult patients on continuous cyclic peritoneal dialysis (CCPD) as compared to those undergoing continuous ambulatory peritoneal dialysis (CAPD). Preliminary results of our ongoing prospective randomized study comparing CAPD-Y with CCPD also suggest a lower peritonitis incidence among CCPD-treated patients. To investigate whether the two dialysis regimens could result in differences in local host defense, we studied peritoneal macrophage (PMO) function and effluent opsonic activity in eight patients established on CAPD-Y matched with eight chronic CCPD patients. Since short and long dwell times are inherent to both dialysis modalities, and we previously found that dwell time has an impact on PMO function and effluent opsonic activity, patients were studied after both a short (4hr) and a long (15hr) dwell time. In both patient groups PMO phagocytic capacity increased significantly with dwell time (39 ± 3.3% at 4hr vs. 58 ± 4.2% at 15hr in CAPD patients, and 40 ± 3.9 vs. 72 ± 3.3% in CCPD patients; P < 0.01), as did PMO peak chemiluminescence response (31 ± 4.9 vs. 77 ± 7.2 counts · min-1/104 cells in CAPD, and 22 ± 3.9 vs. 109 ± 21.2 counts · min-1/104 cells in CCPD; P < 0.01) and effluent opsonic activity (41 ± 7.6 vs. 73 ± 5.8% in CAPD and 39 ± 6.2 vs. 70 ± 5.9% in CCPD; P < 0.01). However, no significant difference was found in either variable between CAPD and CCPD patients when dwell times were equal. In conclusion, no differences were observed in PMO function or effluent opsonic activity between matched CAPD-Y and CCPD patients when dwell times were equal. In both patient groups prolongation of dwell time enhanced PMO function as well as effluent opsonic activity, thereby providing a better host defense. The improvement in peritoneal defenses may, in part, be responsible for the lower peritonitis incidence observed among CCPD-treated patients

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

© The Author(s) 2022.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