Exposure to novel coronavirus in patients on renal replacement therapy during the exponential phase of COVID-19 pandemic: survey of the Italian Society of Nephrology

Background: Between February and April 2020, Italy experienced an overwhelming growth of the COVID-19 pandemic. Little is known, at the country level, where and how patients on renal replacement therapy (RRT) have been mostly affected. Methods: Survey of the network of Nephrology centers using a simplified 17 items electronic questionnaire designed by Italian Society of Nephrology COVID-19 Research Group. We used spatial epidemiology and geographical information systems to map SARS-CoV-2 spread among RRT patients in Italy. Results: On April 9th 2020, all nephrology centers (n = 454) listed in the DialMap database were invited to complete the electronic questionnaire. Within 11 days on average, 365 centers responded (80.4% response rate; 2.3% margin of error) totaling 60,441 RRT patients. The surveyed RRT population included 30,821 hemodialysis (HD), 4139 peritoneal dialysis (PD), and 25,481 transplanted (Tx) patients respectively. The proportion of SARS-CoV-2 positive RRT patients in Italy was 2.26% (95% CI 2.14\u20132.39) with significant differences according to treatment modality (p < 0.001). The proportion of patients positive for SARS-CoV-2 was significantly higher in HD (3.55% [95% CI 3.34\u20133.76]) than PD (1.38% [95% CI 1.04\u20131.78] and Tx (0.86% [95% CI 0.75\u20130.98]) (p < 0.001), with substantial heterogeneity across regions and along the latitude gradient (p < 0.001). In RRT patients the highest rate was in the north-west (4.39% [95% CI 4.11\u20134.68], followed by the north-east (IR 2.06% [1.79\u20132.36]), the center (0.91% [0.75\u20131.09]), the main islands (0.67% [0.47\u20130.93]), and the south (0.59% [0.45\u20130.75]. During the COVID-19 pandemic, among SARS-Cov-2 positive RRT patients the fatality rate was 32.8%, as compared to 13.3% observed in the Italian population as of April 23rd. Conclusions: A substantial proportion of the 60,441 surveyed RRT patients in Italy were SARS-Cov-2 positive and subsequently died during the exponential phase of COVID-19 pandemic. Infection risk and rates seems to differ substantially across regions, along geographical latitude, and by treatment modality

MM2-thalamic Creutzfeldt-Jakob disease-Neuropathological, biochemical and transmission studies identify a distinctive prion strain

In Creutzfeldt-Jakob disease (CJD), molecular typing based on the size of the protease resistant core of the disease-associated prion protein (PrP(Sc) ) and the M/V polymorphism at codon 129 of the PRNP gene correlates with the clinico-pathologic subtypes. Approximately 95% of the sporadic 129MM CJD patients are characterized by cerebral deposition of type 1 PrP(Sc) and correspond to the classic clinical CJD phenotype. The rare 129MM CJD patients with type 2 PrP(Sc) are further subdivided in a cortical and a thalamic form also indicated as sporadic fatal insomnia. We observed two young patients with MM2-thalamic CJD. Main neuropathological features were diffuse, synaptic PrP immunoreactivity in the cerebral cortex and severe neuronal loss and gliosis in the thalamus and olivary nucleus. Western blot analysis showed the presence of type 2A PrP(Sc) . Challenge of transgenic mice expressing 129MM human PrP showed that MM2-thalamic sporadic CJD (sCJD) was able to transmit the disease, at variance with MM2-cortical sCJD. The affected mice showed deposition of type 2A PrP(Sc) , a scenario that is unprecedented in this mouse line. These data indicate that MM2-thalamic sCJD is caused by a prion strain distinct from the other sCJD subtypes including the MM2-cortical form

From the Mailing List of the Italian Society of Nephrology: use of isolation rooms for HBV-positive patients in dialysis[PART TWO]

In the course of recent months, on the mailing list of the Italian Society of Nephrology (ML-SIN), a message asking for opinions on preventative measures for HBsAg patients has stimulated an extensive debate, in particular on the use of separate dialysis rooms. The discussion evidenced significant differences in the procedures adopted, not only between dialysis units, but also in regional health systems' directives. This emphasizes the necessity in dealing carefully with this problem, taking into account the scientific evidence of the infectious risk and epidemiological profile of hepatitis B virus (HBV) in dialysis patients. Moreover, potential solutions must be considered in terms of their effective cost benefit ratio. To complete the previous article, which examined the question from the viewpoint of an expert nephrologist, this issue of the review dedicated to the ML-SIN reports the opinion of an infectious diseases specialist, identified for its scientific contribution to this specific discussion

[Assessment of treatment quality by hierarchical models in the Italian dialysis and transplantation registry]

Given the operative difficulties and expenses inherent in a clinical audit, we explored whether the Italian Dialysis and Transplantation Registry (RIDT) might offer a valid alternative for quality analysis about two aspects of renal replacement therapy: how widespread is the practice of peritoneal dialysis, and how often is a temporary catheter used as first vascular access for dialysis. We analyzed the data of all patients recorded in the RIDT in 2007 with regard to the type of first treatment, age, gender and primary kidney disease. For peritoneal dialysis we compared all Italian regions having scattered data. With regard to the types of vascular access and the comorbidities at the start of treatment, we evaluated patients from Veneto only. The performance of regions and centers were evaluated using a random-effects multilevel logistic model. Only 65% of Italian regions were available in RIDT; 13.8% of patients began RRT with peritoneal dialysis, with only 3 regions exceeding 20%. Differences among regions were due more to differences in patient characteristics than to between center differences in treatment strategies. Data on vascular access were available for 83% of the patients. Almost 40% began RRT with a temporary catheter; in 12 of 22 centers this was less than 35%. Also in this case, differences were due to patient characteristics. Incomplete data limit the strength of the interpretation of our study results. At any rate, differences among regions or centers seem due more to patient characteristics than to treatment strategies

Dalla Mailing-List soci SIN (ML-SIN). La sclerosi peritoneale: terapia e prevenzione [From the Mailing List SIN: Therapy and prevention of peritoneal sclerosis]

Recently, in the Mailing List of the Italian Society of Nephrology (ML-SIN), a message asking for opinions on the diagnosis and treatment of peritoneal sclerosis gave rise to an extensive debate on this interesting clinical topic. The discussion evidenced significant differences both in the reported onset of clinical manifestations, emphasizing the difficulty in obtaining a definite early diagnosis, and in therapy approaches. Occasionally, this is limited to medical treatment, but surgery, although burdened with elevated complexity and high mortality rates due to post-operative complications, is usually advocated for intestinal obstruction. This is the second issue reserved for the review of the ML-SIN concerning this topic, following that dedicated to definition, etiology, pathology and clinical characteristics. In this section, two expert colleagues complete the analysis of the different aspects of peritoneal sclerosis, discussing the therapy and the prevention of this serious complication of peritoneal dialysis

Dalla Mailing-List soci SIN (ML-SIN): la sclerosi peritoneale [From the Mailing List SIN: peritoneal sclerosis]

In the course of previous months, in the Mailing List of the Italian Society of Nephrology (ML-SIN), a message asking for opinions on the diagnosis and treatment of peritoneal sclerosis, gave rise to an extensive debate concerning this clinically interesting topic. The discussion evidenced significant differences both in the reported onset of clinical manifestations, emphasizing the difficulty in obtaining a definite early diagnosis, and in therapy approaches. This is sometimes limited to medical treatment, but surgery, although burdened with elevated complexity and a high mortality rate, mainly due to post-operative complications, is usually advocated for intestinal obstruction. In this issue of the review dedicated to the ML-SIN, two expert colleagues will analyze the different aspects of peritoneal sclerosis. The argument is developed in two sections: the first section is dedicated to the discussion of definition, etiology, pathology and clinical characteristics of this serious complication in peritoneal dialysis (PD)