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  • 1
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    Opportunities to improve the management of anemia in peritoneal dialysis patients: lessons from a national study in routine clinical practice
    Oxford University Press (OUP) ; 2023
    In:  Clinical Kidney Journal ( 2023-06-29)
    Details
    In: Clinical Kidney Journal, Oxford University Press (OUP), ( 2023-06-29)
    Kurzfassung: Current guidelines establish the same hemoglobin (Hb) and iron biomarkers targets for hemodialysis (HD) and peritoneal dialysis (PD) in patients receiving erythropoiesis-stimulating agents (ESAs) even though patients having PD are usually younger, more active and less comorbid. Unfortunately, specific renal anemia [anemia in chronic kidney disease (aCKD)] trials or observational studies on PD are scanty. The aims of this study were to describe current aCKD management, goals and adherence to clinical guidelines, identifying opportunities for healthcare improvement in PD patients. Methods This was a retrospective, nationwide, multicentre study including patients from 19 PD units. The nephrologists collected baseline data, demographics, comorbidities and data related to anemia management (laboratory values, previously prescribed treatments and subsequent adjustments) from electronic medical records. The European adaptation of KDIGO guidelines was the reference for definitions, drug prescriptions and targets. Results A total of 343 patients (mean age 62.9 years, 61.2% male) were included; 72.9% were receiving ESAs and 33.2% iron therapy [20.7% intravenously (IV)]. Eighty-two patients were receiving ESA without iron therapy, despite 53 of them having an indication according to the European Renal Best Practice guidelines. After laboratory results, iron therapy was only started in 15% of patients. Among ESA-treated patients, 51.9% had an optimal control [hemoglobin (Hb) 10–12 g/dL] and 28.3% between 12–12.9 g/dL. Seventeen patients achieved Hb & gt;13 g/dL, and 12 of them remained on ESA after overshooting. Only three patients had Hb & lt;10 g/dL without ESAs. Seven patients (2%) met criteria for ESA resistance (epoetin dose & gt;300 IU/kg/week). The highest tertile of erythropoietin resistance index ( & gt;6.3 UI/kg/week/g/dL) was associated with iron deficiency and low albumin corrected by renal replacement therapy vintage and hospital admissions in the previous 3 months. Conclusion Iron therapy continues to be underused (especially IV). Low albumin, iron deficiency and prior events explain most of the ESA hyporesponsiveness. Hb targets are titrated to/above the upper limits. Thus, several missed opportunities for adequate prescriptions and adherence to guidelines were identified.
    Materialart: Online-Ressource
    ISSN: 2048-8505 , 2048-8513
    URL: Article
    DOI: 10.1093/ckj/sfad152
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2023
    ZDB Id: 2656786-6
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  • 2
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    MO1054IMUP: THE ROLE OF TELEMEDICINA ON THE HOMECARE OF CHRONIC KIDNEY DISEASE PATIENTS AFFECTED WITH COVID19
    Oxford University Press (OUP) ; 2021
    In:  Nephrology Dialysis Transplantation Vol. 36, No. Supplement_1 ( 2021-05-29)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 36, No. Supplement_1 ( 2021-05-29)
    Kurzfassung: COVID19 worldwide crisis has shown the fragility of usually overbooked hospital care, encouraging improvements on the homecare and remote monitoring of patients. IMUP (Intelligent Manager for Ubiquitous Personal Mobile Care) is a Mobile App developed by UPM to follow up  chronic kidney disease (CKD) patients affected with COVID19. Method CKD patients (or their home caregivers) with access to a mobile phone were asked to introduce daily their symptoms (headache, tiredness, short of breath, cough and diarrhea) in addition to blood pressure and temperature. IMUP also allowed: (1) free asynchronous message exchange between patients and physicians, (2) provided general information and guidelines to reduce household COVID19 transmissions, (3) countdown of isolation days, and (4) notified alarms and alerts.  All patients consented to a mobile phone monitor. Physicians categorized clinical situations reviewing IMUP symptoms into: (1) stable, (2) alert, and (3) presential assistance advised. Results A total of 38 patients (9 kidney transplant, 23 haemodialysis, 3 peritoneal dialysis, 3 low clearance)( 58.8% male, age 62.2 ± 15.6 years, 17.6 % diabetics) with confirmed COVID19 infection were followed up with IMUP, 23 after hospitalization (median of 10 [4-16] days) and 15 with complete outpatient follow-up. The mean follow-up with IMUP was 8 [4,17] days. Four houndred and seven daily symptoms were introduced in IMUP, being tiredness the commonest (27%), followed by cough (21.5%) and diarrhea (20.6%).  Reviewing IMUP daily symptoms, 185 clinical situations were categorized in stable and 21 alert. Five patients required presential assistance, 3 of them requiring hospital admission (1 rehospitalization). 81 messages were exchanged, delivering 17 therapeutic recommendations.  IMUP countdown helped to organize isolation on the HD unit (cases and contacts), plus follow up with chest X rays and blood samples. Conclusion The easy and intuitive use of mobile apps makes them widely accepted by the general population. Remote monitoring by mobile phone apps brings a new opportunity to alleviate our overbooked hospital care. Besides, remote monitoring could help to stratify and organize clinical follow up, allowing a closer communication between physicians and patients.
    Materialart: Online-Ressource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfab113.0010
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2021
    ZDB Id: 1465709-0
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  • 3
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    MO052COL4A3/COL4A4 AS A CAUSE OF MULTICYSTIC KIDNEY DISEASE
    Oxford University Press (OUP) ; 2021
    In:  Nephrology Dialysis Transplantation Vol. 36, No. Supplement_1 ( 2021-05-29)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 36, No. Supplement_1 ( 2021-05-29)
    Kurzfassung: Thin basement membrane nephropathy (TBMN), the most common cause of persistent microhaematuria (mH), is due to mutations in genes codifying alfa-3 and alfa-4 collagen IV chains (COL4A4/COL4A3). Initially considered as a benign condition, subsequent studies have shown that an important number of patients develop proteinuria and CKD. We reported in a previous small study the presence of multicystic kidney disease (MCD) in some TBMD patients. In this study we aimed to evaluate the presence of MCD in a larger cohort of TBMD patients and analyze its association with renal outcomes. Method We collected 50 patients with a diagnosis of TBMD based on the presence of persistent mH ( & gt;5 erythocytes per high power field in more than 90% of urinary sediments and radiological examinations to exclude other causes of mH) and at least one first-degree relative with persistent mH. TBMD diagnosis was confirmed by renal biopsy (glomerular basement membrane thickness less than 150nm) in 18 patients and by genetic test (pathogenic mutations in COL4A3/COL4A4) in 6 patients. MCD was diagnosed by the presence of uncountable cysts on renal ultrasonography. Results Mean age at diagnosis was 43.7 years, 34% were males and 18% had hypertension. At baseline, serum creatinine (SCr) was 0.9 mg/dL, proteinuria 0.48 gr/24h and 9 patients (18%) had CKD (estimated glomerular filtration rate -eGFR- lower than & lt;60 mL/min/1.73m2). 7 patients (14%) had CKD G3 and 2 (4%) CKD G4. Kidney cysts were found in 34 patients (68%) and 19 (38%) met MCD criteria. After a mean follow-up of 14.7±11.5 years, 23 patients (46%) had CKD. Among them, 17 patients (34%) had CKD G3, 2 (4%) CKD G4, and 4 (8%) CKD G5. Hypertension was more frequent among CKD patients as compared with no-CKD patients (39 vs 0%, p 0.00), proteinuria was higher (0.58±0.68 vs 0.39±0.58 g/24h, p 0.05) and MCD more frequent (65.2% vs 14.8%, p 0.00). Patients with MCD had higher SCr (2.1 vs 1.1 mg/dL, p 0.004) and lower eGFR (41.7 vs 77.2 mL/min/1.73m2, p 0.00) at the end of follow-up, and MCD was the only risk factor for the occurrence of CKD (OR 6.49, 95% CI 1.3-31.6) by multivariable analysis that included age, hypertension and proteinuria. Conclusion MCD is frequently observed in TBMD patients and is a risk factor for the progression of CKD.
    Materialart: Online-Ressource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfab080.0024
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2021
    ZDB Id: 1465709-0
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  • 4
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    #5730 PERLECAN AS A POTENTIAL BIOMARKER OF CARDIOVASCULAR RISK: ROLE OF ENDOTHELIAL GLYCOCALYX IN CHRONIC KIDNEY DISEASE
    Oxford University Press (OUP) ; 2023
    In:  Nephrology Dialysis Transplantation Vol. 38, No. Supplement_1 ( 2023-06-14)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 38, No. Supplement_1 ( 2023-06-14)
    Kurzfassung: Chronic kidney disease (CKD) is associated with cardiovascular disease (CVD). CVD is in turn related to endothelial dysfunction, endothelial dysfunction, and degradation of the endothelial glycocalyx (EG), releasing its components into the bloodstream. The EG consists of glycosaminoglycans and proteoglycans, such as Perlecan. The aim of the study is to analyse the levels of perlecan in plasma in different stages of CKD, and to relate them to age and inflammatory monocytes, as well as their adhesion capacity (CD54/ICAM-1). Method An observational cross-sectional study was carried out. 56 patients were included: advanced chronic kidney disease (ACKD) (n=13), haemodialysis (HD) (n=13), peritoneal dialysis (PD) (n=15) and transplant recipients (TX) (n=15). Thirteen healthy subjects (CT) were analysed. Plasma perlecan levels were quantified using ELISA and phenotyping of monocyte subpopulations (classical (CD14++CD16-), intermediate (CD14+CD16+) and non-classical (CD14+CD16++)), as well as CD54 (ICAM-1) expression by flow cytometry. Statistical analysis: ANOVA and Spearman correlation. Results Patients with CKD had higher plasma levels of perlecan than healthy participants (p-value = 0.044 vs ACKD, 0.028 vs HD and 0.002 vs PD) (Fig. 1). These levels were associated with higher percentage of classical monocytes (p=0,011) intermediate monocytes (p=0,009) and non-classical monocytes (p=0,003) expressing ICAM-1 but not with a higher expression of ICAM-1 per monocyte. Perlecan levels correlate negatively with age (p=0,03) (Table 1). Conclusion Patients with ACKD, HD and PD have elevated plasma perlecan levels compared to CT and TX. Elevated perlecan concentrations are associated with increased ICAM-1 expression on monocytes, which is important for its possible role in the development of atherosclerosis. Perlecan may be postulated as a molecule of interest to assess endothelial and cardiovascular damage in CKD patients.
    Materialart: Online-Ressource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfad063d_5730
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2023
    ZDB Id: 1465709-0
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  • 5
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    SO007OVERHYDRATION TREATMENT WITH COMBINED CRYSTALLOID AND COLLOID PD SOLUTION
    Oxford University Press (OUP) ; 2020
    In:  Nephrology Dialysis Transplantation Vol. 35, No. Supplement_3 ( 2020-06-01)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 35, No. Supplement_3 ( 2020-06-01)
    Kurzfassung: Peritoneal dialysis (PD) fluids used colloid or crystalloid solutions to achieve ultrafiltration. Here we presented our clinical experience with the intraperitoneal (IP) use of mixed solutions (MS) (crystalloid plus colloid) to treat overhydration. Method We studied the kinetics of 4-hour single-dwell exchange using 2L MS in 3 different sessions. We analysed IP fluids and IP pressure at 0,30,60,120 and 240 min plus blood samples at 0, 120 and 240 min. MS kinetics were compared with standard 4-hour 3.86 % glucose (GS) exchange. MS composition. We modified a single-dwell exchange of 2L Icodextrin (Extraneal, Baxter®) by adding a continuous 50% glucose infusion (50g Glucose per 100mL) in an aseptic technique through infusion pump (42 ml/h) over 4 hours. Results MS exchange induced a progressive increase in IP pressure with an inverse decrease in IP sodium, without significant changes in IP glucose or osmolarity. MS exchanges were well tolerated without side effects (total 25 sessions). We did not observe any remarkable change in bloods samples during the MS exchange. The combination fluid enhanced net ultrafiltration (mean 1030 ml) compared with GS (650 ml). Although the net glucose dispensed was slightly higher with MS (79 g MS vs 77.2 g GS), similar net glucose absorption was observed (49.8 g MS vs 49.9g GS) and smaller maximum intraperitoneal glucose levels (1739 mg/dL at 120 min with MS vs 2695 mg/dL with GS at 0 min). GS induced a faster initial reduction in dialysate sodium concentration while MS maintained the sodium sieving over 4-hour dwell enhancing net ultrafiltration due to sustained IP glucose concentration. Conclusion The combination fluid could be a new strategy to enhance ultrafiltration in PD patients, leaded by colloid osmosis at the beginning of PD exchange maintained by crystalloid osmosis. Figure (A) Intraperitoneal kinetics of MIXED SOLUTION for IP sodium (Na+ PF), Osmolarity PF and intraperitoneal pressure. (B, C, D) Comparison between MIXED SOLUTIONS (black line) vs Glucose solution 3,86 % (gray line) intraperitoneal kinetcs for sodium (B), intraperitoneal pressure (C) and glucose (D).
    Materialart: Online-Ressource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfaa139.SO007
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2020
    ZDB Id: 1465709-0
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  • 6
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    MO663THE UTILITY OF SMART SCALES TO MONITOR BODY COMPOSITION IN HEMODIALYSIS PATIENTS
    Oxford University Press (OUP) ; 2021
    In:  Nephrology Dialysis Transplantation Vol. 36, No. Supplement_1 ( 2021-05-29)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 36, No. Supplement_1 ( 2021-05-29)
    Kurzfassung: Overhydration (OH) is an independent predictor of mortality on hemodialysis (HD). The gold standard to assess OH is BCM monitor from Fresenius®, however BCM is a hospital hold device limiting its use. New smart scales have emerged as household devices reporting daily body composition data. Objective To determine if Renpho ES-CS20M® could be useful on a 52 HD patient to estimate body composition data. Method 72 body composition assessments (BCA) during mid-week HD session were performed. Each BCA included: (1) Predialysis Renpho measurement, (2) Predialysis BCM monitor measurement, (3) Postdialysis Renpho measurement. To track the fluid balance during the HD session: (1) we recorded ultrafiltration, (2) food or fluid intake was not allowed, and (3) none of the HD patients urinated during the HD session. If any intravenous fluids were needed during the HD session, we subtracted them off from UF. Results Data from 52 HD patients were studied (age 58.8 ± 16.8 years, 56.9 % males, 14.7% diabetics), with a mean pre-HD weight of 70.0 ± 13. 4 Kg, overhydration of 1.7 ± 1.5 L and urea distribution volume of 31.7 ± 5.7 L. The mean ultrafiltration during HD session was -1.8 ± 0.9 L. Renpho estimated a Pre – HD hydration of 34.25 ± 6.02 Kg vs 33.4 ± 5.7 Kg by BCM, showing a good concordance between methods (ICC 0.788 [0.67-0.86], B -0.58, p & lt;0.01). Renpho poorly estimated pre – HD lean tissue mass at 45.4 ± 6.9 Kg compared with 33.8 ± 8.0 Kg by BCM. Although Renpho was able to provide a moderate concordant estimation of fat tissue mass (33.8 ± 8.0 % with Renpho vs 34.7 ± 9.6%), the bias proportion was unacceptable. Post- HD hydration by Renpho was not able to reproduce the ultrafiltracion achieved during the HD session (pre-HD 34.25 ± 6.02 Kg vs post-HD 34.08 ± 6.00 Kg). Conclusion Renpho has a proportional bias estimating predialysis hydration compared with BCM monitor, but is not able to assess changes produced with ultrafiltration or other parameters of body composition (as lean or fat tissue mass). Although smart scales are unacurate to assess body composition on HD patients, they could be useful on the follow up of them changing the accuracy for frequency.
    Materialart: Online-Ressource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfab099.008
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2021
    ZDB Id: 1465709-0
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  • 7
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    MO910CHANGE IN BODY COMPOSITION MEASURED BY BIOIMPEDANCE SPECTROSCOPY AFTER COVID19 LOCKDOWN IN HAEMODIALYSIS PATIENTS
    Oxford University Press (OUP) ; 2021
    In:  Nephrology Dialysis Transplantation Vol. 36, No. Supplement_1 ( 2021-05-29)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 36, No. Supplement_1 ( 2021-05-29)
    Kurzfassung: Changes on body composition have an impact on the survival of haemodialysis (HD) patients. The aim of the study was to determine the impact of the reduction of physical activity due to COVID19 lockdown on body composition in HD patients. Method Retrospective and observational study including 149 HD patients. Nutritional and Bioimpedance spectroscopy (BIS) data were recorded before and after COVID19 lockdown (mean of 148 ± 20 days between determinations). Results Over the 49 days of COVID19 lockdown, we observed a decrease in normohydrated weight (NHW) of 1.01 ± 3.59 kg mainly secondary to a reduction on total body water (TBW) 0.95 ± 3.78 L (extracellular water 0.45 ± 1.58 L and intracellular water 0.41 ± 2.36 L). There was also a small loss on lean tissue index (LTI) of 0.28 ± 2.42 kg/m2, with an increase of fat tissue index (FTI) 0f 0.02 ± 2.82 kg/m2. Twenty-three patients presented COVID19 infection, of which 21 required admission (median of 10 [4-16] days). Patients who presented COVID19 were older (70.7 ± 12.0 vs 64.9 ± 16.6 years, NS) with higher Charlson index (7.48 ± 2.77 vs 6.33 ± 2.65, p = 0.07). Patients with COVID19 infection presented a greater loss on LTI (-1.18 ± 3.15 bs -0.16 ± 2.30 kg/m2; p = 0.22), FTI (-0.41 ± 3.38 vs 0.06 ± 2.74 kg/m2; p = 0.54); BMI (-1.49 ± 2.14 vs -0.25 ± 0.96 kg/m2; p = & lt; 0.01) and NHW (-4.00 ± 6.33 vs -0.62 ± 2.90 kg; p = & lt; 0.01) compared to patients without COVID19 infection. The length of hospitalization was associated with greater loss of BMI and NHW, resulting, therefore, in overhydration. There also had lower serum phosphorus (3.6 ± 0.8 vs 5.2 ± 0.8 mg/dl; p = 0.01) and serum albumin (3.5 ± 0.4 vs 4.0 ± 0.1 g/dl; p = 0.01). Seven patients died during hospitalization. Deceased patients were older (78.4 ± 6.6 vs 67.4 ± 12.4 years; p = 0.01), presented higher comorbidity (estimated by Charlson index 10.0 [8.0-11.0] vs 6.5 [4.3-8.0] ; p = 0.02) and were more overhydrated (3.4 ± 3.6 vs 1.9 ± 1.9; p = 0.34). Although not statistically different, they had lower LTI (10.4 ± 2.1 vs 12.0 ± 3.4 kg/m2; p = 0.18) and lower serum albumin (3.4 ± 0.6 vs 3.9 ± 0.4 g/dl; p = 0.08) compared to survivors. Patients who survived COVID19 infection had longer hospitalization (57% were discharged between twelfth and forty third day; mean hospitalization 14.6 ± 11.5 days). Deceased patients died within the first 12 days of hospitalization (6.8 ± 4.1 days). Conclusion COVID19 lockdown induced a weight reduction on HD patients due to decrease in total body water. COVID19 infection increased this reduction, inducing greater loss on lean and fat tissue composition. Moreover, COVID19 impact on body composition was magnified with the length of hospitalization.
    Materialart: Online-Ressource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfab102.0011
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2021
    ZDB Id: 1465709-0
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  • 8
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    #5890 THE IMPACT OF CKD STATUS BEFORE KIDNEY TRANSPLANTION ON ALPHATORQUEVIRUS DNA LEVELS
    Oxford University Press (OUP) ; 2023
    In:  Nephrology Dialysis Transplantation Vol. 38, No. Supplement_1 ( 2023-06-14)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 38, No. Supplement_1 ( 2023-06-14)
    Kurzfassung: Torque teno virus (TTV) is a non-pathogenic anellovirus whose replication kinetics reflects the overall state of immunosuppression. Although chronic kidney disease (CKD) induces a well-stabilised dysfunction of the immune system, long-term use of renal replacement therapies (RRT) itself could also modify the immune response. Method We analyzed TTV DNA loads at baseline (in the pre-transplant assessment), day 7 and months 1, 3,6 and 12 after kidney transplantation (KT). Recipients were categorized according to their RRT status: pre-emptive KT (pre-KT), hemodialysis (HD) and peritoneal dialysis (PD). TTV DNA load was measured by real-time polymerase chain reaction. Results A total of 221 CKD patients were analyzed. The mean age was 53.9 ± 15.7 years, 72.4% were males, and hypertension (85.1%) and diabetes (30.1%) were the most common comorbidities. According to the pre-transplant TTR status, 159 (72.0%) were on HD, 35 (15.8%) on PD and 27 (12.2%) received pre-KT. There were no differences in baseline comorbidities or age between patients according to their RRT status, except for residual diuresis (P & lt;0.01). HD patients had higher serum albumin levels than patients receiving pre-KT or PD (4.4 ± 0.5 vs. 4.1 ± 0.6 vs. 3.9 ± 0.4 g/dL, respectively, P & lt;0.01). PD patients exhibited higher TTV DNA load (3.4 ±1.2 log10 copies/mL) than HD (2.8 ± 1.6 log10 copies/mL) or pre-KT patients (2.4 ± 2.1 log10 copies/mL), although the differences were not statistically significant. PD patients had lower time on dialysis than HD patients (18.4± 16.2 vs. 37.5± 53.6 months, respectively; P = 0.038). Although PD patients had higher TTV DNA load during the post-transplant follow-up than HD and pre-KT patients, viral kinetics were comparable across these three groups by month 12 after transplantation. Time on dialysis was not associated with TTV DNA load (P = 0.18). RRT status was not associated with the incidence of post-transplant infection or a composite of opportunistic infection and/or de novo malignancy. Conclusion TTV DNA load could be useful identifying KT recipients at high risk of immunosuppression-related complications. Although PD patients presented a non-significant higher TTV DNA load, we did not find differences according to the modality of prior RRT or the time on dialysis.
    Materialart: Online-Ressource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfad063c_5890
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2023
    ZDB Id: 1465709-0
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  • 9
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    MO912INMUNE STATUS ON HAEMODIALYSIS PATTIENTS AFFECTED WITH COVID19 INFECTION
    Oxford University Press (OUP) ; 2021
    In:  Nephrology Dialysis Transplantation Vol. 36, No. Supplement_1 ( 2021-05-29)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 36, No. Supplement_1 ( 2021-05-29)
    Kurzfassung: End-stage renal disease patients on haemodialysis (HD) seem more likely to develop severe COVID19 disease. Over the course of COVID disease, we observed a poor tolerance to HD sessions with a marked tendency of clinical deterioration over them. The objective is to evaluate changes on immunological system over HD session on patients affected with COVID19 compared with patients without COVID19. Method Fourteen HD patients were studied including 9 confirmed COVID19 infection and 5 healthy controls. Predialysis and postdialysis blood samples were compared to study alterations on immune status. We identified cytoKines by Luminex (CCL2, CXCL10, IL1Ra, IL10, IL12p70, TNFα, IL17Ra, IL6, IL7) and adaptive lymphocyte subsets (CD4/CD8 naïve, CD4/CD8 MC, CD4/CD8 MP, CD19, CD56). Monocyte subsets (CD14+CD16-, CD14+CD16+, CD14-CD16+) were detected from peripheral blood mononuclear cells (PBMC), as well as immune activation (CD11b, HLA-DR, CD86) and migration factors (CCR2, CCR5). The supernatant of isolated CD14+ cells after 4-hour stimulation with LPS where analysed by Luminex to measure cytokines (CCL2, CXCL10, GM-CSF, IL10, IL12p70, IL17Ra, IL6, IL7, TNFα). Results Patients with COVID19 presented predialysis: (1) higher plasmatic levels of IL12p70, TNFα e IL7, (2) lymphopenia and neutrophilia, (3) higher percentage of intermediate monocytes and lower of non-classical, (4) lower membrane expression of CCR2, HLA-DR y CD86 over Cd14+ cells, and (5) higher production of CCL2, GM-CSF, IL10, IL12p70 y IL17Ra by LPS stimulated monocytes compared with patients without COVID19. When analysed the fold-change between pre and postdialysis values, patients with COVID19 infection present a: (a) higher plasmatic levels of IL6, IL1Ra, CCL2 e CXCL10, (b) reductions of total lymphocites, (c) higher membrane expression of CCR2, CD33 y CD86 on CD14+ cells, and (d) higher production of TNFα, GM-CSF, IL10, IL17, IL6 e IL7 by LPS stimulated monocytes compared with patients without COVID19. No differences on lymphocite subset were found. Conclusion The clinical deterioration on COVID19 infected patients over HD session could be related with monocyte activation and pro-inflammatory cytokines secretion.
    Materialart: Online-Ressource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfab102.0013
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2021
    ZDB Id: 1465709-0
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  • 10
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    Impact of different COVID-19 waves on kidney replacement therapy epidemiology and mortality: REMER 2020
    Oxford University Press (OUP) ; 2022
    In:  Nephrology Dialysis Transplantation Vol. 37, No. 11 ( 2022-10-19), p. 2253-2263
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 37, No. 11 ( 2022-10-19), p. 2253-2263
    Kurzfassung: Kidney replacement therapy (KRT) confers the highest risk of death from coronavirus disease 2019 (COVID-19). However, most data refer to the early pandemic waves. Whole-year analysis compared with prior secular trends are scarce. Methods We present the 2020 REMER Madrid KRT registry, corresponding to the Spanish Region hardest hit by COVID-19. Results In 2020, KRT incidence decreased 12% versus 2019, while KRT prevalence decreased by 1.75% for the first time since records began and the number of kidney transplants (KTs) decreased by 16%. Mortality on KRT was 10.2% (34% higher than the mean for 2008–2019). The 2019–2020 increase in mortality was larger for KTs (+68%) than for haemodialysis (+24%) or peritoneal dialysis (+38%). The most common cause of death was infection [n = 419 (48% of deaths)], followed by cardiovascular [n = 200 (23%)] . Deaths from infection increased by 167% year over year and accounted for 95% of excess deaths in 2020 over 2019. COVID-19 was the most common cause of death (68% of infection deaths, 33% of total deaths). The bulk of COVID-19 deaths [209/285 (73%)] occurred during the first COVID-19 wave, which roughly accounted for the increas ed mortality in 2020. Being a KT recipient was an independent risk factor for COVID-19 death. Conclusions COVID-19 negatively impacted the incidence and prevalence of KRT, but the increase in KRT deaths was localized to the first wave of the pandemic. The increased annual mortality argues against COVID-19 accelerating the death of patients with short life expectancy and the temporal pattern of COVID-19 mortality suggests that appropriate healthcare may improve outcomes.
    Materialart: Online-Ressource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfac234
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2022
    ZDB Id: 1465709-0
    Standort Signatur Einschränkungen Verfügbarkeit
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