MO836INCIDENCE AND OUTCOME OF SARS-COV-2 INFECTION IN THE POPULATION UNDERGOING DIALYSIS TREATMENT IN LAZIO REGION

Abstract Background and Aims Patients with chronic kidney disease (CKD) represent a frail population with severe co-morbidities and different degrees of immune dysfunction. These patients might be at higher risk of SARS-CoV-2 infection and might experience severe consequences of COVID-19. In March 2020, the Lazio Regional Dialysis and Transplantation Registry (LRDTR) implemented a questionnaire to obtain information on dialysis patients who have developed SARS-CoV-2 infection. The aims of this study is to evaluate the incidence and the short-term lethality of SARS-CoV-2 infection in the population undergoing dialysis treatment in Lazio Region. Method A cohort of patients treated in the dialysis units of Lazio Region was enrolled. Prevalent dialysis patients at 1/1/2020 and incident patients during the period 01/01/2020-08/01/2020 were included. The LRDTR collects information on dialysis patients from the start of chronic dialysis treatments with biannual update and immediately informing about the end of dialytic treatment (death, renal transplant, etc). Infection was traced in the LRDTR from March 2020 to 08/13/2020. The information on vital status was obtained from LRDTR and the mortality Lazio registry up to 10/30/2020. Poisson models, crude and adjusted for sex and age, were used to estimate incident rate of infection and mortality rate on dialysis patients and on dialysis patients who have developed SARS-CoV-2 infection, and respective confidence intervals of 95% (CI95%). Results During the study period, the estimate of the number of patients undergoing dialysis treatment was 5196 in Lazio Region, 65% were males with mean age of 70 years. Thirty-seven patients were infected with SARS-CoV-2: 70% males, mean age 73 years. These patients were treated in 24 different dialysis units. The cumulative incidence rate of SARS-CoV-2 infection was 0.71% (95% CI 0.52-0.98) and the adjusted incidence rate was 3.3 *100,000 Person Days (PD) (95% CI 2.4-4.7). The distribution of positive swabs by month was: 21 in March 7 in April, 6 in May, 1 in June, 2 in July. Twenty-seven patients had symptoms while 10 patients, who have had contact with infected individuals, had positive swabs in absence of symptoms. Infected and hospitalised dialysis patients were 78%. Of the 29 hospitalized patients: 6 were in sub-intensive care, 16 in intensive care, of these 7 needed intubations, 9 underwent non-invasive ventilation. The adjusted cumulative mortality rate in dialysis patients was 6.8% (95% CI 6.0-7.6), the same measure for SARS-CoV-2 infected patients was 37.4% (95% CI 19.8-70.4) with an average follow-up of 205 PD. The adjusted mortality rate was 3.3 * 10,000PD (95% CI: 2.9-3.7) among dialysis patients and 21.2*10,000PD (95% CI: 11.1-40.7) among infected dialysis patients. Conclusion This study highlights a greater susceptibility of dialysis patients to SARS-CoV-2 infection, with a rate three times higher than that observed in the general population (source: Civil Protection Department). Mortality risk for dialysis patients with SARS-CoV-2 infection is about 6 times higher than in the dialysis patients it suggesting a major impact of infection on this fragile population.

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FC 117TIME TRENDS IN PROBABILITY OF STARTING HOME DIALYSIS OVER A 20 YEAR PERIOD: A DUTCH REGISTRY STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab127.003 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Anna Bonenkamp ◽

Tiny Hoekstra ◽

Marc Hemmelder ◽

Anita Van Eck van der Sluijs ◽

Alferso C Abrahams ◽

...

Keyword(s):

Kidney Transplantation ◽

The Netherlands ◽

Risk Model ◽

The Elderly ◽

Dialysis Patients ◽

Dialysis Treatment ◽

Home Dialysis ◽

System Utilization ◽

Number Of Patients ◽

Kidney Transplantations

Abstract Background and Aims A growing number of patients suffers from End Stage Kidney Disease(ESKD), causing a logistical and economic burden to the healthcare system. Utilization of home dialysis is low in many countries worldwide, although home dialysis has several advantages including higher quality of life and possibly lower costs. The aim of this study is to explore time trends in the use of home dialysis in the Netherlands. Method Anonymized registry data from the Dutch Renal Registry (RENINE) were used for this study. All dialysis episodes of adult patients who started dialysis treatment between 1997 through 2016 in the Netherlands were included, including those who previously underwent kidney transplantation. Dialysis episodes shorter than 90 days were excluded. The probability of starting home dialysis between 1997 through 2016 was evaluated in time periods of 5 years, using logistic regression analysis. Home dialysis was defined as start with peritoneal dialysis or home haemodialysis, or transfer to either within 2 years after dialysis start. A logistic multilevel model was used to adjust for clustering at patient level. The cumulative incidence function of start of home dialysis in incident patients was estimated with a competing risk model with recovery of kidney function, kidney transplantations, and all-cause mortality as competing events. All analyses were stratified for age categories at dialysis start: 20-44 years, 45-64 years, 65-74 years and ≥75 years. Results A total of 33,340 dialysis episodes in 31,569 patients were evaluated. Between 1997 and 2016, mean age at start of dialysis treatment increased from 62.5±14.0 to 65.5±14.5 years in in-centre haemodialysis patients, whereas it increased from 51.9±15.1 to 62.5±14.6 years in home dialysis patients. In patients < 65 years, the probability of starting home dialysis was significantly lower during each 5-year period compared to the previous period, and kidney transplantation occurred more often. In patients ≥ 65 years, incidence of home dialysis remained constant, whereas mortality decreased. Conclusion In patients < 65 years, the overall probability of starting home dialysis declined consistently over the past 20 years. The age of home dialysis patients increased more rapidly than that of in-centre dialysis patients, implying that pre-dialysis education and organization of home dialysis must be adapted to the needs of the elderly patient. These developments have a significant impact on the organisation of home dialysis for patients with ESKD.

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MO887THE IMPACT OF A MULTI-DISCIPLINARY CLINIC ON THE OUTCOMES OF INCIDENT DIALYSIS PATIENTS IN A REGIONAL HOSPITAL IN SINGAPORE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab100.0012 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Boon Cheok Lai ◽

Mayank Chawla ◽

Shashidahar Baikunje ◽

Lee Ying Yeoh ◽

Marie Tan ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Group Versus ◽

Dialysis Initiation ◽

Conventional Group ◽

Dialysis Access ◽

Dialysis Patients ◽

Care Clinic ◽

Number Of Patients ◽

Initiation Of Dialysis

Abstract Background and Aims Institution of a pre-dialysis programme has been shown to improve the outcome of the chronic kidney disease (CKD) patients approaching end stage renal disease (ESRD). A renal multidisciplinary clinic (MDC) aimed at reducing unprepared dialysis initiation is known to reduce morbidity in such patients and reduce the risks of complications once the patient initiates dialysis. The design of this service is of paramount importance to ensure efficient delivery and to achieve optimal utilization of the resources. The number of patients requiring urgent initiation of dialysis is alarmingly high in Singapore as compared to elective initiation, and our hospital was no exception when we started the renal service in 2018. Patients with unplanned initiation of RRT either because of lack of referral/late referral, infrequent follow up with the nephrologist or because of other factors such as inadequate knowledge of disease trajectory, or poor compliance to medications, tended to have worse outcomes. Method We recruited the patient who initiated dialysis between July 2018 to July 2020 in our Quality Improvement (QI) project. In the MDC group, the patient will be reviewed by a dedicated team of nephrologists, renal coordinators (RC) and medical social workers (MSW) and comprises of 2 mutually exclusive components: low clearance clinic (LCC) and transitional care clinic (TCC). In the MDC, nephrologist takes a lead role for the patient’s overall medical assessment and treatment. Renal coordinator provides the CKD and dialysis education to empower patient to make the correct RRT choice. MSW provides psychosocial support and financial counselling. The LCC became operational from 07th September 2018 while the TCC was initiated on 12th July 2019. CKD patients who are deemed likely to need RRT in the coming one year by the primary nephrologist are scheduled to attend LCC. Upon initiation of haemodialysis, all patients are referred to the TCC in the first month of their discharge. In the conventional group, we recruited the patient who have not attended MDC before or after dialysis initiation. Retrospectively, their data including baseline demographic and morbidity parameters were collected in the MDC group and conventional group. Morbidity outcome like definitive dialysis access, needs of intensive care unit (ICU) admissions, complications like catheter related blood stream infections (CRBSI) and other infections, stroke and myocardial infarction (MI) were analysed. Results There are 130 patients initiated on RRT between July 2018 to July 2020. The percentage of patient started dialysis with a definitive access was greater in the MDC group (25%) as compared to the conventional group (9%) (p=0.03). Although statistically not significant, the incidence of intensive care unit (ICU) admission was also lower in the MDC group (10%) than the conventional group (31%) (p=0.06). After initiation of dialysis, the patients in the MDC group had lower rates of CRBSI (5.6%) than the conventional group (14%) (p=0.17). These patients also had lower rates of other infections and major adverse cardiovascular outcomes (13% in MDC group versus 37% in conventional group) (p=002). The rate of recurrent admission, defined as frequent admissions up to 3 times per year, was lower as well in the MDC group (13%) as compared to the conventional group (35%) (p=0.003). Conclusion This QI project has demonstrated the benefit of MDC in improving the lives of the incident dialysis patients. Moving forward, we aim to continue to evolve this clinic in order to match the changing needs of our patients, with a view to increase its uptake, and to increase the percentage of patients having elective starts with a definitive dialysis access to at least 65% as per target set in NKF-KDOQI 2009 guidelines, in order to help them achieve the maximum benefit out of this endeavour.

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Incidence of SARS-CoV-2 infection in a cohort of workers from the University of Porto

10.1101/2021.10.14.21264980 ◽

2021 ◽

Author(s):

Joana Pinto Costa ◽

Paula Meireles ◽

Pedro N S Rodrigues ◽

Henrique Barros

Keyword(s):

Incidence Rate ◽

Molecular Diagnosis ◽

Linear Models ◽

Rapid Test ◽

White Collar Workers ◽

Adjusted Incidence Rate ◽

Incident Rate ◽

Associated Risk Factors ◽

Rate Ratios ◽

Restrictive Measures

Background: Repeated serosurveys in the same population provide more accurate estimates of the frequency of SARS-CoV-2 infection and more comparable data than notified cases. We aimed to estimate the incidence of SARS-CoV-2 infection, identify associated risk factors, and assess time trends in the ratio of serological/molecular diagnosis in a cohort of university workers. Methods: Participants had a serological rapid test for SARS-CoV-2 Immunoglobulins M and G, and completed a questionnaire, in May-July 2020 (n=3628) and November 2020-January 2021 (n=2661); 1960 participated in both evaluations and provided data to compute the incidence proportion and the incident rate. Crude and adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) were computed using generalised linear models with Poisson regression. Results: The incidence rate was 1.8/100 person-month (95%CI 1.6-2.1), and the 6 months cumulative incidence was 10.7%. The serological/molecular diagnosis ratio was 10:1 in the first evaluation and 3:1 in the second. Considering newly identified seropositive cases at the first (n=69) and second evaluation (n=202), 29.0% and 9.4% never reported symptoms, respectively, 14.5% and 33.3% reported contact with a confirmed case and 82.6%, and 46.0% never had a molecular test. Males (aIRR: 0.59; 95%CI: 0.42-0.83) and "high-skilled white-collar" workers (aIRR: 0.73, 95%CI: 0.52-1.02) had lower incidence of infection. Conclusion: University workers presented a high SARS-CoV-2 incidence while restrictive measures were in place. The time decrease in the proportion of undiagnosed cases reflected the increased access to testing, but opportunities continued to be missed, even in the presence of COVID-19 like symptoms.

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Brazilian chronic dialysis survey 2017

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0178 ◽

2019 ◽

Vol 41 (2) ◽

pp. 208-214 ◽

Cited By ~ 19

Author(s):

Fernando Saldanha Thomé ◽

Ricardo Cintra Sesso ◽

Antonio Alberto Lopes ◽

Jocemir Ronaldo Lugon ◽

Carmen Tzanno Martins

Keyword(s):

Mortality Rate ◽

Venous Catheter ◽

Absolute Number ◽

Incidence Rates ◽

Chronic Dialysis ◽

Dialysis Patients ◽

Positive Serology ◽

The North ◽

Number Of Patients ◽

National Estimates

Abstract Introduction: Having national data on chronic dialysis is essential in treatment planning. Objective: To present data of the survey from the Brazilian Society of Nephrology on patients with chronic kidney disease on dialysis in July 2017. Methods: Data was collected from dialysis units in Brazil. The data collection was done using a questionnaire completed online by the dialysis units. Results: Two hundred and ninety-one centers (38.4%) answered the questionnaire. In July 2017, the estimated total number of dialysis patients was 126,583. National estimates of prevalence and incidence rates of dialysis patients per million population (pmp) were 610 (range: 473 in the North region and 710 in the Midwest) and 194, respectively. The incidence rate of new dialysis patients with diagnosis of diabetic nephropathy was 77 pmp. The annual gross mortality rate was 19.9%. Of the prevalent patients, 93.1% were on hemodialysis and 6.9% on peritoneal dialysis, with 31,226 (24%) on the waiting list for renal transplantation. Venous catheter was used as access in 22.6% of patients on hemodialysis. The prevalence rate of positive serology for hepatitis C continued with a tendency to decrease (3.3%). Conclusion: The absolute number of patients and rates of incidence and prevalence on dialysis continued to increase; the mortality rate tended to rise. There were obvious regional and state discrepancies in these rates.

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Plasma glutamine status at intensive care unit admission: an independent risk factor for mortality in critical illness

Critical Care ◽

10.1186/s13054-021-03640-3 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Marie Smedberg ◽

Johan Helleberg ◽

Åke Norberg ◽

Inga Tjäder ◽

Olav Rooyackers ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critical Illness ◽

Mortality Rate ◽

Do Not Resuscitate ◽

Glutamine Concentration ◽

Normal Range ◽

Icu Admission ◽

Number Of Patients ◽

Risk Scoring

Abstract Background A plasma glutamine concentration outside the normal range at Intensive Care Unit (ICU) admission has been reported to be associated with an increased mortality rate. Whereas hypoglutaminemia has been frequently reported, the number of patients with hyperglutaminemia has so far been quite few. Therefore, the association between hyperglutaminemia and mortality outcomes was studied in a prospective, observational study. Patients and methods Consecutive admissions to a mixed general ICU were eligible. Exclusion criteria were < 18 years of age, readmissions, no informed consent, or a ‘do not resuscitate’ order at admission. A blood sample was saved within one hour from admission to be analysed by high-pressure liquid chromatography for glutamine concentration. Conventional risk scoring (Simplified Acute Physiology Score and Sequential Organ Failure Assessment) at admission, and mortality outcomes were recorded for all included patients. Results Out of 269 included patients, 26 were hyperglutaminemic (≥ 930 µmol/L) at admission. The six-month mortality rate for this subgroup was 46%, compared to 18% for patients with a plasma glutamine concentration < 930 µmol/L (P = 0.002). A regression analysis showed that hyperglutaminemia was an independent mortality predictor that added prediction value to conventional admission risk scoring and age. Conclusion Hyperglutaminemia in critical illness at ICU admission was an independent mortality predictor, often but not always, associated with an acute liver condition. The mechanism behind a plasma glutamine concentration outside normal range, as well as the prognostic value of repeated measurements of plasma glutamine during ICU stay, remains to be investigated.

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Twenty-Five Years of Respiratory Intensive Care

Scottish Medical Journal ◽

10.1177/003693308803300204 ◽

1988 ◽

Vol 33 (2) ◽

pp. 233-236

Author(s):

L. V. H. Martin ◽

D. T. Brown

Keyword(s):

Intensive Care ◽

Mortality Rate ◽

Length Of Stay ◽

Artificial Ventilation ◽

Steady Increase ◽

Royal Infirmary ◽

Present Level ◽

Respiratory Problems ◽

Number Of Patients ◽

Most Significant Change

During the years 1961 to 1986 the four-bedded Artificial Ventilation Unit of the Royal Infirmary of Edinburgh has treated 3046 patients with respiratory problems of all types. There has been a steady increase in the number of patients admitted each year to the present level of 180–190, a fall in mean length of stay from 15 to six days and the mortality rate has been reduced to 13%. The type of case admitted has shown considerable variation over the years with the most significant change being a large increase in the patients admitted post-operatively. The size of the unit has placed severe restrictions on the work that can be undertaken.

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Predicting mortality in intensive care patients with acute renal failure treated with dialysis.

Journal of the American Society of Nephrology ◽

10.1681/asn.v81111 ◽

1997 ◽

Vol 8 (1) ◽

pp. 111-117

Author(s):

C E Douma ◽

W K Redekop ◽

J H van der Meulen ◽

R W van Olden ◽

J Haeck ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Mortality Rate ◽

Prediction Models ◽

Characteristic Curve ◽

Mortality Prediction ◽

Dialysis Treatment ◽

Apache Iii ◽

Mortality Prediction Models

Existing prognostic methods were compared in their ability to predict mortality in intensive care unit (ICU) patients on dialysis for acute renal failure (ARF). The clinical goal of this study was to determine whether these models could identify a group of patients where dialysis would provide no benefit because of a near 100% certainty of death even with dialysis treatment. This retrospective cohort study included 238 adult patients who received a first dialysis treatment for ARF in the ICU. This study examined the performance of seven general ICU mortality prediction models and four mortality prediction models developed for patients with ARF. These models were assessed for their ability to discriminate mortality form survival and for their ability to calibrate the observed mortality rate with the expected mortality rate. The observed in hospital mortality was 76% for our patient group. Areas under the receiver operating characteristic curve ranged from 0.50 to 0.78. With the Acute Physiology and Chronic Health Evaluation (APACHE) III and the Liano models, the observed mortality in the highest quintiles of risk were 97% and 98%. In conclusion, although none of the models examined in this study showed excellent discrimination between those patients who died in hospital and those who did not, some models (APACHE III, Liano) were able to identify a group of patients with a near 100% chance of mortality. This indicates that these models may have some use in supporting the decision not to initiate dialysis in a subgroup of patients.

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Comorbidities, Hospitalization, and Living Status of Dialysis Patients Over 80 Years

Blood Purification ◽

10.1159/000448210 ◽

2016 ◽

Vol 42 (4) ◽

pp. 282-286

Author(s):

Til Leimbach ◽

Joachim Kron ◽

Wolfgang Pommer ◽

Birgit Urbach ◽

Susanne Kron

Keyword(s):

Quality Of Life ◽

Chronic Dialysis ◽

Dialysis Patients ◽

Dialysis Treatment ◽

Younger Patients ◽

Number Of Patients ◽

Age Range ◽

Hospital Days ◽

Satisfactory Quality

Background: An increasing number of patients start dialysis when they are over 80 years or reaches their eighties on dialysis. The burden of dialysis can affect their quality of life. Methods: Clinical and social data of all patients aged 80 years or older who underwent chronic dialysis treatment in a single center were analyzed. Results: Fifty-nine patients aged between 80 and 92 years were in chronic dialysis treatment on December 31, 2015. Median time on dialysis was 57 months (3-330 months). Hospitalization rate and days in hospital were lower in this group than in younger patients (1.05 vs. 1.34 hospitalizations; 8.3 vs. 9.0 hospital days per patient and year) despite the presence of many comorbidities. The median patency of the currently used arteriovenous shunt was 70 months (6-194 months). Social status was comparable with the population of the rest of the same average age range. Conclusion: Dialysis patients aged ≥80 years have a satisfactory quality of life with no more complications than younger patients.

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Outcome of Stroke Patients Admitted to Intensive Care: Experience from an Australian Teaching Hospital

Anaesthesia and Intensive Care ◽

10.1177/0310057x0203000515 ◽

2002 ◽

Vol 30 (5) ◽

pp. 628-632 ◽

Cited By ~ 11

Author(s):

M. Fanshawe ◽

B. Venkatesh ◽

R. J. Boots

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Mortality Rate ◽

Functional Outcome ◽

Functional Outcomes ◽

Haemorrhagic Stroke ◽

Stroke Patients ◽

Care Experience ◽

Biological Variables ◽

Number Of Patients

The objective of this study was to determine the mortality rate and the functional outcomes of stroke patients admitted to the intensive care unit (ICU) and to identify predictors of poor outcome in this population. The records of all patients admitted to the ICU with the diagnosis of stroke between January 1994 and December 1999 were reviewed. Patients with subarachnoid haemorrhage were excluded. Data were collected on clinical and biological variables, risk factors for stroke and the presence of comorbidities. Mortality (ICU, in-hospital and three-month) and functional outcome were used as end-points. In the six-year-period, 61 patients were admitted to the ICU with either haemorrhagic or ischaemic stroke. Medical records were available for only 58 patients. There were 23 ischaemic and 35 haemorrhagic strokes. The ICU, in-hospital and three-month mortality rates were 36%, 47% and 52% respectively. There were no significant differences in the prevalence of premorbid risk factors between survivors and non-survivors. The mean Barthel score was significantly different between the independent and dependent survivors (94±6 vs 45±26, P<0.001). A substantial number of patients with good functional outcomes had lower Rankin scores (92% vs 11%, P<0.001). Only 46% of those who were alive at three months were functionally independent. Intensive care admission was associated with a high mortality rate and a high likelihood of dependent lifestyle after hospital discharge. Haemorrhagic stroke, fixed dilated pupil(s) and GCS <10 during assessment were associated with increased mortality and poor functional outcome.

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Epidemiological Characteristics of Meningococcal Infection in Moscow

Epidemiology and Vaccinal Prevention ◽

10.31631/2073-3046-2020-20-2-56-62 ◽

2020 ◽

Vol 19 (2) ◽

pp. 56-62

Author(s):

M. I. Gritsay ◽

M. A. Koroleva ◽

N. N. Fomkina ◽

I. S. Koroleva

Keyword(s):

Young Adults ◽

Mortality Rate ◽

Incidence Rate ◽

Meningococcal Disease ◽

Invasive Meningococcal Disease ◽

Meningococcal Infection ◽

Epidemic Process ◽

Epidemiological Features ◽

Teenagers And Young Adults ◽

Epidemiological Characteristics

Aims. The purpose of this study was to identify current epidemiological features of meningococcal infection in Moscow.Materials and methods. Cases of invasive meningococcal disease in Moscow from 2014 to 2018 and the biomaterial from patients with an invasive meningococcal disease were analyzed.Results. The features of the epidemic process of meningococcal disease in Moscow were revealed: increasing in the incidence rate involving teenagers and young adults into the epidemic process; meningococcal strains of serogroups W and A increased in the etiology of the invasive meningococcal disease; high mortality rate.Conclusions. It seems reasonable to recommend vaccination against meningococcal disease by including adolescents, young adults and persons over 65 years old.

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