scholarly journals The COVID-19 Epidemic: Management and Outcomes of Hemodialysis and Peritoneal Dialysis Patients in Stockholm, Sweden

2021 ◽  
Vol 46 (2) ◽  
pp. 250-256
Author(s):  
Jessica Smolander ◽  
Annette Bruchfeld
Keyword(s):  
Peritoneal Dialysis ◽  
High Risk ◽  
Kidney Injury ◽  
Mitigation Strategies ◽  
High Morbidity ◽  
Dialysis Patients ◽  
Increased Risk ◽  
Dialysis Vintage ◽  
Long Term Prognosis

<b><i>Background:</i></b> The COVID-19 outbreak has been associated with a high morbidity, mortality, and a risk of long-term sequelae, and patients with severe COVID-19 are at increased risk of acute kidney injury. CKD patients are at high risk of being exposed to COVID-19 and suffer complications and poor outcome. In Sweden, mitigation strategies did not include lockdown. During March–April of 2020, wide-spread infection occurred in Stockholm. <b><i>Methods:</i></b> Management and outcomes in forty hemodialysis (HD) patients and 4 peritoneal dialysis (PD) patients, with symptomatic COVID-19 in greater Stockholm during March and April of 2020 are reported. <b><i>Results:</i></b> Twenty-four HD patients (60%) required medical care and hospitalization, whereas 16 patients (40%) were treated at home. Nine patients died (mortality rate of 22.5%), of whom 8 were men. The median age in non-survivors (78 years) was significantly higher than in survivors (<i>p</i> = 0.003). The median time in dialysis (11.5 years) was also significantly longer in non-survivors (<i>p</i> = 0.01). C-reactive protein (CRP) at diagnosis in 7 of non-survivors (median 213 mg/L, range 86–329 mg/L) was significantly higher than the CRP in 25 survivors (median 87 mg/L, range 1–328 mg/L) (<i>p</i> = 0.0003). Maximum CRP also indicated poorer outcome among hospitalized patients (<i>p</i> = 0.0004). The gender imbalance was striking with only men dying apart from 1 elderly woman. Only 4 PD patients were hospitalized with symptomatic COVID-19. One patient died, 2 were discharged, and 1 was treated at the intensive care unit and survived. <b><i>Conclusion:</i></b> HD patients &#x3e;70 years were reported with longer dialysis vintage, higher CRP, and males were at an increased risk of dying from COVID-19, whereas those &#x3c;70 years seemed to have a milder disease. Mitigation strategies to reduce rates of infection in high-risk populations remain essential. Follow-up focusing on long-term prognosis for extrapulmonary manifestations is likely to be important also in dialysis patients.

scholarly journals Mild increases in plasma creatinine after intermediate to high-risk abdominal surgery are associated with long-term renal injury

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alexandre Joosten ◽  
Brigitte Ickx ◽  
Zakaria Mokthari ◽  
Luc Van Obbergh ◽  
Valerio Lucidi ◽  
...  
Keyword(s):  
High Risk ◽  
Abdominal Surgery ◽  
Renal Injury ◽  
Kidney Injury ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Stage 1 ◽  
Postoperative Aki

Abstract Background The potential relationship between a mild acute kidney injury (AKI) observed in the immediate postoperative period after major surgery and its effect on long term renal function remains poorly defined. According to the “Kidney Disease: Improving Global Outcomes” (KDIGO) classification, a mild injury corresponds to a KIDIGO stage 1, characterized by an increase in creatinine of at least 0.3 mg/dl within a 48-h window or 1.5 to 1.9 times the baseline level within the first week post-surgery. We tested the hypothesis that patients who underwent intermediate-to high-risk abdominal surgery and developed mild AKI in the following days would be at an increased risk of long-term renal injury compared to patients with no postoperative AKI. Methods All consecutive adult patients with a plasma creatinine value ≤1.5 mg/dl who underwent intermediate-to high-risk abdominal surgery between 2014 and 2019 and who had at least three recorded creatinine measurements (before surgery, during the first seven postoperative days, and at long-term follow up [6 months-2 years]) were included. AKI was defined using a “modified” (without urine output criteria) KDIGO classification as mild (stage 1 characterised by an increase in creatinine of > 0.3 mg/dl within 48-h or 1.5–1.9 times baseline) or moderate-to-severe (stage 2–3 characterised by increase in creatinine 2 to 3 times baseline or to ≥4.0 mg/dl). The exposure (postoperative kidney injury) and outcome (long-term renal injury) were defined and staged according to the same KDIGO initiative criteria. Development of long-term renal injury was compared in patients with and without postoperative AKI. Results Among the 815 patients included, 109 (13%) had postoperative AKI (81 mild and 28 moderate-to-severe). The median long-term follow-up was 360, 354 and 353 days for the three groups respectively (P = 0.2). Patients who developed mild AKI had a higher risk of long-term renal injury than those who did not (odds ratio 3.1 [95%CI 1.7–5.5]; p < 0.001). In multivariable analysis, mild postoperative AKI was independently associated with an increased risk of developing long-term renal injury (adjusted odds ratio 4.5 [95%CI 1.8–11.4]; p = 0.002). Conclusions Mild AKI after intermediate-to high-risk abdominal surgery is associated with a higher risk of long-term renal injury 1 y after surgery.

Anemia in Peritoneal Dialysis Patients; Iron Repletion, Current and Future Therapies

2017 ◽  
Vol 37 (1) ◽  
pp. 6-13 ◽  
Author(s):  
Ahmed Zeidan ◽  
Sunil Bhandari
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Iron Deficiency ◽  
Deficiency Anemia ◽  
Limited Data ◽  
Dialysis Patients ◽  
Increased Risk ◽  
Labile Iron ◽  
Methods Of Treatment

Iron deficiency, both functional and absolute, is common in patients with chronic kidney disease (CKD), especially those requiring dialysis. Guidelines advocate treatment of iron-deficiency anemia in patients with CKD and those on peritoneal dialysis (PD). Oral iron is often insufficient and slow to improve hemoglobin concentrations because of high hepcidin levels causing impaired absorption and mobilization, while intravenous (IV) supplementation replenishes and maintains iron stores more effectively and is now standard practice (Kidney Disease Improving Global Outcomes [KDIGO] 2012 guidelines). However, there still remain concerns about the effects of labile iron and possible increased risk of infections for this group of patients.To date, the majority of published studies have focused on hemodialysis (HD) patients; very limited data are available regarding patients on PD. This review summarizes the rationale for iron therapy, methods of treatment, potential adverse effects, and long-term concerns in PD patients. In addition we highlight some interesting potential future therapies under study.

scholarly journals Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians’ perception and practice

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gianluca Villa ◽  
Silvia De Rosa ◽  
Caterina Scirè Calabrisotto ◽  
Alessandro Nerini ◽  
Thomas Saitta ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
High Risk ◽  
Abdominal Surgery ◽  
Serum Creatinine ◽  
Malignant Disease ◽  
Kidney Injury ◽  
Major Surgery ◽  
Single Centre

Abstract Background Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians’ attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease. Methods Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI. Results A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys. Conclusion PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients. Trial registration ClinicalTrials.gov, NCT04341974.

scholarly journals Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

2021 ◽  
Author(s):  
John R. Prowle ◽  
Lui G. Forni ◽  
Max Bell ◽  
Michelle S. Chew ◽  
Mark Edwards ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Baseline Risk ◽  
Major Surgery ◽  
Increased Risk

AbstractPostoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.

scholarly journals SP507FACTORS AFFECTING LONG TERM TECHNIQUE SURVIVAL OF PERITONEAL DIALYSIS PATIENTS

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii546-iii547
Author(s):  
Marios Theodoridis ◽  
Stylianos Panagoutsos ◽  
Eleni Triantafyllidou ◽  
Pelagia Kriki ◽  
Konstantia Kantartzi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Technique Survival

Can radiological assessment of abdominal computerized scans diagnose encapsulating peritoneal sclerosis in long-term peritoneal dialysis patients?

Nephrology ◽  
2016 ◽  
Vol 22 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Sam Stuart ◽  
David Stott ◽  
Antony Goode ◽  
Charlotte J Cash ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Radiological Assessment ◽  
Dialysis Patients

scholarly journals Outcome of Acute Peritoneal Dialysis in Northern Tanzania

2012 ◽  
Vol 32 (3) ◽  
pp. 261-266 ◽  
Author(s):  
Kajiru Gad Kilonzo ◽  
Sudakshina Ghosh ◽  
Siya Anaeli Temu ◽  
Venance Maro ◽  
John Callegari ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Outcomes ◽  
Kidney Injury ◽  
Cost Effective ◽  
High Morbidity ◽  
Poor Countries ◽  
Resource Limited ◽  
Northern Tanzania ◽  
Nephrology Care ◽  
Technical Simplicity

Data on the burden of acute kidney injury (AKI) in resource-poor countries such as Tanzania are minimal because of a lack of nephrology services and an inability to recognize and diagnose AKI with any certainty. In the few published studies, high morbidity and mortality are reported. Improved nephrology care and dialysis may lower the mortality from AKI in these settings. Hemodialysis is expensive and technically challenging in resource-limited settings. The technical simplicity of peritoneal dialysis and the potential to reduce costs if consumables can be made locally, present an opportunity to establish cost-effective programs for managing AKI. Here, we document patient outcomes in a pilot peritoneal dialysis program established in 2009 at a referral hospital in Northern Tanzania.

Predictors of acute kidney injury in patients after extracorporeal cardiopulmonary resuscitation

Perfusion ◽  
2021 ◽  
pp. 026765912110497
Author(s):  
Christopher Gaisendrees ◽  
Borko Ivanov ◽  
Stephen Gerfer ◽  
Anton Sabashnikov ◽  
Kaveh Eghbalzadeh ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Creatine Kinase ◽  
High Risk ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Kidney Injury ◽  
Dialysis Patients ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Outcome Parameters

Objectives: Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly used due to its beneficial outcomes and results compared with conventional CPR. Data after eCPR for acute kidney injury (AKI) are lacking. We sought to investigate factors predicting AKI in patients who underwent eCPR. Methods: From January 2016 until December 2020, patients who underwent eCPR at our institution were retrospectively analyzed and divided into two groups: patients who developed AKI ( n = 60) and patients who did not develop AKI ( n = 35) and analyzed for outcome parameters. Results: Overall, 63% of patients suffered AKI after eCPR and 45% of patients who developed AKI needed subsequent dialysis. Patients who developed AKI showed higher values of creatinine (1.1 mg/dL vs 1.5 mg/dL, p ⩽ 0.01), urea (34 mg/dL vs 42 mg/dL, p = 0.04), CK (creatine kinase) (923 U/L vs 1707 U/L, p = 0.07) on admission, and CK after 24 hours of ECMO support (1705 U/L vs 4430 U/L, p = 0.01). ECMO explantation was significantly more often performed in patients who suffered AKI (24% vs 48%, p = 0.01). In-hospital mortality (86% vs 70%; p = 0.07) did not differ significantly. Conclusion: Patients after eCPR are at high risk for AKI, comparable to those after conventional CPR. Baseline urea levels predict the development of AKI during the hospital stay.

Are Prolonged Ventricular Pauses in Atrial Fibrillation a Marker of Poor Prognosis?

Cardiology ◽  
2021 ◽  
Author(s):  
Dorte Marie Stavnem ◽  
Rakin Hadad ◽  
Bjørn Strøier Larsen ◽  
Olav Wendelboe Nielsen ◽  
Mark Aplin Frederiksen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Poor Prognosis ◽  
Pacemaker Implantation ◽  
Real Life ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Long Term Prognosis ◽  
Rate Limiting

Background: In patients with atrial fibrillation (AF), the long-term prognosis of long electrocardiographic pauses in the ventricular action is not well-studied. Methods: Consecutive Holter recordings in patients with AF (n=200) between 2009-2011 were evaluated, focusing on pauses of at least 2.5 s. Outcomes of interest were all-cause mortality and pacemaker implantation. Results: Forty-three patients (21.5%) had pauses with a mean of 3.2 s and SD of 0.9 s. After a median follow-up of 99 months (ranging 89-111), 47% (20/43) of the patients with, and 45% (70/157) without pauses were deceased. Pauses of ≥ 2.5 s did not constitute a risk of increased mortality: HR = 0.75; (95% CI: 0.34 - 1.66); p = 0.48. Neither did pauses of ≥ 3.0 s: HR = 0.43; (95% CI: 0.06 - 3.20); p = 0.41. Sixteen percent of patients with pauses underwent pacemaker implantation during follow-up. Only pauses in patients referred to Holter due to syncope and/or dizzy spells were associated with an increased risk of pacemaker treatment: HR = 4.7 (95% CI: 1.4-15.9), p = 0.014, adjusted for age, sex and rate-limiting medication. Conclusion: In patients with AF, prolonged electrocardiographic pauses of ≥ 2.5 s or ≥ 3.0 s are not a marker for increased mortality in this real-life clinical study.

scholarly journals Creatinine Levels at Admission as Predictors of In-Hospital Major Adverse Cardiovascular Events in Acute Heart Failure Patient

2020 ◽  
Vol 6 (1) ◽  
pp. 16-22
Author(s):  
Farida Hanum Margolang ◽  
Refli Hasan ◽  
Abdul Halim Raynaldo ◽  
Harris Hasan ◽  
Ali Nafiah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Roc Curve ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
High Morbidity ◽  
Roc Curve Analysis ◽  
Heart Failure Patients ◽  
Long Term Prognosis

Background: Acute heart failure is a global health problem with high morbidity and mortality. Short term and long term prognosis of these patients is poor. Therefore, early identification of patients at high risk for major adverse cardiovascular events (MACEs) during hospitalization was needed to improve outcome. Creatinine levels at admission could be used as predictors of major adverse cardiovascular events in acute heart failure patients because creatinine is a simple and routine biomarker of renal function examined in patients with acute heart failure. This study aimed to determine whether creatinine can be used as a predictor of major adverse adverse cardiovascular events in patients with acute heart failure.Methods: This study is a prospective cohort study of 108 acute heart failure patients treated at H. Adam Malik Hospital from July 2018 to January 2019. Creatinine cut-off points were determined using the ROC curve, then bivariate and multivariate analyzes were performed to determine predictors of major adverse cardiovascular events during hospitalization.Results: From 108 study subjects, 24 (22.2%) subjects experienced major adverse cardiovascular events during hospitalization. The subjects who died were 20 people (83.4%), subjects with arrhythmia were 2 people (8.3%), and those who had stroke were 2 people (8.3 %). Through the ROC curve analysis, we found creatinine cut-off values of ≥1.7 mg / dl (AUC 0.899, 95% CI 0.840- 0.957, p <0.05). Creatinine ≥1.7 mg/dl could predict major adverse cardiovascular events with a sensitivity of 87.5% and specificity of 79.5%. Multivariate analysis showed that creatinine ≥1.7 mg / dl was an independent factor to predict MACEs during hospitalization in this study (OR 18,310, p 0.001) as well as creatinine clearance and heart rate.Conclusion: Creatinine levels at admission is an independent predictor for major adverse cardiovascular events during hospitalization in acute heart failure patients.

Sign in / Sign up

Export Citation Format

Share Document