COVID-19—Importance for Patients on the Waiting List and after Kidney Transplantation—A Single Center Evaluation in 2020–2021

(1) Background: Dialysis patients and recipients of a kidney allograft are at high risk for infection with SARS-CoV-2. It has been shown that the development of potent neutralizing humoral immunity against SARS CoV-2 leads to an increased probability of survival. However, the question of whether immunocompromised patients develop antibodies has not yet been sufficiently investigated; (2) Methods: SARS-CoV-2 antibodies were examined in hemodialysis patients on the waiting list for kidney transplantation as well as patients after kidney transplantation. Patients were interviewed about symptoms and comorbidities, BMI, and smoking history; (3) Results: SARS-CoV-2 antibodies were found in 16 out of 259 patients (6%). The trend of infections here reflects the general course of infection in Germany with a peak in November/December of 2020. Remarkably, patients on the waiting list experienced only mild disease. In contrast, transplanted patients had to be hospitalized but recovered rapidly from COVID-19. Most interesting is that all immunosuppressed patients developed antibodies against SARS-CoV-2 after infection; (4) Conclusions: Even with extensive hygiene concepts, an above-average number of patients were infected with SARS-CoV-2 during the second wave of infections in Germany. Because SARS-CoV-2 infection triggered the formation of antibodies even in these immunocompromised patients, we expect vaccination to be effective in this group of patients. Thus, dialysis patients and patients after kidney transplantation should be given high priority in vaccination programs.

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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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MO930BURDEN OF DISEASE IN INCIDENT DIALYSIS PATIENTS WAIT LISTED FOR KIDNEY TRANSPLANTATION 2008 – 2016 IN GERMANY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.009 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Martin Wagner ◽

Wolfgang Arns ◽

Katherine Rascher ◽

Heyke Cramer ◽

Mathias Schaller ◽

...

Keyword(s):

Kidney Transplantation ◽

Mortality Risk ◽

Burden Of Disease ◽

Waiting Times ◽

Patient Characteristics ◽

Waiting List ◽

Dialysis Patients ◽

Non Profit ◽

Laboratory Variables ◽

Over Time

Abstract Background and Aims Only a subset of all patients on dialysis is eligible for kidney transplantation (KTx) due to the large variation of mortality risk. It has been shown that the burden of disease is increasing over the last years in patients at dialysis inception. Moreover, the number of available kidney grafts is decreasing, resulting in a prolonged time on the waiting list. In our study we describe the burden of disease and 3-year mortality in a sample of incident dialysis patients in Germany, stratified by KTx status, including trends over time. Method The QiN (Quality in Nephrology) dataset is a registry-based observational study in which >90% of all patients treated in dialysis centers of the non-profit kidney care provider KfH are enrolled. In our analyses we included all adult patients beginning dialysis treatment between 2008 and 2016. Primary outcome was 3-year all-cause death up until Dec 31, 2019. Patients were stratified by last available KTx- status: (a) KTx within 3 years, (b) on dialysis - on waiting list, (c) on dialysis - in evaluation for KTx, (d) on dialysis - KTx never planned, (e) on dialysis - KTx status missing. The burden of disease was assessed by the AROii score (Floege et al. 2015), a predictive model including patient characteristics, laboratory variables and dialysis parameters. Results Of a total of n=25987 incident patients analyzed, 3.2% underwent KTx within 3 years, 10.6% were listed for KTx, and 13.4% were in evaluation. In 49.5% KTx was never planned and in 23.3% KTx status was missing. These groups differed significantly in median AROii score, reflecting their burden of disease at dialysis inception: KTx never planned or missing (AROii score 10) as compared to KTx (AROii score 1), listed (AROii score 3) and in evaluation (AROii score 4) (p<0.001). Similarly, 3-year observed mortality (n=8059 [31%]) differed widely across KTx strata (log rank p<0.001), ranging from 11% in listed patients to 44% (HR 5,982; [5.335; 6.707]) in those with missing KTx status (figure). In the period 2008-2019 the number of KTx within 3 years decreased, but the proportion of patients on the waiting list and the proportion of patients in evaluation increased. In all patients on dialysis the burden of disease at dialysis inception increased over time across KTx strata (p<0.05). Conclusion About three quarters of patients started dialysis with a very high mortality risk and at least half of them were considered ineligible for KTx. Patients listed or in evaluation for KTx in Germany have become sicker over the last decade. With decreasing numbers of KTx in Germany the time on the waiting list is prolonged. Longer waiting times and the increasing burden of disease result in advanced risk at the time of transplantation.

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Impact of the establishment of waiting list committee on recipient evaluation for kidney transplantation: experience of the Budapest Centre

Orvosi Hetilap ◽

10.1556/oh.2011.29020 ◽

2011 ◽

Vol 152 (5) ◽

pp. 190-195

Author(s):

Éva Toronyi ◽

Rita Chmel ◽

Anikó Maléth ◽

Etelka Borsodi ◽

Anikó Mező ◽

...

Keyword(s):

Kidney Transplantation ◽

Clinical Examination ◽

Clinical Evaluation ◽

Clinical Investigation ◽

Waiting List ◽

Effective Work ◽

Number Of Patients ◽

Unfit Patients ◽

The Impact ◽

Second Period

The aim of this study was to assess the impact of the establishment of waiting list committee on recipient evaluation for kidney transplantation. Studies on this issue have not been previously reported. Methods: Data of 714 patients were collected between September 1, 2007 and April 20, 2010. Of the 714 patients 354 were transplanted. Data from the first 16 months period were compared to those obtained during the second 16 months period. Results: During the first period 171 patients (47.9%) were unfit for transplantation [129 patients (36.1%) were refused after telephone information and 42 patients (11.8%) after clinical investigation]. During the second period 141 (39.5%) patients were found to be unsuitable [80 patients (22.4%) after telephone information and 61 patients (17.1)] after clinical examination. During the two periods of the study 44% of patients were unfit for transplantation. A considerable number of patients were refused because of cardiologic reasons. The percent of fit patients was 52.1% in the first period and 60.5% in the second period. In addition, the percent of unfit patients who were unsuitable for kidney transplantation after telephone information decreased from 36.1% to 22.4%, while the percent of unfit patients after clinical evaluation increased from 11.% to 17.1%. Conclusions: Authors conclude that waiting list committee made an effective work. Orv. Hetil., 2011, 152, 190–195.

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COVID-19 in Children with Chronic Dialysis and Kidney Transplantation

10.21203/rs.3.rs-493945/v1 ◽

2021 ◽

Author(s):

Nur Canpolat ◽

Zeynep Yürük Yıldırım ◽

Nurdan Yıldız ◽

Mehmet Taşdemir ◽

Nilüfer Göknar ◽

...

Keyword(s):

Kidney Transplantation ◽

Severe Disease ◽

Pediatric Nephrology ◽

Kidney Injury ◽

Chronic Dialysis ◽

Dialysis Patients ◽

Multicenter Observational Study ◽

Entire Cohort ◽

Mild Disease ◽

Increased Risk

Abstract The aim of the study is to present incidence of COVID-19 in children with renal replacement therapy (RRT) and compare the severity and outcomes of the disease between the groups undergoing dialysis and kidney transplantation (KTx). This multicenter observational study was based on data collected from children receiving RRT, either chronic dialysis or KTx, diagnosed with COVID-19. All members of the Istanbul branch of the Turkish Pediatric Nephrology Association were requested to submit all their confirmed COVID-19 cases between April 1 and December 31, 2020. They were also asked to report the number of their prevalent patients on RRT under the age of 20. A total of 46 RRT patients diagnosed with COVID-19 were reported from 12 centers. Of these, 29 were KTx recipients, and 17 were on dialysis. COVID-19 cases represented 9.3% of all prevalent dialysis patients and 9.2% of all prevalent KTx recipients. Twelve KTx recipients (41.4%) and three dialysis patients (17.6%) were asymptomatic (p = 0.12). The hospitalization rate was higher in dialysis patients than KTx recipients (82.4% vs. 27.6%, p = 0.001). Two patients, one in each group, experienced a severe disease course, and only one hemodialysis patient had a critical illness that required mechanical ventilation. Acute kidney injury developed in 36% of KTx recipients, but none required dialysis or lost their graft. In the entire cohort, one patient on hemodialysis with multiple comorbidities died.Conclusion: Although most of cases were asymptomatic or had a mild disease, children on RRT seem to have an increased risk for COVID-19.

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Current status of vascular access in Japan—from Dialysis Access Symposium 2017

The Journal of Vascular Access ◽

10.1177/1129729818762982 ◽

2019 ◽

Vol 20 (1_suppl) ◽

pp. 38-44

Author(s):

Mizuya Fukasawa

Keyword(s):

Vascular Access ◽

Current Status ◽

Good Survival ◽

Chronic Glomerulonephritis ◽

Dialysis Access ◽

Dialysis Patients ◽

Survival Prognosis ◽

Access Methods ◽

Number Of Patients ◽

Wide Range

At the second Dialysis Access Symposium held in Nagoya, Japan, a proposal was made to investigate the differences in vascular access methods used in different countries. In this article, we describe the management of vascular access in Japan. The Japanese population is rapidly aging, and the proportion of elderly patients on dialysis is also increasing. There were 325,000 dialysis patients in Japan at the end of 2015, of whom 65.1% were aged 65 years or above. The number of patients with diabetic nephropathy or nephrosclerosis as the underlying condition is also increasing, whereas the number with chronic glomerulonephritis is steadily decreasing. The Japanese health insurance system enables patients to undergo medical treatment at almost no out-of-pocket cost. Percutaneous transluminal angioplasty suffers from a severe device lag compared with other countries, but although there are limitations on permitted devices, the use of those that have been authorized is covered by medical insurance. One important point that is unique to Japan is that vascular access is performed and managed by doctors involved in dialysis across a wide range of disciplines, including nephrologists, surgeons, and urologists. This may be one factor contributing to the good survival prognosis of Japanese dialysis patients.

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SAT0541 THE SEVERITY OF FMF MAY BE ASSOCIATED WITH CO-MORBIDITIES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.801 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1227.3-1228

Author(s):

M. E. Tezcan ◽

N. Şen ◽

M. Yilmaz ◽

Ö. Volkan ◽

E. Tükel ◽

...

Keyword(s):

Familial Mediterranean Fever ◽

Scoring System ◽

Disease Duration ◽

Severe Disease ◽

Smoking History ◽

Disease Group ◽

Severity Scoring ◽

Mild Disease ◽

Co Morbidity ◽

Mediterranean Fever

Background:Familial Mediterranean fever (FMF) is an auto inflammatory disease with recurrent attacks of serositis. Frequent attacks and disease related sequels may be associated with co-morbidities in FMF patients.Objectives:One of the tools for evaluating the FMF severity is the international severity scoring system for FMF (ISSF)1. This score includes disease related sequels, acute phase measurements, attack features and exertional leg pain. Therefore, more severe disease may be link with subclinical inflammation, amyloidosis and frequent, prolonged and widespread attacks. All these components may augment the frequency of non-disease related co-morbidities.Methods:We enrolled 158 FMF patients who fulfilled modifiedTel-HashomerDiagnosisCriteria2. The patients dichotomized based upon disease severity (mild disease or severe disease). Patients with ISSF scores lower or equal to 2 were accepted to have mild disease. Then, we compared frequency of non-disease related co-morbidities between the groups. These co-morbidities arehypertension, hypothyroidism, hyperthyroidism cardiovascular diseases, coronary artery diseases, cerebrovascular diseases, chronic renal disease (non-FMF related), chronic obstructive pulmonary diseases, and diabetes mellitus. This study was approved by the Local Research Ethics Committee and carried out in compliance with the Helsinki Declaration. All the patients gave written informed consent. P-value lower than 0.05 was considered as statistically significant.Results:Demographic features, disease duration, smoking history and body mass index (BMI) were similar between the groups. Frequency of co-morbidity in severe disease group was statistically higher than mild disease group (p=0.02). Most frequent co-morbidity was hypertension in both groups.Table.Features of mild and severe FMF groupsMild (n=135)Severe (n=23)pGender (M/F)47/8811/120.23Age36.4±11.336.5±14.30.68Smoking (%)38 (28.1)5 (21.7)0.52BMI (kg/m2)24.3±9.224.0±8.90.34Disease duration (year)7.7±11.38.6±14.30.09Amyloidosis (%)2 (1.4)3 (13.0)0.02Exon 10 homozygote (%)35 (25.9)9 (39.1)0.19Colchicine dosage (mg/day)1.2±0.41.4±0.50.02ISSF scores0.7 ±0.73.4±0.5<0.001Co-morbidity (%)25 (18.5)9 (39.1)0.02Conclusion:In our FMF patient cohort, we found that severity of the disease may be associated with higher frequency of co-morbidities. Therefore, clinicians should be aware of the high possibility of co-morbidities in patients with more severe FMF and addressed these co-morbidities timely and properly.References:[1]Demirkaya E, et al. Development and initial validation of international severity scoring system for familial Mediterranean fever (ISSF). Ann Rheum Dis 2016;75:1051-6.[2]Berkun Y, et al. Diagnostic criteria of familial Mediterranean fever. Autoimmun Rev 2014;13:388-90.Acknowledgments:NoneDisclosure of Interests:None declared

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Processes of knowing in the translation of a health communication intervention for dialysis patients awaiting kidney transplantation

Patient Education and Counseling ◽

10.1016/j.pec.2020.09.009 ◽

2020 ◽

Author(s):

Marit Helen Andersen ◽

Kristin Hjorthaug Urstad ◽

Marie Hamilton Larsen ◽

Eivind Engebretsen ◽

John Ødemark ◽

...

Keyword(s):

Kidney Transplantation ◽

Health Communication ◽

Communication Intervention ◽

Dialysis Patients

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A “Terrible” Headache in a HIV Patient

Ear Nose & Throat Journal ◽

10.1177/01455613211014106 ◽

2021 ◽

pp. 014556132110141

Author(s):

Marios Stavrakas ◽

Ioannis Koskinas ◽

Jannis Constantinidis ◽

Petros D Karkos

Keyword(s):

Differential Diagnosis ◽

Surgical Treatment ◽

Fungal Infection ◽

Early Identification ◽

Fungal Sinusitis ◽

Immunocompromised Patients ◽

Immunosuppressed Patients ◽

Distant Spread ◽

Nose And Throat

Mucormycosis is a type of fungal infection more prevalent among immunosuppressed patients, requires prompt identification and surgical treatment, as it can is associated with local and distant spread. This case is aiming to highlight the importance of early identification of subtle symptoms in immunocompromised patients. The clinician should be aware of fungal sinusitis, consider it in the differential diagnosis, and seek for an ear, nose, and throat opinion.

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HOW TO REPORT AND MONITOR THE PERFORMANCE OF WAITING LIST MANAGEMENT

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462302000442 ◽

2002 ◽

Vol 18 (3) ◽

pp. 611-618

Author(s):

Markus Torkki ◽

Miika Linna ◽

Seppo Seitsalo ◽

Pekka Paavolainen

Keyword(s):

Hallux Valgus ◽

Waiting Time ◽

Varicose Vein ◽

Elective Surgery ◽

Waiting Times ◽

Waiting List ◽

Mean Waiting Time ◽

Number Of Patients ◽

Potential Problems ◽

Queue Discipline

Objectives: Potential problems concerning waiting list management are often monitored using mean waiting times based on empirical samples. However, the appropriateness of mean waiting time as an indicator of access can be questioned if a waiting list is not managed well, e.g., if the queue discipline is violated. This study was performed to find out about the queue discipline in waiting lists for elective surgery to reveal potential discrepancies in waiting list management. Methods: There were 1,774 waiting list patients for hallux valgus or varicose vein surgery or sterilization. The waiting time distributions of patients receiving surgery and of patients still waiting for an operation are presented in column charts. The charts are compared with two model charts. One model chart presents a high queue discipline (first in—first out) and another a poor queue discipline (random) queue. Results: There were significant differences in waiting list management across hospitals and patient categories. Examples of a poor queue discipline were found in queues for hallux valgus and varicose vein operations. Conclusions: A routine waiting list reporting should be used to guarantee the quality of waiting list management and to pinpoint potential problems in access. It is important to monitor not only the number of patients in the waiting list but also the queue discipline and the balance between demand and supply of surgical services. The purpose for this type of reporting is to ensure that the priority setting made at health policy level also works in practise.

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Toxoplasma Appendicitis: A Once-in-a-Lifetime Diagnosis!

International Journal of Surgical Pathology ◽

10.1177/1066896917724888 ◽

2017 ◽

Vol 26 (1) ◽

pp. 89-92 ◽

Cited By ~ 1

Author(s):

Anisha M. Fernandes ◽

Maheshkumar M. Lakhe ◽

Sanjay A. Pai

Keyword(s):

Differential Diagnosis ◽

Acute Appendicitis ◽

Muscularis Propria ◽

Immunocompromised Patients ◽

Lymphoid Follicles ◽

Negative Results ◽

Immunosuppressed Patients ◽

Life Threatening

Toxoplasmosis is generally asymptomatic in immunocompetent individuals, but it can be life-threatening in immunocompromised patients. We present a case of a 62-year-old man with clinical features of acute appendicitis. Histology showed a transmural infiltrate of eosinophils. In addition, there were reactive lymphoid follicles with histiocytes in the submucosa and tachyzoites in the muscularis propria. Immunohistochemistry confirmed the diagnosis of toxoplasma appendicitis. Serological evaluation yielded negative results. Retrospective review of the history revealed that the patient was on long-term immunosuppressive therapy with methotrexate. The patient was treated with sulfamethoxazole-trimethoprim and is asymptomatic at 7-month follow-up. Toxoplasma appendicitis must be considered in the differential diagnosis of appendicitis in immunosuppressed patients.

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