Impact of Remote Monitoring on Standardized Outcomes in Nephrology-Peritoneal Dialysis.

Introduction: This study aimed to evaluate the association between the use of remote patient monitoring (RPM) in patients on automated peritoneal dialysis (APD) and the Standardized Outcomes in Nephrology in peritoneal dialysis (SONG-PD) clinical outcomes. Methods: A prospective and multicenter cohort study was conducted on patients with advanced chronic kidney disease on APD, recruited at 16 Spanish Hospitals, between June 1 and December 31, 2021. Patients were divided into 2 cohorts, namely patients on APD with RPM (APD-RPM) and patients on APD without RPM. The primary endpoints were the standardized outcomes of the SONG-PD clinical outcomes: PD-associated infection, cardiovascular disease (CVD), mortality rate, technique survival, and life participation (assessed as health-related quality of life [QoL]). Propensity score matching (PSM) was used to evaluate the association of RPM exposure with the clinical outcomes. Results: A total of 232 patients were included, 176 (75.9%) in the APD-RPM group and 56 (24.1%) in the APD-without-RPM group. The mean patient follow-up time was significantly longer in the APD-RPM group than in the APD-without-RPM group (10.4 ± 2.8 vs. 9.4 ± 3.1 months, respectively; P = 0.02). In the overall study sample, the APD-RPM group was associated with a lower mortality rate (hazard ratio [HR]: 0.08; 95% confidence interval [CI]: 0.01 to 0.69; P = 0.020) and greater technique survival rate (HR: 0.25; 95% CI: 0.11 to 0.59; P = 0.001). After PSM, APD-RPM continued to be associated with better technique survival (HR: 0.23; 95% CI: 0.06 to 0.83; P = 0.024). Conclusion: The use of RPM programs in patients on APD was associated with better survival of the technique and lower mortality rates. However, after PSM, only technique survival was significant.

Glomerular hyperfiltration in patients with severe trauma.

BACKGROUND AND OBJECTIVE: Augmented renal clearance or glomerular hyperfiltration (GHF) can significantly affect the clinical outcomes of renally eliminated drugs by promoting subtherapeutic drug exposure. The aggression suffered in patients who suffer severe trauma is a predisposition to manifest GHF and the identification of these patients remains a clinical challenge. The main objective of this study was to describe the prevalence of GHF in a cohort of critically ill trauma patients. MATERIALS AND METHODS: Prospective observational study of a cohort of adult patients admitted after suffering severe trauma or polytrauma in the Anesthesiology ICU of the University Hospital of Albacete (Spain). Creatinine clearance (ClCr) was calculated in a 4-h urine collection sample at 24, 72 and 168 h after admission applying the formula; CrCl: [Diuresis in ml (urine/4 h) × Creatinine in urine (mg/dl)] ÷ [240 (minutes) × Creatinine in plasma (mg/dl)]. A CrCl above 130 mL/min was considered GHF. The analyses were performed with the statistical software R version 4.0.4. RESULTS: 85 patients were included. The median age of the patients was 51 years (IQR 26), 78.82% male. 68 patients were male (78.82%). 75.29% of the patients were polytraumatized. 61 patients (71.76%) presented GHF at some point in the CrCl determination. At 24 h of admission, 56.34% of the patients presented GHF with a mean CrCl of 195.8 ml/min, 61.11% of the patients presented it at 72 h with a mean CrCl of /min and 56.52% presented GHF at 168 h of admission with a mean CrCl of 207 ml/min. A significant positive relationship (p = 0.07) was found between GHF manifested at 72 h and at 168 h. We observed a statistically significant relationship between this phenomenon with younger ages, lower ISS scores and lower plasma creatinines. CONCLUSIONS: GHF are a common condition in critically ill patients admitted for severe trauma. We recommend the use of CrCl to assess renal function and make dosage adjustments. Studies are required to understand the clinical impact of these phenomena on drug elimination and to be able to establish the ideal dosage in those cases.

Comparison of bioimpedance spectroscopy and the Watson formula for measuring body volume in patients on peritoneal dialysis.

INTRODUCTION: Knowing total body volume (V) is crucial in patients on peritoneal dialysis (PD). It is usually calculated by the Watson anthropometric formula, although the use of bioimpedance spectroscopy (BIS) is becoming increasingly widespread. Measuring V with both methods can at times produce quite different results. OBJECTIVE: We aimed to identify differences between the 2 forms of measuring volume in a PD unit and determine which clinical factors are associated with these differences. METHODS: Ours is an observational study of 74 patients on PD. We measured V using BIS (Vbis) and the Watson formula (Vw); 271 measurements were made with each method. We calculated the difference between Vbis and Vw in each patient and classified them into 2 groups: Difference between volumes ≥10% or <10% Vbis. We assessed the presence of several clinical parameters in our patients. We assessed whether there were any differences between Vbis and Vw (Student t-test). We determined whether there was any association between the difference in volumes and the presence of the clinical parameters analysed (chi square test). RESULTS: V was 2.15 l higher measured by the Watson formula than with BIS (P<.01). In 58.67% of the measurements, the difference between Vbis and Vw was ≥10%. Significant differences were found when comparing the presence of difference between volumes and the presence or not of diabetes mellitus (DM) (p=0,03), hypertension (HTN) (p=0,036), hypoalbuminemia (p<0,01), hypoprealbuminemia (p<0,01), low phase angle at 50 Hz (p<0,01), high C reactive protein (p<0,01), obesity (p=0,027), E/I ratio (ratio between extracellular and intracellular water) ≥1 (p<0.01) and residual diuresis (p=0.029). CONCLUSIONS: There are significant differences in the V of PD Unit patients when obtained by Watson formula or by BIS. A difference between the measurements is associated with the presence of DM, HTN, hypoalbuminaemia, obesity, malnutrition, inflammation, E/I ratio ≥1 and the absence of residual diuresis.