Changes in pulmonary restrictive parameters by intensive home hemodialysis: a case report.

BACKGROUND: Patients with End-Stage Renal Disease (ESRD) are at an increased risk for restrictive lung disease due to accumulation of uremic toxins and volume overload. Hemodialysis is the preferred treatment for improving lung function in dialysis patients. However, the effects of fluid removal and solute clearance by hemodialysis on lung function remain unclear. CASE PRESENTATION: We report a case of restrictive lung disorder in a hemodialysis patient, who showed improvement in both clinical and spirometric lung function after initiation of intensive home hemodialysis (32 h per week). CONCLUSION: Intensive hemodialysis augments fluid removal and solute clearance, which in turn may improve restrictive lung function.

Atypical Antiglomerular Basement Membrane Disease in a Pregnant Patient with Systemic Lupus Erythematosus.

Antiglomerular basement membrane disease (anti-GBM) is an unusual cause of glomerulonephritis. Patients usually present with rapidly progressive glomerulonephritis with or without pulmonary hemorrhage. The diagnosis is based on linear deposits of IgG along the GBM and the presence of anti-GBM antibodies. However, cases with atypical anti-GBM disease in which an anti-GBM antibody was not detected have been reported. We report a 29-year-old pregnant woman with underlying systemic lupus erythematosus (SLE) who presented with severe glomerulonephritis due to atypical antiglomerular basement membrane disease. She was initially diagnosed with active lupus nephritis and her renal function gradually worsened after steroid treatment, so the pregnancy was terminated due to the high maternal and fetal risks. A kidney biopsy showed linear capillary wall staining with fibrous crescents without endocapillary proliferation. The anti-GBM antibody showed negative results two times, so she was diagnosed with atypical anti-GBM disease. Treatment began with intravenous pulse methylprednisolone and continued with mycophenolate mofetil and prednisolone. Due to the intolerability of side effects, the treatment regimen was subsequently changed to intravenous cyclophosphamide. Although she had a significant improvement in clinical edema, serum albumin, and hematuria, her renal function gradually decreased during the 12 months of treatment. A review of the literature showed that the atypical anti-GBM is less aggressive than the typical anti-GBM disease. However, several patients had persistent renal dysfunction and 20-30% of patients had progression to ERSD. To the best of our knowledge, this is the first case of atypical anti-GBM disease in pregnant patients with suspected SLE reported in the literature.

Comparing non-invasive diagnostic methods for arteriovenous fistula stenosis: a prospective study.

PURPOSE: International guidelines recommend screening for arteriovenous fistula (AVF) stenosis using various non-invasive methods. We evaluate different non-invasive AVF flow measurements for detecting AVF stenosis. METHODS: Twenty-three haemodialysis patients with suspected AVF stenosis are enrolled based on abnormal physical signs or high venous pressure during dialysis. Ultrasound dilution, urea dilution, Doppler ultrasonography, and fistulography are performed on all patients. The accuracy of three non-invasive methods is compared. RESULTS: Fistulography reveals AVF stenosis in 18 patients, 12 of whom have severe stenosis (greater than 50% stenosis in diameter). Concerning the location of the stenosis lesions, eight are at the inflow site, six at the outflow site, and four on both sites. Receiver operating characteristic curve analysis shows that Doppler ultrasonography has a high discriminative ability and the averaged areas under the curves are 0.933 (95% confidence interval [CI]; 0.81 to 0.99) for stenosis and 0.929 (95% CI 0.82-0.99) for severe stenosis. The sensitivity of each method for the prediction of access stenosis using ultrasound dilution, urea dilution, and Doppler ultrasonography is 73%, 73%, and 80%, respectively. The respective specificity of each method is 40%, 80%, and 100%, respectively. Physical examination (PE) shows an 80% sensitivity and 80% specificity in the detection of AVF stenosis. The combination of Doppler ultrasound with PE produces the highest sensitivity (93%) for detecting AVF stenosis. CONCLUSIONS: Doppler ultrasound combined with physical examination is more accurate than other non-invasive methods for detecting AVF stenosis.

Evaluation of different methods to improve culture-negative peritoneal dialysis-related peritonitis: A single-center study.

BACKGROUND: ISPD recommends culture-negative peritonitis in each peritoneal dialysis (PD) center should less than 15%. The hospital in Thailand, however faced a significantly high rate of culture negative peritonitis, even using blood culture bottles technique. This study evaluates the performance of three different culture methods in detecting organisms in PD related peritonitis. METHODS: A prospective cohort diagnostic study was performed in PD patients diagnosed with PD related peritonitis in Surin Hospital from October 2018 to June 2020. The Diagnosis of peritonitis was followed ISPD guidelines. PDF sample from each patient was processed by three different blood culture bottle-based techniques, including i) 50 ml PDF centrifugation, and ii) 10 ml PDF centrifugation before inoculated into blood culture bottles, and iii) inoculation into blood culture bottles without centrifugation. The sensitivities and isolated organisms were compared among the individual methods. RESULTS: Of 126 PD patients with clinical peritonitis, PD related peritonitis was diagnosed in 87 patients with 105 PDF analysis. PDF culture showed gram-positive organisms 34%, gram-negative organisms 41%, fungal 5.71%, and culture-negative result in 22.86%. The direct blood culture method was positive in 59.05%, while centrifugation before inoculated into blood culture bottles, has a higher percentage of positive results, 60.95% and 64.76% from 10 ml to 50 ml PDF volume; respectively. The sensitivity was 84% and 76.5% for 50 ml PDF centrifugation and blood culture without centrifugation. CONCLUSION: Large volume PDF centrifugation before inoculating into blood culture bottles may improve the positive culture rate in PD related peritonitis.

Coffee Consumption is Associated with a Decreased Risk of Incident Chronic Kidney Disease: A Systematic Review and Meta-analysis of Cohort Studies.

BACKGROUND: Recent studies have suggested a renal protective effect of coffee consumption against development of chronic kidney disease (CKD) although the results remain inconclusive. This systematic review and meta-analysis aimed to comprehensively investigate this association by summarizing all available data. METHODS: A systematic review was performed using MEDLINE and EMBASE database from inception to November 2019 to identify all cohort studies that compared the risk of developing CKD after index date among coffee-drinkers versus non-drinkers. Pooled risk ratio and 95% confidence interval (CI) were calculated using random-effect, generic inverse-variance method of DerSimonian and Laird. RESULTS: A total of 4 cohort studies comprising of 25,849 participants met the inclusion criteria and were analyzed in the meta-analysis. The meta-analysis found a significantly decreased risk of incident CKD among coffee-drinkers compared with non-drinkers with the pooled risk ratio of 0.87 (95% CI, 0.81-0.95; I2 of 57%). The funnel plot of this study was relatively symmetric and was not indicative of publication bias CONCLUSIONS: A significant association between coffee consumption and a lower risk of incident CKD was demonstrated in this study.

Jejunal perforation during peritoneal dialysis catheter placement: A case report.

INTRODUCTION: Bowel perforation is a rare but serious complication after peritoneal dialysis (PD) catheter insertion, which significantly increases mortality. Currently, there is no recommendation for preferring catheter insertion technique, since neither open surgical or percutaneous technique demonstrate superior outcome. PRESENTATION OF CASE: This is a 78-year-old man who developed jejunal perforation during PD catheter placement, presenting with initial clear and satisfying PD fluid drainage. Bowel perforation was recognized after long dwell of PD fluid returned in yellowish color. Operative finding revealed a through and through jejunal wall perforation. CONCLUSION: Satisfying dialysate flow and tip catheter location could not exclude accidental bowel perforation after PD catheter placement. Carefully patient monitoring is crucial in detecting postoperative complication.

The survival analysis of tunnel-cuffed central venous catheter versus arteriovenous hemodialysis access among elderly patients: A retrospective single center study.

BACKGROUND: There is currently a controversy for the optimal vascular access option in the elderly, regarding their multiple comorbidities and life expectancies. Our study aimed to compare the survival of tunneled cuff venous catheter (CVC) and arteriovenous access (AV access) in elderly patients. METHODS: A retrospective cohort study was performed by electronic medical record review. All hemodialysis patients aged 65 years and over who firstly initiated dialysis from January 1, 2012 to December 31, 2016 at Siriraj hospital, Thailand, were included. The primary outcomes are to compare a 2-year period of survival between CVC and AV access in terms of abandonment, death, and combined outcome. Propensity score covariate and Charlson Comorbidity Score (CCI) were used for multivariable analysis adjustment. RESULTS: A total of 359 patients were included; 216 (60.2%) patients had initiated hemodialysis via CVC while the rest used AV access. The patients' average ages were 76.7 ± 7.0 and 74.0 ± 5.8 years (p-value<0.001) in the CVC and AV access group, respectively. The 2-year mortality rates of CVC and AV access groups were 24.1% and 15.4%, respectively (p-value = 0.038). Multivariable analyses showed that the adjusted hazard ratio (aHR) of combined endpoints, i.e., vascular access abandonment and death, was statistically different only in the CCI-adjusted model (aHR = 0.68, 95% CI: 0.46-0.99). Mortality from infection cause was more common in the CVC group than the AV access group. CONCLUSION: CVC access maybe considers an alternative option for frail elderly patients. However, the patient selection is a crucial issue, given higher infection-related mortality in patients using CVC.

Are adverse events in newly trained home dialysis patients related to learning styles? A single-centre retrospective study from Toronto, Canada.

OBJECTIVES: Home haemodialysis (HD) and peritoneal dialysis (PD) have seen growth in utilisation around the globe over the last few years. However, home dialysis, with its attendant technical complexity and risk of adverse events continues to pose challenges for wider adoption. We examined whether differences in patients' learning styles are associated with differing risk of adverse events in both home HD and PD patients. DESIGN: Retrospective cohort study. SETTING: Tertiary care hospital in Toronto, Ontario, Canada. PARTICIPANTS: One hundred and eighteen prevalent adult (≥18 years) home dialysis patients (40 PD and 78 home HD) were enrolled. Patients on home dialysis for less than 6 months or receiving home nursing assistance for dialysis were excluded from the study. INTERVENTIONS: Enrolled patients completed (VARK) Visual, Aural, Reading-writing and Kinesthetic questionnaires to determine learning styles. PRIMARY AND SECONDARY OUTCOME MEASURES: Home HD and PD adverse events were identified within 6 months of completing home dialysis training. Event rates were then stratified and compared according to learning styles. RESULTS: Thirty patients had a total of 53 adverse events. We used logistic regression analysis to determine unadjusted and adjusted ORs for a single adverse event. Non-visual learners were 4.35 times more likely to have an adverse event (p=0.001). After adjusting for age, gender, dialysis modality, training duration, dialysis vintage, prior renal replacement therapy, visual impairment, education and literacy, an adverse event was still four times more likely among non-visual learners compared to visual learners (p=0.008). A subgroup analysis of home HD patients showed adverse events were more likely among non-visual learners (OR 11.1; p=0.003), whereas PD patients showed a trend for more adverse events in non-visual learners (OR: 1.60; p=0.694). CONCLUSIONS: Different learning styles in home dialysis patients exist. Visual learning styles are associated with fewer adverse events in home dialysis patients within the first 6 months of completing training. Individualisation of home dialysis training by learning style is warranted.

The need for outpatient back-up for home hemodialysis patients: Implications for resource utilization.

INTRODUCTION: The provision of sufficient support contributes to home hemodialysis (HHD) technique survival. The need for back-up treatment in incident and prevalent patients on HHD has not been well described previously, and is important from both technique survival and resource allocation. We aimed to quantify the amount of back-up treatment given to patients in our HHD unit, and hypothesized that the provision of back-up HD facilitated technique survival. METHODS: This was a retrospective, single-center cohort study quantifying the provision of back-up HD between January and December 2018. Electronic and paper medical records were accessed for data collection. FINDINGS: One hundred and nineteen patients dialyzed independently at home during the study period (96 patient years of HHD). Seventy-eight (66%) patients required a total of 292 back-up HD sessions in the HHD unit, representing an average of three back-up HD runs per patient year of HHD. Fifty-three percent of back-up HD runs were required for vascular access related issues. The most common clinical issue requiring assessment and back-up HD was extracellular fluid volume management. An equal proportion (95%) of those that utilized back-up HD and those that did not utilize back-up HD maintained a positive disposition (transplant or ongoing HHD) in relation to technique survival in the short term. CONCLUSIONS: From a resource viewpoint, this program of approximately 100 HHD patients required the availability of one to two staffed HD stations each weekday for back-up HD. The provision of back-up HD was not a harbinger of HHD discontinuation.