Screening for tropical and imported infections in migrant kidney transplant candidates from the kidney transplant access consultation.

BACKGROUND AND OBJECTIVE: Kidney transplantation (KT) should be postponed in those people with active bacterial, fungal, viral and parasitic processes, since these must be treated and resolved previously. The objective of this study is to present the screening circuit implemented by the Nephrology clinic and describe the prevalence of tropical and imported infections in KT candidates born or coming from endemic areas. MATERIALS AND METHODS: Descriptive cross-sectional study, carried out in 2021. Sociodemographic and clinical variables, serological data of general infections and specific tests of tropical infectious diseases were collected. A descriptive analysis of the data was carried out. RESULTS: 67 TR candidates from Latin America (32.8%), North Africa (22.4%), Sub-Saharan Africa (14.9%) and Asia (29.9%) were included. 68.7% were men and the mean age was 48.9 ±â€¯13.5 years. After the general and specific studies, 42 (62.7%) patients were referred to the Infectious Diseases Service to complete this study or indicate treatment. 35.8% of the patients had eosinophilia, and in one case parasites were detected in feces at the time of the study. Serology for strongyloidiasis was positive in 18 (26.9%) cases, while positive serology for other tropical infections was hardly detected. 34.3% of patients had latent tuberculosis infection. CONCLUSIONS: The prevalence of tropical and imported infections in migrant candidates for RT was low, except for strongyloidiasis and latent tuberculosis infection. Its detection and treatment are essential to avoid serious complications in post-TR. To this end, the implementation of an interdisciplinary screening program from the KT access consultation is feasible, necessary and useful.

Kidney transplantation reduces the risk of chronic limb threatening ischemia and amputation among patients with end-stage renal disease on hemodialysis.

OBJECTIVE: This study aimed to analyze the risk of chronic limb threatening ischemia (CLTI) or amputation among patients with end-stage renal disease (ESRD) entering a hemodialysis (HD) program and to evaluate the protective effect associated with kidney transplantation (KT). DESIGN, MATERIAL AND METHODS: Retrospective cohort of all consecutive ESRD patients entering into a HD program at our institution between 2000 and 2010. Collected variables included baseline characteristics (pre-entry in hemodialysis), time on HD program, KT and the composite outcome of chronic limb threatening ischemia or need for any amputation (CLTI/AMP). Patients with previous symptomatic peripheral arterial disease or amputation were excluded. RESULTS: The study group included 336 patients (mean age 63 years, 66% male). The mean follow up was 6.7 years with an average time on HD of 4.2 years. Ninety two patients (27.4 %) underwent transplantation. CLTI free survival rates were 90.3 % and 82.6 % at 5 and 10 years, respectively. The episodes of CLT involved 28 revascularization procedures (17 endovascular and 11 open surgeries), 18 minor amputations and 20 major amputations. KT was associated with a protective effect over the development of CLTI (HR: 0.065; CI 95% 0.02-0.21) after adjustment for confounding factors. The long-term survival of non-transplanted patients was 45 % and 15 % at 5 and 10 years, respectively and the long-term survival in transplanted patients was 89% and 80% at 5 and 10 years, respectively; but decreased to 47 % at 1 year and 18.2 % at 5 years once CLTI occurred. CONCLUSION: Patients on HD program show a notorious risk of chronic limb threatening ischemia or amputation over time. Once this complication occurs, patient's survival is markedly reduced. Transplantation confers an independent protective effect over the development of chronic limb threatening ischemia or amputation.

A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis.

INTRODUCTION: Duplex ultrasound (DUS) is increasingly used before vascular access (VA) surgery for haemodialysis. However, the cost-effectiveness of this approach is unknown. Our objective was to assess whether the introduction of a specialised consultation with DUS assessment modifies the cost and the time delay to achieve a first VA valid for haemodialysis. PATIENTS AND METHODS: Prospective cohort of patients undergoing a first VA (June 2014-July 2017) after a specialised consultation with DUS (ECO group). They were compared with a historical cohort (January 2012-May 2014) where VA was indicated exclusively by clinical evaluation (CLN group). We analysed the cost related to visits, DUS assessments, interventions, hospital admissions and graft materials to achieve a first VA valid for haemodialysis at least during 1 month. RESULTS: 86 patients in the CLN group were compared with 92 in the ECO group. Patients in the ECO group were younger (68.4 vs. 64.0 years; P=.038) but no other differences were seen among groups. The average cost to achieve a first AV valid for haemodialysis was significantly lower in the ECO group (2707 vs. 3347€; P=.024). There was a higher cost associated with DUS assessments in the ECO group yet the CLN group had a higher cost related to follow-up visits, successive surgical interventions, prosthetic material, days of hospital admission and catheters. The mean time needed to achieve a first AV valid for haemodialysis was also shorter in the ECO group (49.9 vs. 82.9 days, P=.002). CONCLUSION: The introduction of a specialised vascular access consultation with DUS prior to VA surgery has reduced the cost necessary to achieve a first VA valid for haemodialysis. From the patient's point of view this has meant less interventions and hospital admissions and a shortening of the time delay.

Are continued policies of prioritizing native vascular access in patients on hemodialysis programs useful?

The guidelines recommend establishing native vascular access as opposed to prosthetic or catheter-based access despite information relating to its effectiveness being scarce from a patient-orientated perspective. We analyzed the effectiveness of a continued policy of native vascular access (CPNVA) in patients undergoing hemodialysis. A retrospective, observational study, including 150 patients undergoing hemodialysis between 2006 and 2012 at our center, and who underwent a CPNVA. Statistical analysis was based on treatment intention. In 138 patients (92%), the first useful access (FUA) was native, and in 12 patients (8%), it was prosthetic. In 50 patients (33.3%), more than one procedure had to be carried out in to order to achieve FUA. The probability of dialysis occurring via a FUA was 67.1% and 45.3% at 1 and 5 years respectively. Over the follow-up period (mean time = 30 months), 84 patients (56%) required repairs or new access, extending the effectiveness of the CPNVA to 88.3% and 73.2% at 1 and 5 years respectively. The effectiveness of the CPNVA was reduced if the patient: required a catheter initially (HR: 3.6, p = 0.007); in cases of initially elevated glomerular filtration rate (HR: 1.1, p = 0.040); in cases of history of previous access failure before FUA (HR: 3.9, p = 0.001); and in female patients (HR: 2.4, p = 0.031). The long-term effectiveness of a CPNVA is high. However, the percentage of patients requiring diverse procedures in order to achieve FUA and the need for re-interventions yield the necessity to optimize preoperative evaluation and postoperative follow-up.

A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis. / Impacto de la introducción de una consulta específica con valoración eco-doppler en el costo asociado a la obtención de un primer acceso vascular para hemodiálisis.

INTRODUCTION: Duplex ultrasound (DUS) is increasingly used before vascular access (VA) surgery for haemodialysis. However, the cost-effectiveness of this approach is unknown. Our objective was to assess whether the introduction of a specialised consultation with DUS assessment modifies the cost and the time delay to achieve a first VA valid for haemodialysis. PATIENTS AND METHODS: Prospective cohort of patients undergoing a first VA (June 2014-July 2017) after a specialised consultation with DUS (ECO group). They were compared with a historical cohort (January 2012-May 2014) where VA was indicated exclusively by clinical evaluation (CLN group). We analysed the cost related to visits, DUS assessments, interventions, hospital admissions and graft materials to achieve a first VA valid for haemodialysis at least during 1 month. RESULTS: Eighty-six patients in the CLN group were compared with 92 in the ECO group. Patients in the ECO group were younger (68.4 vs. 64.0 years; P=.038) but no other differences were seen among groups. The average cost to achieve a first AV valid for haemodialysis was significantly lower in the ECO group (2707 vs. 3347€; P=.024). There was a higher cost associated with DUS assessments in the ECO group yet the CLN group had a higher cost related to follow-up visits, successive surgical interventions, prosthetic material, days of hospital admission and catheters. The mean time needed to achieve a first AV valid for haemodialysis was also shorter in the ECO group (49.9 vs. 82.9 days, P=.002). CONCLUSION: The introduction of a specialised vascular access consultation with DUS prior to VA surgery has reduced the cost necessary to achieve a first VA valid for haemodialysis. From the patient's point of view this has meant less interventions and hospital admissions and a shortening of the time delay.

Utility of doppler ultrasound in the preoperative evaluation of the first vascular access for haemodialysis. / Utilidad de la valoración ecográfica previa a la realización del primer acceso vascular para hemodiálisis.

INTRODUCTION: Traditionally, the indication of the type of vascular access (VA) has been based on the surgeon's physical examination, but it is now suggested that imaging methods could provide a clinical benefit. Our aim was to determine whether or not preoperative Doppler ultrasound modifies outcomes of the first VA for haemodialysis. PATIENTS AND METHODS: Prospective cohort of patients undergoing a first VA from June 2014 to July 2017 who had a preoperative Doppler ultrasound (ECO group). They were compared to a historical cohort (January 2012-May 2014) of first VA indicated exclusively by clinical assessment (CLN group). RESULTS: A total of 86 patients from the CLN group were compared to 92 from the ECO group, which was younger (68.4 vs 64.0, P=.038). The primary patency (CLN/ECO) at 1 and 2years was 59.5%/71.9% and 53.1%/57.8% respectively, marginally better in the ECO group (P=.057). The assisted patency at 1 and 2years was 63.2%/80.7% and 58.1%/70.2%, respectively, significantly better for the ECO group (P=.010). Due to lack of patency/utility of the initial VA, 26.7% in the CLN group and 7.6% in the ECO group (P<.001) required a new VA during the first 6months. An average of 1.39 interventions were performed to achieve a useful VA in the CLN group and 1.08 in the ECO group (P<.001), the first VA being useful at the radiocephalic level in 31.0%/45.1% (P=.039). CONCLUSION: The indication of the first VA according to a preoperative Doppler ultrasound examination could decrease the need for new VA, enable them to be made more distal, and significantly improve patency.

Factores de riesgo y complicaciones cardiovasculares en pacientes con enfermedad renal crónica en hemodiálisis: prevalencia, morbilidad y mortalidad / Risk factors and cardiovascular complications in patients with chronic renal disease on hemodialysis: prevalence, morbidity and mortality

Objetivos: describir los factores de riesgo cardiovasculares (FRCV) y la asociación con enfermedad cardiovascular (ECV) de los pacientes con enfermedad renal crónica (ERC) en hemodiálisis (HD). Métodos: se realizó un estudio descriptivo transversal. Se incluyeron 345 pacientes prevalentes adultos en programa de HD convencional, por cualquier etiología, de ambos sexos, con 18 y más años, que se encontraban en el Hospital del Mar de Barcelona y 3 centros de diálisis de los que dicho hospital es centro de referencia, y que mostraron su consentimiento informado por escrito, se revisaron historias clínicas de las bases de datos de dichos centros y se emplearon estadísticas descriptivas. Resultados: la edad media fue de 69,19 ± 14,03 años; 71,5 porciento del sexo masculino; el tiempo promedio en tratamiento 62,26 ± 84,79 meses. La frecuencia de los FRCV clásicos ha sido hipertensión (82,5 porciento), diabetes mellitus (DM, con 32,2 porciento), sexo masculino (71,6 porciento) y dislipemia (55,7 porciento). La ECV ha estado presente en el 60,5 porciento de los pacientes y el 53,9 porciento propiamente de origen cardíaco. Los factores de riesgo que se asociaron con enfermedad cardiovascular fueron: tabaquismo, dislipidemia, DM, hipertensión arterial (HTA), HVI, edad e índice de comorbilidad de Charlson, con una significación estadística (p< 0,05). Conclusiones: los pacientes con enfermedad renal crónica en hemodiálisis tienen elevada frecuencia de ECV y de FRCV clásicos. Los factores predictores de ECV clínica en nuestra población fueron la edad, la presencia de ECV subclínica HVI y FRCV clásicos (HTA, DM, dislipidemia y hábito tabáquico, edad, índice de comorbilidad de Charlson)

Objectives: Describe cardiovascular risk factors (CVRF) and their association with cardiovascular disease (CVD) in patients with chronic renal disease (CRD) on hemodialysis (HD). Methods: A descriptive cross-sectional study was conducted with 345 prevalent adult patients of both sexes, aged 18 and over, following a conventional HD program irrespective of etiology at Mar de Barcelona Hospital and 3 other dialysis centers for which the said hospital is a reference center. All patients gave their informed consent in writing. A review was made of the medical records contained in databases at the said centers, and descriptive statistics were applied. Results: Mean age was 69.19±14.03; 71.5 percent of patients were male; mean treatment time was 62.26 ± 84.79 months. The frequency of classical CVRFs was the following: hypertension (82.5 percent), diabetes mellitus (DM, 32.2 percent), male sex (71.6 percent) and dyslipemia (55.7 percent). CVD was present in 60.5percent of patients; 53.9 percent was of cardiac origin proper. The following risk factors were associated with cardiovascular disease: smoking, dyslipidemia, DM, arterial hypertension (AHT), LVH, age, and Charlson comorbidity index, with a statistical significance of (p< 0.05). Conclusions: Patients with chronic renal disease on hemodialysis have a high frequency of CVD and classical CVRFs. The factors predicting clinical CVD in our population were age, the presence of subclinical CVD, LVH, and classical CVRFs (AHT, DM, dyslipidemia, smoking, age and Charlson comorbidity index)