High Plasma Levels of Fibroblast Growth Factor 23 Are Associated with Increased Risk of COVID-19 in End-Stage Renal Disease Patients on Hemodialysis: Results of a Prospective Cohort.

End-stage renal disease (ESRD) patients are a population with high rates of COVID-19 and mortality. These patients present a low response to anti-SARS-CoV-2 immunization, which is associated with immune dysfunction. ESRD patients also present high plasma titers of Fibroblast Growth Factor 23 (FGF23), a protein hormone that reduces immune response in vivo and in vitro. Increased FGF23 levels associate with higher infection-related hospitalizations and adverse infectious outcomes. Thus, we evaluated whether ESRD patients with high FGF23 titers have an increased rate of SARS-CoV-2 infection. METHODS: We performed a prospective cohort of ESRD patients in hemodialysis who had measurements of plasma intact FGF23 in 2019. We determined COVID-19 infections, hospitalizations, and mortality between January 2020 and December 2021. RESULTS: We evaluated 243 patients. Age: 60.4 ± 10.8 years. Female: 120 (49.3%), diabetes: 110 (45.2%). During follow-up, 45 patients developed COVID-19 (18.5%), 35 patients were hospitalized, and 12 patients died (mortality rate: 26.6%). We found that patients with higher FGF23 levels (defined as equal or above median) had a higher rate of SARS-CoV-2 infection versus those with lower levels (18.8% versus 9.9%; Hazard ratio: 1.92 [1.03-3.56], p = 0.039). Multivariate analysis showed that increased plasma FGF23 was independently associated with SARS-CoV-2 infection and severe COVID-19. DISCUSSION: Our results suggest that high plasma FGF23 levels are a risk factor for developing COVID-19 in ESRD patients. These data support the potential immunosuppressive effects of high circulating FGF23 as a factor implicated in the association with worse clinical outcomes. Further data are needed to confirm this hypothesis.

Integrity of the oral tissues in patients with solid-organ transplants.

The relationship between the use of immunosuppressants in solid-organ transplant patients and oral tissue abnormalities has been recognized. The objective of this study was to determine the state of oral tissue integrity in renal, heart, and liver transplant patients who are on continuous medical and dental control. Forty patients of both sexes were clinically evaluated at the Clinical Hospital of the University of Chile to identify pathologies of oral mucosa, gingival enlargement (GE), decayed, missing, filled teeth (DMFT) index, and salivary flow. The average age of the transplant subjects was 49.4 years, and the age range was 19 to 69 years. Most subjects maintained a good level of oral hygiene, and the rate mean of DMFT was 14.7. The degree of involvement of the oral mucosa and GE was low (10%). Unlike other studies, the frequency of oral mucosal diseases and GE was low despite the fact that these patients were immunosuppressed. Care and continuous monitoring seem to be of vital importance in maintaining the oral health of transplant patients.

[Assessment and follow up of diabetic patients in hemodialysis]. / Diabetes y hemodiálisis. Caracterización de una cohorte y seguimiento a cuatro años.

BACKGROUND: Despite a better management of the variables that influence the development of diabetic nephropathy there is a progressive increase in the prevalence of terminal renal failure among diabetics, whose cause is not clear. AIM: To study in a group of patients in hemodialysis, the quality of diabetes control previous to the entry to dialysis, their physical condition and their evolution. MATERIAL AND METHODS: Diabetic patients with at least three months of hemodialysis answered a questionnaire about diabetes control quality previous to dialysis and had physical and laboratory assessment. They were followed for at least four years thereafter. RESULTS: Fifty seven patients aged 62+/-11 years were studied. Eighty four percent had some degree of disability. Eighty seven percent had high blood pressure and 73% had to enter dialysis as an emergency. Mean glycosilated hemoglobin was 7.7% and 58% had a dialysis dose with a Kt/Vofless than 1.2. Fifty eight percent died during follow up. No relationship between mortality and age, blood pressure, glycosilated hemoglobin of Kt/V, was observed. CONCLUSIONS: There is an inadequate management of blood glucose and blood pressure of diabetic patients before entry to dialysis. They are referred inverted exclamation markate to the nephrologist, the dialysis dose is insufficient and they have a high mortality.

[Study of aerobic capacity in chronic hemodialized patients: effect of L-carnitine supplementation]. / Estudio exploratorio de la capacidad aerobia en pacientes en hemodiálisis: efecto de la suplementación con L-carnitina.

BACKGROUND AND OBJECTIVE: Chronic hemodialyzed patients have a low level of aerobic capacity, caused by the pathologies concomitant to renal insufficiency, according with a low level of physical activity. One of the factors that would contribute to this level of aerobic capacity is the L-carnitine deficit on skeletal muscle. However, the value of the supplementation of L-carnitine to improve the physical fitness has been controversial. The objective of this work was to evaluate the effect of the administration of L-carnitine on VO2 max in hemodialyzed patients. PATIENTS AND METHODS: A group of 21 patients (20-50 years old) on a program of chronic hemodialysis was studied. During 12 weeks, 13 of them received L-carnitine, 7 men and 6 women, 38.8 (9.5) years old; BMI 24.2 (2.1) Kg/m2; 8 of them received placebo, 4 men and 4 women, 35.8 (11.4) years old; BMI 24.5 (5.8) Kg/m2. RESULTS: There was an increase in VO2 peak on L-carnitine group from 16.3 (2.8) mL x Kg(-1) x min(-1) to 19.5 (3.3) mL x Kg(-1) x min(-1), and the same was seen in the placebo group (increase in VO2 peak from 14.8 (3.8) mL x Kg(-1) x min(-1) to 18.9 (4.8) mL x Kg(-1) x min(-1)). The L-carnitine and placebo groups did not show statistical differences at the end of this study (all values above p > 0.05). CONCLUSION: In this group of patients, the intravenous supplementation of L-carnitine during 12 weeks did not have an impact on the improvement of the VO2 peak.

Diabetes y hemodiálisis. Caracterización de una cohorte y seguimiento a cuatro años / Assessment and follow up of diabetic patients in hemodialysis

Background: Despite a better management of the variables that influence the development of diabetic nephropathy there is a progressive increase in the prevalence of terminal renal failure among diabetics, whose cause is not clear. Aim: To study in a group of patients in hemodialysis, the quality of diabetes control previous to the entry to dialysis, their physical condition and their evolution. Material and methods: Diabetic patients with at least three months of hemodialysis answered a questionnaire about diabetes control quality previous to dialysis and had physical and laboratory assessment. They were followed for at least four years thereafter. Results: Fifty seven patients aged 62±11 years were studied. Eighty four percent had some degree of disability. Eighty seven percent had high blood pressure and 73 percent had to enter dialysis as an emergency. Mean glycosilated hemoglobin was 7.7 percent and 58 percent had a dialysis dose with a Kt/Vofless than 1.2. Fifty eight percent died during follow up. No relationship between mortality and age, blood pressure, glycosilated hemoglobin of Kt/V, was observed. Conclusions: There is an inadequate management of blood glucose and blood pressure of diabetic patients before entry to dialysis. They are referred ¡ate to the nephrologist, the dialysis dose is insufficient and they have a high mortality.

[Effects of midodrine on symptomatic hypotension during hemodialysis]. / Efecto de la midodrina en la hipotensión sintomática en hemodiálisis.

BACKGROUND: Hypotension occurs in 20% of hemodialysis procedures. AIM: To study the effects of midodrine on hypotension during hemodialysis. PATIENTS AND METHODS: Ten patients on chronic hemodialysis and with a history of hypotension during the procedure, were studied. They received midodrine 10 mg per os or placebo during 5 dialytic procedures each, in a double blind cross over design. RESULTS: Blood pressure levels prior to dialysis were similar during the midodrine or placebo administration periods. During dialysis, systolic blood pressure fell 19.3 +/- 28 mmHg with midodrine and 23.4 +/- 28 mmHg with placebo. Diastolic blood pressure fell 7.3 +/- 11.5 mmHg with midodrine and 11.1 +/- 12 mmHg with placebo. The reduction in median arterial pressure was also less pronounced with midodrine. CONCLUSIONS: Midodrine lessens the fall in arterial pressure during hemodialysis, in patients with symptomatic hypotension.

[Correction of anemia in hemodialysis, effect of intravenous iron without erythropoietin]. / Corrección de la anemia en hemodiálisis, efecto del fierro intravenoso sin eritropoyetina.

BACKGROUND: In the last two decades, the use of erythropoietin for the correction of anemia in hemodialysis patients has been recommended. In Chile, only 10% of hemodialysis patients use erythropoietin, therefore, the correction of iron deficiency must be optimized. AIM: To report the effects of intravenous iron without erythropoietin in the management of anemia in hemodialysis patients. MATERIAL AND METHODS: Retrospective analysis of 42 patients that received intravenous ferrous sacharate in doses of 100 mg/week during 5 weeks and 100 mg bimonthly during six months. These patients did not receive erythropoietin. RESULTS: Thirty six patients had iron deficiency. Basal ferritin was 137 +/- 22 micrograms/l and increased to 321 +/- 28 micrograms/l after treatment. Packed red cell volume increased from 24 +/- 2% to 29 +/- 3%. No adverse effects were reported. CONCLUSIONS: Iron deficiency is frequent in hemodialyzed patients. Intraveineous iron is safe and effective in the treatment of iron deficiency in these patients.