Kidney Transplant Recipients Show Limited Lung Diffusion Capacity but Similar Hydrogen Peroxide Exhalation as Healthy Matched Volunteers: A Pilot Study.

Patients with end-stage chronic kidney disease show higher systemic oxidative stress and exhale more hydrogen peroxide (H2O2) than healthy controls. Kidney transplantation reduces oxidative stress and H2O2 production by blood polymorphonuclear leukocytes (PMNs). Kidney transplant recipients (KTRs) may be predisposed to an impairment of lung diffusing capacity due to chronic inflammation. Lung function and H2O2 concentration in the exhaled breath condensate (EBC) were compared in 20 KTRs with stable allograft function to 20 healthy matched controls. Serum interleukin eight (IL-8) and C-reactive protein (CRP), blood cell counts, and spirometry parameters did not differ between groups. However, KTRs showed lower total lung diffusing capacity for carbon monoxide, corrected for hemoglobin concentration (TLCOc), in comparison to healthy controls (92.1 ± 11.5% vs. 102.3 ± 11.9% of predicted, p = 0.009), but similar EBC H2O2 concentration (1.63 ± 0.52 vs. 1.77 ± 0.50 µmol/L, p = 0.30). The modality of pre-transplant renal replacement therapy had no effect on TLCOc and EBC H2O2. TLCOc did not correlate with time after transplantation. In this study, TLCOc was less reduced in KTRs in comparison to previous reports. We suggest this fact and the non-elevated H2O2 exhalation exhibited by KTRs, may result perhaps from the evolution of the immunosuppressive therapy.

Distribution, preparedness and management of Ukrainian adult refugees on dialysis-an international survey by the Renal Disaster Relief Task Force of the European Renal Association.

BACKGROUND: Due to the Russian-Ukrainian war, some of the about 10 000 adults requiring dialysis in Ukraine fled their country to continue dialysis abroad. To better understand the needs of conflict-affected dialysis patients, the Renal Disaster Relief Task Force of the European Renal Association conducted a survey on distribution, preparedness and management of adults requiring dialysis who were displaced due to the war. METHODS: A cross-sectional online survey was sent via National Nephrology Societies across Europe and disseminated to their dialysis centers. Fresenius Medical Care shared a set of aggregated data. RESULTS: Data were received on 602 patients dialyzed in 24 countries. Most patients were dialyzed in Poland (45.0%), followed by Slovakia (18.1%), Czech Republic (7.8%) and Romania (6.3%). The interval between last dialysis and the first in the reporting center was 3.1 ± 1.6 days, but was ≥4 days in 28.1% of patients. Mean age was 48.1 ± 13.4 years, 43.5% were females. Medical records were carried by 63.9% of patients, 63.3% carried a list of medications, 60.4% carried the medications themselves and 44.0% carried their dialysis prescription, with 26.1% carrying all of these items and 16.1% carrying none. Upon presentation outside Ukraine, 33.9% of patients needed hospitalization. Dialysis therapy was not continued in the reporting center by 28.2% of patients until the end of the observation period. CONCLUSIONS: We received information about approximately 6% of Ukrainian dialysis patients, who had fled their country by the end of August 2022. A substantial proportion were temporarily underdialyzed, carried incomplete medical information and needed hospitalization. The results of our survey may help to inform policies and targeted interventions to respond to the special needs of this vulnerable population during wars and other disasters in the future.

Lessons learned during the war in Ukraine: a report from the Renal Disaster Relief Task Force of the ERA.

People living with kidney disease are among the most vulnerable at times of natural or man-made disasters. In addition to their unpredictable course, armed conflicts impose a major threat given the disruption of infrastructure, sanitation and access to food, water and medical care. The ongoing war in Ukraine has once more demonstrated the importance of preparedness, organization, coordination and solidarity during disasters. People living with kidney disease face serious challenges given their dependence on life-sustaining treatment, irrespective of whether they remain in the war zone or are displaced internally or externally. This especially affects those requiring kidney replacement therapy, dialysis or transplantation, but also patients with other kidney diseases and the medical staff who care for them. Soon after the war started, the European Renal Association assigned a Renal Disaster Relief Task Force dedicated to support the people living with kidney disease and the nephrology community in Ukraine. This report summarizes the major challenges faced, actions taken and lessons learned by this task force. We anticipate that the experience will help to increase preparedness and mitigate the devastating effects of armed conflicts on the kidney community in the future and propose to establish an international collaboration to extend this effort to other parts of the world facing similar challenges.

Activity and Profile of the Users of a Novel Mobile Application Supporting Proper Diet Among Maintenance Hemodialysis Patients.

OBJECTIVE: Diet plays a key role in the management of chronic kidney disease. The aim of our study was to evaluate the usage of a self-developed mobile application supporting proper dietary choices among maintenance hemodialysis (HD) patients. METHODS: The primary functions of the application are to provide databases of products and recipes. Data on user activity recorded using Internet solutions were collected for 12 months from April 2021. The application was promoted both via the Internet and directly to patients. Additionally, a questionnaire was employed to evaluate the usage of the software. RESULTS: The application was downloaded by 841 smartphone users, 44.4% of whom were from 2 regions of Poland with the largest populations of HD patients. Residents of cities with a population above 250,000 accounted for 86.0% of users. Sixty HD patients (32 males, 28 females; age 56.2 ± 14.8 years) filled the questionnaire. All features of the application scored a median of 4.0 points or higher on a 5-point Likert scale; however, 63.3% of respondents indicated the need to improve particular functions of the application. There was a significant difference in dialysis vintage between respondents who used the application for less than 1 month and others (1.0 vs. 3.3 years; P = .02). The positive perception of its influence on diet adherence was significantly higher among younger (<50 years) compared to older users (5.0 vs. 4.0; P = .03) and among women compared to men (5.0 vs. 4.0; P = .01). CONCLUSION: HD patients showed interest in dietary mobile applications, and Internet channels were effective in promoting the software. Place of residency, age, gender, and dialysis vintage are factors that influence patient satisfaction with and the time of using the mobile application.

Effect of intravenous iron on endogenous erythropoietin and FGF-23 secretion in patients with chronic kidney disease.

INTRODUCTION: It has been observed that intravenous iron administration may suppress endogenous production of erythropoietin (EPO). We postulate that this effect may be mediated by increased FGF-23 secretion. AIM OF THE STUDY: To evaluate the short-term effect of intravenous iron sucrose administration on endogenous EPO secretion in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: The cohort comprised 35 nondialysis patients with CKD stages 3-5. All received 100 mg of intravenous iron (III)-hydroxide sucrose complex daily for five consecutive days. Plasma EPO, iFGF-23, cFGF-23, PTH, bone alkaline phosphatase (BAP), phosphorus (PO4), calcium (Ca), and high-sensitive C-reactive protein (CRP) were measured before, and two hours after, the first and third iron infusions, and after completing iron therapy. RESULTS: EPO concentration at the end of iron treatment was significantly lower than two hours after the first iron infusion (p = 0.0003) and before the third dose (p = 0.0006) (12.6 [10.2, 41.4] mIU/mL. vs. 30.9 [15.9, 54.2] mIU/mL and 33.4 [15.4, 56.7] mIU/mL, respectively). Conversely, plasma iFGF-23 was significantly higher before the third dose (61.1 [18.6, 420.1 4] pg/mL; p = 0.025) and after the course of treatment (92.1 [28.4, 878.1] pg/mL; p = 0.004) compared to pretreatment value (48.4 [16.2, 420] pg/mL). cFGF-23 concentration was significantly lower than baseline after the first iron dose (491.8 [257.7, 1086.3] vs. 339.2 [75.4, 951.2] RU/mL; p = 0.005) and after treatment (398.7 [90.4, 1022.3] RU/mL; p = 0.025). No significant linear correlation was found between changes in plasma EPO and FGF-23. CONCLUSIONS: Although intravenous iron therapy causes parallel increase of FGF-23 and supression of endogenous EPO, these two effects seem to be independent.

Armed conflicts and kidney patients: a consensus statement from the Renal Disaster Relief Task Force of the ERA.

During conflicts, people with kidney disease, either those remaining in the affected zones or those who are displaced, may be exposed to additional threats because of medical and logistical challenges. Acute kidney injury developing on the battlefield, in field hospitals or in higher-level hospital settings is characterized by poor outcomes. People with chronic kidney disease may experience treatment interruptions, contributing to worsening kidney function. Patients living on dialysis or with a functioning graft may experience limitations of dialysis possibilities or availability of immunosuppressive medications, increasing the risk of severe complications including death. When patients must flee, these threats are compounded by unhealthy and insecure conditions both during displacement and/or at their destination. Measures to attenuate these risks may only be partially effective. Local preparedness for overall and medical/kidney-related disaster response is essential. Due to limitations in supply, adjustments in dialysis frequency or dose, switching between hemodialysis and peritoneal dialysis and changes in immunosuppressive regimens may be required. Telemedicine (if possible) may be useful to support inexperienced local physicians in managing medical and logistical challenges. Limited treatment possibilities during warfare may necessitate referral of patients to distant higher-level hospitals, once urgent care has been initiated. Preparation for disasters should occur ahead of time. Inclusion of disaster nephrology in medical and nursing curricula and training of patients, families and others on self-care and medical practice in austere settings may enhance awareness and preparedness, support best practices adapted to the demanding circumstances and prepare non-professionals to lend support.

Novel Complement Factor B Gene Mutation Identified in a Kidney Transplant Recipient with a Shiga Toxin-Triggered Episode of Thrombotic Microangiopathy.

BACKGROUND Atypical hemolytic uremic syndrome (aHUS) is an ultra-rare disorder characterized by over-activation and dysregulation of the alternative complement pathway. The clinical presentation of the disease comprises thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury. In most cases, aHUS is caused by genetic mutations in components of the alternative complement pathway. The risk of graft loss in patients after kidney transplantation with aHUS is dependent on the type of genetic mutation. CASE REPORT We present a case of a 32-year-old patient after a second kidney transplantation with atypical hemolytic uremic syndrome, whose clinical manifestation was triggered by the Shiga toxin-producing E. coli infection. Genetic testing revealed a new mutation (p.I342T) in the gene encoding complement factor B (CFB). Since 2 causative variants for aHUS have been described in the same exon of CFB gene, it might be supposed that the p.I342T variant has similar deleterious effects on CFB function. Despite the implemented treatment, graft function deteriorated and the patient had to return to a hemodialysis program and is currently on a waiting list for a third kidney transplant. The presence of the gene variant with increased susceptibility for aHUS and its recurrence after kidney transplantation makes the patient a good candidate for therapy with complement factor C5 inhibitors during and after the planned kidney transplantation. CONCLUSIONS Our case confirms the importance of genetic testing in patients with any sign of thrombotic microangiopathy. The finding of Shiga toxin-induced HUS with typical clinical course should not limit our vigilance of complement-mediated HUS with high risk of renal failure.

Organizational support, training and equipment are key determinants of burnout among dialysis healthcare professionals during the COVID-19 pandemic.

INTRODUCTION: Burnout was already found to be an important factor in the professional landscape of nephrology prior to the COVID-19 outbreak and is expected to worsen during the pandemic. OBJECTIVES: The aim of our study was to assess pandemic experiences, perceptions, and burnout among Polish dialysis unit professionals in the COVID-19 period. PARTICIPANTS AND METHODS: A survey, which consisted of a Pandemic Experiences and Perceptions Survey (PEPS) and a Maslach Burnout Inventory was distributed online to Polish dialysis units. The study group comprised 379 participants (215 nurses, 148 physicians, and 16 respondents of other professions). RESULTS: The pandemic largely affected or completely dominated the work of dialysis units according to 53.4% and 25.5% of nurses responding to the PEPS, respectively. Among physicians, the prevalence was 55.5% and 15.4% of participants, respectively. Serious or life-threatening risk was perceived by 72.1% and 11.9% of dialysis healthcare professionals, respectively. Furthermore, 74.6% of the study participants stated that their work in a dialysis setting amidst the pandemic was felt to be associated with serious risk for their relatives. Adequate personal protective equipment and information from management decreased burnout among dialysis staff. Burnout was lower in all dimensions among those participants who felt more in control of their exposure to infection, provided by proper training, equipment, and support (p = 0.0004 for emotional exhaustion, p = 0.0007 for depersonalization, and p < 0.0001 for feelings of personal accomplishment). CONCLUSIONS: The COVID-19 pandemic has largely affected the work in dialysis units. Providing proper training, equipment, and support may decrease burnout among dialysis staff.

Interprofessional collaboration in the renal care settings: Experiences in the COVID-19 era.

BACKGROUND: The role of interprofessional collaboration (IPC) in healthcare is increasingly emphasized. Due to significant comorbidity in renal patients who require highly specialized procedures, proper IPC is an essential component in renal care. During the coronavirus disease 2019 (COVID-19) pandemic, the existing and proven collaboration mechanisms were put to the test. OBJECTIVES: To assess IPC in the renal care settings in the era of COVID-19 pandemic. MATERIAL AND METHODS: The survey consisted of the Assessment of Interprofessional Team Collaboration Scale II (AITCS-II) (3 subscales - partnership, cooperation and coordination, maximum of 5 points), questions about work conditions and factors influencing work during the pandemic, as well as demographic data. The survey was distributed in 8 renal care settings (4 hospital wards with dialysis units and 4 individual dialysis units); 127 participants filled out the survey; 26.8% of participants were physicians, 68.5% nurses and 4.7% other staff members, i.e., administrative assistants. Mean work experience in their current team was 16.8 ±11.7 years among nurses and 11.6 ±9.7 years among physicians. RESULTS: Interprofessional collaboration was assessed by physicians and nurses, respectively, as follows: partnership 4.03 ±0.79 compared to 3.58 ±0.73 (p = 0.003), cooperation 4.28 ±0.59 compared to 3.71 ±0.72 (p = 0.0002), and coordination 3.83 ±0.87 compared to 3.48 ±0.82 (p = 0.04). The specific workplace did not influence the IPC rates; 49.9% of physicians and 40.1% of nurses agreed or strongly agreed that the collaboration worsened during the pandemic; 47% of physicians and 42.4% of nurses admitted that the communication has significantly deteriorated. An increased level of stress, new procedures and fear of getting infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were, according to the participants, the most significant factors for the worsening of IPC. CONCLUSIONS: The exceptional circumstances faced during the pandemic have a significant impact on IPC, which may influence patients' satisfaction and safety. An active support for healthcare teams in the field of IPC is especially important in this challenging reality.

Burnout Syndrome among Pediatric Nephrologists-Report on Its Prevalence, Severity, and Predisposing Factors.

BACKGROUND AND OBJECTIVES: Burnout is an occupation-related syndrome comprising emotional exhaustion, depersonalization, and reduced feelings of work-related personal accomplishments. There are reports on burnout among adult nephrologists and general pediatricians, but little is known about burnout among pediatric nephrologists. The aim of our study was to assess the prevalence and severity of burnout syndrome among Polish pediatric nephrologists. MATERIALS AND METHODS: A 25-item study survey consisting of abbreviated Maslach Burnout Inventory and additional self-created questions about work-related factors was completed by 97 physicians affiliated with the Polish Society of Pediatric Nephrology. Women comprised 75.3%, with median time of professional experience in the study group was 15 years. RESULTS: A high level of emotional exhaustion, depersonalization, and reduced feeling of personal accomplishments were observed in 39.2%, 38.1%, and 21.6% of the participants, respectively. At least a medium level of burnout in all three dimensions were observed in 26.8% of the participants and 8.2% of them presented high three-dimensional burnout. About 41.2% of the participants stated that they would like to take part in burnout prevention and support programs. According to the study participants, excessive bureaucracy in healthcare systems, rush at work, and overtime work were the main job-related problems that could influence burnout intensity. CONCLUSIONS: Burnout is an important factor in the professional landscape of pediatric nephrology. Actions aimed at reducing the risk of occupational burnout among pediatric nephrologists should be applied, both at the personal and institutional levels.

Polish medical students facing the pandemic-Assessment of resilience, well-being and burnout in the COVID-19 era.

INTRODUCTION: Recent reports indicate that COVID-19 pandemic has significant influence on medical professionals' mental health. Strict limitations in clinical practice and social interactions within academic community, which had to be introduced, could lead to significant psychological distress in medical students. The aim of the study was to assess resilience, well-being and burnout among Polish medical students in the COVID-19 era. METHODS: The online survey consisting of validated questionnaires assessing resilience (Resilience Scale 14; RS-14), well-being (Medical Student Well-Being Index) and burnout (Maslach Burnout Inventory) as well as self-created survey concerning mental health problems, use of stimulants, SARS-CoV-2 infection, work in COVID-19 units, medical education and social attitude towards health care professionals in the pandemic era was distributed via Facebook and other online students' platforms. 1858 MSs from all polish medical schools agreed to fill in the survey. RESULTS: 'Very low', 'low' and 'on the low end' levels of resilience were found in 26%, 19.1% and 26.9% of the study group, respectively. Students with higher resilience level presented better attitude towards online and hybrid classes. 16.8% of respondents stated that they worked, currently work or plan to work voluntarily at the pandemic frontline. In terms of burnout, these respondents presented lower exhaustion (p = 0.003) and cynicism (p = 0.02), and higher academic efficacy (p = 0.002). That group also showed greater resilience (p = 0.046). The SARS-CoV-2 infection among respondents, their relatives and friends did not influence the results. 39.1% of respondents declared the need of the psychological or psychiatric consultation in relation to pandemic challenges. 231 (26.4%) participants previously diagnosed with mental health disorders noticed worsening of their symptoms. Increased intake of alcohol, cigarettes or other stimulants was noticed by 340 (28.6%) respondents. 80.2% of respondents thought that social aversion and mistrust towards doctors increased during the pandemic and part of them claimed it affected their enthusiasm toward medical career. CONCLUSIONS: The majority of medical students presented low levels of resilience and high burnout at the time of pandemic. Providing necessary support especially in terms of mental health and building up the resilience of this vulnerable group seems crucial to minimize harm of current pandemic and similar future challenges.