[Outbreak of Raoultella ornithinolytica infection in patients cared at a hemodialysis center]. / Brote de infección por Raoultella ornithinolytica en pacientes atendidos en un centro de hemodiálisis.

OBJECTIVE: In July 2022, an outbreak of Raoultella ornithinolytica infection was detected in users of a hemodialysis center in Granada and central venous catheter (CVC) users. The aim of this study was to describe the development of the outbreak and the control measures implemented as well as to identify the risk factors that may have been related to its origin. METHODS: A study of a series of thirteen cases with positive blood culture for Raoultella ornithinolytica was conducted during July 2022. Two hypotheses were considered: direct transmission through contamination of the antiseptic product or cross-contamination through the hands of healthcare personnel. A descriptive data analysis was carried out, with the calculation of attack rates and attributable risk in the exposed group (CVC users). RESULTS: The center performed dialysis on 117 patients. 36 patients had a CVC, and 81 had an arteriovenous fistula (AVF). The total number of infected cases was 13. The attack rate was 11.1%, being 36.1% in patients with CVC and 0% in patients with AVF. The symptoms occurred between 1 and 3 hours after the start of dialysis, except in three cases that occurred after receiving dialysis in other centers. Samples of water, liquids and antiseptics were negative. CONCLUSIONS: An outbreak of Raoultella ornithinolytica bacteraemia is confirmed, due to possible cross-contamination in the CVC handling and antisepsis process. Possibly, the germ was carried by a container of alcoholic chlorhexidine that contaminated the catheter and caused bacteremia during the hemodialysis process.

OBJETIVO: En julio de 2022 se detectó un brote de infección por Raoultella ornithinolytica en usuarios de un centro de hemodiálisis de Granada y portadores de catéter venoso central (CVC). El objetivo del estudio fue describir el desarrollo del brote y las medidas de control que se implantaron al respecto, así como identificar los factores de riesgo que pudieron estar relacionados con su origen. METODOS: Se realizó un estudio de una serie de trece casos con hemocultivo positivo para Raoultella ornithinolytica durante julio de 2022. Se plantearon dos hipótesis: transmisión directa a través de la contaminación del producto antiséptico o transmisión cruzada a través de las manos del personal sanitario del centro. Se llevó a cabo un análisis descriptivo de los datos y se calcularon tasas de ataque y riesgo atribuible en expuestos (portadores de CVC). RESULTADOS: El centro realizó diálisis a 117 pacientes. 36 enfermos portaban un CVC y 81 tenían una fístula arterio-venosa (FAV). El número total de casos infectados fue de 13. La tasa de ataque fue del 11,1%, siendo del 36,1% en pacientes portadores de CVC y del 0% en pacientes con FAV. La sintomatología se presentó entre 1 a 3 horas tras el inicio de la diálisis, salvo en tres casos que fue posterior a recibir diálisis en otros centros. Las muestras de agua, líquidos y antisépticos fueron negativas. CONCLUSIONES: Se confirma un brote de bacteriemia por Raoultella ornithinolytica debido a posible contaminación cruzada durante la manipulación y antisepsia del CVC. Posiblemente, el germen fue vehiculizado por un envase de clorhexidina alcohólica que contaminó el catéter y provocó la bacteriemia en el proceso de hemodiálisis.

Bictegravir/emtricitabine/tenofovir alafenamide in adults with HIV-1 and end-stage kidney disease on chronic haemodialysis.

INTRODUCTION: Treatment for people with HIV-1 and end-stage kidney disease (ESKD) on haemodialysis (HD) has previously required complex dose-adjusted regimens, with limited data on the use of a single-tablet regimen in this population. Our aim was to assess the efficacy and safety of once-daily bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) and to evaluate the pharmacokinetics of bictegravir (BIC) in adults with HIV-1 and ESKD on HD. METHODS: We performed an open-label extension (OLE) of an open-label, multicentre, single-group phase 3b study (NCT02600819) of adults with ESKD on HD and HIV-1 with virological suppression. Participants switched to elvitegravir/cobicistat/F/TAF (E/C/F/TAF) 150/150/200/10 mg for 96 weeks, following which a subgroup of US participants entered an OLE phase in which they switched to B/F/TAF 50/200/25 mg for 48 weeks, returning for study visits at weeks 4 and 12, and every 12 weeks thereafter. Study assessments included virological response, safety and pharmacokinetic analysis of BIC. RESULTS: Ten participants entered the OLE (median age, 55 years). Virological suppression (HIV-1 RNA <50 copies/mL) was maintained in all participants over 48 weeks of B/F/TAF treatment. B/F/TAF was well tolerated, with no treatment discontinuations. Mean BIC trough concentrations were lower than those previously reported for people with HIV-1 with normal kidney function, but remained four- to seven-fold higher than the established protein-adjusted 95% effective concentration against wild-type HIV-1. CONCLUSION: These findings support the use of the once-daily B/F/TAF single-tablet regimen for people with HIV-1 and ESKD on HD. This regimen offers a convenient treatment option for this population as it reduces the need for dose adjustment, eases pill burden and avoids potential drug-drug interactions associated with alternatives that may impact individuals on multiple medications or awaiting transplantation.

Structures for quality assurance and measurements for kidney replacement therapies: A multinational study from the ISN-GKHA.

AIM: Optimal care for patients with kidney failure reduces the risks of adverse health outcomes, including cardiovascular events and death. We evaluated data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to assess the capacity for quality service delivery for kidney failure care across countries and regions. METHOD: We explored the quality of kidney failure care delivery and the monitoring of quality indicators from data provided by an international survey of stakeholders from countries affiliated with the ISN from July to September 2022. RESULTS: One hundred and sixty seven countries participated in the survey, representing about 97.4% of the world's population. In countries where haemodialysis (HD) was available, 81% (n = 134) provided standard HD sessions (three times weekly for 3-4 h per session) to patients. Among countries with peritoneal dialysis (PD) services, 61% (n = 101) were able to provide standard PD care (3-4 exchanges per day). In high-income countries, 98% (n = 62) reported that >75% of centers regularly monitored dialysis water quality for bacteria compared to 28% (n = 5) of low-income countries (LICs). Capacity to monitor the administration of immunosuppression drugs was generally available in 21% (n = 4) of LICs, compared to 90% (n = 57) of high-income countries. There was significant variability between and within regions and country income groups in reporting the quality of services utilized for kidney replacement therapies. CONCLUSION: Quality assurance standards on diagnostic and treatment tools were variable and particularly infrequent in LICs. Standardization of delivered care is essential for improving outcomes for people with kidney failure.

Quality of life and social reinsertion of patients on maintenance haemodialysis in four government funded hospitals in Cameroon.

BACKGROUND: Reduced quality of life is associated with shorter survival in chronic illnesses. However, the health-related quality of life (HRQOL) and social reinsertion of patients on maintenance haemodialysis is much more underappreciated in resource-limited countries such as Cameroon. METHOD: A hospital-based cross-sectional study was carried out from February 22nd to May 20th, 2022, in 4 government-funded haemodialysis centres in three randomly selected regions of Cameroon. Patients received twice-weekly dialysis sessions. Social reinsertion and HRQOL were assessed using a structured questionnaire and the kidney disease quality of life instrument (KDQOL-36™). HRQOL scores < 50 were categorized as low, while scores > 50 reflected better HRQOL. Data were analysed using the software statistical package for Social Sciences version 25.0. Statistical significance was set at a p value < 0.05. RESULTS: The study included 434 patients. The mean age was 48.33 (13.55) years, 65.7% (285/434) were male, 62.3% (269/434) had no monthly income, and the mean dialysis vintage was 3.74 (3.83) years. The mean HRQOL score was 44.34 (9.77), and 76.2% (325/434) had HRQOL scores < 50). Overall HRQOL was associated with older age (aOR: 2.344, CI 1.089-5.04). After the initiation of maintenance haemodialysis, 67.1% (49/73) of students dropped out of school. The main reason for school absenteeism and unemployment was physical insufficiency, with 82.4% (19/24) and 52.4% (75/144), respectively. There were no promotions or marriages after initiation; 51% (221/434) of relationships with relatives and friends were affected negatively, while 83.3% (66/79) of those of marriageable ages could not find suitors. The social participation score was poor in 61.5% (267/434) of participants. There was an association between low QOL and social participation (p = 0.009). CONCLUSION: The HRQOL of patients on maintenance haemodialysis is greatly reduced, especially their physical health status. Older age was a determinant of low QOL. Additionally, social reinsertion remains poor due to adverse changes that occur to these patients and their families after dialysis initiation. CLINICAL TRIAL NUMBER: Not applicable.

Cultural and linguistic diversity is associated with increased inter-dialytic weight gain among patients on long-term haemodialysis.

BACKGROUND: Factors associated with suboptimal interdialytic weight gain have long been established. However, the influence of cultural and linguistic diversity on interdialytic weight gain among patients receiving haemodialysis is not well-understood. OBJECTIVE: This study examined the relationship between interdialytic weight gain and cultural and linguistic diversity among patients receiving haemodialysis. DESIGN: Retrospective cross-sectional study. PARTICIPANTS AND MEASUREMENTS: Demographic and clinical data were collected from electronic medical records of patients receiving haemodialysis at five dialysis units. Logistic regression analysis was performed to determine factors associated with suboptimal interdialytic weight gain. RESULTS: Two hundred and sixty-nine patients, 62% of whom were female, with mean ± age of 65.8 ± 14.8 years, were studied. Most were from culturally and linguistically diverse backgrounds (60%) and a significant number belonged to the most disadvantaged socioeconomic group. Patients from culturally and linguistically diverse backgrounds had significantly higher relative interdialytic weight gain (2.40% ± 1.45%) compared to those from nonculturally and linguistically diverse backgrounds (1.83 ± 1.09%) (mean difference: 0.57%, 95% CI: 0.25-0.90, p = 0.001). Being from culturally and linguistically diverse backgrounds was associated with increased odds of higher relative interdialytic weight gain (OR: 2.40; 95% CI: 1.38-4.17, p < 0.01). CONCLUSION: Among patients on maintenance haemodialysis, individuals from culturally and linguistically diverse backgrounds had higher interdialytic weight gain compared to those from nonculturally and linguistically diverse backgrounds. Future research focusing on co-developing culturally sensitive interventions to improve self-management capability of patients on maintenance haemodialysis from culturally and linguistically diverse backgrounds is needed.

Association between dietary fatty acids and depressive symptoms in Chinese haemodialysis patients: a cross-sectional study.

Depression is highly prevalent in haemodialysis patients, and diet might play an important role. Therefore, we conducted this cross-sectional study to determine the association between dietary fatty acids (FA) consumption and the prevalence of depression in maintenance haemodialysis (MHD) patients. Dietary intake was assessed using a validated FFQ between December 2021 and January 2022. The daily intake of dietary FA was categorised into three groups, and the lowest tertile was used as the reference category. Depression was assessed using the Patient Health Questionnaire-9. Logistic regression and restricted cubic spline (RCS) models were applied to assess the relationship between dietary FA intake and the prevalence of depression. As a result, after adjustment for potential confounders, a higher intake of total FA [odds ratio (OR)T3 vs. T1 = 1·59, 95 % confidence interval (CI) = 1·04, 2·46] and saturated fatty acids (SFA) (ORT3 vs. T1 = 1·83, 95 % CI = 1·19, 2·84) was associated with a higher prevalence of depressive symptoms. Significant positive linear trends were also observed (P < 0·05) except for SFA intake. Similarly, the prevalence of depression in MHD patients increased by 20% (OR = 1.20, 95% CI = 1.01-1.43) for each standard deviation increment in SFA intake. RCS analysis indicated an inverse U-shaped correlation between SFA and depression (P nonlinear > 0·05). Additionally, the sensitivity analysis produced similar results. Furthermore, no statistically significant association was observed in the subgroup analysis with significant interaction. In conclusion, higher total dietary FA and SFA were positively associated with depressive symptoms among MHD patients. These findings inform future research exploring potential mechanism underlying the association between dietary FA and depressive symptoms in MHD patients.

Effect of different dialysate temperatures on post dialysis fatigue in patients undergoing haemodialysis: a quasi-experimental study.

Objective: To compare the effects of warm and cold dialysate solutions on the duration of post-dialysis fatigue in patients undergoing maintenance haemodialysis. METHODS: The quasi-experimental study was conducted at the Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from May 9 to September 10, 2023, and comprised adult patients of either gender undergoing maintenance haemodialysis for a minimum of 3 months. The patient initially underwent haemodialysis with a dialysate temperature of 36°C for 2 weeks. During the subsequent washout period of one week when the dialysate temperature was not monitored, they underwent haemodialysis with a dialysate temperature of 37°C for another 2 weeks. Blood pressure was monitored every 30 minutes to record any hypotensive episodes. Patients were asked if they felt fatigued after the last haemodialysis session, and the duration was noted down. Data was analysed using SPSS 24. RESULTS: Of the 92 patients with mean age 49.1±16.1 years, 57(62%) were males. Post-dialysis fatigue was seen in 67(72.8%) and 75(81.5%) patients with dialysate temperatures at 36°C and 37°C, respectively (p<0.001). The duration of post-dialysis fatigue was also significantly longer at dialysate temperatures 37°C p<0.001). There was no significant difference in the proportion of hypotensive episodes in the two groups (p=0.445). Conclusion: Dialysate temperature 36°C was found to be associated with less frequent and shorter duration of postdialysis fatigue compared to dialysate temperature 37°C.

Performance of an interstitial glucose monitoring device in patients with type 1 diabetes during haemodialysis.

Background: The use of interstitial glucose monitoring devices such as flash glucose monitoring has been shown to be beneficial in patients with type 1 diabetes mellitus (T1DM). However, these devices have been little studied in patients with diabetes treated by chronic haemodialysis (HD). Methods: The goal of this prospective, observational, multicentric study was to evaluate the analytical performance of the FreeStyle Libre 2 (FSL2) sensor in T1DM patients during HD sessions. During three HD sessions, interstitial fluid glucose (ISFG) concentrations given by the FSL2 were compared every 15 minutes with blood glucose (BG) concentrations obtained simultaneously. BG concentrations were measured by two different glucometers: the Accu-Chek Guide and StatStrip meters. Results: Twelve HD patients were included, with a mean age of 54 ± 11 years and a mean diabetes duration of 36.5 ± 11.6 years. Dialysis vintage was 35 ± 22 months. A total of 565 pairs of ISFG/BG values were available for analysis. The mean absolute relative difference, defined as the mean of the absolute relative differences between the ISFG and BG measurements, was 17.4% and 20.9% when the ISFG was compared with the StatStrip meter or Accu-Chek Guide, respectively. Interstitial results tend to underestimate blood results, but all values were classified as having clinically acceptable error. The differences observed remained stable during the dialysis session and were not associated with the ultrafiltration rate. Conclusion: Use of the FSL2 interstitial glucose monitoring device in HD patients with T1DM is clinically acceptable, even though the accuracy of the device is generally poorer than in studies including non-dialysis patients.

Chronic kidney disease-associated pruritus and quality of life with difelikefalin treatment: a post hoc analysis of phase 3 data using the Skindex-10 questionnaire.

Background: Pruritus is a common condition in chronic kidney disease (CKD), especially for patients receiving haemodialysis. CKD-associated pruritus (CKD-aP) can be distressing and have a negative impact on quality of life (QoL). This post hoc analysis aimed to assess the relationship between pruritus relief and QoL. Methods: Data from phase 3 trials [(NCT03422653, NCT03636269 grouped), and NCT03998163] of the novel antipruritic difelikefalin (N = 914) were used to assess the relationship between reductions in pruritus intensity at Week 12 (24-h Worst Itching Intensity Numeric Rating Scale; WI-NRS), perceived improvement in itch (Patient Global Impression of Change, PGI-C) and pruritus-related QoL (Skindex-10 questionnaire). Results: Patients receiving difelikefalin had greater improvements in Skindex-10 total scores than those receiving placebo [LS mean treatment difference -3.4; 95% confidence interval (CI) -5.5, -1.3; P = .002] and greater improvements across Skindex-10 domains (disease, mood and social functioning) at Week 12. In patients receiving difelikefalin, those with clinically meaningful improvements in pruritus (≥3-point reduction in WI-NRS score) at Week 12 had a greater improvement in Skindex-10 total score (mean difference 14.2; 95% CI 11.0, 17.3; P < .001) and Skindex-10 domains than those with a <3-point reduction in WI-NRS score. Improvements in Skindex-10 total scores correlated with PGI-C. Conclusions: Improvements in pruritus intensity following 12 weeks of treatment with difelikefalin were associated with improvements in QoL. Larger improvements in Skindex-10 scores were seen in patients with a greater reduction in pruritus intensity, indicating that improvements in pruritus are associated with a range of factors, such as mood and social functioning, that affect pruritus-related QoL.

Validation of arteriovenous access stage (AVAS) classification: a prospective, international multicentre study.

Background: The arteriovenous access stage (AVAS) classification provides evaluation of upper extremity vessels for vascular access (VA) suitability. It divides patients into classes within three main groups: suitable for native fistula (AVAS1) or prosthetic graft (AVAS2), and patients not suitable for conventional native or prosthetic VA (AVAS3). We validated this system on a prospective dataset. Methods: A prospective, international observational study (NCT04796558) involved 11 centres from 8 countries. Patient recruitment was from March 2021 to January 2024. Demographic data, risk factors, vessels parameters, VA types, AVAS class and early VA failure were collected. Percentage agreement was used to assess predictive ability of AVAS (comparison of AVAS and created VA) and consistency of AVAS assessment between evaluators. Pearson's Chi-squared test was used for comparison of early failure rate of conventional (predicted by AVAS) and unconventional (not predicted by AVAS) VA. Results: From 1034 enrolled patients, 935 had arteriovenous fistula or graft, 99 patients did not undergo VA creation due opting for alternative renal replacement therapies, experiencing health complications, death or non-compliance. AVAS1 had 91.2%, AVAS2 7.2% and AVAS3 1.6% of patients. Agreement between evaluators was 89%. The most frequently created VAs were radial-cephalic (46%) and brachial-cephalic (27%) fistulae. The accuracy of AVAS versus created access was 79%. In comparison, VA predicted by clinicians versus created access was 62.1%. Inaccuracy of AVAS prediction was more common with higher AVAS classes, and the most common reason for inaccuracy was creation of distal VA despite less favourable anatomy (17%). Patients with unconventional VA had higher early failure rate than patients with conventional VA (20% vs 9.3%, respectively, P = .002). Conclusion: AVAS is effective in predicting VA creation, but overall accuracy is reduced at higher AVAS classes when the complexity of decision-making increases and proximal vessels require preservation. When AVAS was followed by clinicians, early failure was significantly decreased.

Association of the modified creatinine index with quality of life in haemodialysis patients.

Aims/Background The evaluation of health-related quality of life in patients undergoing maintenance haemodialysis has garnered increasing attention. The modified creatinine index, a surrogate marker for muscle mass, has been linked to various clinical outcomes. However, the relationship between modified creatinine index and health-related quality of life in maintenance haemodialysis patients remains unclear. This study aims to elucidate the association between modified creatinine index and health-related quality of life in individuals receiving maintenance haemodialysis. Methods This cross-sectional study included 217 maintenance haemodialysis patients. Health-related quality of life was assessed using the Kidney Disease Quality of Life Instrument. Collected data included general patient information, laboratory results, and haemodialysis-related parameters. The modified creatinine index was calculated based on gender, age, single-pool Kt/V (spKt/V), and pre-dialysis serum creatinine levels. Multiple linear regression models and smooth curve fitting were used to investigate the relationship between modified creatinine index and health-related quality of life. Subgroup analyses and interaction tests were performed to identify potential effect modifiers. Results The 217 maintenance haemodialysis patients had a mean age of 53.66±13.15 years and a median dialysis vintage of 39 (25-84) months; 120 (55.30%) were male. The mean health-related quality of life score was 55.76±10.33, and the mean modified creatinine index was 22.72±2.95 mg/kg/day. After adjusting for confounding factors, an increase in modified creatinine index was associated with an improvement in health-related quality of life (ß=0.55, 95% CI: 0.04, 1.06, p = 0.033). No nonlinear relationship was identified between modified creatinine index and health-related quality of life by smooth curve fitting. Subgroup and interaction analyses indicated that the relationship between modified creatinine index and health-related quality of life was stable and not significantly influenced by age, gender, dialysis vintage, diabetes status, or body mass index (p > 0.05). Conclusion Modified creatinine index is positively correlated with health-related quality of life in maintenance haemodialysis patients, suggesting its potential utility in evaluating patient quality of life. Modified creatinine index could be clinically useful to improve the predictability of health-related quality of life in maintenance haemodialysis patients.

Depression and Quality of Life Among Haemodialysis Patients.

Introduction: Depression is likely to be the most common psychopathology in haemodialysis patients. It might affect their adherence to treatment and is associated with increased morbidity and mortality. However, the prevalence of depression in haemodialysis patients has not been definitively determined, and it is generally underdiagnosed and undertreated. Chronic renal failure (CRF) patients have diminished quality of life (QOL) scores compared with healthy persons. Moreover, patients on haemodialysis might have worse QOL than those on peritoneal dialysis. Objectives: To assess the level of depression and quality of life among haemodialysis patients. Methodology: The research design adopted for this study was quantitative method. The population includes patient undergoing haemodialysis in SMCH. The sample size was 60 selected through convenience sampling technique on the basis of criteria. Result: The findings revealed that 30 (50%) had severe depression, 26 (43.34%) had moderate depression, and 2 (3.33%) had borderline clinical depression and extreme depression, respectively. The mean score of overall quality of life score among haemodialysis patients was 34.66 ± 7.16. Conclusion: The analysis revealed that haemodialysis patients had severe to moderate depression, which in turn reduces the quality of life of the haemodialysis patients.

Exploring the correlation between periodontal disease and serum biomarkers in haemodialysis patients.

BACKGROUND: Patients undergoing haemodialysis are more susceptible to infectious diseases, including periodontitis. This study aimed to investigate the Correlation between periodontal disease and serum markers in Yemeni haemodialysis patients. METHODS: A cross-sectional study was conducted on a sample of 70 haemodialysis patients. Patient interviews, clinical examinations, and laboratory tests were performed to collect data. Serum levels of albumin, calcium, phosphorus, haemoglobin, ferritin, and creatinine were measured, with separate measurements for cystatin C The association between categorical variables was assessed using the chi-square test and Pearson's correlation coefficient, considering a significance level of p < 0.05. RESULTS: Significant correlations were found between serum biomarkers and periodontal clinical parameters. Phosphorus, creatinine, albumin, ferritin, and creatinine levels correlated significantly with the Plaque Index (p < 0.001, p < 0.001, p = 0.015, p = 0.018, and p = 0.03). While the Ferritin level showed significant correlations with both the Plaque Index and Miller Classes (r = 0.281, p = 0.018 and r = 0.258, p = 0.031), respectively. The Calcium level showed a significant correlation with the Gingival Index (r = 0.266, p = 0.027). Cystatin C level was statistically correlated with mobility (r = 0.258, p = 0.031). Also, the result showed a significant correlation between Creatinine levels and Periodontitis (r = 0.26, p = 0.03). CONCLUSION: This study provides evidence of a strong association between periodontal disease and chronic kidney disease in Yemeni haemodialysis patients. The findings emphasize the significance of maintaining good oral health in the care of haemodialysis patients.

The relationship between self-care behaviours regarding arteriovenous fistula and the fear of fistula failure in individuals receiving haemodialysis treatment.

Background: Many problems regarding the self-care behaviours of haemodialysis patients are recognised; however, the fear experienced by the patients cannot be adequately explained. Aims: This study was conducted to determine the relationship between self-care behaviours related to arteriovenous fistula and fear of fistula failure in individuals receiving haemodialysis treatment. Methods: In this descriptive and relational study, 259 patients who met the inclusion criteria constituted the sample of the study. A multiple regression analysis enter model was used to evaluate the predictive power of the Self-Care Behaviours in Arteriovenous Fistula Scale. Results: It was found that the primary source of fear related to the fistula was the fear of fistula failure with a rate of 79.5%, and the patients who had this fear had a lower mean self-care scale score. The variables account for 12% of the self-care situation, and it is seen that the model is significant. Conclusions: It was concluded that increasing the fear of failure decreased the self-care score. This study is important for raising awareness among nurses regarding the fear of fistula failure. Nurses must provide appropriate care for vascular access and try to alleviate patients' anxiety and fears by listening to them.

An unusual case of Herbaspirillum huttiense bacteraemia in a haemodialysis patient.

Herbaspirillum spp. is a common environmental bacterium usually found in soil, plant roots, and water. It is rarely associated with infection in immunocompromised patients, and rarely reported infections in immunocompetent patients. We report the first case of a Herbaspirillum huttiense bacteraemia in a non-neutropenic home haemodialysis patient. A 57-year-old male presented to our hospital with a 3-day history of malaise, fevers, rigours, and anorexia following dialysis through his central line. On examination, he was pyrexic (temperature 38.7°C) with splinter haemorrhages noted, but no other signs of infection were present. Blood cultures revealed a polymicrobial infection, with Serratia liquefaciens and Corynebacterium jeikeium isolated from the central line and Herbaspirillum sp. was isolated from both the central line and a peripheral culture. A later peripheral blood culture following central line removal isolated Herbaspirillum huttiense. Regular biological testing of his home water supply and dialysate detected no colony forming units of non-fermenting gram-negative bacilli. He was initially treated with ceftriaxone and vancomycin initially, followed by ertapenem and vancomycin. Intravenous antibiotics were ceased following 5 days after central line removal and he made an uneventful recovery.

Perspectives of Chinese nephrology nurses on discussing sexual dysfunction with patients receiving haemodialysis: A qualitative study.

BACKGROUND: The study underscores the crucial yet often neglected issue of sexual dysfunction in haemodialysis patients. Despite nephrology nurses'close relationships with patients, there is a significant communication gap on this topic. In China, limited research highlights the need for further study. OBJECTIVE: To describe the perspectives of Chinese nephrology nurses on discussing sexual dysfunction with patients receiving haemodialysis. DESIGN: A qualitative descriptive study. PARTICIPANTS: Ten Chinese nephrology nurses from a tertiary public hospital in Guizhou province, China. APPROACH: Semistructured interviews were conducted using an interview guide. Qualitative content analysis approach was utilised in analysis. RESULTS: There were five themes described: (1) lack of training in sexual education, as nephrology nurses described never being trained to manage patients' sexual health issues; (2) discomfort when discussing sexual topics, Chinese nephrology nurses found the topic of sexual dysfunction embarrassing and avoided discussing it; (3) sexual dysfunction viewed as a nonurgent topic, nephrology nurses prioritise physical health to aid patient survival; (4) belief in physicians as ultimate care advisors, nephrology nurses believed that doctors should handle discussions on sexually related topics; and (5) lack of a suitable environment for discussing sexual dysfunction, nephrology nurses viewed sex as a private matter, inappropriate for discussion in a public unit. CONCLUSION: The study identifies barriers to discussing sexual dysfunction in healthcare, including provider knowledge deficits, discomfort and lack of supportive environments. It recommends specialised training and conducive settings to improve communication in renal care. Future research should evaluate the effectiveness of these interventions.

[Clinical Thermography for the Management of Hemodialysis Vascular Access].

The arteriovenous fistula (AVF) represents the favorite vascular access in individuals with chronic kidney disease (CKD). Because AVF is a guarantee of survival for these patients, proper surgical packing and a timely follow-up program is crucial. Although a good objective examination of the limb site of FAV provides useful information both in planning the fistula surgery and in its surveillance and monitoring, it is now well established that the advent of instrumental diagnostics (ultrasonography, digital angiography, Angio-TC, MRI) has contributed significantly to improving primary and secondary patency of FAV and early diagnosis of vascular access complications. In this area, clinical thermography, a noninvasive and nondestructive diagnostic technique for assessing minute surface temperature differences, has shown good potential for the assessment of AVF. In fact, thermographic analysis of a limb site of AVF shows an increase in temperature at the site of the anastomosis and along the course of the arterialized vein. In this article we report our experience on the use of thermography in preoperative evaluation and postoperative surgical packing of an AVF. Further studies could validate the use of clinical thermography as a diagnostic technique to be used in the field of hemodialysis vascular accesses.

The impact of depression on platelet activation, cardiocerebral vascular events and arteriovenous fistula dysfunction in patients undergoing haemodialysis.

Depression is a common psychiatric disorder among patients undergoing maintenance haemodialysis (MHD). Depression may reportedly contribute to poor prognosis in several ways, including its effects on platelet function. We hypothesised that depression contributes to the occurrence of cardiocerebral vascular events (CCVE) and dysfunction of arteriovenous fistula (DAVF) in patients undergoing MHD through its effects on platelets. In this prospective cohort study, patients undergoing MHD were recruited and divided into depression and non-depression groups according to their Hamilton Depression Scale (HAMD) scores. The 286 enrolled patients had 103 occurrences of depressive symptoms (prevalence = 36.01%). Compared with the non-depression group, depression group had a significantly higher cumulative prevalence of CCVE and DAVF during follow-up. Cox regression analysis indicated that higher HAMD scores and lower plasma platelet distribution width (PDW) were common risk factors for CCVE and DAVF. Furthermore, HAMD scores were significantly negatively correlated with plasma PDW and was the main variable affecting changes in PDW, as indicated by multiple linear regression analysis. Depression may increase the risk of CCVE and DAVF in patients undergoing MHD by activating platelets. Plasma PDW may be a convenient indicator of platelet activation status and may predict the risk of CCVE and DAVF.

Vision loss and diabetic retinopathy prevalence and risk among a cohort of Indigenous and non-Indigenous Australians with type 2 diabetes receiving renal haemodialysis treatment: The retinopathy in people currently on renal dialysis (RiPCORD) study.

AIMS: Diabetic nephropathy, vision loss and diabetic retinopathy (DR) are frequent comorbidities among individuals with type 2 diabetes (T2D). The Retinopathy in People Currently On Renal Dialysis (RiPCORD) study sought to examine the epidemiology and risk of vision impairment (VI) and DR among a cohort of Indigenous and non-Indigenous Australians with T2D currently receiving haemodialysis for end-stage renal failure (ESRF). METHODS: A total of 106 Indigenous and 109 non-Indigenous Australians were recruited in RiPCORD across five haemodialysis centres in urban and remote settings. Clinical assessments, questionnaires and medical record data determined the rates of ocular complications and risk factor profiles. RESULTS: Prevalence rates include unilateral VI, 23.5 %; bilateral VI, 11.7 %; unilateral blindness, 14.2 %; and bilateral blindness, 3.7 %, with no significant differences between sub-cohorts (p=0.30). DR prevalence rates were 78.0 % among non-Indigenous Australians and 93.1 % among Indigenous Australians (p=<0.001). Non-Indigenous ethnicity (OR: 0.28) and pre-dialysis diastolic blood pressure (OR: 0.84 per 10-mmHg) were protective, while peripheral vascular disease (OR: 2.79) increased DR risk. CONCLUSIONS: Ocular complications among individuals with T2D and ESRF are disproportionately high, especially for Indigenous Australians, and beyond what can be accounted for by risk factor variation. Findings suggest a need to improve screening and preventative efforts within this high-risk population group.