Thromboelastometry early identifies thrombotic complications related to COVID-19: A case report.

COVID-19 is a contagious infectious disease, which quickly spreads worldwide, whose clinical presentation includes from mild flu-like symptoms to pneumonia and severe acute respiratory syndrome. The severe presentation of the disease can affect different organs and systems. Coagulopathy has been associated with a worse clinical outcome, with manifestations such as pulmonary embolism and systemic arterial thrombosis. Thromboelastometry has been used to identify hypercoagulability in early stages of disease. We report the case of a 59-year-old woman with COVID-19 infection complicated by pulmonary embolism and acute arterial thrombosis associated with critical lower limb ischemia requiring amputation. This report showed a case of thrombotic complication in patient with infection caused by novel coronavirus 2019 whose thromboelastometry allowed the early identification of hypercoagulability pattern. This is a single case report and the use of thromboelastometry should be further evaluated in large prospective cohort studies.

Smoking and Kidney Disease: Risk Factors, Challenges, and Preventive Strategies.

Clinical Background: Although chronic kidney disease (CKD) and smoking are both associated with high rates of morbidity and mortality, the interplay between the two is not widely understood. Epidemiology: The incidence of CKD progression has been shown to be significantly higher among current and former smokers, and continued smoking thereafter has been associated with a nearly twofold higher risk of death. Challenges: Because it is a silent disease, CKD is often diagnosed in advanced stages, which underscores the importance of targeted, active screening for CKD. When CKD progresses to stage 5, life expectancy is drastically shortened unless life-saving renal replacement therapy (dialysis or kidney transplantation) is initiated. The treatment of smoking, which is a risk factor for CKD, also poses a challenge. Less than 10% of adults who want to quit smoking succeed in doing so, and those who do quit typically succeed only after making multiple attempts. In addition, many smokers have limited access to smoking cessation services, are unaware of available resources, or have misconceptions about smoking cessation therapies. Prevention and Treatment: There is evidence that quitting smoking may help prevent the development of CKD. However, glomerular filtration rates have been found to be higher in smokers than in nonsmokers, which could confound efforts to recognize smoking as a major risk factor for kidney disease. Efforts should continue to focus on the prevention of smoking, and nephrologists should promote smoking cessation as a means to prevent CKD progression.

Use of regional citrate anticoagulation for continuous venovenous hemodialysis in critically ill cancer patients with acute kidney injury.

PURPOSE: This study aimed to evaluate the safety and efficacy of a regional citrate anticoagulation (RCA) protocol for continuous venovenous hemodialysis (CVVHD) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) setting. MATERIAL AND METHODS: One hundred twenty two consecutive ICU cancer patients with AKI treated with citrate-based CVVHD were prospectively evaluated in this prospective observational study. RESULTS: A total of 7198 h of CVVHD therapy (250 filters) were performed. Patients were 61.3 ±â€¯15.7 years old, 78% had solid cancer and the main AKI cause was sepsis (50%). The in-hospital mortality was 78.7%. Systemic ionized calcium (SCai) was 4.35 (4.10-4.60) mg/dL, severe hypocalcemia (SCai <3.6 mg/dL) was observed in 4.3% of procedures and post-filter ionized calcium was 1.60 (1.40-1.80) mg/dL. Median filter patency was 24.8 (11-43) hours. Factors related to filter clotting were: no tumor evidence (OR 0.44, CI 0.18-0.99); genitourinary tumor (OR 1.83, CI 1.18-2.81); platelets number (each 10,000/mm3) (OR 1.02, CI 1.00-1.04); International Normatized Ratio (INR) (OR 0.59, CI 0.41-0.85) and citrate dose (each 10 mL/h) (OR 0.88, CI 0.82-0.95). CONCLUSION: Filter patency was relatively short and clotting was associated with active cancer disease, genitourinary tumor, lower citrate dose and lower INR.