Hemodialysis shake-up on the front lines of the Covid-19 pandemic: the Treviglio Hospital experience.

The new coronavirus disease (Covid-19) pandemic in Italy formally started on 21st February 2020, when a 38-years old man was established as the first Italian citizen with Covid-19 in Codogno, Lombardy region. In a few days, the deadly coronavirus swept beyond expectations across the city of Bergamo and its province, claiming thousands of lives and putting the hospital in Treviglio under considerable strain. Since designated Covid-dialysis hospitals to centrally manage infected hemodialysis patients were not set up in the epidemic areas, we arranged to treat all our patients. We describe the multiple strategies we had to implement fast to prevent/control Covid-19 infection and spread resources in our Dialysis Unit during the first surge of the pandemic in one of the worst-hit areas in Italy. The recommendations provided by existing guidelines and colleagues with significant experience in dealing with Covid-19 were combined with the practical judgement of our dialysis clinicians, nurses and nurse's aides.

Personalization of automated peritoneal dialysis treatment using a computer modeling system.

The use of almost standardized dialysis programs--and the absence of any adjustment over time in these program to match the progressive decline in residual kidney function, in addition to the reduction in peritoneal depuration because of the frequency of peritonitis and the use of solutions containing high glucose concentrations--often leads to technique drop-out and transfer to hemodialysis. Our study enrolled 15 clinically stable patients (13 white men, 2 white women; average age: 67.3 +/- 12.99 years; average dialysis vintage: 32.25 +/- 25.10 months) who had been on automated peritoneal dialysis treatment with a standard treatment profile for at least 6 months (dwell time per cycle and solutions fixed at various glucose concentrations in all exchanges). After a peritoneal equilibration test had been performed and clearances (peritoneal and renal) were measured, the dialysis program was modified, individualizing it to the patient ' peritoneal membrane transport by the Twardowski system of classification and taking into account the patient's residual diuresis and need for ultrafiltration. The change was implemented using the Patient on Line software created by Fresenius Medical Care (Bad Homburg, Germany). After a month of personalized dialysis treatment, weekly peritoneal Kt/V in the study group increased significantly (to 1.47 + 0.61 from 1.02 +/- 0.37, p = 0.001); no difference in renal Kt/V was observed. Total Kt/V reached levels of optimum dialysis adequacy (to 2.21 +/- 0.28 from 1.62 +/- 0.33, p = 0.0001). Weekly peritoneal creatinine clearance also increased to 32.86 +/- 16.94 L/1.73 m2 from 22.27 +/- 9.16 L/1.73 m2 (p = 0.005), with renal creatinine clearance essentially stable, and total weekly clearance increasing to 67.58 +/- 14.52 L/1.73 m2 from 53.51 +/- 16.86 L/1.73 m2 (p < 0.0001). The dialysis adequacy improvements obtained involved no statistically significant differences in the total infused volume of dialysis solution, ultrafiltration, or the duration of dialysis treatment. It should also be noted that no changes in residual diuresis occurred.