Vaccination acceptance and its associated factors in patients on hemodialysis in Austria: A nationwide survey.

BACKGROUND: Vaccines are essential in disease prevention among patients on chronic hemodialysis (HD). However, during the coronavirus disease 2019 pandemic, there has been an increased rate of vaccination hesitancy. A better understanding of patients' opinions may help identify a more targeted approach to increase vaccination rates. MATERIALS AND METHODS: Questionnaires with 43 questions based on the recommendations of the Strategic Advisory Group of Experts (SAGE) on Immunization Working Group on Vaccine Hesitancy were administered to patients during routine HD sessions at different dialysis centers in Austria. RESULTS: In total, 347 patients participated in this study. Approximately 81% of the patients were aged > 54 years, and 65% were men. Further, 53% of patients were receiving HD from private units. In ~ 72% of patients, the dialysis physicians were the source of vaccination information. Meanwhile, the source of information in 28% of patients was the primary care physician (28%), and 18% of patients obtained vaccination details from the internet. The number of younger (aged < 55 years) patients who were more likely to use online content as the main source of information was significantly higher than that of older patients (32 vs. 15%, p = 0.001). Furthermore, the number of older patients who wanted to receive more information from the dialysis physician was significantly higher than that of younger patients (57 vs. 38%, p = 0.009). Only 65% of patients had a good understanding of the mechanisms of action of vaccines. The younger population (aged 18 - 54 years) had a higher number of individuals with a good understanding of vaccine mechanisms than the older population (78 vs. 62%, p = 0.016). Moreover, 86% of the whole population wanted to complete the recommended vaccinations. However, only 39% of respondents had sufficient information about the vaccination plan in Austrian. CONCLUSION: Numerous patients receiving HD wanted to obtain more information from their dialysis physicians. Increased awareness among providers and targeted communication might increase vaccination rates.

Biomarkers of alcohol abuse potentially predict delirium, delirium duration and mortality in critically ill patients.

Carbohydrate-deficient transferrin (CDT) and the γ-glutamyltransferase-CDT derived Anttila-Index are established biomarkers for sustained heavy alcohol consumption and their potential role to predict delirium and mortality in critically ill patients is not clear. In our prospective observational study, we included 343 consecutive patients admitted to our ICU, assessed the occurrence of delirium and investigated its association with biomarkers of alcohol abuse measured on the day of ICU admission. 35% of patients developed delirium during ICU stay. We found significantly higher CDT levels (p = 0.011) and Anttila-Index (p = 0.001) in patients with delirium. CDT above 1.7% (OR 2.06), CDT per percent increase (OR 1.26, AUROC 0.75), and Anttila-Index per unit increase (OR 1.28, AUROC 0.74) were associated with delirium development in adjusted regression models. Anttila-Index and CDT also correlated with delirium duration exceeding 5 days. Additionally, Anttila-Index above 4, Anttila-Index per unit increase, and CDT per percent increase were independently associated with hospital mortality.

Myocardial infarction with non-obstructive coronary arteries in a patient double-seropositive for anti-glomerular basement membrane and anti-neutrophil cytoplasmic antibodies: A case report.

We report a case of a patient double-seropositive for anti-glomerular basement membrane (anti-GBM) and anti-neutrophil cytoplasmic antibodies (ANCA) who reported retrosternal chest pain during a regular hemodialysis session associated with ST-segment depression in electrocardiogram and an increase of serum high-sensitivity troponin T. Urgent coronary angiography excluded obstructive coronary artery disease, suggesting the diagnosis of ischemia with non-obstructive coronary arteries. This case illustrates an unusual presentation of cardiovascular involvement in a patient with double-positive ANCA/anti-GBM disease, emphasizing the possible relevance of coronary microvascular dysfunction and the need for close cardiovascular follow-up in this patient population.

Effluent microscopy is a useful adjuvant diagnostic tool in peritoneal dialysis-associated peritonitis.

BACKGROUND: Infectious complications are the leading cause of technical failure in peritoneal dialysis (PD); however, targeted anti-infective therapy is not feasible at the onset, as effluent cultures take days and may be inconclusive. Although recommended by the guidelines, divergent positivity rates of Gram-stained effluent microscopy question the value of its usefulness. This study aimed to evaluate if microscopy of cell types serves as an additional and timely diagnostic approach. MATERIALS AND METHODS: This single-center retrospective analysis included prevalent PD patients (n = 250) between 2007 and 2017. Automated quantitative cell count, cytological analysis of Hemacolor and Gram-stained effluent sediment, and effluent cultures were conducted during peritonitis episodes. We calculated the rate of peritonitis, positivity rate of effluent cultures, and effluent microscopy. RESULTS: There were 155 at-risk cases of peritonitis in 662.7 years during the observation period. The culture positivity rate was 73.5%. In neutrophilic culture-negative peritonitis (CNP), effluent Gram staining yielded the identification of the microbial species in 51.6% cases. In 24.4% of CNP, effluent microscopy showed eosinophilic peritonitis, which occurred with less initial effluent leucocytes and showed better PD survival. CONCLUSION: In PD-associated peritonitis, Gram-stained dialysate with effluent microscopy supplements culture results in CNP. Hemacolor staining is crucial for differentiating eosinophilic peritonitis, showing a divergent clinical course and outcome.

Kidney function, brain morphology and cognition in the elderly: sex differences in the Austrian Stroke Prevention Study.

Impaired kidney function is associated with structural brain changes and cognitive dysfunction. In the aging kidney, hemodynamic and structural alterations reduce the glomerular filtration rate (eGFR). Little is known about differences between men and women regarding decline of kidney function and brain damage. In this community-based study, we assessed associations between the eGFR, focal and diffuse brain abnormalities and cognitive functions. Sex-specific effects were analyzed by interaction terms eGFR x sex on brain structure and cognition. Interactive effects were assessed using mixed-models -stratified by sex. Overall, 196 women and 129 men (median age 68 years and mean eGFR 73.8±14.9 ml/min/1.73m2) were included. Significant associations existed between eGFR and cortical volume (ß: 1.53E-04; SE: 6.72E-05; p=0.023 for neocortex). Sex exerted a significant interactive effect. Only in men, eGFR related to cortical volumes of all lobes and of deep gray matter structures (p= 0.001 for total gray matter, p=0.0004 for neocortex). In the whole group eGFR was not associated with cognition, but men with lower eGFR performed worse on tests for executive function, which, after FDR correction, was not significant. We conclude, that in community-dwelling middle-aged and elderly individuals, reduced eGFR relates to brain volume loss in men but not in women.