Different mortality predictor pattern in hemodialysis and peritoneal dialysis diabetic patients in 4-year prospective observation.

INTRODUCTION: The aim was to identify factors carrying an ominous prognosis in a cohort of diabetic patients (pts) on a hemodialysis (HD) and peritoneal dialysis (PD) program. MATERIALS AND METHODS: We analyzed survival rates of 61 diabetic dialysis pts (35 HD/26 PD). The participants were matched in baseline characteristics, standard indicators of dialysis care and laboratory parameters. The studied group was prospectively observed up to 4 years. RESULTS: 21 pts (34.4%) survived the whole observation period. The annual mortality rate was 23.2%, with no difference between HD and PD. Irrespective of dialysis modality, the only factor associated with mortality in the Cox proportional hazard model was serum albumin lowering. Referring to dialysis modality, the HD survivors were characterized by lower IL-6 level, higher albumin concentration, and increased serum cholesterol values with higher cholesterol left in multivariate analysis; under PD therapy the only factor significantly associated with mortality was older age. In contrast to HD treatment, elevated cholesterol was a universal finding in PD patients, significantly above levels in HD, with a slight tendency to lower values in PD survivors. CONCLUSIONS: 1. A difference in mortality predictor pattern appeared in diabetic patients treated by PD and HD. 2. In the PD group more advanced age had a decisive negative impact on survival whereas in the HD group the outlook was dependent on factors related to nutrition and inflammation. 3. Elevated cholesterol level was associated with survival benefit in HD patients, being a common abnormality in the PD group, without positive prognostic significance.

Psychological burden and disease-related quality of life in dialysis patients during the first wave of the COVID-19 pandemic - a cross-sectional observational study. / Obciazenie psychiczne a jakosc zycia zwiazana z choroba u pacjentów dializowanych podczas pierwszej fali pandemii COVID-19 - przekrojowe badanie obserwacyjne.

OBJECTIVES: Since the first reports of the spread of the new SARS-CoV-2 virus, experts have pointed to the possible psychological consequences of the pandemic. In this study, we tried to answer the question of whether the level of perceived stress related to the pandemic affects the quality of life related to the disease and the functioning of patients on peritoneal and hemodialysis. METHODS: Out of 106 patients from the dialysis center of the University Clinical Hospital in Wroclaw during the first wave of the pandemic, 73 patients were enrolled, including 61 hemodialysis (HD) and 12 peritoneal dialysis (PD). The study used The Perceived Stress Scale (PSS), The General Health Questionnaire (GHQ-28), The Impact of Events Scale-Revised (IES-R), and The Kidney Disease and Quality of Life (KDQOL-SF™). RESULTS: Nearly half of the respondents (48%) experienced psychological distress and 5.6% of the respondents showed clinically significant psychopathological symptoms (GHQ). Half of the study group declared a significant occurrence of post-traumatic stress symptoms (IES-R). A high score of subjectively perceived stress related to the pandemic was observed in both study groups. Numerous significant negative correlations were found between the results of the KDQOL subscales and psychopathological symptoms (IES-R and GHQ) without significant differences between the two groups (HD vs. PD). Almost all KDQOL subscales were significantly moderately or strongly correlated with the level of perceived stress related to the pandemic. CONCLUSIONS: The level of subjectively assessed stress related to the pandemic and the severity of psychopathological symptoms, including post-traumatic stress, were significant in the entire group of patients undergoing renal replacement therapy, regardless of the dialysis type. Numerous confirmed relationships between the domains of the quality of life related to the disease and the level of perceived stress and psychopathological symptoms indicate an urgent need to provide effective psychological support to this group of patients and to develop preventive programs in the field of mental health of people undergoing renal replacement therapy.

Immune Response to Vaccination against COVID-19 in Breastfeeding Health Workers.

BACKGROUND: Initially, there were no data on the safety of COVID-19 vaccines in lactating women. The aim of our study was to evaluate the immune response to COVID-19 vaccinations in breastfeeding women. METHODS: The study included 32 breastfeeding women who, regardless of the study, had decided to be vaccinated. Maternal serum and breast milk samples were simultaneously collected on days 8 ± 1, 22 ± 2, 29 ± 3, and 43 ± 4 after the first dose of the vaccine. The immune response was assessed by determining the presence of anti-SARS-CoV-2 IgG and IgA. RESULTS: The breast milk IgG level was detectable (6.50 ± 6.74, median 4.7, and maximum 34.2 BAU/mL) and highly correlated to serum IgG level (rS 0.89; p < 0.001). The breast milk ratio of IgA to the cut-off value was higher in serum IgA-positive (4.18 ± 3.26, median 2.8, and maximum >10) than in serum IgA-negative women (0.56 ± 0.37, median 0.5, and maximum 1.6; p < 0.001). The highest concentrations of serum and breast milk antibodies were observed on day 29 ± 3 with a decrease on day 43 ± 4. CONCLUSION: The immune response to the vaccination against SARS-CoV-2 is strongest 7 ± 3 days after the second dose of the vaccine. Lactating mothers breastfeeding their children after vaccination against SARS-CoV-2 may transfer antibodies to their infant.

[Selected indices of peritoneal fibrosis in patients undergoing peritoneal dialysis]. / Wybrane wskazniki wlóknienia otrzewnej u chorych w programach dializy otrzewnowej.

Peritoneal dialysis is an alternative to hemodialysis in the treatment of patients with end-stage renal disease. Long-term use of peritoneal dialysis is limited by progressive alterations in the peritoneal membrane. The pathological changes in the peritoneum are due to the exposure to traditional nonphysiological peritoneal dialysis fluids that have low pH, high glucose and glucose degradation product content, and high molarity. Repeated episodes of bacterial peritonitis are another cause of peritoneal membrane damage. The characteristic features of peritoneal alterations include peritoneal fibrosis and morphologic changes in the peritoneal microvasculature with the accumulation of extracellular matrix in the submesothelial area and loss of mesothelial cells.These changes in the peritoneal membrane cause ultrafiltration failure and loss of dialysis efficacy. The pathogenesis of the peritoneal membrane damage is very complicated and understanding the processes involved in these alterations will be crucial in improving treatment with peritoneal dialysis. Some points of view on fibrosis of peritoneal membrane in patients undergoing peritoneal dialysis are presented here.

Current epidemiology and practice patterns in prevention and treatment of PD-related infections in Poland.

BACKGROUND: Peritoneal dialysis (PD) related infections are associated with technique failure and mortality. The aim of this multicentre study was to examine epidemiology, treatment and outcomes of PD-related infections in Poland as well as practice patterns for prevention of these complications in the context of current ISPD recommendations. METHODS: A survey on PD practices in relation to infectious complications was conducted in 11 large Polish PD centres. Epidemiology of peritonitis and exit-site infections (ESI) was examined in all patients treated in these units over a 2 year period. RESULTS: The study included data on 559 PD patients with 62.4% on CAPD. Practice patterns for prevention of infectious complications are presented. The rate of peritonitis was 0.29 episodes per year at risk, with Gram positive microorganisms responsible for more than 50% of infections and 85.8% effectively treated. Diagnosis and treatment followed ISPD guidelines however most units did not provide an anti-fungal prophylaxis. Although neither of the centres reported routine topical mupirocin on catheter exit-site, the rate of ESI was low (0.1 episodes per year at risk), with Staphylococcus aureus as most common pathogen and full recovery in 78.3% of cases. CONCLUSION: The study shows rewarding outcomes in prevention and treatment of PD-associated infections, mainly due to a thorough compliance with the current ISPD guidelines, although some deviations from the recommendations in terms of practice patterns have been observed. More studies are needed in large numbers of patients to differentiate the importance of specific recommendations and further support the guidelines.

Radial artery-perforating vein fistula for hemodialysis.

BACKGROUND: The proximal forearm antecubital fistula described by Gracz is a valuable option for autogenous vascular access for hemodialysis in patients with destroyed forearm veins or advanced arteriosclerotic and calcified radial arteries. Results obtained with a variant of the Gracz fistula are presented. STUDY DESIGN: Patients with forearm vein destruction or failed distal radiocephalic fistulas were selected to have a variant of the Gracz fistula created and were followed up for 36 months. In each patient, the radial artery was anastomosed side to end or end to end to the perforating vein. Additionally, in some patients, the median cephalic or basilic vein was relocated subcutaneously to increase the accessibility of veins for puncture. SETTING & PARTICIPANTS: Native arteriovenous fistulas (AVFs) in the cubital region using a perforating vein were created in 77 patients (34 women, 43 men) referred to the Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland, from 1992 to 2006. OUTCOMES & MEASUREMENTS: Percentages of successful fistula creation and primary patency rates, defined from fistula placement to any maintaining intervention, and cumulative patency, defined from placement to fistula abandonment, were assessed. RESULTS: AVF creation was successful in 56 patients (73%). Primary patency rates during the follow-up period were 47% after 1 year, 43% after 2 years, and 39% after 3 years. Cumulative patency rates were 67% after 1 year, 56% after 2 years, and 53% after 3 years. LIMITATIONS: These results reflect performance of a single center and thus may not be generalizable to surgeons less experienced in this technique. CONCLUSIONS: Radial artery-perforating vein fistulas have an acceptable survival rate and do not produce circulatory complications. This method may be applicable for AVF creation in patients with forearm vein destruction/abnormalities and as a rescue procedure for an old clotted fistula after kidney transplant failure.

[Individualization of the choice of renal replacement therapy in patients with diabetic nephropathy on the basis of medical, psychological and social considerations]. / Indywidualizacja wyboru metody leczenia nerkozastepczego chorych z nefropatia cukrzycowa w oparciu o wzgledy medyczne, psychologiczne i spoleczne.

This work presents general rules for qualifying patients with end-stage renal failure in the course of diabetic nephropathy for renal replacement therapy by haemodialysis or peritoneal dialysis. Both medical and social considerations conditioning the choice of the dialytic therapy and the most frequent problems characteristic of each method were discussed in the paper. Much attention was focused on the psychological aspect of accepting the disease and the possibilities of emotional disorder in a patient and on the social aspect defining interpersonal relations within patient's family and environment.

Glucose challenge test (50-g GCT) in detection of glucose metabolism disorders in peritoneal dialysis patients: preliminary study.

BACKGROUND: The aim was to evaluate the clinical utility of the oral glucose tolerance screening test (50-g GCT--glucose challenge test) for the detection of glucose metabolism disorders (GMD) in peritoneal dialysis (PD) patients with normal fasting glucose levels. METHODS: The 50-g GCT was performed in 20 prevalent patients without history of diabetes before PD treatment onset, who had been on dialysis for a median time of 15.34 months. In addition, other indicators of glucose metabolism were measured: C-peptide, fasting insulin serum concentration, and the glycated hemoglobin level (HbA1c). The patients were prospectively followed for a median time of 25.8 months. RESULTS: 50-g GCT revealed GMD in 15 studied patients (75%)--impaired glucose tolerance in 11 patients (55%) and diabetes mellitus in four patients (20%). HbA1c and insulin resistance, estimated by homeostasis model assessment, were elevated in two (10%) and seven (35%) patients, respectively. In patients with GMD, dietetic and pharmacologic interventions were performed. When the 50-g GCT was repeated at the end of the observation period, 12 (60%) patients reported GMD, with no case of diabetes. CONCLUSION: 50-g GCT appears to be a simple and practical tool for the detection of GMD in PD patients with normal fasting glucose. Timely therapeutic intervention can effectively inhibit the progression of glucose intolerance during PD treatment.

Elderly dialysis patients: analysis of factors affecting long-term survival in 4-year prospective observation.

PURPOSE: To assess factors influencing the long-term survival of elderly dialysis patients. METHODS: The study group consisted of 51 prevalent dialysis patients aged over 70 years (32 F and 19 M, all caucasians), who had been on a chronic hemodialysis (27) or peritoneal dialysis program (24) for at least 2 months; median age was 77 years, median time on dialysis before inclusion was 16 months, and median residual diuresis was 600 ml. The patients were prospectively followed up to 4 years, and an analysis of factors affecting survival was performed. RESULTS: Thirteen patients from the initial cohort of 51 (25.5 %) survived the whole 48-month observation period: 10 HD patients (37 %) and 3 PD patients (12.5 %). Annual mortality rate was 28.2 %: 37.4 % on PD vs. 20.9 % on HD. The dialysis modality had a significant impact on patients' survival (p = 0.049; Cox F-test). The independent mortality risk factors in the Cox proportional hazard regression model were higher plasma pro-atrial natriuretic peptide (pro-ANP) (p = 0.006), lower residual diuresis (p = 0.048), and lower systolic blood pressure (BP) value (p = 0.039). CONCLUSIONS: Paramount for the survival of the elderly on dialysis is adequate extracellular volume control. Residual renal function is a protective factor for the survival of elderly HD patients. This observation is novel, not previously reported in an elderly dialysis population.