Impact of Medium Cut-Off Dialyzers on Patient-Reported Outcomes: COREXH Registry.

INTRODUCTION: A new generation of hemodialysis (HD) membranes called medium cut-off (MCO) membranes possesses enhanced capacities for middle molecule clearance, which have been associated with adverse outcomes in this population. These improvements could potentially positively impact patient-reported outcomes (PROs). OBJECTIVE: The objective of this study was to evaluate the impact of MCO membranes on PROs in a cohort of HD patients in Colombia. METHODS: This was a prospective, multicenter, observational cohort study of 992 patients from 12 renal clinics in Colombia who were switched from high-flux HD to MCO therapy and observed for 12 months. Changes in Kidney Disease Quality of Life 36-Item Short Form Survey (KDQoL-SF36) domains, Dialysis Symptom Index (DSI), and restless legs syndrome (RLS) 12 months after switching to MCO membranes were compared with time on high-flux membranes. Repeated measures of ANOVA were used to evaluate changes in KDQoL-SF36 scores; severity scoring was used to assess DSI changes over time; Cochran's Q test was used to evaluate changes in frequency of diagnostic criteria of RLS. RESULTS: During 12 months of follow-up, 3 of 5 KDQoL-SF36 domains improved compared with baseline: symptoms (p < 0.0001), effects of kidney disease (p < 0.0001), and burden of kidney disease (p < 0.001). The proportion of patients diagnosed with RLS significantly decreased from 22.1% at baseline to 10% at 12 months (p < 0.0001). No significant differences in the number of symptoms (DSI, p = 0.1) were observed, although their severity decreased (p = 0.009). CONCLUSIONS: In conventional HD patients, the expanded clearance of large middle molecules with MCO-HD membranes was associated with higher health-related quality of life scores and a decrease in the prevalence of RLS.

Impact of a Basal-Bolus Insulin Regimen on Metabolic Control and Risk of Hypoglycemia in Patients With Diabetes Undergoing Peritoneal Dialysis.

INTRODUCTION: Clinical interventional studies in diabetes mellitus usually exclude patients undergoing peritoneal dialysis (PD). This study evaluates the impact of an educational program and a basal-bolus insulin regimen on the blood glucose level control and risk of hypoglycemia in this population. METHODS: A before-and-after study was conducted in type 1 and type 2 DM patients undergoing PD at the Renal Therapy Services (RTS) clinic network, Bogota, Colombia. An intervention was instituted consisting of a three-month educational program and a basal-bolus detemir (Levemir, NovoNordisk) and aspart (Novorapid, NovoNordisk) insulin regimen. Prior to the intervention and at the end of treatment were conducted measures of HbA1c levels and continuous glucose monitoring (CGM). RESULTS: Forty-seven patients were recruited. Mean HbA1c level decreased from 8.41% ± 0.83 to 7.68% ± 1.32 (mean difference -0.739, 95% CI -0.419, -1.059; P < .0001). Of subjects, 52% achieved HbA1c levels <7.5% at the end of study. Mean blood glucose level reduced from 194.0 ± 42.5 to 172.9 ± 31.8 mg/dl ( P = .0015) measured by CGM. Significant differences were not observed in incidence of overall ( P = .7739), diurnal ( P = .3701), or nocturnal ( P = .5724) hypoglycemia episodes nor in area under the curve (AUC) <54 mg/dl ( P = .9528), but a reduction in AUC >180 ( P < .01) and AUC >250 ( P = .01) was evidenced for total, diurnal, and nocturnal episodes. CONCLUSIONS: An intervention consisting of an educational program and a basal-bolus insulin regimen in type 1 and type 2 diabetes mellitus patients undergoing PD caused a decrease in HbA1c levels, and mean blood glucose levels as measured from CGM with no significant increases in hypoglycemia episodes.

Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, el diagnóstico y el manejo de la lesión renal aguda por SARS-CoV-2/COVID-19 / Colombian consensus of experts on recommendations informed in the evidence for the prevention, diagnosis and management of acute kidney injury by SARS-CoV-2/COVID-19

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Abstract Introduction: Acute kidney injury is a frequent complication in patients with COVID-19 and its occurrence is a potential indicator of multi-organ dysfunction and disease severity. Objective: Develop, through an expert consensus, evidence-based recommendations for the prevention, diagnosis, and management of acute kidney injury in patients with SARS CoV2 / COVID-19 infection. Materials and methods: Based on a rapid systematic review in Embase and Pubmed databases and documents from scientific societies, we made preliminary recommendations and consulted with an expert group through an online tool. Then we defined agreement after at least 70 % consensus approval. Quality evidence was evaluated according to the type of document included. The strength of the recommendations was graded as strong or weak. Results: Fifty clinical experts declared their conflict of interest; the consultation took place between May 2 and 29, 2020. The range of agreement ranged from 75.5 % to 100 %. Recommendations for prevention, diagnosis and management of acute kidney injury in patients with SARS CoV2 infection are presented. Conclusions: Although the good quality information available regarding acute kidney injury in patients with COVID-19 is scarce, the recommendations of clinical experts will guide clinical decision-making and strategies around patients with this complication, guaranteeing care focused on the people, with high quality standards, and the generation of safety, health and wellness policies for multidisciplinary care teams.

Mortalidad observada versus esperada en una red de unidades de diálisis en Colombia / Observed versus expected mortality in a network of dialysis units in Colombia

Resumen Antecedentes: la mortalidad en diálisis es uno de los principales indicadores de gestión clínica y se ve influenciada por diversos factores sociodemográficos y clínicos. Objetivos: calcular la mortalidad observada versus la esperada en las unidades de diálisis de la red de RTS en Colombia. Métodos: cohorte histórica de pacientes mayores de 18 años, prevalentes en diálisis entre el 1 de enero y el 31 de diciembre de 2012, de 51 unidades renales de la red Renal Therapy Services (RTS). Se calculó la razón estandarizada de mortalidad (REM) siguiendo la metodología propuesta por la Universidad de Michigan Centro de Costos y Epidemiologic Renal (UM-KECC); se implementó un modelo de supervivencia de riesgos proporcionales de Cox en dos etapas, la primera estimó los parámetros asociados con las variables explicativas y la segunda estandarizó los resultados. Resultados: se evaluaron 9798 pacientes, 4125 (42.1%) fueron mujeres, la media de edad fue de 59 años (DE=15.6). Se observaron 1253 eventos de muerte (12.7%). El modelo arrojó un valor de 1067 muertes esperadas, con un valor estimado de REM de 1.17 (IC95%: 1.11-1.24). La REM fue mayor para pacientes diabéticos 1.28 (IC95%:1.19-1.38) y mujeres (1.36 (IC95%: 1.25-1.48); y varió significativamente por zona del país (1.11 a 2.0). Conclusiones: encontramos diferencias importantes en la REM según sexo, presencia de diabetes y por zonas del país. Se requiere mediante nuevos estudios entender mejor la influencia de estas y otras variables sobre el fenómeno de mortalidad en diálisis en nuestro contexto. (Acta Med Colomb 2017; 42: 106-111).

Abstract Background: mortality in dialysis is one of the main indicators of clinical management and is influenced by various socio-demographic and clinical factors. Objectives: to calculate the observed versus expected mortality in the dialysis units of the RTS network in Colombia. Methods: a historical cohort of patients older than 18 years, prevalent on dialysis between January 1 and December 31, 2012, of 51 renal units of the Renal Therapy Services (RTS) network. The standardized mortality ratio (SMR) was calculated following the methodology proposed by the University of Michigan Center for Costs and Renal Epidemiology (UM-KECC); a Cox proportional hazards survival model was implemented in two stages, the first estimated the parameters associated with the explanatory variables and the second standardized the results. Results: 9798 patients were evaluated, 4125 (42.1%) were women. The mean age was 59 years (SD = 15.6). There were 1253 death events (12.7%). The model gave a value of 1067 expected deaths, with an estimated SMR value of 1.17 (95% CI: 1.11-1.24). SMR was greater for diabetic patients 1.28 (95% CI: 1.19-1.38) and women (1.36 (95% CI: 1.25-1.48)) and it varied significantly depending on the region of the country (1.11 to 2.0). Conclusions: important differences in SMR according to sex, presence of diabetes and by regions of the country were found. Further studies are required to better understand the influence of these and other variables on the mortality phenomenon in dialysis in our context. (Acta Med Colomb 2017; 42: 106-111).