ABSTRACT
BACKGROUND: Peritonitis is a common complication of chronic peritoneal dialysis treatment contributing to both technique failure and/or death. Little is effectively known about the actual benefits of a continuous training program on peritonitis rates. In the present study, we measured the impact of our patients' training protocol on peritonitis rates. We further studied which consequences the COVID-related disruption of our follow-up program had on peritonitis rates. METHODS: We present our yearly peritonitis rates since our patients' training and retraining program was implemented in 2010. We then focused our study on three consecutive years: 2019, 2020 (emergence of COVID-19), and 2021, collecting microbiological data from each peritonitis episode. Statistical analysis were used to corroborate our findings. RESULTS: Since 2010, peritonitis rates declined linearly (R2=0,6556; df=8; P<0.01) until its nadir in 2019 with 4 peritonitis episodes. The majority of infections were then treated in the outpatient Clinic. In 2020, our continuous technique evaluation decreased by 51% and 28 peritonitis episodes occurred, 47% secondary to strict cutaneous bacteria's, and 31% gastro-intestinal, irrespective of patients' experience or peritoneal dialysis modality. The hospitalization rate reached 71%. Having restored our protocol, we decreased peritonitis rates by 50% in 2021. CONCLUSIONS: Risk factors for peritonitis are identifiable and modifiable and require sustained intervention, continuous visual monitoring and training. These interventions significantly reduce peritonitis rates. Any brief interruption to patients' technique evaluation may elevate peritonitis rates significantly.
Subject(s)
COVID-19 , Peritoneal Dialysis , Peritonitis , Humans , COVID-19/epidemiology , Pandemics , Peritoneal Dialysis/adverse effects , Peritoneal Dialysis/methods , Peritonitis/etiology , Peritonitis/microbiology , Risk FactorsABSTRACT
Résumé Introduction : La péritonite est une complication fréquente du traitement par dialyse péritonéale chronique, contribuant à l’échec de la technique et/ou au décès. Les avantages réels d’un programme de formation continue sur les taux de péritonites sont peu connus. Dans cette étude, nous avons mesuré l’influence du protocole de formation continue de nos patients sur le taux de péritonite. Nous avons également étudié les conséquences de la perturbation de notre protocole liée au COVID sur les taux de péritonites. Méthode : Nous présentons nos taux annuels de péritonites depuis la mise en place de notre programme de formation continue des patients en 2010. Nous avons ensuite concentré notre étude sur trois années consécutives : 2019, 2020 (émergence de la COVID-19) et 2021, en recueillant les données microbiologiques de chaque épisode de péritonite. Des analyses statistiques ont été utilisées pour corroborer nos résultats. Résultats : Depuis 2010, le taux de péritonites a diminué linéairement (R2 = 0,6556 ;df = 8 ;p < 0,01) jusqu’à son nadir en 2019 avec 4 épisodes de péritonites. La majorité des infections ont alors été traitées en ambulatoire. En 2020, notre évaluation continue des procédures de dialyse au domicile des patients a diminué de 51 % et 28 péritonites sont survenues, 47 % secondaires à des bactéries cutanées strictes, et 31 % gastro-intestinales, indépendamment de l’expérience des patients ou de la modalité de dialyse péritonéale. Le taux d’hospitalisations a atteint 71 %. Après avoir rétabli notre protocole, nous avons diminué le taux de péritonites de 50 % en 2021. Conclusions : Les facteurs de risque de développer une péritonite sont identifiables et modifiables, et nécessitent des interventions soutenues, une surveillance visuelle ainsi qu’une formation continue. Ces interventions réduisent de manière significative les taux de péritonites. Toute brève interruption de l’évaluation de la technique des patients peut augmenter de manière significative les taux de péritonites.
ABSTRACT
BACKGROUND: Since March 2020, health care systems were importantly affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, with some patients presenting severe acute respiratory distress syndrome (ARDS), requiring extra-corporeal membrane oxygenation (ECMO). We designed an ambispective observational cohort study including all consecutive adult patients admitted to 5 different ICUs from a university hospital. The main objective was to identify the risk factors of severe COVID-19 ARDS patients supported by ECMO associated with 90-day survival. RESULTS: Between March 1st and November 30th 2020, 76 patients with severe COVID-19 ARDS were supported by ECMO. Median (interquartile range IQR) duration of mechanical ventilation (MV) prior to ECMO was of 6 (3-10) days. At ECMO initiation, patients had a median PaO2:FiO2 of 71 mmHg (IQR 62-81), median PaCO2 of 58 mmHg (IQR 51-66) and a median arterial pH of 7.33 (IQR 7.25-7.38). Forty-five patients (59%) were weaned from ECMO. Twenty-eight day, 60-day and 90-day survival rates were, respectively, 92, 62 and 51%. In multivariate logistic regression analysis, with 2 models, one with the RESP score and one with the PRESERVE score, we found that higher BMI was associated with higher 90-day survival [odds ratio (OR): 0.775 (0.644-0.934), p = 0.007) and 0.631 (0.462-0.862), respectively]. Younger age was also associated with 90-day survival in both models [OR: 1.1354 (1.004-1.285), p = 0.044 and 1.187 (1.035-1.362), p = 0.014 respectively]. Obese patients were ventilated with higher PEEP than non-obese patients and presented slightly higher respiratory system compliance. CONCLUSION: In this ambispective observational cohort of COVID-19 severe ARDS supported by ECMO, obesity was an independent factor associated with improved survival at 90-day.
ABSTRACT
BACKGROUND: Patients with end-stage-renal-disease (ESRD) undergoing hemodialysis (HD) represent a vulnerable population for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, due to their intrinsic fragility and increased exposure to the virus. Therefore, applying effective screening strategies and infection control measures is essential to control the spread of the epidemic within hemodialysis centers. OBJECTIVE: Description and evaluation of the efficacy of systematic screening by rt-PCR and viral cultures, in addition to triage to limit the spread of the epidemic. Evaluation of the performance of these tests using "post-hoc" SARS-CoV-2 serology as a surrogate marker of infection. METHODS: One hundred and forty-four patients undergoing hemodialysis in the Nephrology-Hemodialysis center of CHU Brugmann, Brussels, benefited from systematic virological screening using viral cultures in asymptomatic patients, or molecular tests (rt-PCR) for symptomatic ones, in addition to general prevention measures. Post-hoc serology was performed in all patients. RESULTS: Thirty-eight (26.3%) individuals were infected with SARS-CoV-2. Seventeen infected patients (44.7%) were asymptomatic and thus detected by viral culture. Our strategy allowed us to detect and isolate 97.4% of the infected patients, as proven by post-hoc serology. Only one patient, missed by clinical screening and sequential viral cultures, had a positive serology. CONCLUSION: The implementation of a control and prevention strategy based on a systematic clinical and virological screening showed its effectiveness in limiting (and shortening) the spread of the SARS-CoV-2 epidemic within our hemodialysis unit.
Subject(s)
COVID-19 , SARS-CoV-2 , Hemodialysis Units, Hospital , Humans , Polymerase Chain Reaction , Renal Dialysis/adverse effects , TriageABSTRACT
Neurological manifestations of coronavirus disease 2019 (COVID-19) often have tragic repercussions. Although many reports of neurological complications of severe acute respiratory syndrome coronavirus 2 infection exist, none of them are of patients on hemodialysis, who have a fivefold greater risk of stroke than the general population. In this report, we emphasize the importance of being vigilant for mild stroke in high risk populations-such as patients on hemodialysis-with COVID-19, since these conditions have overlapping symptoms.
Subject(s)
COVID-19 , Cognitive Dysfunction , Nervous System Diseases , Cognitive Dysfunction/etiology , Humans , Renal Dialysis/adverse effects , SARS-CoV-2ABSTRACT
The aim of this study was to investigate 28-day mortality after COVID-19 diagnosis in the European kidney replacement therapy population. In addition, we determined the role of patient characteristics, treatment factors, and country on mortality risk with the use of ERA-EDTA Registry data on patients receiving kidney replacement therapy in Europe from February 1, 2020, to April 30, 2020. Additional data on all patients with a diagnosis of COVID-19 were collected from 7 European countries encompassing 4298 patients. COVID-19-attributable mortality was calculated using propensity score-matched historic control data and after 28 days of follow-up was 20.0% (95% confidence interval 18.7%-21.4%) in 3285 patients receiving dialysis and 19.9% (17.5%-22.5%) in 1013 recipients of a transplant. We identified differences in COVID-19 mortality across countries, and an increased mortality risk in older patients receiving kidney replacement therapy and male patients receiving dialysis. In recipients of kidney transplants ≥75 years of age, 44.3% (35.7%-53.9%) did not survive COVID-19. Mortality risk was 1.28 (1.02-1.60) times higher in transplant recipients compared with matched dialysis patients. Thus, the pandemic has had a substantial effect on mortality in patients receiving kidney replacement therapy, a highly vulnerable population due to underlying chronic kidney disease and a high prevalence of multimorbidity.