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2.
Lakartidningen ; 118(11):16, 2021.
Article in Swedish | MEDLINE | ID: covidwho-1824413

ABSTRACT

Data from the Swedish Renal Registry (SRR) show that during the period March 16, 2020 to March 15, 2021 0.4% of all renal transplant recipients and 3% of all dialysis patients died due to COVID-19 in Sweden. Of all registered deaths, 20% were attributed to COVID-19. In the age group 50-59 years the risk ratio for COVID-19 related mortality was 16 (95% CI 6.5-38) among transplant recipients and 22 (95% CI 7.1-69) among dialysis patients, compared to the background population in the same age group. Excess mortality, compared to the five years preceding the pandemic, was 30% for transplant recipients and 8.7% for dialysis patients, compared to 7.7% for the entire Swedish population. Detailed reports were sent to SRR for 864 patients with confirmed COVID-19 infection representing 5.0% of all transplant recipients and 13% of all dialysis patients. The case fatality rate was 7.0% and 21% respectively.

4.
Ren Replace Ther ; 7(1): 59, 2021.
Article in English | MEDLINE | ID: covidwho-1817287

ABSTRACT

BACKGROUND: The Japanese Association of Dialysis Physicians, the Japanese Society for Dialysis Therapy, and the Japanese Society of Nephrology jointly established COVID-19 Task Force Committee and began surveying the number of newly infected patients. METHODS: This registry of the COVID-19 Task Force Committee was used to collect data of dialysis patients; a total of 1010 dialysis patients with COVID-19 were included in the analysis. Overall survival of patients was investigated with stratification by age group, complication status, and treatment. In addition, predictive factors for mortality were also investigated. The overall survival was estimated by Kaplan-Meier methods and compared by using log-rank test. Multivariate analysis was performed to identify the risk factor of mortality. For all statistical analyses, p < 0.05 was considered to be statistically significant. RESULTS: The mortality risk was increased with age (p < 0.001). The mortality risk was significantly higher in patients with peripheral arterial disease (HR: 1.49, 95% CI 1.05-2.10) and significantly lower in patients who were treated with remdesivir (HR: 0.60, 95% CI 0.37-0.98). Multivariate analysis showed increased risk of mortality with increment in BMI, and increment in CRP, and decreased risk with increment in albumin. CONCLUSION: Dialysis patients have a high severity of illness and a high risk of mortality in cases of COVID-19. Treatment with remdesivir might be effective in shortening the duration of hospitalization and reducing the risk of mortality.

5.
Nephron ; : 1-6, 2022.
Article in English | PubMed | ID: covidwho-1816963

ABSTRACT

BACKGROUND AND OBJECTIVES: Patients undergoing maintenance hemodialysis have an attenuated immune response to vaccination. The aim of our study was to determine the predictive factors for humoral response to vaccination with the BNT162b2 mRNA vaccine (Pfizer-BioNTech) in patients on maintenance hemodialysis. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: In this retrospective, single-center study, we included patients on maintenance hemodialysis already vaccinated with two doses of the BNT162b2 vaccine (Pfizer-BioNTech) and with a post-vaccination serological follow-up. RESULTS: 252 patients were included for study with a mean age of 71.9 (±14.4) years. Twelve patients (4.7%) were under immunosuppressive therapy (calcineurin inhibitors: n = 4;chemotherapy for myeloma: n = 3;last infusion of rituximab over the previous 4 years: n = 2;abatacept: n = 2;adalimumab n = 1). Three of these patients were under immunosuppressive therapy for nonrenal solid organ transplantation. Multivariate analysis identified immunosuppressive therapy (OR 4.73 [1.38-16.17], p = 0.013) and lower baseline albumin levels (OR 1.23 [1.09-1.38], p < 0.001) as independent predictive factors of nonresponse to vaccination. Older age (β = -0.59 ± 0.21, p = 0.006) and immunosuppressive therapy (β = 40.33 ± 13.33, p = 0.003) were significantly associated with lower humoral response to vaccination. CONCLUSIONS: Approximately 90% of patients under maintenance hemodialysis developed specific antibodies to the BNT162b2 mRNA vaccine. Immunosuppressive therapy, malnutrition, and older age were associated with a higher risk of nonseroconversion or lower humoral response to mRNA-based vaccination against SARS-CoV-2. We strongly recommend serological monitoring after vaccination to determine booster timing, especially for patients with malnutrition or on immunosuppressive therapy.

6.
Blood Purification ; 50(SUPPL 1):8, 2021.
Article in English | EMBASE | ID: covidwho-1816958

ABSTRACT

Background: Systemic inflammation in Covid-19 patients may induce multiorgan dysfunction. Blood purification techniques may allow resolution of cytokynes storm and help in reducing systemic inflammation. Oxiris® set allows the contemporary removal of cytokines, endotoxin and uremic toxins. The aim of the present study was to assess the efficacy of Oxiris in the treatment of Covid- 19 patients developing AKI during the course of the disease. Methods: We included 11 patients admitted in the Intensive Care Unit (ICU) for severe ARDS secondary to Covid-19 infection and presenting severe AKI requiring CRRT. Oxiris® set was used in patients with clinical and laboratory signs of sepsis and septic shock. The protocol consisted in the two sets for each patient (first change of dialysis circuit after 24 hours). Clinical and laboratory parameters were monitored during the first 72 hours of treatment. Outcomes at 7 days were reported. Results. Median age of included patients was 61 (IQR 55-67) years with a predominance of male participants (7/9, 77.8%). After 72h of treatment, an improvement of inflammatory markers was documented, with the reduction of C-reactive protein (CRP, 122 [77.40, 147] vs 59 [48.10, 125.03]mg/L), procalcitonin (PCT, 5.60 [2.57, 43.80] vs 1.94 [1.86, 2.02]ng/ml), although we did not reach a statistical significance due to the limited sample size. Moreover, a significant emodynamic improvement was documented with the increase of mean arterial pressure (MAP 71.67 [68.33, 82] vs 85.83 [78.33, 89.58]mmHg). Finally, PaO2/FiO2 improved in the first 72h after (P/F ratio 88.60 [72, 129] vs 166 [110.25, 234.50])(Figure 1). 3 patients died in the first 7 days after treatment (3/11, 27%), while 3 patients presented renal recovery. Conclusion Oxiris set represents a valid therapeutic option in the management of patients with Covid-19 infection and severe sepsis. Further studies with higher sample size are needed to assess the role of this treatment in improving clinical outcomes.

7.
Blood Purification ; 50(SUPPL 1):4, 2021.
Article in English | EMBASE | ID: covidwho-1816953

ABSTRACT

Background: Approximately 5 to 10% of patients with AKI require RRT during their stay in the intensive care unit (ICU). The mortality ranges from 30 to 70% so we consider it as high. A common factor that these patients present is hemodynamic instability. Continuous renal replacement therapy (CRRT) has provided physicians with a versatile tool for the care of critically ill patients with hemodynamic instability with indications for RRT such as acid-base disorders, fluid and electrolyte abnormalities, uremia, and / or fluid overload. The CRRT presents different modalities for its application and allows the use of different membranes and cartridges, which is why it is frequently used in patients with multiple organ failure and sepsis with different indication, based upon De basal disease and the need for extracorporeal support. The pathophysiological understanding of this last entity has generated new strategies as a measure for the decrease of inflammatory cytosines. For these reasons, the TRRC has earned a place in the ICU during the SARS-CoV-2 pandemic. Currently, a mortality of 50% is described in the patient with critical Covid-19 and a decrease in it has been reported when they undergo CRRT with the use of the oXiris® membrane. Therefore, the following study was carried out to describe our experience with the oXiris® membrane in patients with Covid-19 in the ICU of a tertiary hospital in northeast Mexico. Methods: Observational, retrospective, and analytical study. Thirteen patients older than 18 years hospitalized in the ICU with a diagnosis of Covid-19 by real-time PCR test were included, who required CRRT with the oXiris® filter between January 2020 and August 2021. Sociodemographic data, number of days total hospital stay (EIH) and ICU;duration and specifications of the TRRC, and its outcome. Results: 13 patients were included, of which 10 were men (76.9%). The mean age was 59.4 ± 12.9 years. The most frequent comorbidities were arterial hypertension (53.8%) and type 2 diabetes mellitus (38.4%);in 7 and 5 patients, respectively. The mean EIH was 60.3 ± 44.9 and 45.8 ± 30 days in the ICU. The median duration of the days with CRRT was 8 (3-11). The main indication for the initiation of CRRT was anuria (61.5%), followed by fluid overload (23%) and uremia (15.4%). Of the total population, 4 (30.7%) recovered kidney function, 5 (38.4%) were discharged with intermittent hemodialysis, and 8 (61.5%) died. In the first 48 hours of the initiation of CRRT with oXiris® the vasopressor requirements decreases besides the creatinine and urea. Conclusions: Despite the use of the oXiris® filter in the patient with critical covid-19, mortality exceeds 50%, even if there is a good response in hemodynamical improvement at the begging of the therapy. We consider that this outcome is dependent on multiple comorbidities and clinical situations not included, so its application should continue to be investigated.

8.
Blood Purification ; 50(SUPPL 1):7, 2021.
Article in English | EMBASE | ID: covidwho-1816950

ABSTRACT

Background: During COVID - 19 pandemia, Obesity has been associated by several authors with worse outcomes in ICU. Acute kidney injury (AKI) is highly prevalent In ICU patients and a main determinant of ominous ICU outcomes. We wanted to evaluate the association between obesity and AKI as a predictor of mortality and need of RRT. Methods: We retrospectively selected from our critical Care Nephrology database in LaCardio hospital in Bogotá- Colombia, adult patients admitted in our ICUs between February to august 2020. Those patients with diagnosis at admission of AKI (according to KDIGO criteria), serum creatinine > 2,5 mg/dL or those receiving dialysis (acute or chronic) or kidney transplantation were excluded. We analyzed obese patients (BMI > 30) admitted to ICU, incidence of AKI, need of replacement therapy (RRT) and mortality during ICU hospitalization. Results: From 1204 new ICU patients, according to selection criteria, we found 490 patients, with mean age 61,3 y.o (18-98). 37% were women. Mean BMI was 26,5 in the overall population. We found 102 obese patients (45,1%), with a mean BMI of 33,6 (30- 46,9). There were 198 patients with acute COVID- 19 (40,4%), of whom 50 patients were obese: 49% (p NS). Basal creatinine value was 1,02 mg/dL at start of hospitalization and 0,91 mg/dL at ICU admission. In the whole group (n 490) there were 160 patients with some AKI KDIGO stage (32%). There was AKI KDIGO 1 or 2 in 27 obese patients, and KDIGO 3 in 8 obese patients (7,8%). There was requirement of RRT in 13 obese patients (12,7%) and 52 in the overall analyzed population (10,6%). We found no statistically significative differences in AKI incidence with non-obese patients. (Table 1) Mean ICU stay was 11,8 days (1-62): in obese patients mean time was 11,4 and in non-obese patients 1,9 days. Mortality was the outcome in 19,2% of our population, in 13 of obese patients (12,7%) and 81 (20,9%) of non-obese patients. Conclusion: In patients admitted to ICU without previous AKI, there was an incidence of newly developed AKI of 32%, and we found no difference between obese or non-obese patients in AKI incidence, mortality or time in ICU. In our hospital, Obese patients with diagnosis of COVID 19 admitted to ICU, did not have more frequent AKI than non-obese COVID patients.

9.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816906

ABSTRACT

The ability to control the proliferation and cell death by inhibiting specific target kinase offers the opportunity to apply targeted therapies in the treatment of cancer. It has been found that (S)-valine-thiazole-derived compounds such as NEOS-223 are effective inhibitors of one or more of these kinases. NEOS 223 was developed, synthesized, and tested in the NCI 60 human tumor cell-screening panel demonstrating inhibition of colon (-53%), melanoma (-41%), and breast cancers (-9%). Microsomal clearance was determined in mouse, rat, dog, and human, and analyzed by LC-MS/MS by percent of parent material. IC50 values for CYP inhibition of >10 μM were calculated for 1A2, 2C19, and 3A4 with IC50 values of 4.86, 4.31, and 7.84 μM for 2C9 and 2D6. Microsomal clearance was high in all species with clearance rates ranging from 69-136 mL/min/kg. Plasma protein binding was determined by Rapid Equilibrium Dialysis in mice, rats, dogs, and humans. High plasma protein binding (>70%) was observed across all species. Based on the NCI results several cell lines were assayed in an MTT assay (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide) to determine cell viability in the presence of NEOS-223 resulting in <20% viability in colon, breast, melanoma, pancreatic and prostate human cancer cell lines at a 10 uM concentration. Maximum tolerated dose studies were conducted by both intraperitoneal and oral administration in mice. NEOS-223 delivered up to 80 mg/kg was well tolerated. Minimal or no toxicity was observed in acute and repeat dose animal studies. Pharmacokinetics of oral administration demonstrated adequate systemic exposure at therapeutic levels in mice, rats, and dogs. Preliminary in vivo mouse xenograft studies were performed on colon (COLO 205, HT-29 red FLUC), breast (MDA-Sumathi Chittamuru;Timothy M. Murphy;Sara A. Little;Andrew A. Taylor;Roseanne Wexler;Laxman Desai MB-468), melanoma (M-14), pancreatic (PANC-1), and prostate (PC3) human cancer cells with significant tumor inhibition observed compared to positive control agent groups with twice daily dosing of NEOS-223. In addition, a five-day pilot oral toxicity study in rats with dose range-finding studies and a 28-day repeat dose toxicity study performed in both rats and dogs provided favorable results. NEOS-223 has demonstrated active in vitro activity along with a favorable safety profile. in vivo efficacy resulted in inhibition of growth of multiple cell line. As a novel effective structure possibly targeting multiple kinases and transporters in one hybrid molecule, NEOS-223 may be a preferred monotherapy or combined therapy for multiple cancers. If upon further development, this drug is effective in humans, it would advance clinical practice and could improve current therapy significantly.

10.
Archives of Medical Research ; 2022.
Article in English | ScienceDirect | ID: covidwho-1814127

ABSTRACT

Aim. We aimed at performing a situation analysis to identify challenges that Mexico's peritoneal dialysis centers (PDCs) have faced before and during the COVID-19 pandemic. Methods. From May–August 2021, we conducted a cross-sectional nationwide online survey with the heads of 136 PDCs at the Mexican Institute of Social Security. The survey gathered information about PDCs characteristics and the adaptations and challenges they faced before and during the COVID-19 pandemic. The response rate to the survey was 79.5% (136 out of 171 PDCs). We used descriptive statistics to analyze the data. Results. The survey responses suggest wide variations between PDCs regarding their number of patients, healthcare staff availability, and compliance with the International Society for Peritoneal Dialysis recommendations. In the pre-pandemic period, PDCs faced staff shortages (71.3%);scarcity of supplies (39.0%);catheter dysfunctions (29.4%);poor patient adherence to peritoneal dialysis (PD) (28.6%);and lack of patient support networks (25.7%). During the pandemic, PDCs faced emergent challenges, such as losing designated PDC areas within hospitals (61.0%), and staff and supply shortages (60.2%, 41.1%, respectively) because of a reallocation of human and physical resources towards the COVID-19 response. The pandemic prompted 86.7% of PDCs to implement preventive public health measures (89%), delay non-urgent consultations and procedures (63.6%), and introduce telemedicine (37.3%). Additionally, fewer patients visited PDCs because of their fear of COVID-19 contagion (36.0%). Conclusions. Actions are urgently needed to ensure adherence to evidence-based PD guidelines and sufficient resources, including trained staff, supplies, and designated spaces to strengthen PDCs and provide safe and effective PD.

11.
Journal of Parenteral and Enteral Nutrition ; 46(SUPPL 1):S127-S128, 2022.
Article in English | EMBASE | ID: covidwho-1813569

ABSTRACT

Background: The consequences of the COVID-19 pandemic in long-term care facilities could be severe for frail and immunocompromised older adults.1 These older adult patients are hypermetabolic due to pressure ulcers, infection, fever, and elevated inflammatory labs such as CRP.1 They experience decreased appetite due to taste and smell changes. The inadequate intake, fat, and muscle loss due to prolonged hospitalization and increased nutrition demands create a negative nutrient balance, leading to unintentional weight loss (UWL).1 According to the Center for Medicare and Medicaid Services (CMS), UWL is defined as a weight loss of 5% in 30 days, 7.5% in 90 days, and 10% in 180 days.2 In this proposal, our focus was unintentional weight loss (UWL) in long-term skilled care patients and how collaborative nursing and dietitian intervention impacts the UWL in this specific population. Methods: The data were collected retrospectively for all patients admitted between May 2020 to March 2021. The patient's demographic data was collected from the chart review using the point click care program. The top five patient diagnoses were retrieved using MDS coding for the study period. Additionally, the most common chronic disease in the geriatric population was used. The red napkin program was initiated in Oct 2020. The red napkin program was initiated to alert the nursing staff for patients with UWL and who also have pressure ulcers. Results: The results indicated that the average census was 152 patients during the study period. The majority of the patients (84%) were long-term care, with more females than males (59 vs 40%). Most of the patients were African American and Caucasian ethnic group. Nearly 40-45% of patients had diabetes, hypertension;one-fourth of the patients had CHF, dialysis, and dementia. During this period, there was a total of 77 patients who had unintentional weight loss as defined by CMS criteria. There were 60 patients before the intervention, and the numbers declined significantly to 33 patients post-intervention. Out of these 33 post-intervention patients, only 17 patients were new, and 16 were from the previous months of the preintervention period. The number has also declined from 12 to 7 expected weight loss related to hospice and comfort care patients. Most patients received oral nutrition supplements to halt weight loss. Four patients received alternate routes of nutrition support (TPN/EN) in addition to an oral diet. Almost 40% of patients had COVID-19 infection, and 38% of patients had pressure ulcers, which may have affected unintentional weight loss. Conclusion: The results indicated that appropriate and timely collaborative dietitian and nursing efforts improve patient outcomes or quality of care to halt unintentional weight loss in long-term skilled care facilities.

12.
Revista de la Federacion Argentina de Cardiologia ; 51(1):32-36, 2022.
Article in Spanish | EMBASE | ID: covidwho-1813131

ABSTRACT

Background: Coronavirus disease (COVID-19) is one of the largest pandemics known to date. Elevated troponin can be caused by multiple factors, but its increase is related to adverse outcomes and higher mortality. In the First Argentine Registry of Cardiac Complications in patients with CO-VID-19 (RACCOVID-19) the Argentine Society of Cardiology (SAC) and the Argentine Federation of Cardiology (FAC) data were analyzed. Objectives: The aim of this study was to learn the troponin elevation rate and its relationship with the prognosis of patients included into the RACCOVID-19. Methods: A total of 2750 patients were included in 50 centers in 11 provinces of the country from May 18 to October 31, 2020. Results: Troponin samples were taken from 2378 patients. The positivity rate was 15.2%. The most common cause of troponin elevation was related to infection (inflammatory) followed by heart failure. The group of patients with elevated troponin showed a higher age, predominant male sex, higher rate of history of asthma/COPD, diabetes mellitus, kidney failure and/or dialysis, and more severe forms of COVID-19. Mortality in the registry was 19.3% and 43.3% in patients with troponin elevation (43.8% vs. 13.9%, p < 0.001). Troponin elevation was independently associated with mortality. Conclusions: The RACCOVID-19 registry showed a troponin positivity rate of 15.2%. These patients presented more comorbidities and more severe forms of the disease. The increase in troponin during hospitalization for COVID-19 is independently associated with higher mortality.

13.
Blood Purification ; 50(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1812556

ABSTRACT

The proceedings contain 33 papers. The topics discussed include: acute kidney injury in children and adolescents hospitalized for diabetic ketoacidosis;urinary biomarkers as predictors of AKI in COVID-19 hospitalized patients with pneumonia;critically ill patients with COVID-19 pneumonia requiring renal replacement therapy with Oxiris membrane in a third level hospital in north-east Mexico;legionellosis followed by acute respiratory distress syndrome successfully treated with antibiotics and polymyxin B hemoperfusion therapy;the role of serum miRNA in leptospirosis-associated acute kidney injury;and polymixin B hemoperfusion in patients with COVID-19 infection and endotoxin shock: a case report.

14.
Journal of Research in Health Sciences ; 22(1):6, 2022.
Article in English | Web of Science | ID: covidwho-1812133

ABSTRACT

Background: Identification of the predictors of coronavirus disease 2019 (COVID-19)-related death in hemodialysis patients plays a key role in the management of these patients. In this regard, the present study aimed to evaluate the predictors of death among COVID-19 infected hemodialysis patients in Hamadan province, Iran. Study design: A cross-sectional study. Methods: This cross-sectional study investigated 50 COVID-19 infected hemodialysis patients who were confirmed by polymerase chain reaction (PCR) test and referred to hemodialysis wards of hospitals located in Hamadan province, Iran, from March 2019 and January 2020. In order to compare the demographic characteristics and clinical variables between survived and deceased patients, the independent student t test and chi-square test were applied. Results: Out of 50 confirmed COVID-19 hemodialysis patients, 27 (54%) cases were male, 38 (76%) subjects were urban residents, and 4 (8%) individuals were smokers. A significant relationship was observed between patients' gender, age, acute respiratory distress syndrome (ARDS) status, and body mass index (BMI) with the treatment outcome (P< 0.05). A significantly higher level of serum albumin was observed in the survived patients (3.49 +/- 0.37 vs. 3.17 +/- 0.42, P= 0.030). Moreover, in terms of lactate dehydrogenase (LDH) level, a significantly higher level of LDH was observed in the patients who died (1471.1 +/- 1484.89 vs. 670.86 +/- 268.85, P = 0.005). Conclusions: It can be concluded that some demographic characteristics of the patients, including age, gender, ARDS status, BMI, co-morbidities, and laboratory signs and symptoms are associated with disease outcomes in COVID-19 infected hemodialysis patients. Therefore, awareness about the predictors of death in these patients can help make better and direct clinical decisions and inform health officials about the risk of COVID-19 mortality among hemodialysis patients.

15.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-333388

ABSTRACT

Abstract Background: The COVID-19 pandemic has resulted in worldwide kidney transplantation (KT) moratoriums. The impacts of these moratoriums on the life expectancy of KT candidates remain unclear. Methods: We simulated the evolution of several French candidate populations for KT using a multistate semi-Markovian approach and according to moratorium durations ranging from 0 to 20 months. The transition rates were modeled from the 63,927 French patients who began dialysis or were registered on the waiting list for KT between 2011 and 2019. Findings: Among the 8,350 patients active on the waiting list at the time of the French KT moratorium decided on March 16, 2020, for 2.5-months, we predicted 4.0 additional months [CI: 2.9, 5.1] on the waiting list and 45 additional deaths [CI: -52, 142] up to March 16, 2030. In this population, we reported a significant impact for a 9-month moratorium duration: 139 attributable deaths [CI: 44, 260] up to March 16, 2030. The other populations of patients who became active on the list after March 2020 were less impacted. Interpretation: The temporary moratorium of KT during a COVID-19 peak represents an acceptable decision to free up hospitals’ resources if the moratorium does not exceed a prolonged period.

16.
Nephrology (Carlton) ; 27(5): 391-403, 2022 May.
Article in English | MEDLINE | ID: covidwho-1799261

ABSTRACT

Peritoneal dialysis (PD) has several advantages compared to haemodialysis (HD), but there is evidence showing underutilization globally, especially in low-income and lower-middle-income countries (LLMICs) where kidney replacement therapies (KRT) are often unavailable, inaccessible, and unaffordable. Only 11% of all dialysis patients worldwide use PD, more than 50% of whom live in China, the United States of America, Mexico, or Thailand. Various barriers to increased PD utilization have been reported worldwide including patient preference, low levels of education, and lower provider reimbursement. However, unique but surmountable barriers are applicable to LLMICs including the excessively high cost of providing PD (related to PD fluids in particular), excessive cost of treatment borne by patients (relative to HD), lack of adequate PD training opportunities for doctors and nurses, low workforce availability for kidney care, and challenges related to some PD outcomes (catheter-related infections, hospitalizations, mortality, etc.). This review discusses some known barriers to PD use in LLMICs and leverages data that show a global trend in reducing rates of PD-related infections, reducing rates of modality switches from HD, and improving patient survival in PD to discuss how PD use can be increased in LLMICs. We therefore, challenge the idea that low PD use in LLMICs is unavoidable due to these barriers and instead present opportunities to improve PD utilization in LLMICs.


Subject(s)
Kidney Failure, Chronic , Peritoneal Dialysis , Developing Countries , Dialysis Solutions , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Peritoneal Dialysis/adverse effects , Renal Dialysis , United States
17.
Journal of Heart and Lung Transplantation ; 41(4):S459, 2022.
Article in English | EMBASE | ID: covidwho-1796806

ABSTRACT

Introduction: Extracorporeal photophoresis (ECP) has been used for select heart transplant (HT) recipients with acute cellular rejection, recurrent or refractory rejection, antibody-mediated rejection (AMR) and as prophylactic therapy. Effects of ECP on coronary allograft vasculopathy (CAV) are not as well-described. Case Report: A 48 year-old man with a history of familial cardiomyopathy required left ventricular assist device therapy and ultimately HT in 2001. He developed ISHLT CAV 1 (40% stenosis of LCx and RCA) with severe microvascular dysfunction detected on PET scan (MFR Total 1.14, LAD 1.11, LCx 0.98, RCA 1.40). He was started on treatment with everolimus, but progressive chronic kidney disease necessitated a change back to mycophenolate mofetil. Following this change, his chronic Class II DSA increased significantly and his renal function worsened requiring dialysis, during which time he also had COVID-19. He then presented in cardiogenic shock with ISHLT CAV 3 and pAMR 2 in July 2020 and was treated with an IABP, plasmapheresis, and thymoglobulin. He had recurrent pAMR 2 three months later, for which he was treated with plasmapheresis, bortezomib, rituximab, and ECP. Prior to initiation of ECP, his coronary angiogram demonstrated rapidly progressive ISHLT CAV 3 (80% proximal LAD, 80% ostial LCx, 70% OM1, and 80% mid RCA). Right heart catheterization demonstrated restrictive filling pressures and echocardiogram demonstrated normal graft systolic function. Four months following initiation of ECP therapy, repeat coronary angiography showed improvement of his CAV: the stenosis in the pLAD had regressed to 50%, the proximal LCX stenosis had regressed to 50%, and disease in the distal circumflex artery had also improved (Figure). In our patient, ECP along with multiple other therapies was associated with significant regression of CAV. Even many years post-HT, CAV may be amenable to some therapies.

18.
Journal of Heart and Lung Transplantation ; 41(4):S508-S509, 2022.
Article in English | EMBASE | ID: covidwho-1796805

ABSTRACT

Purpose: Many acceptable donor hearts are turned down by pediatric centers with varying criteria for an acceptable donor. Advanced Cardiac Therapy Improving Outcome Network (ACTION) and Pediatric Heart Transplant Society (PHTS) centers convened a multi-institutional donor decision discussion forum (DDDF) aimed at assessing donor acceptance practice and reducing practice variation across centers. Methods: The team hosted an hour-long monthly virtual DDDF among pediatric transplant centers across North America, UK and Brazil. Each call had two case presentations posing a donor decision challenge for the presenting center at the time of donor offer. Following each presentation, the attendee group was polled to obtain insight on donor acceptance practices after which the presenting center's decision was revealed. Then, group discussion occurred including a review of relevant literature and latest PHTS data related to the case. Metrics of participation, participant agreement with presenting center decision and impact on future decision making were collected and analyzed. Results: Over 14 months, 23 cases were discussed;an average of 50 physicians, nurses and fellows attended each call. The mean donor age was 8.2 ± 3.3 years (28.6% infants, 52.4% young adults), and the mean recipient age was 8.36 ± 3.3 years (27.3% infants and 40.9% teenagers). Reason for listing was congenital heart disease in 10, cardiomyopathy in 5 and retransplantation in 3. Risk factors influencing decision making included size discrepancy (4), Infection (5), COVID (2), Prolonged QT (2), Malignancy (2), Drugs (2), Distance (1) Prolonged CPR (1) high inotrope use (1) Dialysis (1) Diabetes (1) HLA mismatch (1). Of the 23 cases, 15 were declined by presenting center. Donor characteristics influenced 45% of the decisions and recipient only 20%, with rest being other factors. Participants agreed with the decision made by the presenting center 55% of the times. The post-presentation discussion resulted in 30% of participants changing their original decision. Conclusion: DDDF identified significant variation in pediatric donor acceptance practices;with donor characteristics most influential in decision-making. Given that the discussions changed decisions in 1/3rd of the participants, DDDF may be a useful format to reduce practice variation, provide education to decision makers and eventually increase donor utilization.

19.
Journal of Heart and Lung Transplantation ; 41(4):S341-S342, 2022.
Article in English | EMBASE | ID: covidwho-1796804

ABSTRACT

Purpose: Gene expression profiling (GEP) and donor-derived cell-free DNA (dd-cfDNA) provide effective non-invasive rejection surveillance for heart transplant (HT) recipients with a trend toward improved quality of life. During the COVID-19 pandemic, rejection monitoring and titration of mediations in HT patients was difficult due to limited health-care resources for endomyocardial biopsy (EMBx). This is the first Canadian study to assess non-invasive rejection surveillance in improving patient satisfaction and reducing anxiety during HT rejection screening. Methods: Adult HT recipients, at least 6 months post-transplant, were enrolled to have surveillance EMBx replaced by non-invasive rejection testing with GEP and dd-cfDNA. Patients with multiorgan transplant, dialysis, or high rejection risk (recent acute cellular rejection ≥ grade 2R, new graft dysfunction, or heart failure) were excluded. All patients completed the Medical Outcomes Study 12-item Short Form Health Survey (SF-12) and a patient satisfaction survey. Thematic analysis was performed for open-ended responses. Results: Out of 90 patients screened, 31 had their routine EMBx replaced by non-invasive rejection testing. Based on test results, 89% of EMBx were safely eliminated. On the SF-12, participants had a median physical health score of 43 (40-53) and mental health score of 53 (46-58) out of 100. Patients’ self-reported satisfaction was 90%. Median self-reported anxiety score prior to EMBx was 50 (10-71) versus 2.5 (0-7.5) out of 100 prior to GEP/dd-cfDNA. Four codes (“emotions” (pain, anxiety, fear), “time”, “biopsy”, “accuracy”) were used to uncover two themes of “Superiority to Biopsy” and “Mental or Physical Stress”. Patients described feeling much more satisfied and less emotionally distressed with the non-invasive screening compared to EMBx. HT patients reported less fear and anxiety, reduced pain, and enjoyed the simplicity of non-invasive testing. Conclusion: Non-invasive rejection surveillance screening can positively impact patients’ mental health. In this study, non-invasive rejection surveillance eliminated the recovery time and risk of an invasive procedure for HT recipients while reducing anxiety, improving patient satisfaction, and providing an alternative way to screen patients during a period of limited resources due to a global pandemic.

20.
Journal of Heart and Lung Transplantation ; 41(4):S344, 2022.
Article in English | EMBASE | ID: covidwho-1796802

ABSTRACT

Introduction: Myocarditis is an inflammatory disease of cardiac muscle caused by a variety of infectious and non-infectious conditions. Viral infection is the most frequent cause of myocarditis;however, herpes simplex virus 1 (HSV-1) infection causing myocarditis has been rarely described. We present a case of a young woman with HSV-1 viremia and fulminant myocarditis presenting with cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO), complicated by hyperhemolysis. Case Report: A 35 year-old immunocompetent woman with moderate alcohol consumption presented to hospital with a 4-day history of fever and flu-like symptoms. She was fully vaccinated for COVID-19 two months prior to symptom onset. Her COVID-19 testing was negative and she was discharged home. She returned to hospital 4 days later in cardiogenic shock. Transthoracic echocardiogram demonstrated LVEF of 30% with a small pericardial effusion. Coronary angiogram revealed normal coronaries. She was placed on peripheral VA-ECMO for worsening cardiogenic shock. Due to inadequate LV unloading, she underwent atrial septostomy. Five days after VA-ECMO cannulation, HSV-1 was detected in the blood and she was started on intravenous acyclovir. Her ECMO course was complicated by acute kidney injury requiring dialysis, and hyperhemolysis with a peak LDH of 12,000 U/L. The mechanism of hemolysis was attributed to an intravascular process (plasma free hemoglobin 7487 mg/L, normal < 150 mg/L) likely from a combination cold agglutinins and the mechanical circuit. Interestingly the membrane pressure gradient was within normal. The patient received treatment with plasmapheresis (Table 1), and was eventually decannulated after 12 days following hemodynamic improvement. This case report highlights a rare viral cause of fulminant myocarditis and emphasizes the need for collaboration among various specialists in the management of complex cases.

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