Treatment of acute kidney injury with continuous renal replacement therapy and cytokine adsorber (CytoSorb®) in critically ill patients with COVID-19.

INTRODUCTION: This retrospective study aimed to evaluate the 30 and 60-day survival of critically ill patients with COVID-19 and AKI. METHODS: Inflammatory and biochemical biomarkers, length of intensive care unit (ICU) stay and mortality at Day 30 and Day 60 after ICU admission were analyzed. A total of 44 patients treated with continuous renal replacement therapy (CRRT) with cytokine adsorber (CA group) were compared to 58 patients treated with CRRT alone (non-CA group). RESULTS: Patients in CA group were younger, had better preserved kidney function prior to the beginning of CRRT and had higher levels of interleukin-6. There were no statistically significant differences in their comorbidities and in other measured biomarkers between the two groups. The number of patients who died 60 days after ICU admission was statistically significantly higher in non-CA group (p = 0.029). CONCLUSION: Treatment with CRRT and cytokine adsorber may have positively influenced 60-day survival in our COVID-19 ICU patients with AKI.

Association between lung comets and subendocardial viability ratio in peritoneal dialysis patients.

AIMS: Pulmonary congestion is a direct result of either general overhydration or cardiac dysfunction. Lung ultrasonography (LUS) with lung B-lines (LUS comets) can be used to assess extravascular lung water in patients with end-stage renal disease on hemodialysis or peritoneal dialysis (PD). Subendocardial viability ratio (SEVR) is a pulse wave analysis parameter that is a non-invasive measure of coronary perfusion and is related to cardiac work and oxygen consumption. Our aim was to investigate the association between LUS comets and SEVR in PD patients. MATERIALS AND METHODS: We performed an observational study in 25 PD patients in a single dialysis center. Extravascular lung water was quantified by the number of LUS comets, using a portable ultrasound (US) device. LUS comets were recorded in each intercostal space and defined as hyperechoic US bundles at a narrow base extending from the transducer to the edge of the screen. The sum of LUS comets yields a score reflecting the extent of water accumulation in the lungs. SEVR was determined non-invasively by radial applanation tonometry. RESULTS: Mean age of patients was 54.7 ± 10.7 years, mean PD vintage 27 ± 33 (1 - 167) months, 60% were men. The mean number of LUS comets was 13 ± 19 (0 - 71), and the mean SEVR was 153 ± 40%. We found a statistically significant negative correlation between the number of LUS comets and SEVR (r = -0.467; p = 0.019). Multiple regression analysis with LUS comets as dependent variable, and SEVR and age as independent variables showed a statistically significant relationship between SEVR and the number of LUS comets (ß = -0.467, p = 0.021). CONCLUSION: Higher number of LUS comets is associated with lower SEVR in PD patients.

Collagen type III nephropathy as a systemic disease? - A case report / Glomerulopatía por colágeno tipo III como enfermedad sistémica: caso clínico

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The effect of high-flux hemodialysis and post-dilution hemodiafiltration on platelet closure time in patients with end stage renal disease.

INTRODUCTION: We aimed to compare prospectively the effect of high-flux hemodialysis and post-dilution hemodiafiltration on platelets. METHODS: Twenty-two hemodialysis patients were treated with one high-flux hemodialysis and one post-dilution hemodiafiltration procedure. PFA-100 closure times (collagen/epinephrine-CEPI and collagen/adenosine diphosphate-CADP) were measured before and after the procedure, as well as platelet count, hemoglobin, hematocrit, and red blood cell count. All pre-dialysis and post-dialysis samples were taken from the afferent line. FINDINGS: The platelet count after vs. before hemodialysis did not change significantly (229.3 ± 55.0 x109 /L vs. 233.6 ± 55.8 × 109 /L; P = 0.269), but was significantly lower after post-dilution hemodiafiltration (215.5 ± 51.7 × 109 /L vs. 245.3 ± 59.9 × 109 /L; P < 0.0001). CEPI after vs. before hemodialysis was not significantly prolonged (192.9 ± 60.8 s vs. 173.4 ± 52.5 s; P = 0.147), and the same applied to CADP (143.6 ± 40.3 s vs. 142.6 ± 38.4 s; P = 0.897). CEPI after vs. before post-dilution hemodiafiltration was significantly prolonged (268.3 ± 41.3 s vs. 176.4 ± 54.0 s; P < 0.0001) as was CADP (221.0 ± 53.9 s vs.133.9 ± 31.1 s; P < 0.0001). DISCUSSION: Only after post-dilution hemodiafiltration, we found a lower platelet count and prolonged platelet closure times.

Relationship between subendocardial viability ratio and hemoglobin in patients with chronic kidney disease.

AIMS: Pulse wave analysis (PWA) uses the technique of applanation tonometry to obtain a peripheral pulse pressure waveform from which central hemodynamic information is derived. Using PWA, subendocardial viability ratio (SEVR) can be measured. SEVR represents a noninvasive measure of myocardial perfusion. It is related to the work of the heart, the oxygen consumption, and the energy supply of the heart. Anemia is a common complication of chronic kidney disease (CKD). A complex relationship exists between CKD, cardiovascular disease (CVD), and anemia. The aim of our study was to assess the relationship between SEVR and hemoglobin in non-dialysis CKD patients. MATERIAL AND METHODS: We examined the associations between PWA hemodynamic parameters, 24-hour ambulatory blood pressure (BP) measurements, and laboratory variables including hemoglobin, cardiac biomarkers troponin I, NT-proBNP, and hs-CRP in a cohort of 91 nondialysis CKD patients. PWA was assessed by radial applanation tonometry (SphygmoCor, Atcor, Sydney, Australia). The patients were divided into two groups according to the median value of hemoglobin. RESULTS: Mean age of included patients was 60.2 years, 67% were men, 44% were smokers, 25.3% had diabetes. A significant correlation between hemoglobin and SEVR was found (r = 0.26; p = 0.012). With multivariate regression analysis, SEVR as dependent variable turned out to be statistically significantly associated with hemoglobin (ß = 0.344, p = 0.013) and with troponin I (ß = -0.217, p = 0.037). Patients in the group with lower hemoglobin had statistically-significantly higher serum creatinine, cystatin C, NT-proBNP, and 24-hour ambulatory systolic BP and lower e-GFR, SEVR, and office diastolic BP. CONCLUSIONS: Results of our study show that SEVR is independently associated with hemoglobin in nondialysis CKD patients. CKD patients with lower hemoglobin have lower SEVR.
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Fetuin-A as a risk factor for mortality in hemodialysis patients.

OBJECTIVES: Fetuin A, a circulating inhibitor of calcification, is regulated as a negative acute-phase protein. However, its relationship with outcomes of patients undergoing hemodialysis has not been well evaluated. The aim of our study was to determine the association between fetuin-A and some factors of metabolism and their impact on all-cause mortality in hemodialysis patients. PATIENTS AND METHODS: The study comprised 106 hemodialysis patients, 45 of whom were women. Levels of serum fetuin-A were measured by ELISA and serum intact parathyroid hormone (iPTH) by immunoassay in each patient. Serum Ca, serum P, Ca x P product, alkaline phosphatase, cholesterol, triglycerides, bicarbonate, albumin, homocysteine and C-reactive protein (CRP) were measured using routine laboratory methods. Survival rates were analyzed using Kaplan-Meier survival curves. A Cox regression model was used to access the possible influence of variables on all-cause mortality. RESULTS: The mean value of fetuin-A was 15.3 +/- 3.8 g/l, range 5.5-23.7 g/l. Significant correlations were found between serum fetuin-A and serum iPTH (r = -0.239; P = 0.014), alkaline phosphatase (r = -0.240; P = 0.013), triglycerides (r = +0.236; P = 0.015) and serum albumin level (r = +0.286; P = 0.003). Patients were followed-up prospectively from the first day of the laboratory measurement for a maximum of 752 days or until death. A total of 24 patients died. Surviving patients had higher levels of fetuin-A (P = 0.005), serum cholesterol (P = 0.0001), triglycerides (P = 0.004), albumin (P = 0.0001) and homocysteine (P = 0.028). Kaplan-Meier survival analysis showed higher mortality in the first tertile of fetuin-A than in the third tertile (P = 0.0297). In our patients, serum Ca (P = 0.025), serum P (P = 0.040) and the Ca x P product (P = 0.039) were found to be predictors of mortality in the Cox multivariable regression model. CONCLUSIONS: In patients undergoing hemodialysis, lower fetuin-A levels are associated with higher mortality. Metabolism of Ca and P were directly associated with higher mortality.

Vitamin D as a novel nontraditional risk factor for mortality in hemodialysis patients.

We examined the prevalence of vitamin D deficiency in hemodialysis patients and tested the hypothesis that decreased levels of 25-hydroxyvitamin D (25D) are associated with an increased risk for early all-cause mortality. One hundred and two patients, 57 (56%) men and 45 (44%) women, mean age 60.5 +/- 13.1 years, were included in our study. Serum calcium and phosphorus levels were measured by routine laboratory methods. Parathyroid hormone (PTH) was measured by immunoassay and 25D by enzyme immunoassay. Patients were divided into two groups depending on the serum concentration of 25D: below or above 50 nmol/L. Survival rates were analyzed using the Kaplan-Meier survival curves. The Cox regression model was used to define potential variables effecting all-cause mortality. The mean level of 25D in all patients was 58 +/- 35.6 nmol/L, 52% of patients had 25D levels >50 nmol/L and 48% had levels of 10.5-50 nmol/L. Compared with men, women were more likely to be 25D deficient (67% vs. 37%; P = 0.005). Patients were observed from the date of laboratory measurement until their death or to a maximum of 730 days. Kaplan-Meier survival analysis showed that mortality in patients was significantly higher in the group with 25D levels < or =50 nmol/L (P < 0.033). With Cox multivariable regression modeling, the PTH level (P < 0.029) turned out to be the only predictor of mortality in our patients. Using the definitions recommended in the National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines, we found that our hemodialysis patients on average have vitamin D insufficiency. Our results indicate that patients with 25D levels < or =50 nmol/L are associated with higher all-cause early mortality.