Peritoneal videodialysis: first Italian audit.

Conceived and developed since 2001 at the Alba Center, Videodialysis (VD) was used initially to prevent dropout in prevalent PD patients by guiding them in performing dialysis (VD-Caregiver). Subsequently, its use was extended to the clinical follow-up of critical patients (VD-Clinical), problems relating to transport to the Center (VD-Transport), and since 2016 for training/retraining all patients (VD-Training). Since 2017 other Centers have employed VD using modalities analyzed in this paper. Methods: the paper reports the findings of an Audit (February 2021) of the Centers using VD on 31-12-2020. The Centers provided the following information: the characteristics of the patients using VD; the main and secondary reasons for using VD, considering nursing home (VD-NH) patients separately; VD outcomes: duration, drop-out, peritonitis, patient/caregiver satisfaction (minimum: 1 - maximum: 10). Results: VD, which began between 09-2017 and 12-2019, has been used in 6 Centers for 54 patients at 31-12-2020 (age:71.8±12.6 years - M:53.7% - CAPD:61.1% - Assisted PD:70.3%). The most frequent reason has been VD-Training (70.4%), followed by VD-Caregiver (16.7%), VD-NH (7.4%), VD-Clinical (3.7%), and VD-Transport (1.9%), with differences between Centers. VD-Training is used most with self-care patients (93.8% - p<0.05), while with patients on Assisted PD it is associated with secondary reasons (95.7% - p<0.02). VD-Training (duration: 1-4 weeks) has always been completed successfully. No peritonitis was reported; satisfaction was 8.4±1.4. Conclusion: videodialysis is a flexible, effective, safe, and valued tool that can be employed using various modalities depending on the choice of the Center and the complexity of the patient.

Blood pressure and cardiovascular mortality in dialysis patients with left ventricular systolic dysfunction.

BACKGROUND: In patients chronically treated with hemodialysis, the prevalence of heart failure is high with a consequently poor prognosis. The role played by blood pressure (BP) on cardiovascular (CV) mortality of these patients has not been clearly defined. METHODS: In this follow-up study, we investigated the relationship of pre- and postdialysis measurements of BP with CV and all-cause mortality in a cohort of 557 dialysis patients with a left ventricular (LV) ejection fraction <50%. RESULTS: During the follow-up (mean = 21.6 ± 8.8 months), 179 deaths were recorded. Ninety-eight patients died from CV causes. By the Cox multivariable analysis, we constructed a predictive model of CV mortality including age, duration on dialysis, diabetes, serum albumin, diffusive dialysis technique, predialysis mean arterial pressure (MAP) (hazard ratio (HR) = 0.978; 95% confidence interval (CI) = 0.956-0.999), and postdialysis MAP (HR = 1.035; 95% CI = 1.010-1.061). The relationship with mortality was inverse for predialysis MAP and direct for postdialysis MAP. In a subsequent analysis, we found that pre- and postdialysis systolic BP, but not diastolic BP, were predictive of CV mortality. Predialysis MAP was in a direct relationship with body mass index. Postdialysis MAP had an inverse relationship with weight loss during dialysis session. CONCLUSIONS: CV mortality in dialysis patients with LV dysfunction is associated with both pre- and postdialysis BP interacting in a complex relationship. Nutritional state and fluid balance and removal are possible clues to this relationship.

Systolic blood pressure and mortality in chronic hemodialysis patients: results of a nationwide italian study.

Studies on the relationship between blood pressure (BP) and mortality among hemodialysis patients have yielded conflicting results. Reports have come mostly from North America and have dealt with dialysis patients as a homogenous population and differed in methods and time of BP measurement and the optimal BP target. In a prospective nationwide study in 3674 unselected Caucasian patients with end-stage renal disease undergoing chronic hemodialysis from 73 dialysis units, the authors sought to examine the relationship between the different measurements of BP and mortality according to antihypertensive treatment. The mean age of patients was 67.2±14.1 years and the prevalence of diabetes was 19.5%. During follow-up (26.5±10.5 months), 977 deaths were recorded. In the whole cohort, BP was not associated with mortality. After grouping the patients according to antihypertensive treatment, the analysis showed that only in patients who did not take antihypertensive medications (1613) was there an inverse relationship between postdialysis systolic BP and mortality. These patients differed from the others in BP, dialysis vintage, prevalence of diabetes, and type of dialysis technique. This study suggests that with respect to the relationship of BP with mortality, dialysis patients are not a homogenous population. Differences in demographic characteristics and in dialysis technique may therefore explain the reported variability of previous results.

Prevalence of hypertension in a large cohort of Italian hemodialysis patients: results of a cross-sectional study.

BACKGROUND: Hypertension is very common among patients receiving hemodialysis; however, little is known about its prevalence and control following the publication of the Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations. METHODS: This was a multicenter, observational, prospective, cross-sectional study aimed at evaluating the prevalence of hypertension and its awareness in a large sample of hemodialysis patients in Italy, and assessing possible relationships between high blood pressure (BP) values and traditional and nontraditional cardiovascular risk factors. Predialysis hypertension was defined as systolic BP (SBP) / diastolic BP (DBP) =140/90 mm Hg, and postdialysis hypertension as SBP/DBP =130/80 mm Hg or the use of antihypertensive medications. RESULTS: We collected data for 4,022 patients (men/women 2,478/1,544, mean age 67.14 ± 14.08 years) from 77 dialysis centers. Of these, 2,832 patients (70.3%) were defined as having predialysis hypertension. At logistic regression analysis, diabetes, months on dialysis, serum albumin levels and treatment with erythropoiesis-stimulating agent (ESA) were independent factors predicting predialysis hypertension. Antihypertensive agents were used in 57.7% of the patients, leading to adequate BP control in only 40% of them. Factors independently predicting inadequate BP control were diabetes, ESA therapy, high serum cholesterol and higher Kt/V values. CONCLUSIONS: Hypertension is highly prevalent in this Italian hemodialysis population; achievement of adequate BP control is inadequate. It is unclear whether this may reflect suboptimal diagnosis or treatment of hypertension or, more likely, the allowance of higher predialysis BP values to try to avoid abrupt BP falls during the dialytic session.