[Frailty in renal diseases]. / "Frailty" bei nephrologischen Erkrankungen.

The term frailty describes a complex syndrome of reduced resistance to stress factors as a consequence of age-related degeneration in various organ systems.In the general population frailty is associated with poor clinical outcomes, including an increased risk of falls, hospitalization, functional impairment and mortality. Frailty occurs earlier and its prevalence is higher in patients with chronic kidney disease (CKD) compared to the general population. Frail patients with CKD, on dialysis or not, have reduced quality of life and increased hospitalization and mortality rates, regardless of age, sex or comorbidities.The identification of frailty in patients with CKD can lead to the detection of important and potentially modifiable risk factors. Early nephrological evaluation coupled with an interdisciplinary approach including primary care physicians, geriatricians, physiotherapists, occupational therapists and nutritionists, is fundamental in the prevention of frailty as well as in the management of frail patients with CKD.Several instruments have been developed to screen for and assess the degree of frailty; however, there is currently no recommendation as to which should be used in nephrology and how to manage frail patients with CKD. In this article we suggest an approach based on a multidimensional, interdisciplinary evaluation aimed at the early identification and management of frail CKD patients independent of the clinical setting of admission; however, more important than the method used is the need to identify and follow-up on frail CKD patients.

Eculizumab in chemotherapy-induced thrombotic microangiopathy.

Thrombotic microangiopathy (TMA) is a rare but severe complication of tumors and their chemotherapeutic treatment. We report on two patients with chemotherapy-induced TMA who were successfully treated with a short course of the terminal complement inhibitor eculizumab. Both patients quickly achieved remission of microangiopathic hemolytic anemia and recovery of renal function. After withdrawal of eculizumab, remission was stable over an observation period of 47 months and 15 months, respectively. Our data show that eculizumab is effective in treating chemotherapy-induced TMA. Discontinuation of eculizumab is feasible once the complement-activating condition is controlled and the trigger is eliminated. Additional studies need to determine the optimal duration of complement-directed therapies and validate effective monitoring strategies after discontinuation of such therapy.

Survey among nephrologists in Germany: current practice and management of pregnant women on dialysis
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BACKGROUND: To assess the experience and practice patterns of nephrologists in Germany with regard to the care of pregnant women on dialysis. METHODS: The 26-item internet survey sent by email asked for demographic information, subjective proficiency, maternal and fetal complications, treatment approaches and goals. RESULTS: Of the 2,015 surveys sent out, 200 (10%) were available for evaluation. 38% of respondents never provided care, whereas 62% treated at least one pregnant patient on dialysis. In 306 total reported cases of pregnant women on dialysis, 58% became pregnant while on maintenance dialysis, and 42% developed dialysis-dependent renal failure in the course of pregnancy. For women on peritoneal dialysis (PD), only 22% of the nephrologists would continue PD until delivery, while 78% would convert to hemodialysis either immediately or shortly before delivery. 40% of the respondents reported complications in either mother or child. 45% of the respondents routinely provided prenatal counseling, and 2/3 of the nephrologists did not routinely perform fetal monitoring. While we found a significant difference in self-reported proficiency between nephrologists having and those not having treated pregnant women on dialysis, only 40% of all physicians felt confident in treating pregnant women on dialysis. CONCLUSIONS: Our survey demonstrates that the practice of nephrologists in treating pregnant women on dialysis differs significantly. These findings highlight the need for European guidelines to standardize the care of pregnant dialysis patients.
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