Bicarbonate levels in hemodialysis patients switching from lanthanum carbonate to sucroferric oxyhydroxide.

AIM: To examine possible alterations in acid-base parameters in patients switching from lanthanum carbonate (LanC) to sucroferric oxyhydroxide (SFOH). METHODS: Fifteen stable hemodialysis patients were switched from LanC to SFOH. Only nine continued on SFOH, three returned to LanC and the other three switched to sevelamer carbonate. The later six patients served as a control group to the SFOH group of nine patients. Blood was sampled on the 3-d and the last 2-d interval of the week prior to switching and six weeks after. Bicarbonate levels (HCO3 -), pH, pO2, pCO2 were measured, and the mean of the two measurements (3-d and 2-d interval) was calculated. RESULTS: Comparing pre-switching to post-switching measurements in the SFOH group, no statistically significant differences were found in any of the parameters studied. The mean pre-switching HCO3 - was 22.41 ± 1.66 mmol/L and the mean post-switching was 22.62 ± 2.25 mmol/L (P = 0.889). Respectively, the mean pH= 7.38 ± 0.03 vs 7.39 ± 0.03 (P = 0.635), mean pCO2= 38.41 ± 3.29 vs 38.37 ± 3.62 mmHg (P = 0.767), and Phosphate = 1.57 ± 0.27 vs 1.36 ± 0.38mmol/L (P = 0.214). There were not any significant differences when we performed the same analyses in the control group or between the SFOH group and control group. No correlations were found, either between pre-switching LanC daily dose or between post-switching daily dose of the new binder and the measured parameters. CONCLUSION: In our small study, switching from LanC to SFOH did not have any significant effect on blood bicarbonate levels and gas analysis, indicating that there is no need to change hemodialysis prescription regarding these parameters.

Right atrial thrombi complicating haemodialysis catheters. A meta-analysis of reported cases and a proposal of a management algorithm.

BACKGROUND: Little is known about the potentially fatal complication of catheter-related right atrial thrombus (CRAT) in dialysis patients, and the optimal management is controversial. The aims of our study were to identify the prognostic factors of mortality in cases of CRAT in dialysis patients and to compare treatment options. METHODS: Retrospective analysis of all reported cases of CRAT in adult dialysis patients, in English-language literature (PubMed search), in which therapy and outcome data were available. RESULTS: Up to December 2010, we identified 71 cases of CRAT in dialysis patients (including our patient). Overall mortality was 18.3% (13/71) and significant predictors were advanced age, presence of complications and non-removal of the catheter. Nine patients received no treatment, except for catheter removal and antibiotics, four of them died. Systemic thrombolysis was administered in eight patients but was successful only in two with pulmonary embolism, the remaining required further treatment. Finally, 37 patients received anticoagulation and 23 underwent surgical thrombectomy (one percutaneous intravascular removal of the thrombus). Mortality was 16.2% (6/37) and 13% (3/23), respectively, P=1. Regarding presence of various complications, no treatment choice was superior over the other. Five of the six patients who had a thrombus≥60 mm underwent successful surgical thrombectomy. CONCLUSIONS: We propose a management algorithm emphasizing the removal of the catheter and recommending anticoagulation as first-line treatment. Surgical thrombectomy is valuable when other treatments fail or in special circumstances. Thrombolysis has a poor success rate but may be useful in pulmonary embolism.

Pandemic 2009 influenza H1N1 virus vaccination: compliance and safety in a single hemodialysis center.

BACKGROUND: Acceptance of vaccination against pandemic 2009 H1N1 influenza virus has been poor in some countries, perhaps because of concerns about safety of the new vaccine. SUBJECTS AND METHODS: We prospectively examined vaccination compliance and reasons for nonvaccination in the dialysis patients and the staff of a single hemodialysis unit, after on-site vaccination with a monovalent inactivated adjuvanted H1N1 vaccine. Safety profile was evaluated and compared to that of a control group without chronic kidney disease (CKD). RESULTS: Vaccination acceptance among dialysis patients in our unit was 68% (110/161). Dialysis patients vaccinated against H1N1 had significantly higher compliance with vaccination for seasonal influenza and pneumococcus than those unvaccinated. Three out of 34 (9%) of the unit's staff received the vaccine. Fear of side effects was the main reason for not vaccinating in both groups, while several participants did not consider pandemic influenza a serious disease. At least one adverse reaction was observed in 37/110 (33.6%) of the vaccinated dialysis patients and in 22/42 (52.4%) of the non-CKD control group, p = 0.034. Local mild pain at injection site was the most common side effect of vaccination in both groups. All side effects were of short duration and no serious adverse reactions related to the vaccine or reactions of special interest occurred during the follow-up period. CONCLUSIONS: Our findings indicate that immunization against H1N1 virus in dialysis patients is safe and do not support the concerns about safety of the vaccine that was the main reason for nonvaccination in our study.

Interstitial nephritis and nephrogenic diabetes insipidus in a patient treated with pemetrexed.

We present a case of interstitial nephritis and nephrogenic diabetes insipidus (NDI) in a patient treated with pemetrexed (500 mg/m(2)) for non-small cell lung cancer. Renal impairment and diabetes insipidus appeared after the first treatment cycle while he totally received four cycles of chemotherapy. There was not any significant myelosuppression and the patient was on regular supplementation with folic acid and vitamin B(12). He was not on any other medications and he did not receive any nephrotoxic agents. Kidney biopsy showed acute tubular necrosis together with interstitial inflammatory infiltrate of mononuclear cells and interstitial fibrosis occupying 25% of the cortex. There was not any improvement of renal function after a 2-week trial of oral prednisone. In the present case report, we review the literature for pemetrexed-induced renal toxicity and the possible mechanisms involved.