The SARS-CoV-2 epidemic is pressuring healthcare systems worldwide. Disease outcomes in certain subgroups of patients are still scarce, and data are needed. Therefore, we describe here the experience of four dialysis centers of the Brescia Renal COVID Task Force. During March 2020, within an overall population of 643 hemodialysis patients, SARS-CoV-2 RNA positivity was detected in 94 (15%). At disease diagnosis, 37 of the 94 (39%) patients (group 1) were managed on an outpatient basis, whereas the remaining 57 (61%) (group 2) required hospitalization. Choices regarding management strategy were made based on disease severity. In group 1, 41% received antivirals and 76% hydroxychloroquine. Eight percent died and 5% developed acute respiratory distress syndrome (ARDS). In group 2, 79% received antivirals and 77% hydroxychloroquine. Forty two percent died and 79% developed ARDS. Overall mortality rate for the entire cohort was 29%. History of ischemic cardiac disease, fever, older age (over age 70), and dyspnea at presentation were associated with the risk of developing ARDS, whereas fever, cough and a C-reactive protein higher than 50 mg/l at disease presentation were associated with the risk of death. Thus, in our population of hemodialysis patients with SARS-CoV-2 infection, we documented a wide range of disease severity. The risk of ARDS and death is significant for patients requiring hospital admission at disease diagnosis.

Indices of adequacy were predictors of mortality and morbidity, both on CAPD and HD, whereas normalized protein catabolic rate and subjective global assessment of nutritional status were not. Serum albumin did not decrease during dialysis; hence its predictive effect for survival is due to the predialysis condition and not to dialysis-induced malnutrition.

High UFRs are independently associated with increased mortality risk in HD patients. Better survival was observed with UFR < 12.37 ml/h/kg BW. For patients with higher UFRs, longer or more frequent dialysis sessions should be considered in order to prevent the deleterious consequences of excessive UFR.

Comparisons of patient and technique survival were made for 120 CAPD and 139 HD patients undergoing dialysis between January 1981 and December 1986. Cox's proportional hazard regression model was used to compare patient and technique survival, with an adjustment for pre-treatment prognostic differences. Only the patients' first treatments were considered. The CAPD patients were 10 years older, on the average, than the HD patients and had more complicated conditions (58% with 3 or more co-existing risk factors vs. 35%). Overall patient survival between CAPD and HD did not differ (P = 0.2694). However, when adjusted for patient age, sex and other comorbid complicating conditions, CAPD patients over the age of 66 had a significantly lower risk of death than their HD counterparts (P less than 0.05). There were no differences in the adjusted patient survival for patients aged 30 to 66. Four pre-treatment prognostic factors had statistically significant adverse effects on patient survival: age, diabetes, malignancy and peripheral vascular disease. Survival of the HD technique, when unadjusted, was better than survival of CAPD (P = 0.0457). Even after adjustment for sex and age, this difference was still very nearly significant (P = 0.0656). No risk factors were found to be significantly associated with technique survival. Based on patient and technique survival, CAPD would appear to be an excellent alternative to HD and may be the preferred treatment for high risk patients over the age of 66.

In iron-replete HD patients treated with rHuEpo in the maintenance phase, Kt/V exerts a significant sparing effect on rHuEpo requirement independent of the use of biocompatible synthetic membranes. By optimizing rHuEpo responsiveness, an adequate dialysis treatment can contribute to the reduction of the costs of rHuEpo therapy.

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Objective To compare the long-term viability of continuous ambulatory peritoneal dialysis (CAPD) to that of hemodialysis (HD). Design Retrospective study of patients of our institution starting dialysis between January 1,1981, and December 31, 1993, and surviving for at least 2 months. Patients Five hundred and seventy-eight new patients (51.3% on CAPD and 48.6% on HD). Main Outcomes Studied Cox -adjusted assessment of patient and technique survival, and of technique success. Differences in results for two successive periods of time. Results Patient survival did not differ between CAPD and HD after adjusting for age and comorbidity, and significantly improved in the second part of the follow-up (1987 -1993). Technique failure was significantly higher on CAPD, in which it was inversely related to age. The probability of a patient continuing on the first method of dialysis (“technique success”) was significantly lower on CAPD than on HD, but the difference decreased progressively with age and disappeared in patients ≥75 years. Conclusion CAPD is as effective as HD in preserving life in uremic patients in the long-term, and gives better results in the older elderly. In adults, the lower technique success rate may not be a problem for patients with access to a good transplantation program; for others, this drawback must be weighed against the advantages of home treatment.

Effects of continuing nursing mode were studied in elderly home patients with chronic renal failure. Eighty five elderly patients with chronic renal failure were randomly divided into an experimental group (41 cases) and control group (43 cases). Patients in the control group were given the conventional discharge guidance and health education, and those in the experimental group were given the continuing nursing implemented by the continuing nursing team. The results showed that the scores on the self-care skills, sense of responsibility, self-concept and health knowledge of patients with chronic renal failure in the experimental group before discharge were significantly improved compared with those after discharge (P<0.01), the indexes of the dimensions in SF-36 scale were not significantly different between the two groups just after the admission (P>0.05), but those on the third month were significantly higher than those at the admission (P<0.05), and the scores of patients on each dimension in the experimental group were higher than those in the control group (P<0.05). Continuing nursing can effectively improve the self-care ability of elderly patients with chronic renal failure, the patients can actively cooperate with the treatment and nursing, thereby effectively controlling the progression of the disease, reducing the patients' suffering and economic burden, and then improving the quality of life of the patients.