Background Automated peritoneal dialysis (APD) has been proved benefit from remote monitoring (RM), but evidences are limited. In this study, we compared clinical outcomes and quality of life (QoL) in two group of patients undergoing APD, with and without exposure of RM. Methods This is a retrospective cohort study, comparing outcomes in two groups of APD patients monitored during 6 months with RM (group A: n = 35) or standard care (group B: n = 38 patients). In our clinical practice, we assign the RM system to patients who live more distant from the PD center or difficulty in moving. We evaluated emergency visits, hospitalizations, peritonitis, overhydration, and dropout. QoL was assessed with the Kidney Disease Quality of life-Short Form (KDQOL-SF). We included four additional questions focused on patient's perception of monitoring, safety and timely problems solution (Do you think that home-therapy monitoring could interfere with your privacy? Do you think that your dialysis sessions are monitored frequently enough? Do you think that dialysis-related issues are solved timely? Do you feel comfortable carrying out your home-based therapy?). Results The case group presented a higher comorbidity score, according to Charlson Comorbidity Index (group A: 5.0; IQR 4.0-8.0 versus group B: 4.0; IQR 3.0-6.0) (p = 0.042). The results in group A showed a reduction in the urgent visits due to acute overhydration (group A: 0.17 ± 0.45 versus group B: 0.66 ± 1.36) (p: 0.042) and in the number of disease-specific hospitalization (group A n = 2.0; 18.2% versus group B n = 7.0; 77.8%) (p = 0.022). We did not find any difference between the two groups in terms of hospitalization because of all-cause, peritonitis, overhydration, and dropout. The analysis of KDQOL-SF subscales was similar in the two groups; on the contrary, the answers of our pointed questions have showed a significant difference between the two groups (group A: 100 IQR 87.5-100.0 versus group B 87.5; IQR 75.0-100.0) (p: 0.018). Conclusion RM improved clinical outcomes in PD patients, reducing the emergency visits and the hospitalizations, related to nephrological problems, especially in patients with higher comorbidity score. The acceptance and satisfaction of care were better in patients monitored with RM than with standard APD.

Kidney transplant programmes during the COVID-19 pandemicWe would like to express our concern about kidney transplant programmes during the coronavirus disease 2019 (COVID-19) pandemic. Although we recognise the importance of kidney transplants for dialysis patients, we cannot ignore the potential safety issues during this pandemic.The limited accuracy of the RT-PCR test might lead to underdiagnosis of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Weaknesses in the detection of SARS-CoV-2 infection have been identified in the pre-analytical phase (ie, collection, handling, transport and storage, and timing of the test) and in the analytical phase (ie, viral recombination, assay quality, harmonisation, and instrument perform ance). 1 All these issues could result in a high risk of false-negative test results. 2 Additionally, a Chinese study of chest CT in the diagnosis of COVID-19 infection reported positive RT-PCR assays in only 601 (59•3%) of 1014 patients with suspected infection. 3 Among the 308 patients with baseline negative RT-PCR, 147 (47•7%) were reconsidered after the test as highly probable cases, and 103 (33•4%) as probable cases (based on symptoms, CT scan, and subsequent swab test), whereas only 58 (18•8%) patients were regarded as true negative cases. This high rate of negative results from RT-PCR in patients with radiological features typical of SARS-CoV-2 pulmonary infection raises doubts about test sensitivity in patients with no symptoms. Furthermore, the

Extrahepatic glucose release was evaluated during the anhepatic phase of liver transplantation in 14 recipients for localized hepatocarcinoma with mild or absent cirrhosis, who received a bolus of [6,6-2H2]glucose and l-[3-13C]alanine or l-[1,2-13C2]glutamine to measure glucose kinetics and to prove whether gluconeogenesis occurred from alanine and glutamine. Twelve were studied again 7 mo thereafter along with seven healthy subjects. At the beginning of the anhepatic phase, plasma glucose was increased and then declined by 15%/h. The right kidney released glucose, with an arteriovenous gradient of -3.7 mg/dl. Arterial and portal glucose concentrations were similar. The glucose clearance was 25% reduced, but glucose uptake was similar to that of the control groups. Glucose production was 9.5 ± 0.9 μmol·kg-1· min-1, 30% less than in controls. Glucose became enriched with 13C from alanine and especially glutamine, proving the extrahepatic gluconeogenesis. The gluconeogenic precursors alanine, glutamine, lactate, pyruvate, and glycerol, insulin, and the counterregulatory hormones epinephrine, cortisol, growth hormone, and glucagon were increased severalfold. Extrahepatic organs synthesize glucose at a rate similar to that of postabsorptive healthy subjects when hepatic production is absent, and gluconeogenic precursors and counterregulatory hormones are markedly increased. The kidney is the main, but possibly not the unique, source of extrahepatic glucose production.

Abdominal aortic calcification (AAC) is reported as a predictor for cardiovascular events in general population and in hemodialysis patients. At present, there are no AAC data in peritoneal dialysis. The purpose of this study was to evaluate the prognostic role of AAC score on cardiovascular events in peritoneal dialysis patients. Seventy‐four peritoneal dialysis patients were enrolled. AAC was measured on baseline lateral abdomen radiographs by the semi‐quantitative method as described by Kauppila. The other cardiovascular risk factors were obtained from patient history and blood examination. The Kaplan–Meier method was used to evaluate freedom from cardiovascular events, and differences were assessed with the log‐rank statistic. Multivariate Cox regression models addressed time to cardiovascular events. The median period of follow‐up was 30.5 months (IQR 19.4–32.7). During follow‐up, there were 29 cardiovascular events (39.2%). In univariable analysis, patient's age (HR = 1.050; P = 0.001), urine output (HR = 0.999; P = 0.02), and AAC stratified by tertiles (overall P‐value < 0.001) were significantly associated with cardiovascular events. In multivariable regression analysis, AAC score stratified by tertiles was the only independent predictor for cardiovascular events (overall P‐value <0.001). To our knowledge, we have shown for the first time that AAC score is an independent predictor of cardiovascular events in peritoneal dialysis patients. Risk stratification by assessment of AAC score may provide important information for the management of cardiovascular disease in peritoneal dialysis patients without any additional expense, because these patients have several abdominal X‐ray scans to evaluate the catheter position.