Serum FGF23 concentrations remain increased in long-term kidney graft recipients, even in the early stages of CKD. It remains to be seen whether measures aimed at reducing serum levels of PTH and phosphate and/or corticosteroid doses might help to lower serum FGF23 and whether this will improve kidney recipient outcomes.
BackgroundMost people who make the transition to renal replacement therapy (RRT) are treated with a fixed dose thrice-weekly hemodialysis réegimen, without considering their residual kidney function (RKF). Recent papers inform us that incremental hemodialysis is associated with preservation of RKF, whenever compared with conventional hemodialysis. The objective of the present controlled randomized trial (RCT) is to determine if start HD with one sessions per week (1-Wk/HD), it is associated with better patient survival and other safety parameters.Methods/designIHDIP is a multicenter RCT experimental open trial. It is randomized in a 1:1 ratio and controlled through usual clinical practice, with a low intervention level and non-commercial. It includes 152 incident patients older than 18 years, with a RRF of ≥4 ml/min/1.73 m2, measured by renal clearance of urea (KrU). The intervention group includes 76 patients who will start with incremental HD (1-Wk/HD). The control group includes 76 patients who will start with thrice-weekly hemodialysis régimen. The primary outcome is assessing the survival rate, while the secondary outcomes are the morbidity rate, the clinical parameters, the quality of life and the efficiency.DiscussionThis study will enable to know the number of sessions a patient should receive when starting HD, depending on his RRF. The potentially important clinical and financial implications of incremental hemodialysis warrant this RCT.Trial registrationU.S. National Institutes of Health, ClinicalTrials.gov. Number: NCT03239808, completed 13/04/2017. Sponsor: Foundation for Training and Research of Health Professionals of Extremadura.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-1189-6) contains supplementary material, which is available to authorized users.
In the last years there has been an increasing interest in expanded hemodialysis (HDx), an emerging renal replacement therapy based on the use of medium cut off membranes (MCO). Thanks to the internal architecture of these type of membranes with a higher pore size and smaller fiber inner diameter to favour internal filtration rate they can increase the removal of larger middle molecules in conventional hemodialysis. Secondarily, several reports suggest that this therapy potentially improve the outcomes for end-stage renal disease patients. However, HDx has not been defined yet and the characteristics of MCO membranes are not well stablished. The aim of this narrative review is to define HDx and summarize the dialyzers that have been used so far to perform this therapy, collect the evidence available on its efficacy and clinical outcomes compared to other hemodialysis technics and settle the bases for its optimal prescription.
INTRODUCCION: La infección por SARS-CoV-2 se asocia con frecuencia con hiponatremia (sodio plasmático <135 mmol/l), relacionándose con peor pronóstico. La incidencia de la hiponatremia se estima en 20-37% según las series, pero no existen datos sobre el pronóstico tras la corrección de la hiponatremia. Por ello, nuestros objetivos fueron: analizar la incidencia y gravedad de la hiponatremia al ingreso hospitalario, y determinar la asociación de dicha hiponatremia con el pronóstico del COVID-19.
MATERIAL Y MÉTODO: Estudio de cohorte observacional y retrospectivo. Se incluyeron pacientes que ingresaron con diagnóstico de infección por COVID-19 e hiponatremia, en el periodo marzo-mayo 2020. Registramos variables epidemiológicas, demográficas, clínicas, analíticas y radiológicas de la infección por SARS-CoV-2 e hiponatremia al momento del diagnóstico y durante la hospitalización. El seguimiento clínico comprendió desde el ingreso hasta el exitus o el alta.
RESULTADOS: 91 pacientes (21,8%) de los 414 ingresados por infección del SARS-CoV-2 presentaron hiponatremia (81,32% hiponatremia leve, 9,89% moderada y 8,79% grave). La ausencia de corrección de la hiponatremia a las 72–96 horas del ingreso hospitalario estuvo asociado a mayor mortalidad en los pacientes con COVID-19 (OR 0,165; 95% intervalo de confianza: 0,018 – 0,686; p=0,011). Fallecieron 19 pacientes (20,9%). Se observó un aumento de la mortalidad en pacientes con hiponatremia grave en comparación con hiponatremia moderada y leve durante el ingreso (37,5% versus 11,1% versus 8,1%, respectivamente, p=0,041).
CONCLUSIONES: La persistencia de la hiponatremia tras las primeras 72-96 horas del ingreso hospitalario fue asociada a mayor mortalidad en los pacientes con SARS-Cov-2.
Background and Aims
Recently, serum chloride has gained greater importance in the assessment of patients with heart failure and sepsis. Hypochloremia has been associated with higher mortality. On the other hand, COVID-19 pandemic continues to be, to date, a threat to public health. Patients with cardiovascular comorbidity or chronic kidney disease are particularly vulnerable. There are some studies that show a trend towards a lower serum chloride concentration in patients with a positive PCR test for SARS-CoV-2. Therefore, the objective of our study was to determine if there is a relationship between serum chloride levels at the time of diagnosis and a greater tendency to develop COVID-19 pneumonia in chronic hemodialysis patients.
Method
Retrospective cohort study. We analyzed the serum chloride, C-reactive protein (CRP), procalcitonin, neutrophil-lymphocyte (NLR) and platelet-lymphocyte (PLR) ratios of 11 chronic hemodialysis patients with a positive SARS-CoV-2 TMA PCR test during the second wave of the pandemic in our hospital (August-December 2020). We collected the length of hospital stay, the diagnosis of pneumonia (yes/no) and the final state of the infection (cure or death). The patients were divided into two groups taking the median serum chloride as the cut-off point (1: <97 mEq / L and 2:> 97mEq / L)
Results
The mean age was 57 ± 13 years and 36.36% (N = 4) were women. All patients required hospital admission and mean hospitalization time was 19 ± 13 days. 3 patients (27.3%) died. The medians of the parameters were the following: serum chloride 97 mEq / L (IQR 94-99); CRP 29.04 mg / L (IQR 8.53-76.13); NLR 4.13 (IQR 2.67-8.48) and PLR 244.06 (IQR 208.08-320). 81.8% (N = 9) had COVID-19 pneumonia. Group 1 patients (Chloride <97 mEL / L) had a higher incidence of pneumonia (p = 0.049) (Figure 1) and a greater tendency to be admitted to the Intensive Care Unit (ICU) (p = 0.029). Despite not reaching statistical significance, there was also a higher mortality in patients with lower chloride levels.
Conclusion
Chronic hemodialysis patients with SARS-CoV-2 infection and lower serum chloride levels at hospital admission were more likely to develop pneumonia.
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