The patients with a persistent elevation of CRP had a higher mortality rate than the patients with occasional CRP elevation. Thus, persistent, rather than occasional, inflammation is an important predictor of death in HD patients.

The first case of the novel coronavirus disease (Covid-19) pandemic in Brazil was reported on February 26th, 2020, in São Paulo. On June 30th, Brazil ranked 2nd in the world in the number of cases, with 1.4 million victims officially reported and an average number of 37,600 new cases per day [Coronavirus disease case panel 2019 (COVID-19) in Brazil by the Ministry of Health. Available at: https ://covid .saude .gov.br/. Accessed June 27, 2020.]. Brazil is the third country in the world in the number of patients on chronic dialysis, with 133,500 in July, 2018 [2]. Ninety-two percent of them are on in-center hemodialysis (HD). A large number of kidney disease patients particularly those with kidney failure on dialysis are at a higher risk of complications of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection [3, 4]. The Brazilian Society of Nephrology, in conjunction with the Brazilian Association of Dialysis and Transplant Centers, has been conducting a national on-line survey of Covid-19 on kidney failure patients undergoing regular HD, since June 1st, 2020. In the present study, we describe the incidence, mortality, and fatality rates due to Covid-19 since the beginning of the outbreak until June 30th in a sample of 37,852 hemodialysis patients. Cases were considered confirmed if they had laboratory isolation of the SARS-CoV-2 by RT-PCR test from nasopharyngeal/oropharyngeal swabs. As of June 30th, there were 1,402,041 cases and 59,594 deaths reported in the overall Brazilian population [1, 5].

Short-term oral NAC treatment resulted in reduction of circulating IL-6, suggesting that such treatment could be a useful strategy in blunting the inflammatory response in PD patients.

Osteoprotegerin (OPG) regulates bone mass by inhibiting osteoclast differentiation and activation, and plays a role in vascular calcification. We evaluated the relationship between osteoprotegerin levels and inflammatory markers, atherosclerosis, and mortality in patients with stages 3-5 chronic kidney disease. A total of 145 subjects (median age 61 years, 61% men; 36 patients on hemodialysis, 55 patients on peritoneal dialysis, and 54 patients with stages 3-5 chronic kidney disease) were studied. Clinical characteristics, markers of mineral metabolism (including fibroblast growth factor-23 [FGF-23]) and inflammation (high-sensitivity C-reactive protein [hsCRP] and interleukin-6 [IL-6]), and the intima-media thickness (IMT) in the common carotid arteries were measured at baseline. Cardiac function was assessed by color tissue Doppler echocardiography. After 36 months follow-up, the survival rate by Kaplan-Meier analysis was significantly different according to OPG levels (χ 2=14.33; P=0.002). Increased OPG levels were positively associated with IL-6 (r=0.38, P<0.001), FGF-23 (r=0.26, P<0.001) and hsCRP (r=0.0.24, P=0.003). In addition, OPG was positively associated with troponin I (r=0.54, P<0.001) and IMT (r=0.39, P<0.0001). Finally, in Cox analysis, only OPG (HR=1.07, 95%CI=1.02-1.13) and hsCRP (HR=1.02, 95%CI=1.01-1.04) were independently associated with increased risk of death. These results suggested that elevated levels of serum OPG might be associated with atherosclerosis and all-cause mortality in patients with chronic kidney disease.

End-stage renal disease (ESRD) is characterized by an exceptional cardiovascular mortality rate. Although traditional risk factors are common in ESRD patients, they alone may not be sufficient to account for the high prevalence of cardiovascular disease (CVD). Recent evidence demonstrated that chronic inflammation, a non-traditional risk factor which is commonly observed in ESRD patients, may cause malnutrition and progressive atherosclerotic CVD by several pathogenetic mechanisms. Although both malnutrition and inflammation have been shown to be strong predictors of cardiovascular mortality in ESRD patients, it must be remembered that the majority of studies describing the presence of inflammation and malnutrition have been performed in Western and Asian industrialized countries. As it is evident that the prevalence of malnutrition and inflammation may differ markedly between different regions of the world and developing countries face a much higher prevalence of chronic infectious diseases, comparative inter-regional studies focusing on the etiology and prevalence of the malnutrition, inflammation and atherosclerosis syndrome are warranted.

Using TVI, HD patients demonstrate myocardial dysfunction, which is found less frequently when using conventional echocardiography. The systolic function seems to be impaired by high plasma levels of phosphate and an increased Ca x P product. One single session of HD improved systolic function as indicated by increases in IVCv, PSv and SR. Further studies are needed to clarify if this effect of HD is due to the acute removal of fluid, the removal of solutes or both.

There is growing concern about the development of antibacterial resistance with the use of antibiotics in catheter lock solutions. The use of an antibiotic that is not usually used to treat other serious infections may be an alternative that may reduce the clinical impact should resistance develop. We conducted a randomized controlled trial to compare a solution of minocycline and EDTA with the conventional unfractionated heparin for the prevention of catheter-related bacteremia in hemodialysis patients during a period of 90 d. The study included 204 incident catheters (27.8% tunneled); 14 catheters were excluded because of early dysfunction and 3 because of protocol violations. We observed catheter-related bacteremia in 19 patients in the heparin group (4.3 per 1000 catheter-days) and in 5 patients in the minocycline-EDTA group (1.1 per 1000 catheter-days; P ϭ 0.005). We did not detect a significant difference in the rate of catheter removal for dysfunction. Catheter-related bacteremia-free survival was significantly higher in the minocycline-EDTA group than in the heparin group (P ϭ 0.005). In conclusion, a minocycline-EDTA catheter lock solution is effective in the prevention of catheter-related bacteremia in hemodialysis patients. 22: 193922: -194522: , 201122: . doi: 10.1681 Despite all efforts to reduce the use of catheters in hemodialysis units because of related complications, the frequency of catheter use continues to rise, probably in consequence of the tendency to place native arteriovenous fistula at all cost. 1,2 The main complications related to catheter use are dysfunction (inadequate blood flow) and infection. The type of infections comprise exit-site infection, tunnel infection, and bacteremia. Despite the fact that exit-site and tunnel infections are the most common complications, 3,4 catheter-related bacteremia (CRB) is the most serious one, representing a barrier to long-term catheter use and emerging as a significant cause of morbidity and mortality. 5 Some studies have demonstrated that in patients using a hemodialysis catheter, the risk of death is 1.5-to threefold higher when compared with patients with a primary arteriovenous fistula. [5][6][7] Moreover, in a large cohort, the occurrence of septicemia was associated subsequently with higher cardiovascular morbidity and mortality. 8 A recent clinical trial addressing the prevention of CRB demonstrated that 12% of bacteremia-episodes resulted in death. 9 For these reasons, the prevention of CRB has become one of the major challenges in the routine care of hemodialysis patients. J Am Soc NephrolIn recent years several studies have employed specific locking solutions instead of the usual hep-

Both physical examination (PE) and intra-access pressure (IAP) measurements have been used in the identification of stenosis in an arteriovenous access. The aim of this study was to evaluate the accuracy of PE and IAP in the diagnosis of arteriovenous fistula (AVF) stenosis. A total of 84 patients were enrolled in the study (54% men, mean age of 50.7 +/- 12.7 years and mean AVF patency of 24.9 +/- 7.8 months, 52% radiocephalic). Abnormalities of pulse and thrill were used as the diagnostic tools for the detection of stenosis using the physical examination. For IAP, stenosis was suspected when the ratio between IAP at the arterial puncture site and the mean blood pressure was <0.13 or >0.43. The diagnosis of stenosis was confirmed by Doppler ultrasound (DU). Sensitivity (S), specificity (SP), positive predictive value (PPV), negative predictive value (PNV), and accuracy were calculated for the two early detection tests. According to DU, 50 (59%) AVF were considered positive for the presence of stenosis. Fifty-six (66%) AVF were considered positive for the presence of stenosis by PE and 34 (40%) by IAP. S, SP, PPV, and NPV for PE and IAP were 96%, 76%, 86%, and 93% and 60%, 88%, 88%, and 60%, respectively. The accuracy for PE and IAP was 88% and 71%, respectively. PE proved to be an accurate method for the diagnosis of stenosis and should be part of all surveillance protocols of stenosis detection in AVF.