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.

Background: Lipopolysaccharide (LPS), also known as endotoxin, is cell wall component of Gram-negative (GN) bacteria, which may contribute to the progression of a local infection to sepsis. Previous studies demonstrate that LBP is detectable in peritoneal effluents of peritoneal dialysis (PD) patients and it is significantly elevated in PD patients with peritonitis caused by both GN and Gram-positive (GP) bacteria. Aim: The aim of this study was to evaluate LPS levels in PD patients; in particular, we investigated different LPS levels in the context of GP and GN peritonitis. Material and Methods: We enrolled 49PD (61% Continuous Ambulatory PD and 39% Automated PD) patients: 37 with peritonitis and 12 without. Quantitative determination of LPS was performed by Enzyme-linked Immunosorbent Assay Kitin peritoneal and plasma samples. Results: Quantitative analysis of peritoneal and plasma LPS showed significantly higher levels in PD patients with peritonitis compared to patients without (p = 0.001). Furthermore, we divided patients with peritonitis in 2 groups on the basis of Gram staining (GP 27; GN 12). Peritoneal and plasma LPS levels showed significantly lower levels in PD patients with GP peritonitis than in patients with GN (p = 0.001). The median level of LPS showed no significant differences between patients without peritonitis and with GP peritonitis (p = 0.195). On the contrary, LPS levels showed significantly higher levels in PD patients with GN peritonitis compared to patients without peritonitis (p = 0.001). A significant positive correlation was observed between peritoneal white blood cells count (pWBC) and peritoneal LPS (Spearman's rho = 0,412, p = 0.013). However, no statistically significant correlation was observed between plasma LPS and WBC count. Conclusion: We observed LPS presence in all PD patients. In particular, our results demonstrated that LPS is significantly elevated in PD patients with GN peritonitis. Furthermore, pWBC and LPS levels increased proportionally in PD patients with peritonitis. Peritoneal and plasma LPS levels could be a useful marker for diagnosis and management of GN peritonitis in PD patients.

The episodes of bacteremia occurred exclusively in the patients who were not receiving antibiotics, were transient and completely no symptomatic.

RESUMO -OBJETIVO. A proposta deste estudo foi a avaliação da atividade in vitro INTRODUÇÃOA resistência bacteriana tem emergido como um problema mundialmente importante, fazendo com que muitas classes de antimicrobianos tenham se tornado menos efetiva nos últimos anos. Algumas vezes, parte da emergência de resistência está relacionada ao uso intensivo ou inadequado desses compostos, ocasionando a seleção de patógenos resistentes 1 . Pacientes infectados por bactérias resistentes necessitam de maior tempo de hospitalização, apresentam risco aumentado de mortalidade e utilizam antimicrobianos mais potentes, que normalmente são mais caros e/ou mais tóxicos 2 . Esses fatores têm motivado a busca por drogas cada vez mais potentes e estáveis aos mecanismos de resistência bacteriana. Muitas vezes, modificações estruturais são realizadas nas moléculas de antimicrobianos já utilizados na prática clínica para que esse objetivo seja alcançado.No final dos anos 80, as fluoroquinolonas tornaram-se uma excelente opção para o tratamento de infecções causadas por bactérias aeróbias gram-negativas, pois, além de potentes, essas drogas permitiam a continuação do tratamento por via oral 3,4 . Atualmente, com o aumento da importância das infecções por cocos gram-positivos como os enterococos e estreptococos, para os quais as fluoroquinolonas têm potência limitada 5 , e com a emergência de bactérias gram-negativas resistentes a essa classe de antimicrobianos 6,7 , tem sido incentivada a pesquisa por novos compostos dessa classe.A grepafloxacina (anteriormente designada OPC 17116) é uma fluoroquinolona que mantém potente ação contra gram-negativos e maior potência contra gram-positivos, quando comparada com as fluoroquinolonas já disponíveis comercialmente no Brasil. Como essa droga parece apresentar excelente penetração tecidual, principalmente pulmonar, e possuir melhor atividade bactericida contra Staphylococcus

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Background and Aims Dialysis treatment (DT) is the most common approach for patients with kidney failure. However, this may not be optimal for geriatric individuals, as more than half of elderly patients who initiate DT die within the first year. As a result, current guidelines advocate for presenting comprehensive conservative management (CM) as an alternative option for vulnerable patients and their families. A recent meta-analysis (2022) revealed that DT had a median survival time of 20-67 months, compared to 6-31 months for CM, indicating that individuals who opt for DT may have higher survival benefits. This distinction, however, disappears in +80 y/o patients, suggesting that both therapies may yield similar outcomes in this population. The efficacy of CM, however, remains poorly recognized due to the difficulty in comparing the treatments and the heterogeneous nature of the studies conducted. Therefore, our study aimed to investigate and compare the survival of the elderly who elected to undergo either conservative therapy or dialysis. Method We present a preliminary analysis of a prospective observational study conducted across 3 Nephrology Units (Veneto, Italy). We enrolled 117 patients in the pre-dialysis or CM clinics, meeting the eligibility criteria: ≥75 y/o, eGFR>15 ml/min/1.73 m2 (CKD-EPI formula), and had not already undergone DT or CM (personalized pharmacological therapy combined with a low-protein diet). At baseline, socio-demographic information, patient comorbidities, and blood and urine tests were collected through medical records and interviews. Additionally, the SF-36 questionnaire, the Barthel questionnaire, and the Mini-Mental State Examination assessed the quality of life, functional status, and global cognitive functioning. Survival was evaluated at 3 and 9 months after follow-up initiation, defined as the date of the first dialysis session or when the eGFR dropped below 10 ml/min/1.73 m2 in CM patients. The follow-up ended when patients reached the 9th month, died from any cause, switched treatments, discontinued medical follow-up, dropped out of the study voluntarily, or at the end of the project. To determine if any across-group differences existed at the baseline, non-parametric tests were used for continuous variables and the chi-square test for categorical variables. Kaplan-Meyer curve, Log Rank Test and Cox regression were performed for survival analysis. Results Of the 117 enrolled patients, 64 initiated the follow-up, 47 (59.6% M) in CM, and 17 (64.7% M) in DT. The patients in CM were older than those in DT (p = 0.028), with a median age of 82.5 (75.4-91.7) compared to 78.9 (75.6-87.9). At baseline, there were other statistically significant differences (p<0.05) in median levels of BUN, creatinine, PTH, haemoglobin, and total cholesterol. Comorbidities were similar in both groups. During the follow-up, 11 patients died (17.2%), 10 in CM (21.3%) and 1 in DT (5.9%). One patient in CM had an unavailable death date and was, therefore, excluded from further analysis. Kaplan-Meier curves and Log Rank Test revealed no significant difference in survival (p = 0.25). The median survival time was undefined, as over 50% of subjects in both groups did not experience the event during follow-up. In CM, unadjusted survival rates at 3 and 9 months were 91.3% and 78.2%, respectively. The effect of the therapies resulted in not significant after adjusting for important prognostic covariates. Conclusion In this study, we found that middle-term survival in the elderly is comparable to DT and CM. Despite limitations, these results provide valuable information for clinical decision-making. Our results suggest that well-organized CM can be a reasonable option for elderly patients with kidney failure.