S ince late 2019, the global community has witnessed the unprecedented exponential increase in the number of cases of coronavirus disease 2019 (COVID-19), a novel coronavirus disease caused by the severe acute respiratory syndrome (SARS) coronavirus 2, which led to the World Health Organization declaring COVID-19 a pandemic on March 11, 2020. 1 As of April 25, 2020, more than 2,700,000 cases and 187,000 deaths have been reported, 1 and the situation is rapidly evolving.Patients with end-stage kidney disease (ESKD) are immunocompromised, frequently have multiple comorbid conditions, and thus are particularly vulnerable, with increased risk for the development of severe COVID-19 infection. In addition, the nature of community in-center hemodialysis (HD) poses challenges to containment measures when a dialysis patient develops COVID-19 infection. Furthermore, reports of transmission among minimally symptomatic or presymptomatic patients 2,3 explains in part why COVID-19 is far more challenging to contain. Acute kidney injury and need for kidney replacement therapy (KRT) have also been reported, 4 and delivering KRT in critically ill COVID-19-infected patients poses unique challenges. Overall, it must be recognized that dialysis patients are a highly susceptible population and that HD centers are a high-risk area, and therefore additional measures must be undertaken to mitigate the risk to dialysis patients in this pandemic.We report our current strategies for managing dialysis and share the practical issues faced when providing dialysis support for patients during this COVID-19 outbreak.
BackgroundUremic neuropathy is a common complication in patients with end stage kidney disease. Its pathogenesis has been attributed to accumulation of uremic toxins. Kidney transplantation has been the best therapeutic option.Case presentationWe describe a case of severe uremic peripheral neuropathy, which improved after conversion from a conventional renal replacement therapy to nocturnal hemodialysis.ConclusionEnhanced uremic control by intensive hemodialysis may contribute at least in part to clinical and neurophysiological improvements of uremic neuropathy.
Adrenal insufficiency is a complication of chronic corticosteroid therapy. Unexplained hypotension may be a manifestation of an adrenal insufficient state in patients with a history of corticosteroid therapy on hemodialysis. We present a series of five cases of patients on nocturnal home hemodialysis with hypotension as the main manifestation of adrenal insufficiency. Unexplained hypotension in patients with a history of corticosteroid therapy should prompt the managing clinician to consider adrenal insufficiency as a possible cause.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.