Pub Date : 2024-07-10DOI: 10.3390/kidneydial4030012
Francesco Locatelli, G. Piccoli, Peter Roth
Prof. Dr. George Bakris was an Editorial Board Member of Kidney and Dialysis. His invaluable contributions were instrumental in guiding the journal’s direction and enhancing its success. We are deeply grateful for his unwavering dedication, commitment, and active involvement in the journal’s development.
George Bakris 博士教授是《肾脏与透析》杂志的编委。他的宝贵贡献对指导期刊的发展方向和提高期刊的成功率起到了重要作用。我们对他在期刊发展过程中坚定不移的奉献、承诺和积极参与深表感谢。
{"title":"In Memory of George Bakris (1952–2024)","authors":"Francesco Locatelli, G. Piccoli, Peter Roth","doi":"10.3390/kidneydial4030012","DOIUrl":"https://doi.org/10.3390/kidneydial4030012","url":null,"abstract":"Prof. Dr. George Bakris was an Editorial Board Member of Kidney and Dialysis. His invaluable contributions were instrumental in guiding the journal’s direction and enhancing its success. We are deeply grateful for his unwavering dedication, commitment, and active involvement in the journal’s development.","PeriodicalId":509262,"journal":{"name":"Kidney and Dialysis","volume":"33 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141661783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-09DOI: 10.3390/kidneydial4030011
Mauro Valente, Francesca Orecchioni, F. Brigante, Maria Ilaria Moretti, Roberta Mariani, M. M. D’Errico, Marco Moretti, Marcello Tavio, Maria Soledad Ferreiro Cotorruelo, Massimo Marchi, Emanuele Moglie, Andrea Ranghino
The Ralstonia species (RB) and Burkholderia species (BB) are bacteria responsible for nosocomial infections in frail patients such as hemodialyzed (HD) patients. Here, we report how we managed an outbreak caused by RB and BB that occurred in a dialysis unit. From the 7th to the 16th of April 2021, an infection due to RB and BB occurred in 7 out of 39 (17.9%) HD patients with central venous catheter (CVC). Disinfectants, CVC-lock therapy solutions, water by reverse osmosis unit (ROW) and dialysis concentrates were cultured, including the biofilm from the loading plastic tubes (LPTs) that connect the hemodialysis consoles (HCs) to the ROW delivery line. The antibiotic treatment was successful for all patients. RB and BB were isolated in the biofilm of 11/37 LPTs. Three out of 11 positive LPTs were associated with the infected patients. The ROW delivery line was modified to provide a whole disinfection with the HCs connected, avoiding the risk of new contamination of the LPTs. A filtration module of 0.01 mm was added prior to the ROW delivery line. Our experience suggests that outbreaks sustained by unusual bacteria such as RB and BB should be promptly investigated to treat the infected patients with the appropriate therapy and to identify the possible source of infection, making the needful changes to achieve a safer dialysis unit.
{"title":"Outbreak of Ralstonia spp. and Burkholderia spp. Catheter-Related Bloodstream Infection in Hemodialysis Unit","authors":"Mauro Valente, Francesca Orecchioni, F. Brigante, Maria Ilaria Moretti, Roberta Mariani, M. M. D’Errico, Marco Moretti, Marcello Tavio, Maria Soledad Ferreiro Cotorruelo, Massimo Marchi, Emanuele Moglie, Andrea Ranghino","doi":"10.3390/kidneydial4030011","DOIUrl":"https://doi.org/10.3390/kidneydial4030011","url":null,"abstract":"The Ralstonia species (RB) and Burkholderia species (BB) are bacteria responsible for nosocomial infections in frail patients such as hemodialyzed (HD) patients. Here, we report how we managed an outbreak caused by RB and BB that occurred in a dialysis unit. From the 7th to the 16th of April 2021, an infection due to RB and BB occurred in 7 out of 39 (17.9%) HD patients with central venous catheter (CVC). Disinfectants, CVC-lock therapy solutions, water by reverse osmosis unit (ROW) and dialysis concentrates were cultured, including the biofilm from the loading plastic tubes (LPTs) that connect the hemodialysis consoles (HCs) to the ROW delivery line. The antibiotic treatment was successful for all patients. RB and BB were isolated in the biofilm of 11/37 LPTs. Three out of 11 positive LPTs were associated with the infected patients. The ROW delivery line was modified to provide a whole disinfection with the HCs connected, avoiding the risk of new contamination of the LPTs. A filtration module of 0.01 mm was added prior to the ROW delivery line. Our experience suggests that outbreaks sustained by unusual bacteria such as RB and BB should be promptly investigated to treat the infected patients with the appropriate therapy and to identify the possible source of infection, making the needful changes to achieve a safer dialysis unit.","PeriodicalId":509262,"journal":{"name":"Kidney and Dialysis","volume":"32 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141665175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-03DOI: 10.3390/kidneydial4020007
Ilaria Godi, Paolo Feltracco, G. Lorenzoni, Alessio Antonelli, Renato Salvador, D. Gregori, Ivo Tiberio, Michele Valmasoni
Background: Limited data exist on postoperative acute kidney injury (AKI) in patients who have undergone esophageal cancer surgery. The purpose of this study was to evaluate the incidence, risk factors, and consequences of postoperative acute kidney after esophagectomy. Methods: This was a retrospective cohort study. The study was conducted in a tertiary specialized cancer center in Italy. All patients undergoing elective esophageal cancer surgery between 2016 and 2021 were included in the study. AKI was defined according to Kidney Disease Improving Global Outcomes criteria (both serum creatinine and urine output), within 48 h after surgery. Preoperative and intraoperative data were registered. We also collected data concerning progression of AKI, need for renal replacement therapy, mortality, and medical (pulmonary, cardiovascular, septic) and surgical complications within 30 days from surgery, as well as length of hospital stay. Results: Incidence of postoperative AKI was 32%. The independent risk factors were body mass index and the use of an invasive surgical approach. Persistent AKI accounted for 15% of the cases and it was associated with increased risk of major cardiovascular events (odds ratio 4.14, 95% CI 1.05–15.8, p-value 0.036), pulmonary complications (OR 3.67, 95% CI 1.04–14.9, p-value 0.050), and increased length of hospital stay (AME 7.2, 0.5–13.9, p-value 0.035). Conclusions: Postoperative AKI is common after esophageal cancer surgery. BMI and a totally invasive surgical approach are independent risk factors. Persistent AKI lasting more than 48 h increased the risk for any cardiovascular or pulmonary complications, with prolonged length of hospital stay.
背景：关于食管癌手术患者术后急性肾损伤（AKI）的数据有限。本研究旨在评估食管切除术后急性肾脏的发生率、风险因素和后果。研究方法这是一项回顾性队列研究。研究在意大利一家三级专科癌症中心进行。所有在2016年至2021年期间接受食管癌择期手术的患者均被纳入研究范围。根据肾脏疾病改善全球结果标准（血清肌酐和尿量）对术后48小时内的AKI进行定义。我们对术前和术中数据进行了登记。我们还收集了有关 AKI 进展、肾脏替代疗法需求、死亡率、术后 30 天内的内科（肺部、心血管、败血症）和外科并发症以及住院时间的数据。研究结果术后 AKI 发生率为 32%。体重指数和采用侵入性手术方法是独立的风险因素。持续性 AKI 占 15%，与主要心血管事件风险增加（几率比 4.14，95% CI 1.05-15.8，P 值 0.036）、肺部并发症（OR 3.67，95% CI 1.04-14.9，P 值 0.050）和住院时间延长（AME 7.2，0.5-13.9，P 值 0.035）相关。结论食管癌术后 AKI 很常见。体重指数和全侵入性手术方式是独立的风险因素。持续性 AKI 超过 48 小时会增加心血管或肺部并发症的风险，并延长住院时间。
{"title":"Incidence, Risk Factors, and Consequences of Acute Kidney Injury in Patients Undergoing Esophageal Cancer Surgery: A Historical Cohort","authors":"Ilaria Godi, Paolo Feltracco, G. Lorenzoni, Alessio Antonelli, Renato Salvador, D. Gregori, Ivo Tiberio, Michele Valmasoni","doi":"10.3390/kidneydial4020007","DOIUrl":"https://doi.org/10.3390/kidneydial4020007","url":null,"abstract":"Background: Limited data exist on postoperative acute kidney injury (AKI) in patients who have undergone esophageal cancer surgery. The purpose of this study was to evaluate the incidence, risk factors, and consequences of postoperative acute kidney after esophagectomy. Methods: This was a retrospective cohort study. The study was conducted in a tertiary specialized cancer center in Italy. All patients undergoing elective esophageal cancer surgery between 2016 and 2021 were included in the study. AKI was defined according to Kidney Disease Improving Global Outcomes criteria (both serum creatinine and urine output), within 48 h after surgery. Preoperative and intraoperative data were registered. We also collected data concerning progression of AKI, need for renal replacement therapy, mortality, and medical (pulmonary, cardiovascular, septic) and surgical complications within 30 days from surgery, as well as length of hospital stay. Results: Incidence of postoperative AKI was 32%. The independent risk factors were body mass index and the use of an invasive surgical approach. Persistent AKI accounted for 15% of the cases and it was associated with increased risk of major cardiovascular events (odds ratio 4.14, 95% CI 1.05–15.8, p-value 0.036), pulmonary complications (OR 3.67, 95% CI 1.04–14.9, p-value 0.050), and increased length of hospital stay (AME 7.2, 0.5–13.9, p-value 0.035). Conclusions: Postoperative AKI is common after esophageal cancer surgery. BMI and a totally invasive surgical approach are independent risk factors. Persistent AKI lasting more than 48 h increased the risk for any cardiovascular or pulmonary complications, with prolonged length of hospital stay.","PeriodicalId":509262,"journal":{"name":"Kidney and Dialysis","volume":"551 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140749534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-03DOI: 10.3390/kidneydial4020006
Elber Osorio-Rodríguez, Dairo Rodelo-Barrios, C. Rebolledo-Maldonado, Alberto Polo-Barranco, Jhonny Patiño-Patiño, Mauricio Aldana-Roa, Valeria Sánchez-Daza, Emily Sierra-Ordoñez, Alfonso Bettin-Martínez
Leptospirosis is a re-emerging zoonotic disease that has had an unprecedented impact on most health systems in the world. The spectrum of symptoms is variable and usually ranges from asymptomatic cases to severe manifestations involving multiple organ dysfunction accompanied by jaundice, hemorrhage, meningitis, and acute kidney injury that requires the need for intensive care assistance. Although early antibiotic treatment is usually effective, in severe cases, it may require renal replacement therapy, invasive mechanical ventilation, vasoactive support, and invasive hemodynamic monitoring, increasing the risk of death. In Latin America, the real burden of acute kidney injury in this condition is unknown and may be underestimated due to the rapid progression of the disease, similar to other vector zoonoses, and the low coverage of diagnostic tests in primary care, especially in rural regions. Therefore, below, we review the clinical aspects and describe the scientific, clinical, and therapeutic evidence of acute kidney injury attributed to Leptospira spp. and its relevance in patients with severe leptospirosis in Latin America.
{"title":"Acute Kidney Injury Associated with Severe Leptospirosis: Fatal Re-Emerging Disease in Latin America","authors":"Elber Osorio-Rodríguez, Dairo Rodelo-Barrios, C. Rebolledo-Maldonado, Alberto Polo-Barranco, Jhonny Patiño-Patiño, Mauricio Aldana-Roa, Valeria Sánchez-Daza, Emily Sierra-Ordoñez, Alfonso Bettin-Martínez","doi":"10.3390/kidneydial4020006","DOIUrl":"https://doi.org/10.3390/kidneydial4020006","url":null,"abstract":"Leptospirosis is a re-emerging zoonotic disease that has had an unprecedented impact on most health systems in the world. The spectrum of symptoms is variable and usually ranges from asymptomatic cases to severe manifestations involving multiple organ dysfunction accompanied by jaundice, hemorrhage, meningitis, and acute kidney injury that requires the need for intensive care assistance. Although early antibiotic treatment is usually effective, in severe cases, it may require renal replacement therapy, invasive mechanical ventilation, vasoactive support, and invasive hemodynamic monitoring, increasing the risk of death. In Latin America, the real burden of acute kidney injury in this condition is unknown and may be underestimated due to the rapid progression of the disease, similar to other vector zoonoses, and the low coverage of diagnostic tests in primary care, especially in rural regions. Therefore, below, we review the clinical aspects and describe the scientific, clinical, and therapeutic evidence of acute kidney injury attributed to Leptospira spp. and its relevance in patients with severe leptospirosis in Latin America.","PeriodicalId":509262,"journal":{"name":"Kidney and Dialysis","volume":"582 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140749402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-15DOI: 10.3390/kidneydial4010005
Elyce Cutajar, Kelly Lambert
Pregnancy in the dialysing population is an infrequent but increasing event. There is a lack of contemporary guidance regarding the nutritional management of this complex patient group. The aim of this scoping review was to identify, evaluate and summarise the evidence base describing nutritional recommendations for pregnant women receiving dialysis. A systematic search strategy of four databases and the grey literature was conducted. Eligible publications contained reference to recommendations regarding nutrition, supplements, breastfeeding, dietary patterns, and/or weight recommendations for pregnant dialysing women. A total of 136 eligible records were included for synthesis including 66 case reports/case series, 46 reviews, 15 book chapters, 5 editorials, and 4 consensus guidelines/position papers. Recommendations regarding energy, protein, dietary patterns, weight, and vitamin and mineral supplementation were common. However, significant discrepancy across these recommendations was evident. There were limited recommendations regarding other nutrients and breastfeeding. A summary of nutritional recommendations to guide clinical practice was constructed. Pregnancy planning, pre-conception dietetic counselling, interprofessional education, and the guidance synthesised in this review could be utilised by clinicians to improve clinical management and optimise outcomes in these patients. Future research should explore the experiences and perspectives of pregnant dialysing women, investigate nutrient losses during intensive dialysis, and evaluate postpartum follow-up.
{"title":"Nutritional Recommendations for Pregnant Women Receiving Dialysis: A Scoping Review","authors":"Elyce Cutajar, Kelly Lambert","doi":"10.3390/kidneydial4010005","DOIUrl":"https://doi.org/10.3390/kidneydial4010005","url":null,"abstract":"Pregnancy in the dialysing population is an infrequent but increasing event. There is a lack of contemporary guidance regarding the nutritional management of this complex patient group. The aim of this scoping review was to identify, evaluate and summarise the evidence base describing nutritional recommendations for pregnant women receiving dialysis. A systematic search strategy of four databases and the grey literature was conducted. Eligible publications contained reference to recommendations regarding nutrition, supplements, breastfeeding, dietary patterns, and/or weight recommendations for pregnant dialysing women. A total of 136 eligible records were included for synthesis including 66 case reports/case series, 46 reviews, 15 book chapters, 5 editorials, and 4 consensus guidelines/position papers. Recommendations regarding energy, protein, dietary patterns, weight, and vitamin and mineral supplementation were common. However, significant discrepancy across these recommendations was evident. There were limited recommendations regarding other nutrients and breastfeeding. A summary of nutritional recommendations to guide clinical practice was constructed. Pregnancy planning, pre-conception dietetic counselling, interprofessional education, and the guidance synthesised in this review could be utilised by clinicians to improve clinical management and optimise outcomes in these patients. Future research should explore the experiences and perspectives of pregnant dialysing women, investigate nutrient losses during intensive dialysis, and evaluate postpartum follow-up.","PeriodicalId":509262,"journal":{"name":"Kidney and Dialysis","volume":"87 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140239667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-17DOI: 10.3390/kidneydial4010004
G. Spasovski
A perturbation in the water balance rather than any change in salt content is the main cause of hyponatremia, the most frequent electrolyte abnormality, defined as a serum sodium concentration <135 mEq/L. Hyponatremia may be divided between mild (Na > 120 mEq/L) or severe (Na < 120 mEq/L) hyponatremia, and is most frequently observed in elderly ICU hospitalized patients. Based on tonicity, hyponatremia may be hypotonic (a decreased concentration of the solute), isotonic, and hypertonic (falsely low sodium). According to the volume of extracellular fluid (ECF), hyponatremia is further divided among hypovolemic, euvolemic, or hypervolemic hyponatremia. Finally, hyponatremia may develop rapidly as acute (<48 h), usually with severe symptoms, or slowly as chronic hyponatremia, usually being asymptomatic or with mild symptoms. Acute severe hyponatremia presents with severe CNS problems, increased hospitalization rates, and mortality. The treatment with 3% sodium chloride and a 100 mL IV bolus based on severity and persistence of symptoms needs careful monitoring. A non-severe hyponatremia may be treated with oral urea. In asymptomatic mild hyponatremia, an adequate solute intake with an initial fluid restriction of 500 mL/d adjusted according to the serum sodium levels is preferred. Vaptans could be considered in patients with high ADH activity regardless of whether they are euvolemic or hypervolemic. In general, the treatment of hyponatremia should be based on the underlying cause, the duration and degree of hyponatremia, the observed symptoms, and volume status of patient.
{"title":"Etiology, Clinical Approach, and Therapeutic Consequences of Hyponatremia","authors":"G. Spasovski","doi":"10.3390/kidneydial4010004","DOIUrl":"https://doi.org/10.3390/kidneydial4010004","url":null,"abstract":"A perturbation in the water balance rather than any change in salt content is the main cause of hyponatremia, the most frequent electrolyte abnormality, defined as a serum sodium concentration <135 mEq/L. Hyponatremia may be divided between mild (Na > 120 mEq/L) or severe (Na < 120 mEq/L) hyponatremia, and is most frequently observed in elderly ICU hospitalized patients. Based on tonicity, hyponatremia may be hypotonic (a decreased concentration of the solute), isotonic, and hypertonic (falsely low sodium). According to the volume of extracellular fluid (ECF), hyponatremia is further divided among hypovolemic, euvolemic, or hypervolemic hyponatremia. Finally, hyponatremia may develop rapidly as acute (<48 h), usually with severe symptoms, or slowly as chronic hyponatremia, usually being asymptomatic or with mild symptoms. Acute severe hyponatremia presents with severe CNS problems, increased hospitalization rates, and mortality. The treatment with 3% sodium chloride and a 100 mL IV bolus based on severity and persistence of symptoms needs careful monitoring. A non-severe hyponatremia may be treated with oral urea. In asymptomatic mild hyponatremia, an adequate solute intake with an initial fluid restriction of 500 mL/d adjusted according to the serum sodium levels is preferred. Vaptans could be considered in patients with high ADH activity regardless of whether they are euvolemic or hypervolemic. In general, the treatment of hyponatremia should be based on the underlying cause, the duration and degree of hyponatremia, the observed symptoms, and volume status of patient.","PeriodicalId":509262,"journal":{"name":"Kidney and Dialysis","volume":"502 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140453500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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