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Pinerolo de Septis MC, Alberghini E, Cornacchiari M, Galassi A, Heidempergher M, Vettoretti S, de Leonardis R, Sangalli L, Aucella F, Esposito C. [Palliative and Supportive Dialysis: Current Practices and Recommendations for Best Clinical Practice]. G Ital Nefrol 2024; 41:2024-vol2. [PMID: 38695224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
"Palliative dialysis" is defined as the renal replacement therapy directed to patients living the most critical phases of illness and the end-of-life stage. Offering targeted dialysis prescriptions becomes imperative when health conditions, along with comorbidities, unfavorable prognosis and complications, do not allow standard dialysis to be started or continued. Management should also integrate adequate supportive care measures in both incident and prevalent patients. This document summarizes nephrological recommendations and scientifical evidence regarding the palliative approach to dialysis, and proposes operative tools for a good clinical practice. After planning and sharing the route of care ("shared-decision-making"), which includes multidimensional evaluation of the patient, a pathway of treatment should be started, focusing on combining the therapeutical available options, adequacy and proportionality of care and patients' preferences. We propose a framework of indications that could help the nephrologist in practicing appropriate measures of treatment in patients' frailest conditions, with the aim of reducing the burden of dialysis, improving quality of life, providing a better control of symptoms, decreasing the hospitalization rates in the end-of-life stage and promoting a home-centered form of care. Such a decisional pathway is nowadays increasingly needed in nephrology practice, but not standardized yet.
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Affiliation(s)
| | - Elena Alberghini
- Gruppo di Lavoro sulle Cure Palliative in Nefrologia, sezione Lombardia della Società Italiana di Nefrologia
| | - Marina Cornacchiari
- Gruppo di Lavoro sulle Cure Palliative in Nefrologia, sezione Lombardia della Società Italiana di Nefrologia
| | - Andrea Galassi
- Gruppo di Lavoro sulle Cure Palliative in Nefrologia, sezione Lombardia della Società Italiana di Nefrologia
| | - Marco Heidempergher
- Gruppo di Lavoro sulle Cure Palliative in Nefrologia, sezione Lombardia della Società Italiana di Nefrologia
| | - Simone Vettoretti
- Gruppo di Lavoro sulle Cure Palliative in Nefrologia, sezione Lombardia della Società Italiana di Nefrologia
| | - Rossella de Leonardis
- Gruppo di Lavoro sulle Cure Palliative in Nefrologia, sezione Lombardia della Società Italiana di Nefrologia
| | - Luisa Sangalli
- Gruppo di Lavoro sulle Cure Palliative in Nefrologia, sezione Lombardia della Società Italiana di Nefrologia
| | - Filippo Aucella
- Struttura Complessa di Nefrologia e Dialisi, Fondazione "Casa Sollievo della Sofferenza", Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo (FG)
| | - Ciro Esposito
- Gruppo di Lavoro sulle Cure Palliative in Nefrologia, sezione Lombardia della Società Italiana di Nefrologia
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Malho Guedes A, Punzalan S, Brown EA, Ekstrand A, Gallieni M, Rivera Gorrín M, Gudmundsdottir H, Heidempergher M, Kitsche B, Lobbedez T, Hahn Lundström U, McCarthy K, Mellotte GJ, Moranne O, Petras D, Povlsen JV, Wiesholzer M. Assisted PD throughout Europe: advantages, inequities, and solution proposals. J Nephrol 2023; 36:2549-2557. [PMID: 37856067 PMCID: PMC10703983 DOI: 10.1007/s40620-023-01765-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/13/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Peritoneal dialysis provides several benefits for patients and should be offered as first line kidney replacement therapy, particularly for fragile patients. Limitation to self-care drove assisted peritoneal dialysis to evolve from family-based care to institutional programs, with specialized care givers. Some European countries have mastered this, while others are still bound by the availability of a volunteer to become responsible for treatment. METHODS A group of leading nephrologists from 13 European countries integrated real-life application of such therapy, highlighting barriers, lessons learned and practical solutions. The objective of this work is to share and summarize several different approaches, with their intrinsic difficulties and solutions, which might helpperitoneal dialysis units to develop and offer assisted peritoneal dialysis. RESULTS Assisted peritoneal dialysis does not mean 4 continuous ambulatory peritoneal dialysis exchanges, 7 days/week, nor does it exclude cycler. Many different prescriptions might work for our patients. Tailoring PD prescription to residual kidney function, thereby maintaining small solute clearance, reduces dialysis burden and is associated with higher technique survival. Assisted peritoneal dialysis does not mean assistance will be needed permanently, it can be a transitional stage towards individual or caregiver autonomy. Private care agencies can be used to provide assistance; other options may involve implementing PD training programs for the staff of nursing homes or convalescence units. Social partners may be interested in participating in smaller initiatives or for limited time periods. CONCLUSION Assisted peritoneal dialysis is a valid technique, which should be expanded. In countries without structural models of assisted peritoneal dialysis, active involvement by the nephrologist is needed in order for it to become a reality.
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Affiliation(s)
- Anabela Malho Guedes
- Serviço de Nefrologia, Centro Hospitalar Universitário Do Algarve, Faro, Portugal.
| | - Sally Punzalan
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Agneta Ekstrand
- Abdomen Centre, Nephrology Helsinki University Hospital, Helsinki, Finland
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences, Università Di Milano, Milan, Italy
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | | | | | - Benno Kitsche
- Kuratorium Für Dialyse Und Nierentransplantation E.V, Cologne, Germany
- NADia-Netzwerk assistierte Dialyse, Berlin, Germany
| | | | - Ulrika Hahn Lundström
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kate McCarthy
- Baxter Healthcare Ltd, Wallingford, Compton, Newbury, UK
| | - George J Mellotte
- Trinity Health Kidney Centre, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Olivier Moranne
- Department of Nephrology-Dialysis-Apheresis, CHU Caremeau Nimes, IDESP Montpellier University, Nimes, France
| | - Dimitrios Petras
- Department of Nephrology, General Hospital 'Hippokration', Athens, Greece
| | - Johan V Povlsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Wiesholzer
- Clinical Department for Internal Medicine, University Hospital St Poelten, Karl Landsteiner University of Health Sciences, St Poelten, Austria
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Bartoli A, Gallieni M, Cogliati C, Casella F, Calloni M, Melchionda C, Heidempergher M, Foschi A, Luca Brucato A, Rizzi G, Quici M, Gidaro A. A decision-making algorithm proposal for PICCs and midlines insertion in patients with advanced kidney disease: A pilot study. J Vasc Access 2023:11297298231152499. [PMID: 36726229 DOI: 10.1177/11297298231152499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Kidney Disease Outcomes Quality Initiative clinical practice guidelines recommend avoiding placement of peripherally inserted vascular access devices in patients with an estimated glomerular filtration rate (eGFR) <45 ml/min. On the other hand, many patients with severe chronic kidney disease (CKD) have poor prognosis.This study carried out a global assessment of mortality at 2 years through Charlson Comorbidity Index (CCI) and Beclap score in patients with PICCs or Midlines, assuming that in those with an estimated high mortality rate at 2 years, it could be acceptable to implant a peripheral vascular access device (PVAD) despite the presence of CKD. METHODS We analyzed data on patients with PICCs or Midlines inserted from October 2018 to November 2019. CCI, Beclap score, and eGFR were calculated for each patient at the time of the catheter insertion. We then followed patients for 2 years to assess 2-year mortality for each. RESULTS One hundred and thirty-one patients were enrolled, 49 (37.4%) had eGFR<45 ml. The 2-year mortality rate was 57.3%. The cut off derived from ROC curve analysis of 15 for Beclap score and 5 for CCI, showed good sensitivity and specificity in predicting mortality of the total population, patients without an oncological disease and patients with eGFR<45 ml/min. CONCLUSION CCI and Beclap score are good predictors of mortality at 2 years.Physicians and nurses can use these tools in the evaluation of patients at risk for future dialysis, instead of relying exclusively on renal function to decide whether implanting PICCs, Midlines, or other vascular access devices.
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Affiliation(s)
- Arianna Bartoli
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Francesco Casella
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Maria Calloni
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Chiara Melchionda
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | | | - Antonella Foschi
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | - Antonio Luca Brucato
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Giulia Rizzi
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Massimiliano Quici
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
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Brown EA, Ekstrand A, Gallieni M, Gorrín MR, Gudmundsdottir H, Guedes AM, Heidempergher M, Kitsche B, Lobbedez T, Lundström UH, McCarthy K, Mellotte GJ, Moranne O, Petras D, Povlsen JV, Punzalan S, Wiesholzer M. Availability of assisted peritoneal dialysis in Europe: call for increased and equal access. Nephrol Dial Transplant 2022; 37:2080-2089. [PMID: 35671088 DOI: 10.1093/ndt/gfac193] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Availability of assisted PD (asPD) increases access to dialysis at home, particularly for the increasing numbers of older and frail people with advanced kidney disease. Although asPD has been widely used in some European countries for many years, it remains unavailable or poorly utilised in others. A group of leading European nephrologists have therefore formed a group to drive increased availability of asPD in Europe and in their own countries. METHODS Members of the group filled in a proforma with the following headings: personal experience, country experience, who are the assistants, funding of asPD, barriers to growth, what is needed to grow, and their top 3 priorities. RESULTS Only 5 of the 13 countries surveyed provided publicly funded reimbursement for asPD. The use of asPD depends on overall attitudes to PD with all respondents mentioning need for nephrology team education and/or patient education and involvement in dialysis modality decision making. CONCLUSION AND CALL TO ACTION Many people with advanced kidney disease would prefer to have their dialysis at home, yet if the frail patient chooses PD most healthcare systems cannot provide their choice. AsPD should be available in all countries in Europe and for all renal centres. The top priorities to make this happen are education of renal healthcare teams about the advantages of PD, education of and discussion with patients and their families as they approach the need for dialysis, and engagement with policy makers and healthcare providers to develop and support assistance for PD.
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Affiliation(s)
- Edwina A Brown
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Centre, London, UK
| | - Agneta Ekstrand
- Helsinki University Hospital, Abdomen Center, Nephrology, Helsinki, Finland
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences, Università di Milano, Italy.,Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Maite Rivera Gorrín
- Hospital Ramón y Cajal, Servicio de Nefrología. UAH. IRyCis. Carretera de Colmenar km 9, 100 28034 Madrid, Spain
| | | | - Anabela Malho Guedes
- Serviço de Nefrologia, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | | | - Benno Kitsche
- Kuratorium für Dialyse und Nierentransplantation e.V., Cologne.,NADia - Netzwerk assistierte Dialyse, Berlin, Germany
| | - Thierry Lobbedez
- Néphrologie, CHU CAEN, Avenue de la Côte de Nacre, CAEN CEDEX 9, France
| | - Ulrika Hahn Lundström
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kate McCarthy
- Baxter Healthcare Ltd, Wallingford, Compton, Newbury, UK
| | - George J Mellotte
- Trinity Health Kidney Centre, Tallaght University Hospital, Tallaght, Dublin NROA
| | - Olivier Moranne
- Department Nephrology-Dialysis-Apheresis, CHU Caremeau Nimes, France
| | - Dimitrios Petras
- Department of Nephrology, General Hospital 'Hippokration', Athens, Greece
| | - Johan V Povlsen
- Dept. Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sally Punzalan
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Centre, London, UK
| | - Martin Wiesholzer
- Clinical Department for Internal Medicine1, University Hospital St.Poelten, Austria, Karl Landsteiner University of Health Sciences
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Sabiu G, Heidempergher M, De Salvo C, Orani MA, Tricella C, Gallieni M. Influence of peritoneal dialysis catheter type on dislocations and laxative use: a retrospective observational study. J Nephrol 2022; 35:1497-1503. [PMID: 35522428 PMCID: PMC9217771 DOI: 10.1007/s40620-022-01329-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/03/2022] [Indexed: 11/04/2022]
Abstract
Background There is currently no consensus regarding the optimal type of peritoneal dialysis (PD) catheter. Although few studies showed that weighted catheters result in lower complication rates and superior long-term outcomes than non-weighted catheters, there are no studies on the use of laxatives linked to catheter malfunction, a patient-related outcome potentially affecting the quality of life. Thus, we compared the burden of acute and chronic laxative use in a cohort of PD patients having either weighted or non-weighted catheters. Methods We performed a single-center, retrospective, observational study in two renal units, comparing acute and chronic laxative therapy related to catheter drainage failure in a cohort of 74 PD patient,s divided by peritoneal dialysis catheter type. In addition, we evaluated the number of patients who experienced minor and major dislocations, catheter-related infection rate, hospitalization for catheter malfunctioning, episodes of catheter repositioning, and dropout from PD. Results Laxative use was significantly more common among patients in the non-weighted catheter group (acute: 30.3% vs. 9.8%, p = 0.03; chronic: 36.4% vs. 12.2%; p≤0.02). Furthermore, weighted catheters were superior to non-weighted catheters for all the secondary outcomes (dislocations: 12.2% vs. 45.5%; p = 0.001). Conclusions Weighted self-locating catheters have lower drainage failure, thus reducing the need and burden of acute and chronic laxative use among PD patients. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40620-022-01329-6.
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Affiliation(s)
- Gianmarco Sabiu
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy.,School of Nephrology, Università di Milano, Milano, Italy
| | | | - Cristina De Salvo
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy.,School of Nephrology, Università di Milano, Milano, Italy
| | | | - Chiara Tricella
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy.,School of Nephrology, Università di Milano, Milano, Italy
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy. .,School of Nephrology, Università di Milano, Milano, Italy. .,Department of Biomedical and Clinical Sciences, Università di Milano, Via Giovanni Battista Grassi 74, 20157, Milano, Italy.
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6
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Rastelli F, Baragetti I, Buzzi L, Ferrario F, Benozzi L, Di Nardo F, Devoti E, Cancarini G, Mezzina N, Napodano P, Gallieni M, Santoro D, Buemi M, Pecchini P, Malberti F, Colombo V, Colussi G, Sabadini E, Remuzzi G, Argentiero L, Gesualdo L, Gatti G, Trevisani F, Slaviero G, Spotti D, Baraldi O, La Manna G, Pignone E, Saltarelli M, Heidempergher M, Tedesco M, Genderini A, Ferro M, Rollino C, Roccatello D, Guzzo G, Clari R, Barbara Piccoli G, Comotti C, Brunori G, Cameli P, Bargagli E, Rottoli P, Dugo M, Cristina Maresca M, Bertoli M, Giozzet M, Brugnano R, Giovanni Nunzi E, D'Amico M, Minoretti C, Acquistapace I, Colturi C, Minola E, Camozzi M, Tosoni A, Nebuloni M, Ferrario F, Dell'Antonio G, Cusinato S, Feriozzi S, Pozzi C. Renal involvement in sarcoidosis: histological patterns and prognosis, an Italian survey. Sarcoidosis Vasc Diffuse Lung Dis 2021; 38:e2021017. [PMID: 34744417 PMCID: PMC8552569 DOI: 10.36141/svdld.v38i3.11488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
Background Granulomatous interstitial nephritis in sarcoidosis (sGIN) is generally clinically silent, but in <1% causes acute kidney injury (AKI). Methods This Italian multicentric retrospective study included 39 sarcoidosis-patients with renal involvement at renal biopsy: 31 sGIN-AKI, 5 with other patterns (No-sGIN-AKI), 3 with nephrotic proteinuria. We investigate the predictive value of clinical features, laboratory, radiological parameters and histological patterns regarding steroid response. Primary endpoint: incident chronic kidney disease (CKD) beyond the 1°follow-up (FU) year; secondary endpoint: response at 1°line steroid therapy; combined endpoint: the association of initial steroid response and outcome at the end of FU. Results Complete recovery in all 5 No-sGIN-AKI-patients, only in 45% (13/29) sGIN-AKI-patients (p=0.046) (one lost in follow-up, for another not available renal function after steroids). Nobody had not response. Primary endpoint of 22 sGIN-AKI subjects: 65% (13/20) starting with normal renal function developed CKD (2/22 had basal CKD; median FU 77 months, 15-300). Combined endpoint: 29% (6/21) had complete recovery and final normal renal function (one with renal relapse), 48% (10/21) had partial recovery and final CKD (3 with renal relapse, of whom one with basal CKD) (p=0.024). Acute onset and hypercalcaemia were associated to milder AKI and better recovery than subacute onset and patients without hypercalcaemia, women had better endpoints than men. Giant cells, severe interstitial infiltrate and interstitial fibrosis seemed negative predictors in terms of endpoints. Conclusions sGIN-AKI-patients with no complete recovery at 1°line steroid should be treated with other immunosuppressive to avoid CKD, in particular if males with subacute onset and III stage-not hypercalcaemic AKI.
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Affiliation(s)
- Francesco Rastelli
- Nephrology SS. Trinità Hospital, Borgomanero, Italy.,Nephrology Bassini Hospital, Cinisello Balsamo, Italy
| | | | - Laura Buzzi
- Nephrology Bassini Hospital, Cinisello Balsamo, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Giuseppe Remuzzi
- Nephrology Papa Giovanni XXIII Hospital, Bergamo, Italy.,Clinical Research Centre for Rare Diseases, Mario Negri Institute for Pharmacological Research, Pediatric Nephrology Department Bergamo, Italy
| | | | | | - Guido Gatti
- Nephrology S.Raffaele Hospital, Milano, Italy
| | | | | | | | - Olga Baraldi
- Nephrology Policlino Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Giorgina Barbara Piccoli
- Nephrology S.Luigi Hospital, Orbassano, Italy.,Nephrologie Centre Hospitalier du Mans, Le Mans, France
| | | | | | - Paolo Cameli
- Pneumology S.Maria alle Scotte Hospital, Siena, Italy
| | | | - Paola Rottoli
- Pneumology S.Maria alle Scotte Hospital, Siena, Italy
| | - Mauro Dugo
- Nephrology S.Maria dei Battuti Hospital, Treviso, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Claudio Pozzi
- Nephrology Bassini Hospital, Cinisello Balsamo, Italy
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7
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Rombolà G, Heidempergher M, Cornacchiari M, Baragetti I, Pieruzzi F. SARS-CoV-2 and Hemodialysis: diffusion and mortality in patients and health care team. Reflections from the Lombardy experience. J Nephrol 2021; 34:277-279. [PMID: 33646561 PMCID: PMC7919233 DOI: 10.1007/s40620-021-01003-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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8
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Heidempergher M, Sabiu G, Orani MA, Tripepi G, Gallieni M. Targeting COVID-19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter-related infections. J Nephrol 2021; 34:345-353. [PMID: 33369726 PMCID: PMC7768271 DOI: 10.1007/s40620-020-00900-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/03/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND In hemodialysis (HD) patients, central venous catheter (CVC) related bloodstream infections are a major cause of morbidity and mortality. Hygienic precautions are a key aspect of dialysis care for infection prevention, but they are not sufficient to completely avoid the occurrence of CVC related infections. During the COVID-19 pandemic, hygienic precautions for preventing viral transmission have been markedly reinforced. We evaluated their effects on CVC-related infection rates. METHODS An observational retrospective study was conducted in two hemodialysis units of the same institution treating 215 chronic hemodialysis patients, 71 of whom are currently (33%) using a CVC. In the CVC cohort, we compared data on catheter-related infection rates during the maximum spread of the COVID-19 pandemic in Italy (February to May 2020) with data from the same period of the previous year and with the whole of 2019. RESULTS In 2019, we recorded a catheter-related bloodstream infection (CRBSI) rate of 1.19 (95% CI 0.81-1.68)/1000 days [2.07 (95% CI 1.12-3.52)/1000 days in the Feb-May 2019 period] and a tunnel and exit-site infection rate of 0.82 (95% CI 0.51-1.24)/1000 days [1.04 (95% CI 0.41-2.15)/1000 days in the Feb-May 2019 period]. Infection rates drastically decreased during the COVID-19 pandemic, with just one catheter-related bloodstream infection being recorded. Catheter-related bloodstream infection rates showed a significant reduction to 0.20 (95% CI 0.01-0.9)/1000 days (p < 0.05 and p < 0.005 compared to 2019 and to Feb-May 2019, respectively) and a non-significant reduction in tunnel and exit-site infections to 0.6 (95% CI 0.15-1.6)/1000 days. CONCLUSIONS The observed 91% reduction in catheter-related bloodstream infections compared to the same period in 2019 [IRR 0.09 (95% CI 0.002-0.64)] and the 83% reduction compared to the whole of 2019 [IRR 0.17 (95% CI 0.004-1.009)] suggest that a stricter implementation of hygienic precautions in the dialysis setting can markedly improve the problem of CVC-related infections.
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Affiliation(s)
| | - Gianmarco Sabiu
- Nephrology Unit, ASST Fatebenefratelli Sacco, Milano, Italy
- School of Nephrology, Università di Milano, Milano, Italy
| | | | - Giovanni Tripepi
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, National Research Council (CNR), Institute of Clinical Physiology (IFC), Reggio Calabria, Italy
| | - Maurizio Gallieni
- Nephrology Unit, ASST Fatebenefratelli Sacco, Milano, Italy.
- School of Nephrology, Università di Milano, Milano, Italy.
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Università di Milano, via G.B. Grassi, 74, 20157, Milano, Italy.
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9
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Rombolà G, Heidempergher M, Pedrini L, Farina M, Aucella F, Messa P, Brunori G. Practical indications for the prevention and management of SARS-CoV-2 in ambulatory dialysis patients: lessons from the first phase of the epidemics in Lombardy. J Nephrol 2020; 33:193-196. [PMID: 32207068 PMCID: PMC7095015 DOI: 10.1007/s40620-020-00727-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Confronting the SARS-CoV-2 outbreak has allowed us to appreciate how efficiently highly-resourced settings can respond to crises. However even such settings are not prepared to deal with the situation, and lessons are only slowly being learnt. There is still an urgent need to accelerate protocols that lead to the implementation of rapid point-of-care diagnostic testing and effective antiviral therapies. In some high-risk populations, such as dialysis patients, where several individuals are treated at the same time in a limited space and overcrowded areas, our objective must be to ensure protection to patients, the healthcare team and the dialysis ward. The difficult Italian experience may help other countries to face the challenges. The experience of the Lombardy underlines the need for gathering and sharing our data to increase our knowledge and support common, initially experience-based, and as soon as possible evidence-based position to face this overwhelming crisis.
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Affiliation(s)
- Giuseppe Rombolà
- Sezione Lombarda SIN, U.O. Nefrologia, Dialisi e Trapianto, ASST Sette Laghi, Varese, Italy.
| | - Marco Heidempergher
- Sezione Lombarda SIN, U.O. Nefrologia e Dialisi, ASST FBF Sacco, Milan, Italy
| | - Luciano Pedrini
- U.O. Nefrologia e Dialisi, Ospedale Bolognini ASST Bergamo Est, Bergamo, Italy
| | - Marco Farina
- U.O. Nefrologia e Dialisi, ASST Lodi, Lodi, Italy
| | - Filippo Aucella
- Società Italiana di Nefrologia, U.O. Nefrologia e Dialisi, IRCCS "Casa Sollievo della Sofferenza" San Giovanni Rotondo, Foggia, Italy
| | - Piergiorgio Messa
- Società Italiana di Nefrologia-SIN, U.O. Nefrologia, Dialisi e Trapianto, Ospedale Ca Granda Milano, Milan, Italy
| | - Giuliano Brunori
- Società Italiana di Nefrologia-SIN, U.O. Nefrologia e Dialisi, Ospedale Santa Chiara, Trento, Italy
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Rombolà G, Heidempergher M, Pedrini L, Farina M, Aucella F, Messa P, Brunori G. Correction to: Practical indications for the prevention and management of SARS-CoV-2 in ambulatory dialysis patients: lessons from the first phase of the epidemics in Lombardy. J Nephrol 2020; 33:197. [PMID: 32232773 PMCID: PMC7103894 DOI: 10.1007/s40620-020-00729-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Giuseppe Rombolà
- Sezione Lombarda SIN, U.O. Nefrologia, Dialisi e Trapianto, ASST Sette Laghi, Varese, Italy.
| | - Marco Heidempergher
- Sezione Lombarda SIN, U.O. Nefrologia e Dialisi, ASST FBF Sacco, Milan, Italy
| | - Luciano Pedrini
- U.O. Nefrologia e Dialisi, Ospedale Bolognini ASST Bergamo Est, Bergamo, Italy
| | - Marco Farina
- U.O. Nefrologia e Dialisi, ASST Lodi, Lodi, Italy
| | - Filippo Aucella
- Società Italiana di Nefrologia, U.O. Nefrologia e Dialisi, IRCCS "Casa Sollievo della Sofferenza" San Giovanni Rotondo, Foggia, Italy
| | - Piergiorgio Messa
- Società Italiana di Nefrologia-SIN, U.O. Nefrologia, Dialisi e Trapianto, Ospedale Ca Granda Milano, Milan, Italy
| | - Giuliano Brunori
- Società Italiana di Nefrologia-SIN, U.O. Nefrologia e Dialisi, Ospedale Santa Chiara, Trento, Italy
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11
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Heidempergher M, Landriani N, Airaghi C, Buskermolen M, Barone MT, Scorza D, Cuoccio P, Genderini F, Scandiani L, Genderini A. Pancake polycystic kidney: case report. Arch Ital Urol Androl 2012; 84:276-278. [PMID: 23427763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Pancake kidney is a very rare fusion abnormality, characterised by the presence of a renal parenchymal mass located in pelvic site, generally with two pelvies and two ureters and without an intervening fibrous septum. The case here reported describes a condition of "pancake kidney", eventually associated with polycystic disease and abnormous vascular supply. Hypertension and microscopic hematuria were the only clinical signs.
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