Oana Rap

BACKGROUND: Acute kidney injury (AKI) is a life-threatening complication of severe rhabdomyolysis. This study was conducted to assess risk factors for AKI and to develop a risk score for early prediction. METHODS: Retrospective observational cohort study with a 9-year follow-up, carried out in an acute-care teaching-affiliated hospital. A total of 126 patients with severe rhabdomyolysis defined as serum creatine kinase (CK) > 5,000 IU/L fulfilled the inclusion criteria. Univariate and logistic regression analyses were performed to determine risk factors for AKI. Based on the values obtained for each variable, a risk score and prognostic probabilities were estimated to establish the risk for developing AKI. RESULTS: The incidence of AKI was 58%. Death during hospitalization was significantly higher among patients with AKI, compared to patients without AKI (19.2% vs 3.6%, p = 0.008). The following variables were independently associated with AKI: peak CK (odds ratio [OR] 4.9, 95%CI 1.4-16.8), hypoalbuminemia (< 33 mg/dL, [OR 5.1, 95%CI 1.4-17-7]), metabolic acidosis (OR 5.3, 95%CI 1.4-20.3), and decreased prothrombin time (OR 4.4, 95% CI 1.3-14.5). A risk score for AKI was calculated for each patient, with an OR of 1.72 (95%CI 1.45-2.04). The discrimination value of the predictive model was established by means of a ROC curve, with the area under the curve of 0.871 (p<0.001). CONCLUSIONS: The identification of independent factors associated with AKI and a risk score for early prediction of this complication in patients with severe rhabdomyolysis may be useful in clinical practice, particularly to implement early preventive measures.

INTRODUCTION: COVID-19 is a very high transmission disease with a variable prognosis in the general population. Patients in hemodialysis therapy are particularly vulnerable to developing an infectious disease, but the incidence and prognosis of hemodialysis patients with COVID-19 is still unclear. The main objective is to describe the experience of our dialysis unit in preventing and controlling the spread of SARS-CoV-2 infection. METHODS: Preventive structural and organizational changes were applied to all patients and health care personnel in order to limit the risk of local transmission of SARS-CoV-2 infection. FINDINGS: The Nephrology department at Sant Joan Despí Moises Broggi Hospital-Consorci Sanitari Integral is a reference for two satellite hemodialysis centers caring for 156 patients. We combine our own hemodialysis maintenance program for 87 patients with hospitalized patients from peripheral hemodialysis centers. In this area, the reported incident rate of COVID-19 in these peripherical hemodialysis centers was 9.5% to 19.9% and the death rate 25% to 30.5%. In our hemodialysis program, the incidence rate was 5.7%. Three out of five required hospitalization (60%) and nobody died. DISCUSSION: Although the risk of local transmission of the disease was very high due to the increase in hemodialysis patients from peripheral centers admitted to hospital, the incidence rate of COVID-19 was very low in our own hemodialysis patients. We believe that the structural and organizational changes adopted early on and the diagnosis algorithm played an important role in minimizing the spread of the disease.

Abstract Background and Aims Morbimortality and quality of life in hemodialysis patients is directly related to the reliability and integrity of the vascular access. Current guidelines recommend a shift from a "fistula first" approach to a patient-centered approach due to the aging dialysis population. Frailty, defined as vulnerability to adverse health states due to impaired functional status, comorbidities and psychosocial factors, conditions a worse outcome of patients with end-stage kidney disease (ESKD) undergoing dialysis. Our aim was to assess frailty status before the performance of native arteriovenous fistulas (nAVF) as a predictor of failure to mature. Method Retrospective analysis of ESKD clinic patients who underwent a first nAVF between 2020-2022 and had undergone a frailty assessment before the surgery. The Frail-VIG index, evaluating frailty through deficit accumulation (scored from 0 to 1), vas employed. Patients were categorized as either non-frail (NF-ESKD: Frail-VIG &amp;lt; 0.2) or frail (F-ESKD: Frail-VIG ≥ 0.2). the study evaluated early nAVF and recorded the first ultrasound maturation values 4 weeks after surgery. Results Throughout the study period, 180 patients underwent a first nAVF, 57 (31.6%) having undergone a prior frailty assessment. 27 (47.4%) patients were classified as NF-ESKD, 30 (52.6%) as F-ESKD (23 mild, 6 moderate and 1 severe frailty). In the descriptive analysis, no differences in age, sex, toxic habits, CKD etiology or medical conditions were observed between the two groups (Table 1). Regarding surgical technique, there were no differences in nAVF location and laterality between the two groups (Table 1). F-ESKD patients had a higher primary fistula failure, defined as no flow prior to the first ultrasound evaluation (36.7% vs. 3.8%; p=0.002). In patients with an initial ultrasound evaluation, the F-ESKD group had lower arterial flow (1020.76 ± 589.42 vs. 1455.56 ± 679.78 ml/min; p=0.027) and smaller fistula diameter (4.52 ± 1.51 vs. 6.4 ± 1.61 mm; p=0.018). Maturation was assessed after the first ultrasound evaluation, defined as the presence of an arterial flow greater than 500 ml/min and a diameter greater than 4 mm. A higher proportion of frail patients (88.9% vs. 33.11%; p = 0.004), a lower capacity to perform instrumental activities measured by Lawton Brody index (4.63 ± 2.2 vs. 6.55 ± 2.2; p = 0.034) and a higher percentage of diabetic patients (88.89% vs. 48.48%; p = 0.033) were found in nAVF that had not reached ultrasound-guided maturity (Table 2). In a multivariate analysis adjusted for functional status, type of vascular access and comorbidities, the presence of frailty conferred a higher risk of fistula non-maturation (OR 11.42 95%CI 1.005 - 128.74; p = 0.049). Conclusion The prevalence of frailty is notable among in ESKD patients and contributes to a higher rate of failure in native nAVF. Within this population, adopting an individual approach to the selection of a definitive vascular access may prove both feasible and beneficial in ensuring optimal dialysis access.