Andreana De Mauri

Risk Factors for Chronic Renal Dysfunction in Lung Transplant Recipients

Several factors predispose to renal dysfunction (RD), a common complication of solid organ transplants. We evaluated the impact of clinical and laboratory parameters on the decline of renal function in lung and heart-lung transplant recipients. We enrolled 45 patients who survived more than 6 months after transplantation, had normal renal function and urinalysis before the surgery. The prognostic value of variables for the occurrence of RD was calculated by univariate analysis. Thirty patients developed RD, defined as doubling of serum creatinine or creatinine steadily >1.5 mg/dL after a median time of 12 months. Serum creatinine above 0.9 mg/dL during the month preceding lung transplant, systolic blood pressure above 130 mmHg, and pretransplant idiopathic pulmonary hypertension were significantly associated with the development of RD. Our findings indicate that increased systolic blood pressure, reduced glomerular filtration rate, and idiopathic pulmonary hypertension are risk factors for chronic RD in lung transplant recipients.

Estimated radiation risk of cancer from medical imaging in haemodialysis patients

BACKGROUND In recent years the widespread use of medical procedures increased the cumulative effective doses of ionizing radiation. Although many haemodialysis patients undergo multiple examinations with high radiation exposure, no data are available characterizing their attendant potential risks of cancer. METHODS The radiation exposures were obtained from a retrospective study of 159 consecutive haemodialysis patients with a follow-up duration ≥ 1 year. Effective dose and organ dose were estimated on an individual basis. Radiation risk was expressed as risk of exposure-induced death (REID) (%). RESULTS The 159 patients (101 males) were followed for a median of 2.7 years (mean 3.0 years). A total of 486 patient-years were available for follow-up. The mean age at study entry was 65.3 years. The mean cumulative organ doses were 103, 102, 100, 99, 77 and 58 mSv for kidneys, lung, stomach, liver, colon and bone marrow, respectively. On average, computed tomography, nuclear medicine and interventional radiology accounted for 90, 4.5 and 5.5% of organ doses, respectively. The average REID was 0.99% (i.e. odds 1 in 100) and the median REID was 0.45%. At univariate analysis, increasing age and presence of diabetes were independent predictors of lower REID, whilst patients eligible for kidney transplantation were exposed to a significantly higher REID. At multivariate analysis, younger age was an independent predictor of higher REID. CONCLUSIONS The excess cancer risk-attributable radiation exposure in haemodialysis patients is not negligible. Particular attention should be paid to younger patients and to patients who will undergo kidney transplantation.

Vitamin K Antagonist Therapy Is a Risk Factor for Ulcer Development and Death Among Dialyzed Patients

Peripheral artery disease is a common complication among dialyzed patients. Since Vitamin K antagonists promote metastatic calcifications and these are the main determinants of vascular damage, we investigated their role in the development of lower limb ulcers in dialyzed patients. We retrospectively enrolled 316 dialyzed patients, aged 68 ± 15 years, 65% male, 32% diabetic, 43% with ischemic heart disease and followed them for 36 ± 25 months. 60 patients assumed Vitamin K antagonists: they were older, with a higher prevalence of heart disease, at greater risk of death and they developed more ulcers and underwent more lower limb amputations compared to the rest of our cohort. Peripheral artery disease, Vitamin K antagonists and diabetes were independent risk factors for foot lesions. In addition, Vitamin K antagonists were also an independent risk factor for death. Vitamin K antagonists are a potent independent risk factor for the development of the uremic foot syndrome and death.

Report of a transient increase in tunneled catheter infections following dialysis facility transfer to a prefabricated structure.

Purpose Despite the efforts to promote the native artero-venous fistula as dialysis access, the use of tunneled central venous catheters (tCVC) is increasing. Main complications remain infections of the access, and the environment plays an important role in determining them; however, no studies are available that report dialysis provided in prefabricated temporary buildings. The aim of our study was to assess the incidence of tCVC infections in a container building. Methods Since May 2009 our Dialysis Center has been located in a container building. The occurrence of local and systemic infections of tCVC when dialysis was provided in the container was compared with the previous two years, when dialysis was provided at the “Home” center. Each year was also divided into semesters to maintain the temporary relationship between the new location and the infections. Results tCVCs represented approximately 13% of all vascular accesses. In the first six months in the temporary building, 50% of patients presented infections, compared to 13% to 20% during the other periods (P=0.02). In the first six months in the container the incidence of infections was 1.44 per 1000 catheters-days, higher than in any other semester (P=0.02). More infections requiring systemic antibacterial agents occurred over this period. Conclusions Our study demonstrates that, when a dialysis center is moved to a prefabricated temporary building, the likelihood of tCVC infections increases within the initial months and returns back to the previous levels after a period of adaptation.