Dimitrios Tsakiris

Fungal Peritonitis Complicating Peritoneal Dialysis during an 11-Year Period: Report of 46 Cases

The incidence of fungal peritonitis (FP) and the fungi that caused FP were evaluated in 422 patients treated with peritoneal dialysis. During an 11-year period, 804 episodes of peritonitis occurred, 46 (5.7%) of which were caused by fungi. Treatment was successful for 39 patients. Early diagnosis of FP and prompt therapy decreases morbidity and mortality.

Osteonecrosis and fractures following renal transplantation

Skeletal radiological surveys in 161 renal transplant recipients identified 36 patients with 115 lesions of osteonecrosis. A further two patients with osteonecrosis found at autopsy had had no radiographic abnormality. The total incidence of osteonecrosis was, therefore, 38 (24%) out of 161. The lesions were frequently multiple and bilateral with structural failure being the most common initial abnormality and the femoral head the most frequent site. Lesions also occurred in the femoral condyles, the talus, the humeral heads and the metatarsals, many being symptom-free. Calcification was demonstrated in the femoral and tibial shafts. The initial radiological abnormality appeared at a mean interval of 19 months after transplant but could occur as late as 75 months. Significantly fewer patients, three (7%) out of 41, developed osteonecrosis following a low-dose prednisolone regimen (0.8 g) compared with a high-dose group (2.8 g) where 35 (29%) out of 120 were affected. More females than males developed osteonecrosis, but no correlation could be demonstrated with regard to age, primary renal disease, number and type of transplant and duration of dialysis prior to transplant. Osteonecrosis is a complication which can be reduced with a low-dose prednisolone regimen. Most lesions will be demonstrated by radiological survey undertaken during the second and fourth years after transplantation.

Impact of Long-Term Cinacalcet, Ibandronate or Teriparatide Therapy on Bone Mineral Density of Hemodialysis Patients: A Pilot Study

Background: Insufficient evidenced-based information is available for the treatment of osteoporosis in hemodialysis (HD) patients. Methods: In 102 HD patients, bone mineral density (BMD) was measured twice 16 ± 3 months apart. In the second BMD measurement 66 of them had a femoral neck (FN) T-score <–2.5. Of these 66 patients, 38 consented to a bone biopsy. Depending on both the bone biopsy findings and parathyroid hormone levels, patients were assigned to treatment groups. Eleven patients with osteitis fibrosa and iPTH >300 pg/ml received cinacalcet, 11 with osteitis fibrosa and iPTH <300 pg/ml received ibandronate, 9 with adynamic bone disease received teriparatide, and 7 with mild abnormalities received no treatment. A third BMD measurement was done after an average treatment period of 13–16 months. We compared the annual percent change of FN and lumbar spine (LS) BMD before and during treatment. Results: FN and LS BMD decreased significantly in the cinacalcet group, with an annual change of 3.6 and 3.4% before treatment to –4.2% (p = 0.04) and –7.7% (p = 0.02) during treatment, respectively. In the teriparatide group, FN and LS BMD increased, although not significantly, with an annual change of –5.4 and –2.6% before treatment to 2.7 and 4.9% during treatment, respectively. In both the ibandronate and the no treatment groups, BMD change rate remained negative during the whole study. Conclusions: Teriparatide administration improved BMD in HD patients with adynamic bone disease, although these results did not reach statistical significance. In HD patients with osteitis fibrosa, ibandronate did not improve BMD while cinacalcet reduced BMD.

Fever of unknown origin in a haemodialysis patient: a late diagnosis requiring a novel treatment

Fever in haemodialysis patients is usually attributed to infection, with less frequent causes including malignancy and autoimmune disorders [1]. Sometimes, fever persists despite empirical treatment, and investigations towards the above mentioned diagnoses fail to reveal the cause. Thus, rarer aetiologies need to be considered, which may appear rather unexpected, especially in patients under prolonged medical follow-up.