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ABSTRACTIntroductionWe present the results of the COVID-19 rule-out protocol at Ghent University Hospital, a step-wise testing approach which included repeat NFS SARS-CoV-2 rRT-PCR, respiratory multiplex RT-PCR, low-dose chest CT and bronchoscopy with BAL to confirm or rule-out SARS-CoV-2 infection in patients admitted with symptoms suggestive of COVID-19.ResultsBetween 19 March 2020 and 30 April 2020, 455 non-critically ill patients with symptoms suspect for COVID-19 were admitted. The initial NFS for SARS-CoV-2 rRT-PCR yielded 66.9%, the second NFS 25.4% and bronchoscopy with BAL 5.9% of total COVID-19 diagnoses. In the BAL fluid, other respiratory pathogens were detected in 65% (13/20) of the COVID-19 negative patients and only in 1/7 COVID-19 positive patients. Retrospective antibody testing at the time around BAL sampling showed a positive IgA or IgG in 42.9 % of the COVID-19 positive and 10.5% of the COVID-19 negative group. Follow-up serology showed 100% COVID-19 positivity in the COVID-19 positive group and 100% IgG negativity in the COVID-19 negative group.ConclusionIn our experience, bronchoscopy with BAL can have an added value to rule-in or rule-out COVID-19 in patients with clinical and radiographical high-likelihood of COVID-19 and repeated negative NFS testing. Furthermore, culture and respiratory multiplex PCR on BAL fluid can aid to identify alternative microbial etiological agents in this group. Retrospective analysis of antibody development in this selected group of patients suggests that the implementation of serological assays in the routine testing protocol will decrease the need for invasive procedures like bronchoscopy.

New-onset diabetes after transplantation (NODAT) is a frequent complication and has an impact on patient and graft survival. Hypomagnesemia is common in both renal transplant recipients and in diabetics. This study examines the relationship between hypomagnesemia, NODAT and the type of immunosuppression in renal transplant recipients.

To make an evidence-based evaluation of the relationship between kidney failure and cardiovascular risk, we reviewed the literature obtained from a PubMed search using pre-defined keywords related to both conditions and covering 18 years (1986 until end 2003). Eighty-five publications, covering 552 258 subjects, are summarized. All but three studies support a link between kidney dysfunction and cardiovascular risk. More importantly, the association is observed very early during the evolution of renal failure: an accelerated cardiovascular risk appears at varying glomerular filtration rate (GFR) cut-off values, which were >/=60 ml/min in at least 20 studies. Many studies lacked a clear definition of cardiovascular disease and/or used a single determination of serum creatinine or GFR as an index of kidney function, which is not necessarily corresponding to well-defined chronic kidney disease. In six studies, however, chronic kidney dysfunction and cardiovascular disease were well defined and the results of these confirm the impact of kidney dysfunction. It is concluded that there is an undeniable link between kidney dysfunction and cardiovascular risk and that the presence of even subtle kidney dysfunction should be considered as one of the conditions necessitating intensive prevention of this cardiovascular risk.

Introduction: Although peritoneal dialysis (PD) is considered favorable regarding hemodynamic stability, little is known on potential acute effects of fluid exchange. We aimed to assess central hemodynamic changes during infusion and dwell time. Methods: Patients were randomized to 3 different starting volumes (1000, 1500 and 2500 mL) of the non-glucose containing icodextrin, followed by addition or drainage of 200 mL every 10 minutes for 50 minutes. Hemodynamic parameters were studied using the SphygmoCor, before and after infusion of the starting volumes and after each volume change. Local carotid systolic blood pressure (BP), augmentation index (AI) and central augmentation pressure (AP) and were used as central measures. Results: We included 13 patients (9 male, 4 female) on PD aged 57 years (range: 40–82) and with a median BP of 126/77 mmHg (range: 94–200/51–94 mmHg). After infusion of the starting volume, central systolic BP and central AP increased by 4.7 mmHg (p = 0.006) and 2.8 mmHg (p = 0.005). AI increased by 5.7% (p = 0.04) and heart rate decreased by 2.6 bpm (p = 0.006). The difference in heart rate adjusted AI was not significant. Intraperitoneal pressure increased by 2.3 cm H2O (p = 0.03). No significant changes were observed on subsequent addition or drainage of volumes. Conclusions: Infusion of PD fluids causes a significant acute increase in central systolic BP that persists for at least one hour and is associated with a slight decrease in heart rate. This may be due to an enhanced preload from intraperitoneal venous compression and/or to an increased wave reflection.