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Background Dialysis patients are considered at high risk for COVID-19 and the infection can easily spread in dialysis units. Methods We conducted an observational single-centre cohort study to describe clinical characteristics, treatments and outcomes of dialysis patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We tested patients who presented symptoms or had contact with a confirmed case. We enrolled 15 patients positive for SARS-CoV-2. Results We tested 37 of 306 dialysis patients. Patients with SARS-CoV-2 infection were older (mean age 75.96 ± 11.09 years) and all had comorbidities. At presentation, most had interstitial infiltrates on chest X-ray, three-quarters had leucopenia and none had respiratory insufficiency. During follow-up, there was an increase in serum C-reactive protein and interleukin-6. Eighty percent of patients received supplemental oxygen; none received non-invasive ventilation, one was intubated. Most patients (80%) were treated with oral hydroxychloroquine for a median time of 6.5 days [interquartile range (IQR) 5–14.5] and 40% received azithromycin; two patients received a short course of antivirals and one received a single dose of tocilizumab. Only two patients did not require hospitalization. Of the nine survivors, eight still tested positive for SARS-CoV-2 a median of 19 days (IQR 9.25–23) after diagnosis. Six patients died (case fatality rate 40%) a median of 5.5 days (IQR 1.75–9.75) after diagnosis. The main reported cause of death was respiratory failure related to COVID-19 (five patients). Conclusions We report a single-centre experience of SARS-CoV-2 infection in dialysis patients. The disease showed a high case fatality rate and most patients required hospitalization. Survivors show prolonged viral shedding. [ABSTRACT FROM AUTHOR]

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright of Clinical Kidney Journal is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. [Extracted from the article]

Donation after circulatory death (DCD) is an accepted strategy to widen organ procurement worldwide. Authorized centers in Italy are spreading, increasing kidney transplantation (KTX) from DCD donors (40 in 2017 vs 24 in 2016). In this study, we describe DCD KTX activity at the University of Modena and Reggio Emilia (Modena, Italy) since its beginning in November 2017. We retrospectively studied DCD KTX performed in our center from November 2017 to June 2018. We considered donor characteristics (age, sex, cause of death) and recipient clinical data (length of hospital stay, serum creatinine, estimated glomerular filtration rate, delayed graft function [DGF]), primary nonfunction [PNF], HLA match). All the grafts underwent in situ normothermic (ExtraCorporeal Membrane Oxygenation-ECMO) and ex situ hypothermic oxygenated perfusion (HOPE) with Kidney Assist machines. We monitored ex situ perfusion solution biochemical (lactate dehydrogenase [LDH] and lactate) and dynamic (resistance and flow) parameters. A kidney biopsy was performed for allocation strategy according to Karpinski score. We performed 6 kidney transplants (3 single and 3 double); the mean recipient (57.5 ± 4.9) and donor age (57.3 ± 7.5) were similar. Mean ECMO duration was 3 h 27 ± 57 min, HOPE was 4 h 47 min ± 119 min, lactate sample values (collected every 15 minutes from the beginning of perfusion) were always lower than1.6 mmol/L, and LDH maximum value was 400 UI/L. Median cold ischemia time was 11 h 18 min. Mean Karpinski score was 3.6; mean HLA match 1.7.We experienced 1 DGF (16.6%), no PNF, with a mean hospital stay of 14.6 days, mean creatinine at hospital discharge 2 ± 1.04 mg/dL), and mean eGFR 53.8 ±27.3 mL/min); at 1 month, mean creatinine and eGFR were 2 ± 1.34 mg/dL and 59.8 ± 24.5 mL/min, respectively. DCD is a promising resource for increasing organ donation. The Emilia Romagna regional organization allowed short ischemia times, with solid KTX outcomes, supporting further development of this program. • DCD kidney transplantation is a valid resource to expand the pool of deceased donors. • Clinical, histological, and perfusion parameters are essential in graft evaluation. • Double kidney transplantation is possible in the DCD settings. • Preliminary results of our center confirm satisfactory outcomes. [ABSTRACT FROM AUTHOR]

Introduction and aim of the study. The centralized preparation and distribution system of acidic concentrate represents a true innovation in hemodialysis, when compared to acid bags, in terms of convenience and eco-sustainability. The aim of this study is to compare the use of traditional acid bags with the centralized distribution system of acidic concentrate, with particular attention to differences in terms of eco-sustainability and convenience. Methods. At the Nephrology Dialysis and Renal Transplantation Unit of the University Hospital of Modena was installed the Granumix system® (Fresenius Medical Care, Bad Homburg, Germany). Data collected before the introduction of the Granumix® system (including the used acid bags, boxes and pallets used for their packaging, liters of acid solution used and kilograms of waste generated from wood, plastic, cardboard and residual acid solution) were compared with those collected after the implementation of the Granumix® system. Factors such as material consumption, volume of waste generated, unused and wasted products, time required for dialysis session preparation and nurses' satisfaction were analyzed to document which system was more environmentally sustainable. Results. Data collected in 2019 at our Dialysis Center showed a consumption of 30,000 acid bags, which generated over 20,000 kg of waste from wood, plastic and cardboard, and approximately 12,000 liters of residual acid solution to be disposed of, with a handling weight by operators reaching nearly 160,000 kg. The use of the centralized distribution system of acidic concentrate resulted in a significant reduction in waste generated (2,642 kg vs 13,617 kg), residual acid solution to be disposed of (2,351 liters vs 12,100 liters) and weights handled by operators (71,522 kg vs 158,117 kg). Conclusions. The acidic concentrate appears to be better suited to the sustainability challenge that dialysis must faces today, particularly due to the significant increase in the number of patients, which leads to a higher number of treatments and, therefore, a growing demand for eco-sustainable products., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Purpose: Acid-base derangement has been poorly described in patients with coronavirus disease 2019 (COVID-19). Considering the high prevalence of pneumonia and kidneys injury in COVID-19, frequent acid-base alterations are expected in patients admitted with SARS-Cov-2 infection. The study aimed to assess the prevalence of acid-base disorders in symptomatic patients with a diagnosis of COVID-19., Methods: The retrospective study enrolled COVID-19 patients hospitalized at the University Hospital of Modena from 4 March to 20 June 2020. Baseline arterial blood gas (ABG) analysis was collected in 211 patients. In subjects with multiple ABG analysis, we selected only the first measurement. A pH of less than 7.37 was categorized as acidemia and a pH of more than 7.43 was categorized as alkalemia., Results: ABG analyses revealed a low arterial partial pressure of oxygen (PO 2 , 70.2 ± 25.1 mmHg), oxygen saturation (SO 2 , 92%) and a mild reduction of PO 2 /FiO 2 ratio (231 ± 129). Acid-base alterations were found in 79.7% of the patient. Metabolic alkalosis (33.6%) was the main alteration followed by respiratory alkalosis (30.3%), combined alkalosis (9.4%), respiratory acidosis (3.3%), metabolic acidosis (2.8%) and other compensated acid-base disturbances (3.6%). All six patients with metabolic acidosis died at the end of the follow-up., Conclusion: Variations of pH occurred in the majority (79.7%) of patients admitted with COVID-19. The patients experienced all the type of acid-base disorders, notably metabolic and respiratory alkalosis were the most common alterations in this group of patients., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in patients with COVID-19., Methods: We reviewed the health medical records of 307 consecutive patients with COVID-19 hospitalized at the University Hospital of Modena, Italy., Results: AKI was diagnosed in 69 out of 307 (22.4%) COVID-19 patients. Stages 1, 2, or 3 AKI accounted for 57.9%, 24.6% and 17.3%, respectively. AKI patients had a mean age of 74.7 ± 9.9 years. These patients showed higher serum levels of the main markers of inflammation and higher rate of severe pneumonia than non-AKI patients. Kidney injury was associated with a higher rate of urinary abnormalities including proteinuria (0.44 ± 0.85 vs 0.18 ± 0.29 mg/mg; P =  < 0.0001) and microscopic hematuria (P = 0.032) compared to non-AKI patients. Hemodialysis was performed in 7.2% of the subjects and 33.3% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were age, male sex, CKD and higher non-renal SOFA score. Patients with AKI had a mortality rate of 56.5%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (hazard ratio [HR] = 4.82; CI 95%, 1.36-17.08) compared to non-AKI patients., Conclusion: AKI was a common and harmful consequence of COVID-19. It manifested with urinary abnormalities (proteinuria, microscopic hematuria) and conferred an increased risk for death. Given the well-known short-term sequelae of AKI, prevention of kidney injury is imperative in this vulnerable cohort of patients., (© 2021. Japanese Society of Nephrology.)

Background: Donation after circulatory death (DCD) is a solid resource to widen the kidney donor pool. Italian activity has grown in the last years with encouraging results. Our center has been active in DCD kidney transplantation (KTX) since November 2017, providing 22.5% of Italian DCD donations in 2018. We present a single-center retrospective analysis after a 1-year follow-up comparing DCD and donation after brain death (DBD) KTX outcomes., Methods: DCD (controlled only) and DBD KTX performed in our center from November 2017 to December 2018 were considered. All DCDs underwent in situ normothermic perfusion with extracorporeal membrane oxygenation, ex situ hypothermic oxygenated perfusion, and renal biopsy prior to allocation. We considered features of donors and recipients, immunosuppressive regimen, delayed graft function (DGF), primary nonfunction (PNF), graft and patient survival (Kaplan-Meier), creatinine, and estimated glomerular filtration rate at 1 year. Mean comparison with a Student t test and with χ 2 test for frequencies were elaborated., Results: Twenty-eight DBD, 18 double (64.3%) and 10 single (35.7%), were performed; 7 DCD, 3 double (42.8%) and 4 single (57.2%), were performed. By comparing single and double KTX, no statistically significant difference was found. We recorded 7 DGFs (25%) in DBD and 1 (14.3%) in the DCD group (P > .99) and no PNF. No graft was lost during the first year. One-year estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration) was, respectively, 62.7 ± 25.3 and 54.71 ± 14.66 mL/min (P = .25). DBD patient survival rate was 92.8%, DCD was 100%, and Kaplan-Meier was not statistically significant (P = .72)., Conclusions: Controlled DCD is a valid resource for KTX, with similar outcomes to DBD. A multidisciplinary donor evaluation, combining clinical, perfusion, and histologic data in the allocation process, allows excellent results., (Copyright © 2020 Elsevier Inc. All rights reserved.)