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COVID-19 is a pandemic and life-threatening respiratory disease. Chronic kidney disease is a probable risk factor for more severe COVID-19, but outcomes in the peritoneal dialysis population are scarce. We analyzed our peritoneal dialysis center COVID-19 cases from March 2020 to January 2021, before full vaccination with the Pfizer BNT 162b2 mRNA vaccine in February 2021. There were 13 cases of COVID-19 out of 96 patients on peritoneal dialysis (cumulative incidence 13,5 cases per 1000 patients-month). Nine were considered mild (76,9%), two moderate (15,4%) and one severe/critical (7,7%). There was one asymptomatic case. The most common presenting signs and symptoms were myalgia, cough, fever, asthenia, hypotension, and loss of smell and/or taste. Only one patient required oxygen in the ICU. There was a hospitalization rate of 30,8% (three mild and one severe/critical) and a median time of hospitalization until discharge, or death, of 6 days. The most common reason for hospitalization was hypotension and asthenia, without respiratory failure (three mild out of four hospitalizations). One patient died (7,7%) and 12 patients recovered well (92,3%). Of eleven patients presenting with COVID-19 symptoms, nine reported persisting symptoms for over one month (81,8%). In conclusion, COVID-19 in patients under peritoneal dialysis had a relatively benign course with symptoms mainly unrelated to the respiratory tract.

Point-of-care ultrasound aims to enhance physical examination findings with real-time information from the ultrasound. Peritoneal dialysis catheter-related infections are a frequent complication of peritoneal dialysis and a major predisposing factor to peritonitis. The diagnosis of peritoneal dialysis catheter-related infections is made with physical examination, but physical findings usually lack sensitivity or specificity. This is a single-center observational study that aimed to evaluate the accuracy of point-of-care ultrasound for the diagnosis of peritoneal dialysis catheter-related infections. Sixteen peritoneal dialysis patients with peritoneal dialysis catheter-related infections clinical suspicion were enrolled in this study, as well as nine controls. Peritoneal dialysis catheter-related infection was defined as a purulent discharge with or without inflammatory signs in the peritoneal dialysis catheter exit-site or subcutaneous tunnel, and a positive microbiological culture collected from the exit-site. Point-of-care ultrasound was considered positive when an anechoic collection in relation to the external cuff or catheter tunnel was identified. Physical examination findings were coded using the Exit-site Scoring System. A total of 13 peritoneal dialysis catheter-related infections were diagnosed. The mean Exit-site Scoring System score for the suspected cases of peritoneal dialysis catheter-related infections was 2,82 ± 1,22, and the most commonly encountered sign was purulent discharge. All of the cases of peritoneal dialysis catheter-related infections had a positive point-of-care ultrasound. In contrast, none of the controls had a positive point-of-care ultrasound (p < 0,001). The area under the receiver operating characteristic curve of physical examination for the diagnosis of peritoneal dialysis catheter-related infections was 0,6 (95% CI 0,37-0,84). In contrast, point-of-care ultrasound had an AUROC of 0,91 (95% CI: 0,73-1) for the diagnosis of peritoneal dialysis catheter-related infections. Nephrologist-performed point-of-care ultrasound is feasible and superior to physical examination for the diagnosis of peritoneal dialysis catheter-related infections.

Operational tolerance in kidney transplantation is characterized by stable serum creatinine < 1.7 mg/dL and proteinuria < 1 g/day in the absence of immunosuppression or immunodeficiency for over one year. However, simultaneous donor specific antibodies are common and serum creatinine is a poor surrogate of early lesions. Consequently, subclinical rejections will meet operational tolerance criteria if sérum creatinine remains stable. We report a patient with operational tolerance criteria followed by biopsy-proven chronic active antibody mediated rejection, discussing the intricate challenges of immunosuppression management.

Peritonitis is a serious complication in peritoneal dialysis, usually secondary to an infectious cause. Chemical peritonitis is rarer. No case exclusively attributed to vancomycin has been reported in the last 20 years. Data from 4 consecutive patients diagnosed with culture‑negative peritonitis following administration of intraperitoneal vancomycin between May and June 2019 were retrospectively recorded. All patients were treated with 2 grams of intraperitoneal vancomycin after a break in aseptic technique and developed a cloudy effluent. No patient was previously known to be allergic to vancomycin. All had a clear dialysate before vancomycin. All developed an elevated leukocyte count in the dialysate. All had sterile cultures. All resumed a clear effluent with less

Introduction: Exit-site infections are an important complication of peritoneal dialysis; however, very little is known about fungi-related exit-site infections. The literature is very sparse and there are virtually no studies that report it. Objective: To evaluate in retrospect the risk factors associated with exit-site fungal infection and its development. Methods: The study included all diagnosed episodes of exit- site fungal infections in patients undergoing peritoneal dialysis in a hospital unit between 2011 and 2014, analyzed in relation to demographic, clinical and analytical variables. Results: The studied group included 26 patients, 70% of which were female, with a median age of 54 years old; average length in PD treatment three years. The majority of patients (70%) were undergoing manual peritoneal dialysis. About 30 episodes of exit-site fungal infections were diagnosed during the follow-up period, which corresponded to 5.6% of total exit-site infections diagnosed. About 23% of patients suffered from diabetes mellitus and 13% had undergone immunosuppressive therapy in the six months previous to the episode. Two thirds of patients (n=20) had undergone antibiotherapy in the previous three months, the majority (65%) for the treatment of peritoneal dialysis-related infection and 46% of these patients underwent concomitant antifungal prophylaxis with fluconazole. The exit-site fungal infections were predominantly caused by Candida parapsilosis (67%). Eighty per cent of patients (n=24) improved with antifungal therapy (fluconazole or itraconazole), and the remaining patients underwent peritoneal catheter replacement (n=3) or removal (n=3) due to persistent infection. Exit-site fungal infections were the cause of technique failure in 2 of these patients. Conclusion: Exit-site fungal infections are an unusual but important complication of peritoneal dialysis. In this study, the most relevant risk factor associated with these infections was previous antibiotherapy and the majority of patients evolving favourably under medical treatment