Carlo Crepaldi

INTRODUCTION AND AIMS: Bacterial peritonitis is a frequent complication during treatment of end-stage kidney disease by Peritoneal Dialysis (PD); severe or repeated episodes of peritonitis cause long-term complications that potentially lead to peritoneal membrane failure. Lipopolysaccharide (LPS) or endotoxin is an abundant glycolipid present on the outer membrane of Gram-negative bacteria and it may contribute to the progression of a local infection to sepsis. Previous studies demonstrated that LPS level is related to the degree of systemic inflammation and atherosclerosis in PD patients. The aim of this study was to evaluate LPS levels in PD patients, in particular, we investigated LPS levels in PD with Gram positive/ negative peritonitis.

INTRODUCTION AND AIMS: In the international literature there is growing evidence about alteration in cognitive function in patients with renal replacement therapy (RRT). It seems that the executive domain is mainly involved. Further, we know little about possible differences in patients undergoing different treatments. The aim of the present study is to evaluate the executive domain of dialysis pts after 1 year of follow up by rapid neuropsychological screening battery.

Abdominal aortic calcification (AAC) is reported as a predictor for cardiovascular events in general population and in hemodialysis patients. At present, there are no AAC data in peritoneal dialysis. The purpose of this study was to evaluate the prognostic role of AAC score on cardiovascular events in peritoneal dialysis patients. Seventy‐four peritoneal dialysis patients were enrolled. AAC was measured on baseline lateral abdomen radiographs by the semi‐quantitative method as described by Kauppila. The other cardiovascular risk factors were obtained from patient history and blood examination. The Kaplan–Meier method was used to evaluate freedom from cardiovascular events, and differences were assessed with the log‐rank statistic. Multivariate Cox regression models addressed time to cardiovascular events. The median period of follow‐up was 30.5 months (IQR 19.4–32.7). During follow‐up, there were 29 cardiovascular events (39.2%). In univariable analysis, patient's age (HR = 1.050; P = 0.001), urine output (HR = 0.999; P = 0.02), and AAC stratified by tertiles (overall P‐value < 0.001) were significantly associated with cardiovascular events. In multivariable regression analysis, AAC score stratified by tertiles was the only independent predictor for cardiovascular events (overall P‐value <0.001). To our knowledge, we have shown for the first time that AAC score is an independent predictor of cardiovascular events in peritoneal dialysis patients. Risk stratification by assessment of AAC score may provide important information for the management of cardiovascular disease in peritoneal dialysis patients without any additional expense, because these patients have several abdominal X‐ray scans to evaluate the catheter position.

The management of anemia in uremic patients undergoing hemodialysis requires the appropriate combination of erythropoietin treatment, iron supplementation, and on occasion androgen therapy. Identifying and correcting functional iron deficiency is crucial to optimizing erythropoietin efficiency. Recently, however, the trend to administer maintenance iron with resultant high serum ferritin and high transferrin saturation has led to an increase in reports of iron overload. Oral iron supplementation is inexpensive and safe, but poor patient compliance and reduced intestinal absorption may limit its efficacy. Intravenous iron, on the other hand, is effective, and its safety is related to the iron salt used. Currently available data suggest that iron saccharate may be the safest iron salt available for intravenous administration, although iron gluconate is safer than the dextran forms of intravenous iron. It should be kept in mind, however, that all forms of intravenous iron may have the potential of inducing iron overload. At this time, the levels of ferritin that define iron overload are not clearly established. The side effects of iron overload are well recognized (infections, malignancies, vascular diseases); however, no guidelines exist for safe practice. There are many markers of iron deficiency, with serum ferritin and hypochromic red cell percentage currently the best markers available in clinical practice.