Clinical Aspects of Continuous Ambulatory and Continuous Cyclic Peritoneal Dialysis in Diabetic Patients

The treatment of end-stage renal diabetic nephropathy, remains a challenge. A large experience allows us to clearly outline the advantages and the drawbacks of continuous ambulatory peritoneal dialysis (CAPO) and continuous cyclic peritoneal dialysis (CCPO). Eighty-one patients, mean age 51.3 years, were treated over the last 9 years by CAPO-CCPO. Extrarenal complications, mainly vascular lesions, were present in this high-risk group of patients. The technique was modified in order to inject intraperitoneally, 4 times per day, insulin to control blood glucose level in CAPO patients. Actuarial survival was 92% at 1 year, 50% at 4 years mainly influenced by age: 85% survival at 2 years in 35 patients aged less than 50 years old and 62% at 2 years in 46 patients aged more than 50 years old. The main causes of death were of cardiovascular origin: myocardial infarction, stroke, atherosclerotic vasculopathy. The main causes of transfer to hemodialysis were due to technical complications. Peritonitis rate was one episode every 14 patientmonths. Control of blood pressure, blood glucose levels, main biological parameters, and visual status were the clear advantages of the method. Peripheral vascular disease is not influenced by the technique. CAPO-CCPO is the technique of first choice in young diabetics and the preferential technique for home dialysis. </jats:p

MO850: Casirivimab/Imdevimab in Vaccinated Chronic Haemodialyzed Patients With Acute Mild Covid-19: Safety And Efficiency

Abstract BACKGROUND AND AIMS Casirivimab/imdevimab (C/I) is a combination of two neutralizing human monoclonal antibodies against the SARS-CoV-2. It has been approved for primary prophylaxis or acute SARS-CoV-2 infection in patients with a poor vaccine response. Chronic haemodialyzed (CHD) patients are a high-risk population for both severe COVID-19 and impaired vaccine response. We herein report the safety and efficiency of C/I in CHD patients with acute mild COVID-19. METHOD In a single-centre haemodialysis facility, all 56 CHD patients received 3 injections of anti-COVID-19 mRNA BNT162b2 vaccine, with anti-S protein antibodies response assessed 7 months after the last injection. During follow-up, patients who presented an acute mild SARS-CoV-2 infection without the need for oxygen therapy and a poor vaccine response received within 5 days after diagnosis 600mg/600mg of C/I. The combination of monoclonal antibodies was infused only once after the end of the dialysis session during 20 min. Patients were kept under surveillance during 1 h before discharge. Efficiency was assessed by RT-PCR 7 days after C/I infusion and clinical evaluation. RESULTS Six CHD patients had an acute COVID-19 without oxygen therapy requirement and four had a vaccine response &amp;lt; 264 BAU/mL. Among them three had the Delta variant (L452R mutation), and received C/I. Two of them had the opportunity to have a fourth vaccine injection, but got infected within 2 weeks after the boost. Clinical data are summarized in Table 1. No patient presented any adverse effect within the time in the dialysis facility. During follow-up, all patients remained asymptomatic and all control RT-PCR performed 7 days after infusion were negative. CONCLUSION 600 mg/600 mg of C/I is a safe and efficient treatment for CHD patients with a poor vaccine humoral response presenting mild acute Delta variant COVID-19 without oxygen requirement. </jats:sec

213 Elderly Uremic Patients over 75 Years of Age Treated with Long Term Peritoneal Dialysis: A French Multicenter Study

We report our experience in 213 elderly patients over 75 years treated by peritoneal dialysis (PC) as first and exclusive dialysis therapy. The mean age at start of PC was 79.4t3.6 years, and the cumulative time on PC was 4551 months (mean time: 21.4 %19.8 months). Twenty-six patients lived in institutions and 187 1ived at home. Thirty patients had an effective autonomy with the ability to carry on normal activities. One hundred and two patients were cared for by a private nurse at home, and 46 patients were cared for in a family environment. Most cases were treated by three exchanges per day (152 cases) and used a nondisconnect system (175 cases) on account of absence of autonomy. The rate of peritonitis per patient month was one episode per 16.8 patient-months. Patient survival (Kaplan-Meier curves) was 74%,59%,45%, and 19% at one, two, three, and five years, respectively. The causes of death were various with a higher frequency of cardiovascular causes (48.3% of the 116 deaths). Thirtythree patients died in less than six months including 18 patients in less than three months. In conclusion: elderly uremic patients can be treated with long-term PC with relatively good results. Mortality is high but essentially due to age and poor general status -the dedication of private home nursing is very important in treating elderly PC patients. This fact often is a necessary condition in maintaining these elderly patients at home. </jats:p

Presentation and Outcome of Patients with Systemic Amyloidosis Undergoing Dialysis

Background and objectives: Light chain (AL) and secondary (AA) amyloidosis usually present as a systemic disease frequently involving the kidney and leading to ESRD. Data regarding patients with AA or AL amyloidosis undergoing dialysis remain scarce