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Polyomavirus BK (BKV) is the cause of polyomavirus-associated nephropathy resulting in premature graft loss. There are limited data regarding the role of cytomegalovirus (CMV) infection and its prevention in developing BKV viremia and PVAN. In a prospective study, we analyzed 207 consecutive renal transplant recipients previously enrolled in 2 randomized trials evaluating different CMV prevention regimens with routine screening for BKV and CMV. Of these, 59 received valganciclovir and 100 valacyclovir prophylaxis; 48 patients were managed by preemptive therapy. At 3 years, the incidence of BKV viremia and PVAN was 28% and 5%, respectively. CMV DNAemia developed in 55% and CMV disease in 6%. Both BKV viremia (42% vs 23% vs 21%, P = .006) and PVAN (12% vs 2% vs 2%, P = .011) were increased in patients treated with valganciclovir prophylaxis compared to valacyclovir and preemptive therapy. Using multivariate Cox proportional hazard regression, valganciclovir prophylaxis was independent predictor of BKV viremia (hazard ratio [HR] = 2.38, P = .002) and PVAN (HR = 4.73, P = .026). In contrast, the risk of subsequent BKV viremia was lower in patients with antecedent CMV DNAemia (HR = 0.50, P = .018). These data suggest valganciclovir prophylaxis may be associated with increased risk of BKV viremia and PVAN. CMV DNAemia did not represent a risk for BKV., (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)

The solution usually recommended for rinsing the blood side, which is an indispensable step in preparing a dialyzer for hemodialysis (HD), contains saline and heparin. The heparin used for rinsing is said to reduce the thrombogenic properties of the dialysis membrane and, hence, also the need for systemic heparinization during the whole procedure. The aim of our study was to establish whether this postulate also applies to polysulphone steam-sterilized dialyzers. To do so, 16 patients on long-term dialysis were randomized into two groups of eight. One group was subsequently treated with polysulphone low-flux dialyzers (F6HPS), the other with polysulphone high-flux dialyzers (F6OS). Both groups were examined, in a crossover manner during HD using a dialyzer previously rinsed with 1000 ml of saline plus 2,000 IU of heparin, and during HD using a dialyzer previously rinsed with 500 ml of saline without heparin. Except for the rinsing, HD conditions were completely identical. Blood obtained before HD, and at 15, 60 and 240 min of HD at the dialyzer inlet, was used to determine the activated partial thromboplastin time (to test heparinization control), the thrombin-antithrombin III complex (ELISA, to evaluate coagulation system activation), platelet factor 4 (ELISA, a substance with antiheparin activity), and platelet count. None of the above parameters showed, at any of the collecting intervals, a statistically significant difference between HD with and without heparin with a reduced volume of rinsing solution, or between HD using low- and high-flux dialyzers. It is concluded that heparin used to rinse polysulphone dialyzers before HD has no effect on blood coagulation or on the need for heparin during the procedure.

Background: Chronic renal failure is associated with anaemia and a large percentage of patients is indicated for erythropoietin (rHuEPO) treatment. The degree of anaemia depends also on the quality of substitution of renal function. The objective of the present study was to assess whether transfer of patients from haemodialysis (HD) to acetate-free biofiltration (AFB) will influence the anaemia and rHuEPO consumption., Methods and Results: Anaemia and rHuEPO consumption were investigated in 10 patients in a stabilized condition with regular dialyzation treatment. The patients suffered from corrected anaemia on a maintenance dose of rHuEPO. During AFB (follow-up period one year) the rHuEPO consumption declined as compared with the condition during HD, while the target haemoglobin level (95-110 g/l) was maintained. The easier control of anaemia during AFB was not due to a change of iron saturation, the aluminium level or a change of the residual blood volume in the dialyzer. During AFB metabolic acidosis was controlled more effectively, the elimination of urea and beta-2-microglobulin increased., Conclusions: During AFB, as compared with HD, the rHuEPO consumption declines sufficiently to correct anaemia. The authors conclude that one of the reasons may be the more effective control of metabolic acidosis and elimination of uraemic toxins with a low or medium molecular weight. The authors discuss also other factors which affect anaemia during treatment of renal failure by extracorporcal clearing methods.