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BACKGROUND AND AIMS Insertion of tunnelled central venous catheters (TCVC) in patients with chronic kidney disease requiring haemodialysis is a technique of increasing interest in interventional nephrology. Ambulatory placement by a multidisciplinary team of nephrologists and radiologists reduces immediate complications among these patients. METHOD Retrospective study of TCVC implantation from 2011 to 2021. The ultrasound-guided technique was used for localization and venipuncture. Correct catheter location and venous anatomy were subsequently checked by fluoroscopy. Early adverse events (30 days post-placement) were recorded. RESULTS A total of 427 TCVC were placed in 344 patients during this period. Out of these 248 (58.07%) were primary placements (PP) and 179 (41.92%) guidewire exchanges over previous catheter (GE). A total of 406 (95.08%) TCVC were placed in the internal jugular and 374 (87.59%) TCVC with right laterality. During the follow-up period, early minor complications were recorded in 23 procedures (5.39%), 15 of which (3.51%) required catheter replacement. Patients with GE developed more complications (P 0.039), being venous stenosis, the main complication described (Figure). A total of 61 patients required successive catheter placements: 48 (78.69%) underwent two procedures and 13 (21.31%) more than three procedures, for a total of 83 TCVC. There were no differences in the number of early complications between the first (10) and successive (14) placements (P 0.94). Catheter durability was similar in subsequent procedures (355 ± 62.3 days at first placement versus 459 ± 60.3 days in successive placements, P 0.24). CONCLUSION Multidisciplinary TCVC implantation guarantees good effectiveness of the technique. The performance of subsequent procedures is safe and durable in patients with CKD.

Background Cardiovascular disease is the leading cause of death in renal transplant (RT) patients. Both traditional and emerging risk factors, some of which are controversial, have been described in the pathogenesis of cardiovascular disease. Carotid ultrasound (CUS) is considered to be an excellent diagnostic tool for subclinical atherosclerosis. Objective To evaluate the relationship between biomarkers of inflammation, growth factors, metalloproteinases, and the development of subclinical atherosclerosis diagnosed by using CUS. Methods We studied 93 RT patients (aged 54 ± 12 years; 67.9% men; 13.5% with pre-RT diabetes mellitus). The following biomarkers were determined in the patients' blood hours before RT: C-reactive protein (CRP) and serum amyloid A using nephelometry; interleukin (IL) 2, 6, 8, and 10 and soluble IL-2 receptor, tumor necrosis factor (TNF) α, vascular endothelial growth factor (VEGF), epidermal growth factor, and monocyte chemotactic peptide using chemoluminescence; and pregnancy-associated plasma protein (PAPP)A using ELISA. A CUS was carried out during the first month after RT. Results Carotid intima-media thickness (IMT) was elevated in 51% of the patients, and 50.5% of the patients had atherosclerotic plaque. Both plaque ( P = .004) and IMT ( P = .001) correlated with age, and the increase of IMT was progressive, on both the left and the right side. Pre-RT CRP, IL-8, TNF-α, VEGF, MCP-1, and PAPP-A were significantly more elevated in patients with plaque. In the multivariate analysis adjusted for clinical variables, age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01–1.10; P = .04), CRP (OR, 7.5; 95% CI, 2.05–27.3; P = .002), IL-8 (OR, 4.73; 95% CI, 1.27–17.6; P = .02), and PAPP-A (OR, 4.45; 95% CI, 1.22–16.2; P = .023) were independent markers of the presence of plaque. Conclusions Age, CRP, IL-8, and PAPP-A, and not growth factors, are markers of carotid atheromatous plaque in RT patients.

Secondary hyperparathyroidism is a common complication in patients with chronic kidney disease and frequently persists after kidney transplantation. Paricalcitol, a selective vitamin D receptor activator, is indicated in the management of this disorder and recent evidences have suggested that this drug has other beneficial effects. Aiming to elucidate these effects, our study included 52 stable kidney transplant recipients randomized 2:1 to treatment with paricalcitol or to no treatment. Bone mineral parameters, kidney function and inflammatory status were assessed at baseline, at 3 and at 12 months. Moreover, a proteomic approach, based on magnetic beads technology coupled to MALDI-TOF mass spectrometry readout, was used to determine changes in patients' plasma peptidome. Patients treated with paricalcitol showed a significant decrease in parathyroid hormone and alkaline phosphatase levels, and an increase of bone mineral density and glomerular filtration rate. The proteomic analysis revealed a decrease in bradykinin after paricalcitol treatment, whereas 2 peptides identified as fragments of the complement factor C4 decreased only in those patients not treated with paricalcitol. These findings suggest that paricalcitol may offer additional benefits due to immunomodulatory effects via the kallikrein-kinin and complement systems.