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Background Patients on haemodialysis (HD) generally experience poor health-related quality of life (HRQoL) and a broad range of physical and mental symptoms, but it is unknown whether this differs between younger and older patients. We aimed to describe the trajectories of HRQoL and symptom burden of patients <70 and ≥70 years old and to assess the impact of symptom burden on HRQoL. Methods In incident Dutch HD patients, HRQoL and symptoms were measured with the 12-item Short Form Health Survey and Dialysis Symptom Index. We used linear mixed models for examining the trajectories of HRQoL and symptom burden during the first year of dialysis and linear regression for the impact of symptom burden on HRQoL. Results In 774 patients, the trajectories of physical HRQoL, mental HRQoL and symptom burden were stable during the first year of dialysis. Compared with patients <70 years of age, patients ≥70 years reported similar physical HRQoL {mean difference −0.61 [95% confidence interval (CI) −1.86–0.63]}, better mental HRQoL [1.77 (95% CI 0.54–3.01)] and lower symptom burden [−2.38 (95% CI −5.08–0.32)]. With increasing symptom burden, physical HRQoL declined more in older than in younger patients (β = −0.287 versus −0.189, respectively; P -value for interaction = .007). For mental HRQoL, this decrease was similar in both age groups (β = −0.295 versus −0.288, P  = .847). Conclusion Older HD patients generally experience a better mental HRQoL and a (non-statistically significant) lower symptom burden compared with younger patients. Their physical HRQoL declines more rapidly with increasing symptom burden. [ABSTRACT FROM AUTHOR]

Background: Kidney failure due to uterine prolapse is rare, nonetheless, early recognition and treatment of this form of postrenal kidney failure are essential in order to prevent serious complications., Case Description: In this article we describe a 73-year-old woman and a 63-year-old-woman with severe kidney failure due to a uterine prolapse. Both patients were initially treated with a nephrostomy catheter to ensure the passage of urine from the kidneys, after which the uterus was repositioned using a vaginal ring., Conclusion: Renal failure due to uterine prolapse can be easily diagnosed by physical examination. If uterine prolapse is diagnosed in a patient with renal failure, it is essential to quickly ensure the passage of urine in order to secure the function of the kidney.

♦ BACKGROUND: The use of pH-neutral peritoneal dialysis (PD) fluids low in glucose degradation products (GDP) may better preserve the peritoneal membrane and have fewer systemic effects. The effects of conversion from conventional to neutral-pH, low-GDP PD fluids in prevalent patients are unclear. Few studies on the role of neutral-pH, low-GDP PD have studied residual renal function, ultrafiltration, peritonitis incidence and technique failure, transport characteristics, and local and systemic markers of inflammation in prevalent PD patients. ♦ METHODS: In a multi-center open-label randomized clinical trial (RCT), we randomly assigned 40 of 78 stable continuous ambulatory PD (CAPD) and automated PD (APD) patients to treatment with bicarbonate/lactate, neutral-pH, low-GDP PD fluid (Physioneal; Baxter Healthcare Corporation, Deerfield, IL, USA) and compared them with 38 patients continuing their current standard lactate-buffered PD fluid (PDF) (Dianeal; Baxter Healthcare Corporation, Deerfield, IL, USA) during 2 years. Primary outcome was residual renal function (RRF) and ultrafiltration (UF) during peritoneal equilibration test (PET); peritonitis incidence was a secondary outcome. Furthermore, clinical parameters as well as several biomarkers in effluents and serum were measured. ♦ RESULTS: During follow-up, RRF did not differ between the groups. In the Physioneal group ultrafiltration (UF) during PET remained more or less stable (-20 mL [confidence interval (CI): -163.5 - 123.5 mL]; p = 0.7 over 24 months), whereas it declined in the Dianeal group (-243 mL [CI: -376.6 to -109.4 mL]; p < 0.0001 over 24 months), resulting in a difference of 233.7 mL [95% CI 41.0 - 425.5 mL]; p = 0.017 between the groups at 24 months. The peritonitis rate was lower in the Physioneal group: adjusted odds ratio (OR) 0.38 (0.15 - 0.97) p = 0.043. No differences were observed between the 2 groups in peritoneal adequacy or transport characteristics nor effluent markers of local inflammation (cancer antigen [CA]125, hyaluronan [HA], vascular endothelial growth factor [VEGF], macrophage chemo-attractant protein [MCP]-1, HA and transforming growth factor [TGF]β-1). ♦ CONCLUSION: In prevalent PD patients, our study did not find a difference in RRF after conversion from conventional to neutral-pH, low-GDP PD fluids, although there is a possibility that the study was underpowered to detect a difference. Decline in UF during standardized PET was lower after 2 years in the Physioneal group., (Copyright © 2017 International Society for Peritoneal Dialysis.)

Although unusual in the Netherlands, acute kidney injury is sometimes caused by infection with Hantavirus, a zoonosis transmitted by rodents. Hantavirus infections can cause a syndrome known as 'haemorrhagic fever with renal syndrome', characterized by fever, acute kidney injury and thrombocytopenia. Recovery is spontaneous and treatment is mostly supportive. We describe two cases of otherwise healthy men presenting with fever and acute kidney injury. Laboratory tests revealed raised inflammatory parameters and thrombocytopenia. Urine analysis revealed proteinuria, microscopic haematuria and cell casts. Despite treatment with fluids, renal function declined and oliguria and fluid retention developed in one patient. Dialysis could be avoided, with spontaneous recovery of renal function in both cases. Serological testing revealed acute Hantavirus infection. Acute kidney injury caused by Hantavirus infections is rare in the Netherlands, but should be suspected in any patient presenting with renal failure and a history of viral infection.

Initiation of peritoneal dialysis (PD) induces several changes both locally in the peritoneum and systemically. We performed a pilot study to generate insights into the early clinical and systemic changes after catheter insertion and the first weeks of PD. The study included 11 new PD patients (7 men, 4 women). The study period started just before implantation of the Tenckhoff catheter and finished 6 weeks after the start of PD. All patients were treated with lactate-buffered dialysis solutions. Clinical parameters, routine laboratory tests and markers of systemic inflammation were determined. The mean (+/- standard deviation) age of the patients was 52.6 +/- 12.1 years, mean weight was 81.3 +/- 14.7 kg, and mean blood pressure was 143.3/ 87.8 +/- 18.5/8.2 mmHg. Weight and blood pressure did not change significantly during the first weeks of PD. Throughout the study, 24-hour urine production declined by 6.9 mL/day (p = 0.006). Daily residual creatinine clearance (CCr) decreased by 0.036 mL/min (p = 0.008). High-sensitivity C-reactive protein (hs-CRP) was significantly higher in patients who had undergone hemodialysis before the start of the study (p < 0. 0001) and declined during the study in that group (p = 0.001). No significant change in hs-CRP was found in the group that started dialysis with PD. In this pilot study, we found no significant changes in the clinical parameters of weight and blood pressure during the first weeks of PD. However, urine production and residual CCr declined significantly during the study period, starting from the moment of catheter insertion. Levels of the systemic inflammatory marker hs-CRP were higher in patients who had previously undergone hemodialysis; its level in those patients decreased after hemodialysis ended.

Objective: To validate the use of a modified three-pore model for predicting fluid transport during long dwell exchanges that use a 7.5% icodextrin solution., Design: A nonrandomized, single group, repeated measures study., Patients: Ten peritoneal dialysis patients underwent a single 8-hour exchange of a 7.5% icodextrin solution. All patients were naive to icodextrin., Main Outcome Measures: A modified three-pore model was used to model solute and fluid transport during each 8-hour exchange. Concordance correlation coefficients were used to estimate the level of agreement between modeled and measured values of net ultrafiltration (UF) and intraperitoneal volume., Methods: Each patient underwent a modified 8-hour standard peritoneal permeability analysis using a 2-L 7.5% icodextrin exchange. Dextran 70 was added to the icodextrin solution as volume marker to estimate fluid transport kinetics. Transcapillary UF, fluid absorption, and intraperitoneal volumes were assessed via the volume marker at 0, 5, 15, 30, 60, 120, 240, 300, 360, 420, and 480 minutes., Results: There was strong agreement (concordance correlation = 0.9856) between net UF as measured by the volume marker data and net UF as modeled using the modified three-pore model implemented in PD Adequest (Baxter Healthcare, Deerfield, Illinois, USA)., Conclusions: Net UF and intraperitoneal volumes for long dwell exchanges using a 7.5% icodextrin solution can be accurately modeled with a modified three-pore model. Steady state icodextrin plasma levels are needed to accurately predict net UF for chronic users of icodextrin.