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Introdução: Portugal foi atingido severamente pela síndrome respiratória aguda grave (SARS-CoV-2), responsável pela doença por coronavírus 2019 (COVID-19). A população idosa e com comorbilidades, na qual estão incluídas as pessoas com doença renal crónica em estádio 5 em programa regular de hemodiálise (CKD-5D), foi particularmente afetada. Definimos como objetivos deste estudo a identificação do impacto da vacinação no surgimento de novos casos diários e a sua influência na mortalidade na população CKD-5D.Material e Métodos: Estudo observacional, prospetivo, envolvendo doentes com CKD-5D de 38 clínicas da NephroCare, Portugal. A infeção e a mortalidade diárias por SARS-CoV-2 destes doentes foi comparada com a taxa de incidência na população em geral. Foram analisados três períodos: antes da vacinação, durante, e um terceiro período após a vacinação completa pela vacina Comirnaty ®, da Pfizer-BioNTech. Foi considerado desfecho primário a infeção pelo vírus SARS-CoV-2 e como desfecho secundário, a morte associada à infeção.Resultados: Foram analisados 4617 doentes com uma média de 69,37 anos. Durante o primeiro período, verificou-se uma taxa de incidência de COVID 19 de 14,9%, significativamente maior nos doentes CKD-5D quando comparado com a taxa de incidência de 7,9% da população em geral (p < 0,001). Durante os quinze dias após a vacinação completa observámos uma reversão, com diminuição significativa de casos de COVID-19 (p < 0,001). A mortalidade atribuível a COVID-19 no grupo CKD-5D foi significativamente superior ao da população em geral (p < 0,001).Discussão: Observámos uma elevada taxa de incidência de infeção nos doentes CKD-5D, presumivelmente correlacionada com vários fatores como a idade avançada, as comorbilidades, a impossibilidade de confinar, entre outros. Após a vacinação verificou-se uma redução significativa de novos casos.Conclusão: A vacinação reduziu significativamente a infeção por SARS-CoV-2 nos doentes CKD-5D.

Background: Vascular access surveillance of dialysis patients is a challenging task for clinicians. We derived and validated an arteriovenous fistula failure model (AVF-FM) based on machine learning. Methods: The AVF-FM is an XG-Boost algorithm aimed at predicting AVF failure within three months among in-centre dialysis patients. The model was trained in the derivation set (70% of initial cohort) by exploiting the information routinely collected in the Nephrocare European Clinical Database (EuCliD®). Model performance was tested by concordance statistic and calibration charts in the remaining 30% of records. Features importance was computed using the SHAP method. Results: We included 13,369 patients, overall. The Area Under the ROC Curve (AUC-ROC) of AVF-FM was 0.80 (95% CI 0.79–0.81). Model calibration showed excellent representation of observed failure risk. Variables associated with the greatest impact on risk estimates were previous history of AVF complications, followed by access recirculation and other functional parameters including metrics describing temporal pattern of dialysis dose, blood flow, dynamic venous and arterial pressures. Conclusions: The AVF-FM achieved good discrimination and calibration properties by combining routinely collected clinical and sensor data that require no additional effort by healthcare staff. Therefore, it can potentially enable risk-based personalization of AVF surveillance strategies.

Introduction: Despite the impact needling has had on vascular access survival and patient outcome, there is no universal or standardized method proposed for proper cannulation. Rigorous studies are needed, examining cannulation practices, and challenges to achieving complication-free cannulation. Methods: This randomized, open-label trial was conducted at 18 dialysis units owned by a large private dialysis provider operating in Portugal. Eligible patients were adults on chronic hemodialysis, with a new arteriovenous fistula (AVF); cannulated for at least 4 weeks complication-free. Patients were randomly assigned in a 1:1 ratio to one of three cannulation techniques (CT): Multiple Single cannulation Technique (MuST), rope-ladder (RLC), and buttonhole (BHC). The primary endpoint was AVF primary patency at 1 year. Findings: One hundred seventy-two patients were enrolled between March 2014 and March 2017. Fifty-nine patients were allocated to MuST, 56 to RLC, and 57 to BHC. MuST and RLC were associated with a better AVF primary patency than BHC. Primary patency at 12 months was 76.3% in MuST, 59.6% in BHC, and 76.8% in RLC group. Mean AVF survival times were 10.5 months (95% CI = 9.6, 11.3) in the MuST group, 10.4 months (95% CI = 9.5, 11.2) in RLC, and 9.5 months (95% CI = 8.6, 10.4) in BHC. BHC was a significant risk predictor for AVF survival with 2.13 times more events than the other two CT (HR 2.13; 95% CI = 1.07, 4.21; p = 0.03). Discussion: MuST was easy to implement without a diagram and there is no need to use blunt needles. This study showed MuST was efficacious and safe in maintaining the longevity of AVF in dialysis patients. info:eu-repo/semantics/publishedVersion

Introduction:In post-dilution online hemodiafiltration, a very thin balance subsists in preventingcoagulation of the extracorporeal circuit (ECC) during treatment and bleeding in the patient, con-cerning dialyzer status and anticoagulation dose.The aim of this study was to assess whether there are clinical outcome differences between thevisual aspect of the dialyzer’s status in terms of clottedfibers at end of dialysis treatments, single-pool urea kinetic modeling (spKt/V) and substitution volume (SubsVol).Methods:It is a multicenter, descriptive-correlational study, involving 2829 patients during April2016. Previous training was given to the Nursing staff to evaluate and classify both the dialyzer’sand the venous chamber’s appearance of the ECC venous line. Registration was performed at bed-side immediately after the patient disconnection.Findings and discussion:Mean age was 68.96 years (SD= 13.75), 60.8% were men. The averagehematocrit was 33.91% (SD= 3.45%). The average dry weight was 68.53 kg (SD= 13.27 kg). Meanunfractioned heparin (UFH) dose was 58.13 IU/kg. Only 32.4% of the patients had a clean dialyzerat the end of treatment. 19.4% of patientsfinished the treatment with more than 10% of clottedfibers. Patients with no residual blood (clean, 32.4%) presented a higher UFH dose (66.32 IU/kg)compared to overall average dose. UFH dose had a significant effect on dialyzer status. There weresignificant differences in average ofspKt/V and SubsVol between the category clean and the othercategories of dialyzer’s status.Evaluating the dialyzer status represents an excellent opportunity to help the physicians to estab-lish an ideal heparin dose. Only the categorycleanis significant to achieve the target. The nursingstaff, by classifying the ECC appearance at patient’s bedside and recording it in a centralized database, can be a major contributor to achieve an individualized and optimal UFH dose and subsequently better patient outcomes. info:eu-repo/semantics/publishedVersion

Although buttonhole cannulation has some benefits compared to rope-ladder cannulation, the increase of infection rates represents a major obstacle to patient safety, and its use is questionable in routine clinic practice. On the other hand, rope-ladder cannulation is difficult to implement even with a prescribed protocol, leading the cannulator in daily practice to a possible use of the area technique. This article provides a reflection on the impact of cannulation technique on the safety of patients on regular hemodialysis treatment and describes a new approach for arteriovenous fistula cannulation, the Multiple Single Cannulation Technique (MuST). The MuST has not been described before, but it has been used with promising results. Further studies are needed to confirm the benefits of this cannulation technique.