Critically ill trauma patients admitted to the intensive care unit (ICU) experience significant morbidity and mortality, often driven by multi-organ dysfunction and acute kidney injury (AKI). AKI is a common and severe complication that contributes to poor outcomes, yet its prognostic significance in trauma-related ICU mortality remains incompletely understood. This study aimed to investigate the relationship between organ dysfunction, AKI severity, and ICU mortality in a tertiary trauma center to improve risk stratification and clinical management strategies. This prospective observational study was conducted over nine months, enrolling 120 trauma patients admitted to the ICU. Organ dysfunction was assessed using daily Sequential Organ Failure Assessment (SOFA) scores, while AKI was classified according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The association between SOFA scores, AKI severity, and hemodynamic parameters with ICU mortality was analyzed using logistic regression, receiver operating characteristic (ROC) curve analysis, and Youden's J statistic. The cohort had a mean age of 54.5 years (±19.5 SD), with most patients being male (84.7%). Surgical interventions were performed in 13.9%, while critical care interventions included intubation (70.8%), inotropic drugs (19.4%), and nephrotoxic agents (9.7%). AKI occurred in 40.28% (60 patients) of patients, classified as KDIGO Stage I (23/60, 37.93 %), Stage II (25/60, 41.38 %), and Stage III (12/60, 20.69 %). Among the 120 patients, 70 (58.33%) died during ICU admission, with 80.95% (57/70) of deceased patients having AKI at the time of death, highlighting a strong association between renal dysfunction and mortality. After adjusting for age, SOFA score, injury severity score (ISS), and mean arterial pressure (MAP), AKI emerged as an independent predictor of mortality, with affected patients showing a 2.31-fold increased risk of death (RR: 2.31) and 5.25 times higher odds of mortality (OR: 5.25, P = 0.006) compared to non-AKI patients. Organ dysfunction severity, as measured by the maximum daily SOFA score, was a strong predictor of ICU mortality (AUC = 0.84, 95% CI: 0.75–0.93). A SOFA score of ≥8 was identified as the optimal cutoff, significantly increasing mortality risk (Fig. 1). Furthermore, higher SOFA scores were strongly associated with severe AKI (KDIGO Stage II-III), with each 1-point increase in SOFA score raising the odds of severe AKI by 27.5% (OR: 1.28, 95% CI: 1.08–1.50, P = 0.004) (Fig. 2). Additionally, MAP was marginally associated with AKI duration (P = 0.054), suggesting that lower MAP values may contribute to prolonged renal impairment, emphasizing the role of hemodynamic stability in ICU outcomes. This study demonstrates that SOFA scores strongly predict ICU mortality and AKI severity, with a SOFA threshold of 8 serving as an effective mortality cutoff. The high prevalence of AKI among deceased patients underscores its critical role in ICU outcomes, necessitating early identification and intervention. Hemodynamic monitoring and AKI risk assessment should be integrated into ICU protocols to mitigate mortality and renal dysfunction in critically ill trauma patients. These findings highlight the urgent need for multidisciplinary strategies focused on organ dysfunction management and renal protection to improve survival in ICU trauma populations.

Anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitis (AAV) is related to substantial morbidity and mortality, even with the latest treatments. Renal involvement is common in AAV and the most important mortality predictor. The Birmingham Vasculitis Activity Score (BVAS) has emerged as an essential tool in assessing disease activity and predicting long-term prognosis. The study evaluated the association between BVAS and outcomes in renal vasculitis patients. A retrospective study was carried out from 2021 to 2024. Twenty patients (13 women and 7 men) with systemic vasculitis were included in the study. Clinical and laboratory data were collected. The BVAS was evaluated for all the patients. Patients were divided into three groups according to their outcomes: remission, renal replacement therapy (RRT), and nonsurvivors. Eight patients had the presence of PR3- ANCA and twelve patients were positive for MPO-ANCA. All patients were presented with impaired renal function. Nine patients made renal remission, three patients needed RRT, and eight patients did not survive. The BVAS ranged from 6 to 22 (mean 13.2 ± 3.6). The mean BVAS in the remission group was 10.89 ± 2.89, in the RRT group 13.00 ± 1.73, and in the nonsurvivors 15.88 ± 3.18. Independent Kruskal- Walli's test showed a significant relationship between groups χ²(2) = 8.724, P = 0.013, but without specifying among which groups. After the Bonferroni adjustment, a significant difference between BVAS in the remission group and nonsurvivors was found, χ²(2) = 8.444, P = 0.009, and no difference between remission and RRT groups, and RRT and nonsurvivors was found. These findings indicate that BVAS might be a prognostic indicator of ANCA-associated vasculitis. Moreover, BVAS can contribute to the early identification of high-risk patients requiring more aggressive therapeutic interventions. However, further investigation would be necessary to confirm this hypothesis.

Scleroderma renal crisis (SRC) is the most common hallmark of renal involvement in systemic sclerosis (SSc), characterized by acute kidney injury and malignant hypertension. The pathophysiology of SRC involves endothelial dysfunction, activation of the renin-angiotensin-aldosterone system (RAAS), and thrombotic microangiopathy (TMA), leading to renal ischemia and hypertension. When accompanied by overlapping Sjögren's syndrome (SS), the clinical presentation and therapy become considerably more complex. We discuss the diagnosis, management, and outcomes of a patient presenting with SRC and overlapping SS. It highlights the importance of early detection and rapid treatment of SRC, particularly in the presence of overlap syndromes. Early intervention with angiotensin-converting enzyme (ACE) inhibitors and careful monitoring of renal function are crucial for optimal outcomes. The occurrence of overlapping SS complicates the clinical presentation and therapy, emphasizing the importance of an individualized approach to treatment. Healthcare personnel must be especially mindful of this since early detection of renal crisis has a major impact on survival rates and long-term prognosis.

Introduction: Anti-neutrophil cytoplasmic antibody (ANCA)- associated vasculitis (AAV) is a rare group of systemic autoimmune diseases that primarily target small blood vessels. Renal manifestations often present as pauci-immune focal and segmental necrotizing crescentic glomerulonephritis (PI-NCGN), which can progress to acute or chronic kidney failure and multiorgan involvement. It is frequently associated with poor outcomes. We report a case of PR3-positive ANCA-associated vasculitis complicated by rapidly progressive glomerulonephritis, acute kidney injury, and diffuse alveolar hemorrhage during the COVID-19 pandemic. This case highlights the diagnostic challenges of differentiating AAV from conditions associated with SARS-CoV-2 infection, as the clinical and radiological presentations of pulmonary-renal syndromes may overlap. The findings underscore the importance of maintaining a comprehensive differential diagnosis in patients with pulmonary and renal involvement, particularly in the post-COVID-19 era, to ensure timely and accurate management of rare autoimmune conditions such as AAV. Conclusion: ANCA-associated vasculitis (AAV) remains a diagnostic and therapeutic challenge, particularly in the post-COVID-19 era, where overlapping clinical and radiological features with SARS-CoV-2 complications can obscure timely identification. This case highlights the critical importance of maintaining a broad differential diagnosis in patients presenting with pulmonary-renal syndromes to differentiate AAV from more common conditions associated with COVID-19.

Carnitine palmitoyltransferase II (CPT2) deficiency is a rare inherited disorder affecting fatty acid metabolism. This enzymatic defect presents with a broad clinical spectrum, from severe neonatal forms that can be fatal, to milder myopathic variants characterized by myalgia and recurrent myoglobinuria in adolescence and adulthood. Herein, we report the case of a male patient who developed exertional rhabdomyolysis and acute kidney injury due to CPT2 deficiency. This case underscores the importance of considering genetic disorders in the differential diagnosis of patients presenting with recurrent exercise intolerance and metabolic crises. Early recognition and diagnosis enable prompt implementation of dietary and lifestyle modifications aimed at mitigating potential complications such as renal impairment. Moreover, timely diagnosis allows for genetic counseling of affected individuals and their families.

IntroductionInfective endocarditis is a potentially life-threatening condition, more prevalent among chronic maintenance hemodialysis patients, as opposed to the general population.AimCombined involvement of both the right and left heart chambers is exceptionally rare.Case studyHerein, we present the case of a patient on long-term maintenance hemodialysis with right and left sided infective endocarditis.Results and discussionWe discuss potential risk factors leading to the widespread infection and emphasize the importance of an early diagnosis and prompt treatment in yielding better outcomes.ConclusionsThe patient was treated successfully by a multidisciplinary team.

Abstract Background and Aims Prevailing studies indicate a correlation between elevated serum phosphate levels and an augmented incidence of cardiovascular events. In patients undergoing dialysis, hyperphosphatemia contributes to vascular and valvular calcifications. This study analyzes the interrelation of phosphate levels, inflammatory markers, and additional risk determinants in the development of carotid artery atherosclerosis in individuals receiving peritoneal dialysis (PD) versus hemodialysis (HD). Method A cohort of 39 PD and 53 HD patients were recruited, all undergoing stable renal replacement therapy (RRT) for three to thirty-six months. B-mode ultrasonography assessed the carotid artery intima-media thickness (CIMT) and detected plaque and calcification occurrences. Patients were specified as having atherosclerosis when CIMT was greater than 1 cm, and the presence of plaque was identified. Logistic regression analysis was employed to discern the connection between potential risk factors and the incidence of atherosclerosis. Results The study encompassed 92 participants, 61% undergoing HD and an average age of 53.4 years (standard deviation ± 14.5 years). The tubulo-interstitial disease was the predominant initial pathology, followed by chronic glomerulonephritis and nephroangiosclerosis. Diabetic nephropathy was identified as the etiology of end-stage renal disease (ESRD) in 23.1% of PD and 11.4% of HD subjects (p = 0.047). Notably, PD patients showed better residual renal function (RRF) (p < 0.001), urine volume over 24 hours (p < 0.001), and C-reactive protein (CRP) (p = 0.047), alongside diminished phosphate (p = 0.01), parathyroid hormone (PTH) (p < 0.05), alkaline phosphatase (p < 0.05), and albumin levels (p < 0.001) relative to their HD counterparts. Atherosclerosis prevalence was 66.3%, inclusive of the entire diabetic cohort. The incidence of atherosclerosis did not significantly diverge between PD and HD groups [56.4% vs 73.6% in HD, respectively]. Atherosclerotic patients were older (p < 0.001) and exhibited heightened phosphate levels (p = 0.012), pulse pressure (p = 0.01), and calcium index (Ci) (p = 0.034). Multiple regression analysis elucidated age, phosphate, RRF, PTH, pulse pressure, diabetes, and HD modality as autonomous factors linked to atherosclerosis. Conclusion Beyond conventional risk factors like age and diabetes, metabolic disorders arising from renal insufficiency were identified as contributing to atherosclerotic development. Multivariate analysis identified phosphate, RRF, and pulse pressure (PP) as independent atherosclerotic risk factors. The HD modality carried an elevated atherosclerotic risk compared to PD. It was thought that preserving RRF in PD patients would improve phosphate regulation and maybe even improve endothelial function, explaining the differences found.

Abstract Background and Aims Mineral bone disease and cognitive impairment are related diseases in the CKD population. Vascular calcification, a marker of MBD, may play a role in the early detection of cognitive decline. This study aims to identify a relationship between MBD biomarkers and cognitive function and to identify dialysis patients with a high risk of dementia. Method A total of 98 patients participated in this cross-sectional study, with 63 on hemodialysis and 35 on peritoneal dialysis. They underwent the Montreal Cognitive Assessment (MoCA) questionnaire, which categorized mild, moderate, severe, and severe based on scoring. PTH, P, Ca, ALP, and Mg serum concentrations and vascular calcification were measured as MBD biomarkers. The Adragaos score was applied to graphs of the hands and pelvis to evaluate vascular calcification. Results The mean MoCA score was 20,28±5.8. Based on the responses, it was concluded that 70% of HD patients had mild cognitive impairment, compared to 63% of PD patients. According to the descriptive data, patients whose underlying CKD was caused by nephroangisclerosis had the lowest MOCA test results compared to other groups (p<0.001). The degree of calcification was observed to have an adverse effect on cognitive performance in both groups (p<0.012); the high Adragaos score contributed to the decline in the MoCA test score. In multivariate logistic regression analysis, hypercalcemia and hypomagnesemia were independent variables for cognitive function impairment (p = 0.006 and p = 0.04, respectively). The serum concentration of PTH (p = 0.008) and ALP (p = 0.001) were found to be risk factors for HD patients during the evaluation of the MoCA test in each of the groups. Conclusion Vascular calcifications are considered a risk factor for cognitive impairment. In our study, vascular calcification risk is positively impacted by indicators such as hyperparathyroidism, hypercalcemia, high levels of ALP, and hypomagnesemia. Recently research has demonstrated the effectiveness of magnesium as a vascular calcification inhibitor. So, nephrologists should be more careful in monitoring levels of MBD biomarkers.

Abstract Background and Aims It is widely known that chronic dialysis patients experience significantly higher cardiovascular (CV) death rates than the overall population. Among other CV risk factors, recent research has shown pulmonary hypertension (PH) as a consequence of chronic kidney disease and end-stage renal failure. The present study aimed to determine the risk factors that impact survival in chronic haemodialysis and peritoneal dialysis patients and to analyse the correlation of these factors with pulmonary hypertension. Method We studied 125 stable haemodialysis and peritoneal patients (females 40%, mean age 52.42 ±11.88 years) on RRT for more than three months with a two-year follow-up. Demographic information, clinical characteristics, blood tests, and a thorough echocardiographic evaluation were collected at the optimal dry weight. After conventional echocardiographic examination, a tissue Doppler echocardiographic (TDE) examination was performed to evaluate the global and regional myocardial systolic and diastolic functions and pulmonary hypertension. Systolic pulmonary artery pressure (sPAP) of 35 mmHg was used to define PH. Results The cardiovascular mortality rate was 15.5%. In ROC analysis for CV mortality, the area under the curve (AUC) for PH and CRP was found 0.8; for LVM-I, E/E', and PP, the AUC was 0.76, 0.75, 0.72, respectively, while the inverse relationship was found with MASa and TASa with AUC = 0.66 and 0.95 respectively. According to the echocardiographic findings, PH was found in 28% (35 patients) of all patients. The mean PH was 33.46±5.38 mmHg. The higher level of higher parathormone (PTH), C-reactive protein (CRP), and E/E’ average, the lower left ventricular ejection fraction (EF), the peak systolic velocity at the lateral mitral annulus (MASa), and the peak systolic velocity at the lateral tricuspid annulus (TASa) were found to be predictors of PH. Patients evaluated with PH have a significantly lower cardiovascular survival rate [Long Rank (Mantel-Cox) p = 0.0001. Conclusion Our research demonstrates that cardiovascular morbidity and death in dialysis patients are mainly attributed to pulmonary hypertension, inflammation, vascular stiffness, and left ventricular hypertrophy. PH is common among dialysis patients. Inflammation, CKD-MBD biomarkers linked to systolic and diastolic left and right ventricular dysfunction, and inflammation all influence it. These conditions are all connected. Cardiovascular imaging is simple to use, offers a favourable viewpoint in the early identification of cardiac abnormalities and quick treatment of this disease, and is thus strongly advised in the dialysis population.

Abstract Background and Aims Acute renal injury represents a heterogeneous clinical syndrome with multifactorial etiology rather than a single specific pathology, which is associated with high morbidity and mortality. The disease burden of community-acquired AKI in our country is not well understood. In fact it is known little about it. The aim of this study is to identify and evaluate the risk factors for developing AKI in our community. Method This is a cross-sectional study conducted with a small size sample, 76 adult patients. These patients were identified with AKI at hospital admission. AKI was defined according RIFLE Classifications. This champion was selected among patients hospitalized in the Nephrology Clinic, UHC “Mother Tereza” during 2018. The data was collected through medical files. Results Most of the patients with AKI were males (66%), with the average age of 64 years old. Nephrotoxic drugs were the most frequent precipitating factor (51%) followed by sepsis (47%) and hypovolemia (41%). A total of 40% of patients had acute on chronic kidney disease, 32% were with diabetes, 14% with cardiac failure and 63% with arterial hypertension. Mostly (93%) had more than one precipitating factor for developing AKI. All the patients with the longest hospital stay (16-35days) had a septic condition. Almost 89% of patients were treated in a conservative way . Patients treated with Hemodialysis had a higher number of risk factors (P<0,4). Conclusion The socio-economic factor is also quite important in the development of AKI. It includes lack of access to health care, lack of health insurance, low economic level, poor quality nutrition, etc.The identification of risk factors that predispose to AKI is a crucial aspect of care. It should help primary care and hospital providers identify high risk patients. Comorbit conditions like diabetes, cardiac failure increased the risk for hemodialysis treatment.

Pulmonary hypertension (PH) is a recently recognized as a complication of chronic kidney disease and end-stage renal disease. The pathogenesis of pulmonary hypertension in this group of patients is not fully understood, probably due to the interaction of multiple aspects of the altered cardiovascular physiology and also hormonal and metabolic disorders. The present study aimed to determine the prevalence of PH, correlation with cardiac function and other risk factors and its impact of survival in chronic hemodialysis and peritoneal dialysis patients. We studied 125 stable hemodialysis and peritoneal patients (females 40%, mean age 52.42 ± 11.88 years) on renal replacement therapy (RRT) for more than 3 months with a follow up 2 years. Demographic information, clinical characteristics, blood test, and thoroughly echocardiographic evaluation at the optimal dry weight were collected. After conventional echocardiographic examination, tissue Doppler echocardiographic (TDE) examination was performed to evaluate global and regional myocardial systolic as well as diastolic function, and pulmonary hypertension. PH was defined as systolic pulmonary artery pressure (sPAP) ≥ 35 mmHg. To rule out secondary PH, patients with pulmonary disease, collagen vascular disease, and volume overload at the time of echocardiography were excluded. Variables were compared between two groups—subjects with PH and non-PH. Logistic regression analysis was used to evaluate the risk factor for PH and its impact on survival. According to the echocardiographic findings, PH was found in 28% (35 patients) of all patients. Mean PH was 33.46 ± 5.38 mmHg. The higher level of higher parathormone (PTH), C-reactive protein (CRP) and E/E’ average, lower left ventricular ejection fraction (EF), peak systolic velocity at the lateral mitral annulus (MASa) and the peak systolic velocity at the lateral tricuspid annulus (TASa) were found predictor of PH. The cardiovascular mortality rate was 15.5%. Patients evaluated with PH have a significantly lower cardiovascular survival rate [Long Rank (Mantel–Cox) p = 0.0001]. In ROC analysis for CV mortality, the area under the curve (AUC) for PH and CRP was found 0.8; for LVM-I, E/E’ and PP, AUC = 0.76; 0.75; 0.72 respectively while the inverse relationship was found with MASa and TASa with AUC = 0.66 and 0.95 respectively. Our study shows that PH is frequent in dialysis patients. It is influenced by inflammation, CKD-MBD biomarkers associated with diastolic and also systolic left and right ventricle dysfunction. Pulmonary hypertension, inflammation, vascular stiffness, and left ventricular hypertrophy are interrelated and all contribute to cardiovascular morbidity and mortality among dialysis patients. Easy to implement, cardiac imaging at the bedside and in outpatient clinics offers a positive perspective in early diagnosis of cardiac abnormalities and immediate approach to this condition, so is highly recommended in the dialysis population.

Natural mass disasters directly or indirectly affect huge populations, who need basic infrastructural help and assistance to survive. However, despite the potentially negative impact on survival chances, the authorities often dismiss these health care issues. This impact is of great importance, especially in the emerging world, where the casualty rates are much higher because of inappropriate building materials and lack of appropriate construction standards. Thus, massive destruction can occur with earthquakes of even moderately low magnitude. The first description of the crush syndrome appeared in the modern medical literature after the Messina earthquake in 1909. Since crush syndrome is quite rare in daily practice, mistakes are frequent in treating these cases. This review summarizes the etiopathogenesis of traumatic rhabdomyolysis and crush syndrome based acute kidney injury. The clinical and laboratory features, prophylaxis, and treatment of crush cases are described as well. The importance of early and dynamic fluid resuscitation is indicated for the prophylaxis of acute kidney injury. Treatment of both acute and chronic kidney diseases (CKDs) is especially problematic after disasters because they almost always require complex technology and equipment, whereas specific drugs may be difficult to obtain to treat chronic kidney patients. Although crush syndrome is a major cause of mortality in the rescued victims of massive earthquakes, the number of deaths due to crush syndrome (or fatalities of renal disaster) can be decreased by appropriate management. plaints.

Background and Aims: The relationship between alkaline phosphatase and vascular calcifications produces an increase in cardiovascular comorbidity. Alkaline phosphatase degrades pyrophosphate, which is a potent inhibitor of vascular calcifications.The aim of this study was to evaluate the association of ALP with vascular calcifations in patients with dialitic therapy.

Abstract Background and Aims The mortality rate is extremely high in chronic kidney disease (CKD), primarily due to the high prevalence of cardiovascular disease (CVD). Increased pulse pressure (PP), defined as the difference between inappropriately elevated systolic blood pressure (SBP) and reduced diastolic blood pressure (DBP) at any value of mean arterial pressure (MAP), is a surrogate measure of increased arterial stiffness of central elastic arteries (aorta and its major branches). CKD-MBD anomalies leading to calcification contribute to increased arterial stiffness and pulse pressure. This study aimed to evaluate the relationship of pulse pressure parameter with valve calcification and abdominal aortic calcification in hemodialysis patients and its impact on cardiovascular mortality. Method We performed a prospective case series study with 3 years follow- up. Plain X-ray images of the lateral lumbar spine from all subjects were studied to obtain images of the lower abdominal aorta using semiquantitative scores as described by Kauppila et al. Cardiac valve calcifications were evaluated by two-dimensional echocardiography with an HDI 5000 Sono CT echocardiographic machine with a 3.3-MHz multiphase array probe in subjects lying in the left decubitus position an according to the recommendations of the European Association of Echocardiography. The patient was evaluated as having vascular calcification if he had the presence of calcification in at least one of the site examined: a mitral valve, aortic valve or abdominal aorta. Results We studied 85 chronic stable hemodialysis patients. Mean age and meantime is therapy was 49.9±12.4 years and 51.5±28.7 months, respectively. Mean pulse pressure was 55.72±14.2 mmHg. Fifty-nine patients (69.4%) were identified with aortic abdominal calcification, and the mean Kauppila score was 4.91 ± 4.05. Sixty patients (70.5%) had at least one valve calcified, while thirty-three patients (38.8%) had both valves calcified. Univariate analysis revealed that every 1 mmHg increase in pulse pressure was associated with increased cardiovascular calcification risk p=0.020. In multivariate analysis, after adjustment for age, gender, diabetes mellitus, cholesterol, and triglyceride serum levels, the association also remained strong, where every increase of 1 mm Hg in pulse pressure was associated with increased risk for cardiovascular calcification (HR 1.02, 95% CI (1.00-1.03), p= 0.038). Besides, pulse pressure was an independent predictor for cardiovascular mortality (HR 1.03, 95% CI (1.02-1.05), p=0.002). Conclusion Pulse pressure may identify hemodialysis patients with subclinical cardiovascular calcification who need further evaluation. Wide pulse pressure is associated with increased cardiovascular mortality.

Abstract Background and Aims Peritoneal dialysis (PD) is generally associated with a good survival rate and with great preservation of residual renal function (RRF). The various causes of technique failure are responsible for the relative short time staying in PD. Objectives: This study aimed to analyze the outcome and factors correlated with maintenance peritoneal dialysis (PD) to guide for improving prognosis. Method In a retrospective way we examined our PD-cohort concerning mortality, technique survival, peritonitis rate, and other complications. Results From 2005 to 2019 the number of PD patients who have been treated in PD program for more than 3 months was around 199 patient, 29.1% diabetics, mean age 53.3±15.03 years old and meantime in therapy 32.39± 27.34 months. The PD was seen as an alternative for younger patients in the transplant list and elderly patients with comorbidity. Around 7.5% of the PD patients were transplanted and 8.5 % of patients were transferred from HD due to vascular access failure. Around 88.9% of patients were on PD for more than 1 year, 37.7% from 3 up to 5 years and 19.8% percent of the patients have stayed on PD for more than 5 years. Cardiovascular mortality was the main cause of mortality with 53% of the cases. Higher comorbidity index, lower albumin levels, and lower residual renal function were the main risk factors for lower survival. The technical survival of patients was 92.3% during the first year, 79.5% and 69.6% in the second and the fifth year, respectively. There was not found a difference in technical survival between diabetics and nondiabetics patients. Ultrafiltration failure followed by peritonitis was the main reason for transfer patients with more than 24 months in therapy in hemodialysis probably linked with the no availability of icodextrin. Peritonitis rate was 1:41 patient months. Conclusion PD program in our center is organized based in the concept of integrated care in RRT. The outcome of our patients was at least comparable to those reported by larger registries Although we have done good progress in the prevention of infection the nonavailability of icodextrin is an important factor for a technical failure. RRF is an important factor and we need to be more focused to maintain it longer in the future.

Disorders of mineral metabolism and bone disease are common complications in CKD patients. They are very complex and involve a number of feedback loops between the kidney, bone, intestine, and the vasculature associated with an increased morbidity and mortality and decreased quality of life of the patients. The work group of the kidney disease: Improving Global Outcomes (KDIGO) recommended in 2006 the use of the term chronic kidney disease-mineral and bone disorder (CKD-MBD) to describe a systemic disorder that incorporates these abnormalities. Compared to hemodialysis (HD), patients undergoing peritoneal dialysis (PD) appear to have an increased prevalence of low turnover bone disease defined as adynamic bone disease (ABD). The most important risk factors for ABD are age, oversuppression of parathyroid hormone (PTH) with vitamin D, diabetes, circulating antagonist PTH fragments, and frequent presence of a positive calcium balance, which may result in an oversuppression of PTH. PTH levels and bone phosphatase alkaline (bALP) should be assessed among such patients as the earliest markers of abnormal mineral and bone metabolism. Treatments considered are interventions to treat hyperphosphatemia, hyperparathyroidism, and bone disease. The optimal management of chronic kidney disease-mineral and bone disorder (CKD-MBD) includes the prevention of vascular calcifications.