AimsAcute cardiorenal syndrome (CRS) with and without consideration of the volume state was assessed with regard to inflammatory parameters.Methods and resultsBlood samples from patients with acute CRS (Ronco type 1 or 3, Group 1, n = 15), end‐stage renal disease (Group 2, n = 12), hypertension (Group 3, n = 15), and, in a second cohort, with acute CRS and hypervolemia (Group 4, n = 9) and hypertension (Group 5, n = 10) were analysed with regard to lipopolysaccharide‐binding protein (LBP), interleukins (ILs), and monocyte function (flow cytometry) both on admission (all groups) and on discharge (Groups 1 and 4). By discharge, one Group 1 patient died. LBP (ANOVA for Groups 1–3: P = 0.001) and IL‐6 (Kruskal–Wallis for Groups 1–3: P < 0.0001) were higher in Group 1 (LBP: 11.7 ± 2.0 μg/mL; IL‐6: 15.0 ± 6.1 pg/mL) and in Group 2 (LBP: 10.4 ± 1.4 μg/mL; IL‐6: 14.6 ± 3.8 pg/mL) than in Group 3 (LBP: 5.8 ± 0.4 μg/mL; IL‐6: 1.8 ± 0.4 pg/mL). In a direct comparison, the proportion of activated monocytes (CD14 and CD16 positive) was higher in Group 1 (6.9% ± 0.7%) vs. Group 3 (5.1% ± 0.6%; P = 0.018). Group 4 patients had higher IL‐6 plasma levels (34.2 ± 10.1 pg/mL) than Group 1 patients (15.0 ± 6.1 pg/mL; P = 0.03). All other findings obtained in CRS groups (Groups 1 and 4) were comparable.ConclusionsIn acute CRS, a state of systemic inflammation was found, which is comparable with the end‐stage renal disease situation. In comparison with hypertensive controls, a monocytic activation was found in acute CRS regardless of volume state.

IntroductionCardiovascular comorbidities regularly determine renal function. We report a case of acute kidney injury (Acute Kidney Injury Network stage 3) due to an intermittent third-degree atrioventricular block, which had not been diagnosed before.Case presentationA 76-year-old Caucasian man with liver cirrhosis due to non-alcoholic fatty liver disease, and type-2 diabetes was cognitively impaired and had reduced vigilance presumably caused by hepatic encephalopathy and/or Alzheimer dementia. Within 2 years, two hospitalizations occurred for syncope attributed to orthostatic failure and hypovolemia. During the last hospitalization, oliguric acute kidney injury occurred. Sonography ruled out a post-renal cause. His renal resistive index was 1.0; his heart rate was below 50 beats per minute. After cessation of beta-blocker therapy, Holter electrocardiogram showed a new intermittent third-degree atrioventricular block with pauses for less than 3 seconds. Pacemaker insertion resolved his acute kidney injury, despite resumption of beta-blocker therapy. During four months of follow-up, syncope has not occurred, and vigilance was stable. However, his renal resistive index of 1.0 remained.ConclusionsHere, typical neurologic symptoms of bradycardia were misclassified. Diagnostic work-up of oliguric acute kidney injury revealed intermittent third-degree heart block. The pathomechanism of acute kidney injury relates to relevant bradycardia and increased vascular stiffness attenuating arterial diastolic renal blood flow.

Background Cognitive impairment (CI) in chronic kidney disease (CKD) is highly prevalent and is associated with multiple limitations to the patients who show a higher mortality, more days of hospitalisation and a lower quality of life. Frailty in CKD is associated with adverse health outcomes and is also highly prevalent. The aim of our study was to determine the prevalence and characteristics of CI and relate the findings to frailty, mobility, muscle strength, and Health-Related Quality of Life (HRQoL). Methods Non-dialysis patients with CKD-Stages 3–5 were prospectively evaluated for inclusion. Excluded were patients with other cognitive disorders; signs of overt uremic encephalopathy; severe infection and hyponatremia. All patients underwent psychometric testing (5 different tests), assessment of mobility, strength, frailty and evaluation of HRQoL. Based on the number of pathological psychometric test results we established 2 different definitions of CI: subclinical uremic encephalopathy (SUE1: one pathological test; SUE2: two or more pathological test results). Results Sixty-two patients were included [median age 66 (IQR 57–75); male 55%]. Most patients had CKD-Stage 3 (3: 48%; 4: 32%; 5: 19%). CI was highly prevalent (SUE1: 60%; SUE2: 42%) and associated to a higher risk of falls (pathological Tandem-Gait-Test; SUE 1: 50% vs. 16%, P = 0.023; SUE2: 69% vs. 15%, P = 0.001), lower muscle strength (SUE 2-pathological: 39% vs. 7%, P = 0.008), frailty (SUE1: 59% vs. 28%, P = 0.038; SUE2: 67% vs. 33%, P = 0.028) and HRQoL. Conclusion CI is highly prevalent in non-dialysis CKD-patients. Even mild CI is associated with a decrease in mobility, muscle strength, HRQoL and frailty.

Introduction The SARS-CoV-2 pandemic is a major challenge for patients, healthcare professionals, and populations worldwide. While initial reporting focused mainly on lung involvement, the ongoing pandemic showed that multiple organs can be involved, and prognosis is largely influenced by multi-organ involvement. Our aim was to obtain nationwide retrospective population-based data on hospitalizations with COVID-19 and AKI in Germany. Materials & methods We performed a query of G-DRG data for the year 2020 via the Institute for the hospital remuneration system (Institut für das Entgeltsystem im Krankenhaus GmbH, InEK) data portal and therefore included hospitalizations with a secondary diagnosis of RT-PCR proven COVID-19 infection, aged over 15 years. We included hospitalizations with acute kidney injury (AKI) stages 1 to 3. Age-specific and age-standardized hospitalization and in-hospital mortality rates (ASR) per 100.000 person years were calculated, with the German population of 2011 as the standard. Results In 2020, there were 16.776.845 hospitalizations in German hospitals. We detected 154.170 hospitalizations with RT-PCR proven COVID-19 diagnosis. The age-standardized hospitalization rate for COVID-19 in Germany was 232,8 per 100.000 person years (95% CI 231,6–233,9). The highest proportion of hospitalizations associated with COVID-19 were in the age group over 80 years. AKI was diagnosed in 16.773 (10.9%) of the hospitalizations with COVID-19. The relative risk of AKI for males was 1,49 (95%CI 1,44–1,53) compared to females. Renal replacement therapy (RRT) was performed in 3.443 hospitalizations, 20.5% of the hospitalizations with AKI. For all hospitalizations with COVID-19, the in-hospital mortality amounted to 19.7% (n = 30.300). The relative risk for in-hospital mortality was 3,87 (95%CI 3,80–3,94) when AKI occurred. The age-standardized hospitalization rates for COVID-19 took a bimodal course during the observation period. The first peak occurred in April (ASR 23,95 per 100.000 person years (95%CI 23,58–24,33)), hospitalizations peaked again in November 2020 (72,82 per 100.000 person years (95%CI 72,17–73,48)). The standardized rate ratios (SRR) for AKI and AKI-related mortality with the overall ASR for COVID-19 hospitalizations in the denominator, decreased throughout the observation period and remained lower in autumn than they were in spring. In contrast to all COVID-19 hospitalizations, the SRR for overall mortality in COVID-19 hospitalizations diverged from hospitalizations with AKI in autumn 2020. Discussion Our study for the first time provides nationwide data on COVID-19 related hospitalizations and acute kidney injury in Germany in 2020. AKI was a relevant complication and associated with high mortality. We observed a less pronounced increase in the ASR for AKI-related mortality during autumn 2020. The proportion of AKI-related mortality in comparison to the overall mortality decreased throughout the course of the pandemic.

Impact of the SARS-CoV-2 pandemic on the treatment and care of patients with chronic kidney disease in Germany: Results of a nationwide survey Background/Aims The SARS-CoV-2 pandemic is a major challenge for patients, healthcare professionals and populations worldwide. Many peculiarities arise in dealing with outpatient and inpatient dialysis patients, patients with chronic kidney disease, or kidney transplantation. We conducted this first nationwide survey in German dialysis facilities to map the situation in May 2020, to explore the feasibility of the hygiene recommendations, and to identify changes in non-dialysis CKD-patient treatment. Methods A cross-sectional voluntary online questionnaire survey with 65 items was distributed by email using the mailing list of the DGfN as the scientific association for Nephrology, the “Verband Deutscher Nierenzentren (DN)” as the association of German dialysis facilities in private practice, and the “Kuratorium für Dialyse und Nierentransplantation (KfH)”, the largest non-profit dialysis service provider in Germany. The target population was nephrologists in dialysis facilities. 382 participants took part in the survey. Results The majority of centers were able to treat SARS-CoV-2- infected dialysis patients or had agreements with other centers to transfer these patients. Until mid-May 42% already treated SARS-CoV-2 infected dialysis Patients. Compliance with the hygiene recommendations is considered high among employees and patients. Nevertheless 18% of the facilities reported infected staff, which in 55% of the cases were presumably work-related. Changes in the area of deployment of employees who belong to the risk group pressurize personnel situation in the dialysis facilities, as well as sickness-related absences or quarantine orders by the health authorities. Perspectively a majority expects economic losses (82%), shortage of safety equipment (53%) and staff (74%), respectively. Conclusion The SARS-CoV-2 pandemic had a significant impact on the care of patients with chronic kidney disease, but there were no obvious deficits in care. This is probably due to the high degree of cooperation among dialysis provider and comprehensive recommendations of nephrologists societies.