Functional catheter problems are a major challenge for peritoneal dialysis (PD) programs. Here we performed a retrospective single-center study of 110 consecutive patients receiving a first PD catheter (swan neck double-cuff Missouri curled catheters, open surgical technique). Using postimplantation X-ray, the following categories were defined: swan neck angle (posterioanterio view (PA): under 45°, 45-90°, over 90°), inclination (angle between intramural part of catheter and horizontal line; lateral view: greater than/equal to 30°, under 30°), and the position of silicone bead relative to spine (PA view: L1-2, L3-4, lower) and catheter tip (PA view: hypogastric, umbilical, subcostal). Covariates included demographics, body size, previous abdominal surgery, and abdominal wall hernias. During a mean follow-up of 36 months, the time to first functional catheter problem was significantly associated with both the swan neck angle and inclination. The need for surgical intervention was significantly associated with inclination only. Technique failure was not associated with any parameter. In multivariate analysis, inclination was the sole variable significantly associated with functional catheter problems (hazard ratio 3.65 [1.98-6.72]) and the need for surgical intervention (hazard ratio 2.86 [1.19-6.88]). Thus, our study defines a set of X-ray variables that predict functional PD catheter problems and can be used for troubleshooting in individual cases as well as for education and internal audit purposes.

No abstract

No abstract

BACKGROUND AND AIMS Vaccination against COVID-19 is a promising strategy to reduce the risk for severe COVID-19. Patients on maintenance haemodialysis have a less robust immunoresponse than the general population. Triple vaccination might improve immunogenicity, and might benefit patients having a poor initial response. The aim of the current study was to evaluate the humoral response to heterologous (a combination of different vaccine types) versus homologous (three identical vaccines) triple vaccination against COVID-19. METHOD We analyzed serological response to homologous (3 times mRNA-based vaccine) versus heterologous (adenoviral vectored plus mRNA vaccines) triple regimens in samples from patients on maintenance dialysis (NCT04378686). We measured IgG anti–S (spike) SARS-CoV-2 antibody levels using the IgG II Quant assay (Abbott). Samples were collected between 6 and 12 weeks after both the second and the third vaccine dose. RESULTS A total of 302 patients received three vaccine doses. 94 patients received a heterologous regimen of the adenoviral vectored AZD1222 (2 doses) and the mRNA-based BNT162b2 (1 dose). The remaining 208 patients received a triple mRNA vaccine regimen of either BNT162b2 (n = 149) or mRNA-1273 (n = 59). Triple vaccine regimens resulted in significant elevation of anti-S titers, as compared with the conventional prime-boost (double) vaccination. A substantially and significantly larger fraction of patients reached the threshold for neutralizing antibodies after triple vaccination, as compared with after double vaccination. The yield of a third dose of mRNA-1273 is less than the yield of a third dose of BNT162b2. This, however, mainly reflects the initial significant better response to mRNA-1273. In multivariate analysis, a past episode of COVID-19 was a strong modulator of the response after double vaccination, and after triple vaccination. CONCLUSION Both heterologous and homologous triple vaccine regimens significantly augment the humoral response against SARS-CoV-2. The higher the ininitial response to the double prime-boost regimen, the lower the yield of a third vaccine dose. It seems prudent to prioritize vaccination of dialysis patients using mRNA-based vaccines when available.