Background Cardiovascular disease is the leading cause of mortality in peritoneal dialysis (PD) patients. Infection is known to increase the risk of cardiovascular events (CVE); however, no studies have examined the association between PD peritonitis and CVE. Aim To examine peritonitis as a risk factor for CVE in PD patients. Methods This retrospective cohort study included all adults undertaking PD for ≥3 months in one Australian health district from 2001 to 2015. Baseline characteristics and peritonitis event information was obtained from the Australian and New Zealand Dialysis and Transplant registry. The Centre for Health Research Illawarra Shoalhaven Population facilitated data linkage using ICD10 coding to capture CVE information. Results A total of 211 patients was included, with median age of 66 years (interquartile range 54.49–74.45); 64% were male. Peritonitis occurred in 114 (54%) patients and 65 (30.8%) patients experienced a CVE. Identified risk factors for CVE included: cerebrovascular disease (hazard ratio (HR) 2.72, 95% confidence interval (CI) 1.36–5.47), diabetes (HR 2.41, 95% CI 1.47–3.96), coronary artery disease (HR 1.67, 95% CI 1.01–2.77) and age (HR 1.03, 95% CI 1.01–1.06). There was no significant increase in risk of CVE following peritonitis (HR 1.37, 95% CI 0.81–2.32, P = 0.24), even when accounting for age, cerebrovascular disease, diabetes and existing coronary artery disease (HR 1.32, 95% CI 0.78–2.23, P = 0.30). Conclusions We did not find an increase in the risk of CVE following a peritonitis episode in PD patients. This result may be due to small sample size or rapid peritonitis treatment mitigating cardiovascular risk.

Methyl bromide is an odourless, colourless, highly volatile gas, primarily used in fumigation. It can cause significant neurotoxicity, especially with chronic exposure. Haemodialysis has been used in acute toxicity, but its utility in chronic exposure has never been reported. We report the use of haemodialysis in a 20‐year‐old man with chronic methyl bromide toxicity affecting the optic nerves, brain and spinal cord. The patient underwent eight haemodialysis sessions with improvement in plasma bromine concentration, half‐life and marked clinical recovery. The case demonstrates the utility of haemodialysis in the treatment of chronic methyl bromide toxicity.

Introduction: Renal biopsies are a necessary diagnostic test, essential skill for trainee nephrologists to acquire and must be done safely regardless of setting. The aim of this study was to evaluate renal biopsy complication rates between inpatient and day-case patients across two tertiary centres. Patients suitable for day-case biopsy are risk-stratified according to specified criteria. Comparatively those not satisfying criteria are admitted for biopsy and monitored overnight. Thus, we sought to ascertain whether performance in two teaching hospitals is comparable to nationally quoted risk rates. Methods: An analysis was conducted retrospectively of 989 consecutive percutaneous renal biopsies between 2/8/13-25/8/16 in one centre and prospectively for 89 biopsies between 1/1/18-8/6/18 in another. All were performed under real-time ultrasound guidance with trainees supervised by consultants. Study outcomes included failure to acquire an adequate sample, mild bleeding (hypotension/postural symptoms, visible haematuria not requiring intervention), urinary retention, radiological evidence of bleed or significant drop in haemoglobin or haemodynamic instability requiring red cell or platelet transfusion, or active bleeding requiring nephrostomy, embolisation and/or nephrectomy. Results: 989 biopsies were carried out over the two-year period in one centre compared to 89 in 6 months for the other. 56.1% (n=605) were carried out as inpatient, 42.2% (n=455) in day case and 1.7% (n=18) in radiology. 58% (n=626) were performed by a nephrology trainee, 40% (n=431) by a consultant (of which 28 were initially attempted by a trainee) and 2% by radiologists. Mean number of passes were 2 (Range 1-9) and mean cores 1.5. Glomerular yield was sufficient for analysis in 98.6% for consultants' biopsies compared to 93.6% for trainees' from the larger centre and 78.7% from the other. 4.36% (47 patients) had bleeding complications of any sort; 1.6% (n=17) had isolated visible haematuria post procedure and 2.9% had a haematoma (n=29 perinephric, n=1 mesenteric and 1=retroperitoneal). 9 went to interventional radiology for embolization and one was not successful requiring nephrectomy. Of these 47 patients with bleeding, 1% (11) were given red cell transfusions (haemoglobin 65-88g/dL) and 3 received platelets (platelets <100Â 109/L). The complication rates of haematuria, haematoma and transfusion requirement were significantly higher for inpatient vs outpatient biopsies (p<0.05). Conclusions: Despite 57% of biopsies being undertaken by renal trainees, we demonstrate a comparable complication rate to the consensus standard with adequate biopsy samples. Furthermore we evidence an effective risk stratification with our day-case criteria since significantly more complications occur in inpatient compared to outpatient biopsies. This indicates outpatient biopsies can be safely undertaken when appropriately stratified and estimates a saving of between (£876-3016) V984-3390 based on the cost of a day-case vs nonelective/elective inpatient bed.