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Background:The increasing use of immunomodulatory therapies has motivated the development of strategies to assess and prevent infectious diseases in these immunosuppressed patients, in whom the risk of serious infections is higher.Objectives:The aim of this study was to recognize the need to standardize prophylactic and therapeutic strategies in this population.Methods:Retrospective review of clinical files of patients evaluated in the infectious risk assessment in an outpatient clinic at the Infectious Diseases Unit at Hospital de Curry Cabral in Lisbon, between June 2016 and November 2019. We reviewed information regarding sex, age, origin, occupation, past travels as well as plans of future ones, contact with live animals, intake of unpasteurized products or unsafe drinking water, along with relevant data regarding past medical history and previous and/or ongoing treatments, including immunomodulatory ones.Results:During the established timeline,1305 appointments were carried out, corresponding to a total of 415 patients. The majority of patients were female (263; 63.7%), the average age was 50 years and 82% were of Portuguese nationality. The most frequent groups of diseases were autoimmune/inflammatory (84.1%) and demyelinating (10.1%). At the date of the first consultation, 70% were already under immunosuppression. Screening for latent tuberculosis infection (LTBI) was done in 99% of the patients (n = 410) and treatment was proposed to 160 patients (38.5%). At the time of screening, 56,8% of the patients were under immunossuppressive therapies, which included high doses of systemic corticosteroids (37%), anti-TNF alpha (7,7%) and combine therapy with non-biologic agents. Active disease was diagnosed and treated in two patients. Interferon gamma release assay test (IGRA) was positive in 56.8% of patients (n = 91), negative in 32.5% (n = 52) and indeterminate in 7.5% (n=12). Of the 69 patients (43%) with indeterminate/negative or not performed IGRA, Mantoux test (TST) was positive in 48 patients. In the remainder, the treatment proposal for LTBI was based on clinical, epidemiological or radiological signs suggestive of past infection.In order to prevent hyperinfection/disseminated strongyloidiasis, 354 individuals were screened withStrongyloides stercoralisserology, of which 51 patients (14.4%) had a positive result and were treated with ivermectin. Regarding vaccination, the recommendation for annual influenza vaccination was reinforced, together with the prevention of invasive pneumococcal disease. In view of future travelling plans, vaccination against yellow fever (n = 10), meningococcal disease (n = 7), typhoid fever (n = 6), and polio (n = 2) was recommended. In cases without a previous history of measles and according to the year of birth, VASPR was prescribed to 6 patients. Vaccination to prevent herpes zoster was recommended to 20 patients. After serological evaluation, the vaccine against hepatitis A and hepatitis B was prescribed to 89 and 132 patients, respectively, the latter when serological evidence of previous vaccination or contact was absent. We identified 10 cases of positive anti-HCV antibodies, with undetectable viral load. Primary prophylaxis forPneumocystis jiroveciipneumonia was recommended to 104 patients. Prophylaxis against reactivation of Herpes simplex infection was initiated in 4 patients.Conclusion:The decision to start immunosuppressive therapy comes with benefits and risks. Appropriate screening prior to starting therapy is an essential tool for its safe use. Referral to a specialised Infectious Risk Assessment consultation should be done promptly in order to review and address accordingly the risk of specific infections taking in to account the patients clinical and epidemiologic history.Disclosure of Interests:None declared

Background and Aims Vascular calcification is a common complication of chronic kidney disease (CKD), particularly in end-stage-renal disease (ESRD) and is predictive of subsequent cardiovascular disease and mortality. The aim of the present study was to evaluate the relationship between arterial calcification assessed by doppler ultrasound (DUS) performed by the same observer and biochemical parameters of CKD-MBD as well as the standard-of-care therapy for CKD-MBD. Method We present a retrospective study of 454 patients who were evaluated by DUS for pre-surgical vascular mapping from 2018 to 2021. Both arms brachial, radial and cubital arteries were analyzed, and vascular calcification was classified as absent, mild or moderate/severe (presence of acoustic shadowing). Laboratory serum analysis of PTH, serum Calcium (sCa), serum phosphorous (sPi) and serum magnesium (sMg) were collected (with a maximum interval of 6 months from DUS evaluation). Mortality was also registered during follow-up period. Results The demographics and biochemistry of the study population are summarized in Table 1. Arterial calcification was observed in 91.6% (n = 416) of the patients, 62.3% (n = 259) had mild calcification and 37.7% (n = 157) presented moderate/severe calcification. In univariate analysis, male gender (OR 2.2, p < 0.023), age (OR 1.03, p < 0.003), phosphate binders (OR 0.55, p value < 0.03) and cinacalcet use (OR 0.28, p < 0.019) were independently associated with the presence of arterial vascular calcification. Presence of vascular calcification on DUS was associated to mortality. In patients with vascular calcifications, moderate/severe calcification was associated with diabetes mellitus (OR 2.85, p<0.000), male gender (OR 1.69, p < 0.012), PAD (OR 2.43, p <0.001) and hemodialysis therapy for more than 5 years (OR 3.00, p< 0.010). Cinacalcet, phosphate binders, serum calcium, phosphorous, PTH and mortality did not correlate with calcification severity. In the multivariate logistic regression analysis adjusted to age, gender, PAD and serum calcium and magnesium, we found that serum PTHi (OR 1.00, p<0.040), hemodialysis for more than one year (OR 4.44, p< 0.040) and diabetes mellitus (OR 3.95, p< 0.001) were associated with moderate/severe vascular disease. Conclusion Concerning CKD-MBD related markers our study showed that only phosphate binders and cinacalcet use were predictive of absence of vascular calcifications, however no causality could be advanced with these data. For serious calcification, in our multivariable model, only PTH had statistical significance. It is widely recognized the importance of monitoring serum PTH, calcium and Pi to reduce the adverse clinical events associated with CKB-MBD. Widespread implementation of DUS in pre-surgical mapping for VA construction is also an opportunity for vascular study and features as calcifications can be a surrogate of CKD-MBD and cardiovascular burden.