Acute peritoneal dialysis, complications and outcomes in 389 children with STEC-HUS: a multicenter experience

Coccia, Paula; Ramirez, Flavia; Suarez, Ángela; Alconcher, Laura; Balestracci, Alejandro; Chervo, Laura A. García; Principi, Iliana; Vázquez, Ana Eugenia; Ratto, Viviana; Planells, M Celia; Montero, Jorge; Saurit, Mariana; Gutiérrez, María Graciela Perez Y; Puga, María Celeste; Isern, Elsa; Bettendorff, María C.; Boscardin, Marcela V.; Bazán, Marta; Polischuk, Mario A.; Sarrasqueta, Alejo De; Aralde, Adriana; Ripeau, Diego; Leroy, Daniela C; Quijada, Nahir E; Escalante, Romina S.; Giordano, Marta I; Sánchez, Cristian Villalba; Selva, V.; Caminiti, Alejandra; Ojeda, José M; Bonany, Pablo; Morales, Sandra E.; Allende, Daniel; Arias, María Andrea; Exeni, Andrea; Geuna, Jésica D.; Arrúa, Larisa

doi:10.1007/s00467-020-04876-x

Cited by 13 publications

(22 citation statements)

References 28 publications

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“…Early dialysis didn’t alter the effect of clinical outcomes. Indications of dialysis in children diagnosed with HUS remain similar to the children with AKI due to the other forms, which include azotemia (defined as blood urea nitrogen (BUN) >= 80-100 mg/dL), severe electrolyte abnormalities (eg., hyperkalemia) that is refractory to medical management, uremia signs and symptoms, and volume overload (cardiac and pulmonary declination) [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Trends and Outcomes of Hospitalizations Due to Hemolytic Uremic Syndrome: A National Perspective

Lingas¹,

Saju²,

Abdulqader³

et al. 2022

Cureus

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Background: Hemolytic uremic syndrome (HUS) is a rare but challenging disease with varying degrees of mortality and prognosis. We aim to evaluate the trends and outcomes of hospitalizations due to HUS by utilizing a large population-based dataset.Methods: We derived a study cohort from the Nationwide Inpatient Sample (NIS) for the years 2007-2018. Our primary outcomes were in-hospital mortality, discharge disposition, and predictors of poor outcomes. We then utilized the Cochran Armitage trend test and multivariable survey logistic regression models to analyze the trends, outcomes, and predictors.Results: A total of 8043 hospitalizations ranging from age zero to above 65 years of age occurred due to HUS from 2007-2018. The number of hospitalizations with HUS increased steadily from 528 in 2007 to 800 in 2013, but afterwards, we noticed a steady decline to 620 in 2018. Additionally, trends of in-hospital mortality slowly increased over the study period but we noticed a decline in the rate of discharge to skilled nursing facilities (SNFs). Furthermore, in multivariable regression analysis, predictors of increased mortality in hospitalized HUS patients were advanced age (95%CI: 1.221-1.686; p-value <0.0001) and requirement for dialysis (95%CI: 1.141-4.167; p-value: <0.0001). Advanced age >65 years (OR: 2.599, 95%CI: 1.406-4.803; pvalue: 0.0023), as well as comorbidities such as diabetes mellitus and pulmonary circulatory diseases, which are under vascular events (OR: 1.467, 95%CI:1.075-2.000; p-value: 0.0156), were shown to have a higher rate of discharge to SNFs. Moreover, patients needing intravenous immunoglobulin (IVIG) and plasmapheresis had high odds of discharge to SNFs ((OR: 1.99, 95%CI: 1.307-3.03; p-value: 0.0013) and (OR: 5.509, 95%CI: 2.807-10.809; p-value <0.0001), respectively), as well as smaller hospital bed size and hospital type (OR: 1.849, 95%CI: 1.142-2.993; p-value: 0.012). Conclusion:In this national representative study, we observed a total decrease in hospitalizations as well as discharge to SNFs; however we saw an increase in inpatient mortality. We also identified multiple predictors significantly associated with increased mortality, some of which are potentially modifiable and can be points of interest for future studies.

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Section: Discussionmentioning

confidence: 99%

Trends and Outcomes of Hospitalizations Due to Hemolytic Uremic Syndrome: A National Perspective

Lingas¹,

Saju²,

Abdulqader³

et al. 2022

Cureus

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“…It includes peritoneal dialysis (PD), hemodialysis (HD), and continuous renal replacement therapy (CRRT). The selection of dialysis methods should be based on a comprehensive analysis of the characteristics of patients, the performance of dialysis methods (indications/contraindications and advantages/disadvantages), institutional resources, and local practices [ 132 , 133 ]. Current evidence indicates that there is no significant difference in mortality for PD, HD, and CRRT in AKI [ 133 , 134 ].…”

Section: Stec-hus Therapeutic Strategiesmentioning

confidence: 99%

“…Although PD showed more complications compared to HD or CRRT, none of the patients needed to change to another form of RRT due to the ineffectiveness of the technique. Complications related to catheter implantation should be taken into consideration during PD, and the prophylactic use of antibiotics should be considered before placing a PD catheter, to reduce the incidence of peritonitis [ 132 ].…”

Section: Stec-hus Therapeutic Strategiesmentioning

confidence: 99%

“…As such, antibiotic administration is performed on a case-by-case basis in consideration of the necessity of antibiotic use, the STEC strain, the timing of treatment, and the type of antibiotics to be used. The necessity of antibiotic use includes whether infections of other systems exist or the need to prevent potential infection risks, such as the need for peritoneal dialysis catheter implantation and the combined use of eculizumab, among others [ 132 , 146 ].…”

Section: Stec-hus Therapeutic Strategiesmentioning

confidence: 99%

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Diagnosis and Treatment for Shiga Toxin-Producing Escherichia coli Associated Hemolytic Uremic Syndrome

Liu

Thaker

Wang

et al. 2022

Toxins

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Shiga toxin-producing Escherichia coli (STEC)-associated hemolytic uremic syndrome (STEC-HUS) is a clinical syndrome involving hemolytic anemia (with fragmented red blood cells), low levels of platelets in the blood (thrombocytopenia), and acute kidney injury (AKI). It is the major infectious cause of AKI in children. In severe cases, neurological complications and even death may occur. Treating STEC-HUS is challenging, as patients often already have organ injuries when they seek medical treatment. Early diagnosis is of great significance for improving prognosis and reducing mortality and sequelae. In this review, we first briefly summarize the diagnostics for STEC-HUS, including history taking, clinical manifestations, fecal and serological detection methods for STEC, and complement activation monitoring. We also summarize preventive and therapeutic strategies for STEC-HUS, such as vaccines, volume expansion, renal replacement therapy (RRT), antibiotics, plasma exchange, antibodies and inhibitors that interfere with receptor binding, and the intracellular trafficking of the Shiga toxin.

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“…Half or more children with STEC-associated HUS require renal replacement therapy (usually temporary) [9]; the HUS case fatality rate is 1-3% [10][11][12]. Children under age 10 have the greatest incidence of acquiring high-risk STEC infections and of developing HUS if infected.…”

Section: Clinical Course and Hemolytic Uremic Syndromementioning

confidence: 99%

Why antibiotics should not be used to treat Shiga toxin-producing Escherichia coli infections

Tarr

Freedman

2021

Current Opinion in Gastroenterology

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Purpose of reviewThere has been much debate about treating Shiga toxin-producing Escherichia coli (STEC) infections with antibiotics. No data convincingly demonstrate that antibiotics are better than no antibiotic treatment at all, and many studies suggest antibiotics increase the risk of developing the hemolytic uremic syndrome (HUS). This topic is timely, because emerging technology enables rapid identification of STEC-infected patients, and we anticipate questions about management will increase. This review is designed to familiarize readers with the series of observations that underlie our recommendations. Recent findingsThe long debate over antibiotics in STEC infections appears resolved by gradually accruing information that show that antibiotics do not benefit infected patients. In fact, they are associated with an increased likelihood of developing HUS. A meta-analysis published in 2016 demonstrated that low risk of bias studies find a clear association between antibiotic use and development of HUS. Subsequent publications do not refute these findings.

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Acute peritoneal dialysis, complications and outcomes in 389 children with STEC-HUS: a multicenter experience

Cited by 13 publications

References 28 publications

Trends and Outcomes of Hospitalizations Due to Hemolytic Uremic Syndrome: A National Perspective

Trends and Outcomes of Hospitalizations Due to Hemolytic Uremic Syndrome: A National Perspective

Diagnosis and Treatment for Shiga Toxin-Producing Escherichia coli Associated Hemolytic Uremic Syndrome

Why antibiotics should not be used to treat Shiga toxin-producing Escherichia coli infections

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