Acute kidney injury and tacrolimus toxicity in a kidney transplant recipient treated with nirmaltrevir/ritonavir: a case report.

Background: Kidney transplant recipients with severe acute respiratory syndrome-coronavirus-2 infection have an increased risk of severe disease and mortality. Nirmaltrevir/ritonavir (Paxlovid) is an effective oral disease-modifying therapy that has been shown to reduce risk of progression to severe disease in high-risk, nonhospitalized adults. However, owing to the potential for serious drug-drug interactions owing to ritonavir-induced inhibition of the CYP3A enzyme, this drug is not suitable option for transplant recipients with mild-moderate severe acute respiratory syndrome-coronavirus-2 infection.

Human T-cell leukaemia virus type 1 and Adult T-cell leukaemia/lymphoma in Queensland, Australia: a retrospective cross-sectional study.

Objectives: Human T-cell leukaemia virus type 1 (HTLV-1), an STI, is reported to be highly prevalent in Indigenous communities in Central Australia. HTLV-1 is an incurable, chronic infection which can cause Adult T-cell leukaemia/lymphoma (ATL). ATL is associated with high morbidity and mortality, with limited treatment options.

Altered dietary salt intake for people with chronic kidney disease.

Background: Evidence indicates that reducing dietary salt may reduce the incidence of heart disease and delay decline in kidney function in people with chronic kidney disease (CKD). This is an update of a review first published in 2015.

Objectives: To evaluate the benefits and harms of altering dietary salt for adults with CKD.

Methamphetamine intoxication and acute kidney injury: A prospective observational case series.

Aim: The effects of methamphetamine intoxication on the kidney are not well reported. We aimed to investigate acute kidney injury (AKI) associated with methamphetamine intoxication, in particular its severity, duration and association with rhabdomyolysis.

Methods: This is a prospective observational series of methamphetamine-intoxicated patients presenting to an Emergency Department.

Baseline characteristics of patients with atypical haemolytic uraemic syndrome (aHUS): The Australian cohort in a global aHUS registry.

Aims: To describe the baseline characteristics and treatment of Australian patients diagnosed with atypical haemolytic uraemic syndrome (aHUS) reported to the Global aHUS Registry.

Methods: Descriptive analysis of the Australian cohort with aHUS (n = 106) was undertaken for demographics, disease characteristics and prior treatment with eculizumab; comparing with the global cohort (n = 1688) for certain pre-specified disease characteristics.

Results: In Australia, almost two-thirds of patients diagnosed with aHUS were female and over 80% of patients were Caucasians, with similar proportions reported in the global cohort.

Utility of 'back-up' arterio-venous fistulae in patients on peritoneal dialysis and use of haemodialysis catheters.

Background: Patients undergoing peritoneal dialysis may require unanticipated transfer to haemodialysis. Back up fistula are often created in selected patients. These may help reduce the infective burden of haemodialysis (HD) catheter.

Disseminated cryptococcosis presenting initially as lower limb cellulitis in a renal transplant recipient - a case report.

Background: Cellulitis is an unusual presentation of disseminated cryptococcosis, a serious infection seen predominantly in immunocompromised hosts. Disseminated cryptococcosis carries significant morbidity for transplant recipients, especially of the pulmonary and central nervous systems, and carries a high mortality risk.

Case Presentation: We report a 59-year-old renal transplant recipient who presented with bilateral lower leg cellulitis without other symptoms or signs.

Progression of arterial stiffness is associated with changes in bone mineral markers in advanced CKD.

Background: Arterial stiffness is an independent predictor of all-cause and cardiovascular mortality in patients with chronic kidney disease (CKD). There are limited prospective data however on progression of arterial stiffness in CKD, including evaluating associations with bone mineral markers such as fibroblast growth factor 23 (FGF23) and soluble α-klotho (sKl).

Methods: In this prospective, single-center, observational study, arterial stiffness [measured by pulse wave velocity (PWV)] and hormones influencing mineral homeostasis, including serum FGF23 and sKl, were compared between non-dialysis CKD stages 4/5 and healthy controls at baseline and 12 months (12 m).

Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients.

Background: Peritoneal dialysis (PD) is an important therapy for patients with end-stage kidney disease and is used in more than 200,000 such patients globally. However, its value is often limited by the development of infections such as peritonitis and exit-site and tunnel infections. Multiple strategies have been developed to reduce the risk of peritonitis including antibiotics, topical disinfectants to the exit site and antifungal agents.

Association of Socio-Economic Position with Technique Failure and Mortality in Australian Non-Indigenous Peritoneal Dialysis Patients.

Background: Few studies have examined the relationship between socio-economic position (SEP) and peritoneal dialysis (PD) outcomes, particularly at a country level. The aim of this study was to investigate the relationships between SEP, technique failure, and mortality in PD patients undertaking treatment in Australia.

Methods: The study included all Australian non-indigenous incident PD patients between January 1, 1997, and December 31, 2014, using Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data.

Recurrent atypical haemolytic uraemic syndrome post kidney transplant due to a CD46 mutation in the setting of SMARCAL1-mediated inherited kidney disease.

Disorders in the regulation of the alternate complement pathway often result in complement-mediated damage to the microvascular endothelium and can be associated with both glomerulonephritis and atypical haemolytic uraemic syndrome. Inherited defects in complement regulatory genes or autoantibodies against complement regulatory proteins are predictive of the severity of the disease and the risk of recurrence post kidney transplantation. Heterozygous mutations in CD46, which codes for a transmembrane cofactor glycoprotein membrane cofactor protein, usually have a lower incidence of end-stage kidney disease and decreased risk of recurrent disease post transplant, as wild-type membrane cofactor protein is present in the transplanted kidney.

Tacrolimus Toxicity due to Biliary Obstruction in a Combined Kidney and Liver Transplant Recipient.

The immunosuppressant tacrolimus has a narrow therapeutic window, necessitating therapeutic drug monitoring to maintain efficacy and minimise toxicity. There are very few reports examining the impact of impaired biliary excretion on tacrolimus blood levels or toxicity. We report the case of a 26-year-old combined liver and kidney transplant recipient, who developed acute biliary obstruction leading to tacrolimus toxicity with very high blood tacrolimus levels.

Infection Prophylaxis in Peritoneal Dialysis Patients: Results from an Australia/New Zealand Survey.

♦ BACKGROUND: Clinical practice guidelines aim to reduce the rates of peritoneal dialysis (PD)-related infections, a common complication of PD in end-stage kidney disease patients. We describe the clinical practices used by Australian and New Zealand nephrologists to prevent PD-related infections in PD patients. ♦ METHODS: A survey of PD practices in relation to the use of antibiotic and antifungal prophylaxis in PD patients was conducted of practicing nephrologists identified via the Australia and New Zealand Society of Nephrology (ANZSN) membership in 2013.

Temporal Changes in Deceased Kidney Donor Characteristics in Australia.

Background: Demand for deceased donor kidneys has exceeded supply in Australia over the past 2 decades. With a desire to use as many donor organs as possible, the health characteristics of accepted donors may have changed over time.

Methods: All deceased kidney donors actually transplanted in Australia between January 1, 1994, and December 31, 2013, were retrospectively analyzed, using data from the Australian and New Zealand Organ Donor Registry.

Patients' Perspectives on the Prevention and Treatment of Peritonitis in Peritoneal Dialysis: A Semi-Structured Interview Study.

♦ BACKGROUND: Peritoneal dialysis (PD) is recommended for adults with residual kidney function and without significant comorbidities. However, peritonitis is a serious and common complication that is associated with hospitalization, pain, catheter loss, and death. This study aims to describe the beliefs, needs, and experiences of PD patients about peritonitis, to inform the training, support, and care of these patients.

Pro: Meta-analysis: the case for.

With ever-accumulating medical evidence for treatment benefits and harms, it is vital that clinicians are able to access and use up-to-date, best evidence in specific clinical scenarios involving individual patients-the primary goal of evidence-based medicine. In this article, we propose that meta-analysis, when properly conducted and reported in the context of a rigorous systematic review, is an indispensable tool for synthesis and interpretation of clinical evidence for the purpose of informing clinical decision-making by clinicians, patients and health care policy makers. Meta-analysis provides many benefits, including enhanced precision and statistical power, greater transparency, identification of bias, exploration of heterogeneity of effects, enhanced generalizability, efficient integration of clinical knowledge, identification of evidence gaps, better informed future trial design and avoidance of unnecessary research duplication and potential patient harm.

Peritoneal dialysis practice in Australia and New Zealand: A call to sustain the action.

This paper updates a previous 'Call to Action' paper (Nephrology 2011; 16: 19-29) that reviewed key outcome data for Australian and New Zealand peritoneal dialysis patients and made recommendations to improve care. Since its publication, peritonitis rates have improved significantly, although they have plateaued more recently. Peritoneal dialysis patient and technique survival in Australian and New Zealand have also improved, with a reduction in the proportion of technique failures attributed to 'social reasons'.

Pancreatic and biliary obstruction years after retention of a swallowed coin in a duodenal diverticulum: a case report.

Introduction: Congenital duodenal diverticula are a rare anomaly. The discovery of one in association with an ingested foreign body has only been reported on one previous occasion. In this challenging presentation, the presence of the coin led to the correct diagnosis.

Assessment of current practice and barriers to antimicrobial prophylaxis in peritoneal dialysis patients.

Background: Existing Australasian and international guidelines outline antibiotic and antifungal measures to prevent the development of treatment-related infection in peritoneal dialysis (PD) patients. Practice patterns and rates of PD-related infection vary widely across renal units in Australia and New Zealand and are known to vary significantly from guideline recommendations, resulting in PD technique survival rates that are lower than those achieved in many other countries. The aim of this study was to determine if there is an association between current practice and PD-related infection outcomes and to identify the barriers and enablers to good clinical practice.

Altered dietary salt intake for people with chronic kidney disease.

Background: Salt intake shows great promise as a modifiable risk factor for reducing heart disease incidence and delaying kidney function decline in people with chronic kidney disease (CKD). However, a clear consensus of the benefits of reducing salt in people with CKD is lacking.

Objectives: This review evaluated the benefits and harms of altering dietary salt intake in people with CKD.

Prevention of peritoneal dialysis-related infections.

The use of peritoneal dialysis (PD) varies widely from country to country, with the main limitation being infectious complications, particularly peritonitis, which leads to technique failure, hospitalization and increased mortality. A large number of prophylactic strategies have been employed to reduce the occurrence of peritonitis, including the use of oral, nasal and topical antibiotics, disinfection of the exit site, modification of the transfer set used in continuous ambulatory PD exchanges, changes to the design of the PD catheter implanted, the surgical method by which the PD catheter is inserted, the type and length of training given to patients, the occurrence of home visits by trained PD nurses, the use of antibiotic prophylaxis in patients undergoing certain invasive procedures and the administration of antifungal prophylaxis to PD patients whenever they are given an antibiotic treatment course. This review summarizes the existing evidence evaluating these interventions to prevent exit-site/tunnel infections and peritonitis.