bluuebunny/crossref_metadata_2025 huggingface dataset:
MO606: Indoxyl Sulfate is Predictor for Sarcopenia but Myostatin is Indicator For Muscle Mass in Patients with Chronic Kidney Disease: Analysis From Recovery Study
Authors: Lee Sumi , Chul Kim Jun , Suk An Won
Published: May 2022

BACKGROUND AND AIMS

Serum myostatin and indoxyl sulfate (IS) levels are increased according to renal function decline and are the main mediators of chronic kidney disease (CKD)-related sarcopenia. However, a recent report showed that myostatin levels were increased in balance-trained CKD patients associated with increased lean mass. The aim of this study was to assess the association between serum myostatin, IS levels and sarcopenia in CKD patients.

METHOD

Baseline data from the RECOVERY study (clinicaltrials.gov: NCT03788252) conducted from November 2018 to June 2020 were analyzed in 150 CKD patients (mean CKD-EPI eGFR: 33.8 ± 12.5). A Six-meter gait speed test and handgrip strength (HGS) were assessed. Skeletal muscle index (SMI) was measured by using an InBody S10 based on bioelectrical impedance analysis. Sarcopenia was assessed using the Asian Working Group for Sarcopenia 2019. Serum myostatin levels were assessed by an enzyme-linked immunosorbent assay and serum total IS levels were measured using a high-performance liquid chromatography fluorescence detector.

RESULTS

The proportion of patients with sarcopenia was higher (12.0% versus 4.1%, P = 0.075) in patients with high IS levels (≥0.365 mg/dL) but was lower (4.2% versus 11.8%, P = 0.087) in patients with high myostatin levels (≥4.5 ng/mL). SMI and HGS were significantly lower in patients with high IS levels but were significantly higher in patients with high myostatin levels. IS levels showed a negative correlation with eGFR, SMI and HGS but myostatin levels showed a positive correlation with SMI, and HGS and no correlation with eGFR. However, the myostatin/SMI ratio reflected muscle mass was negatively associated with eGFR and was not associated with SMI and HGS. Sarcopenia was independently associated with age and IS levels after adjustment for gender, diabetes mellitus, creatinine and myostatin/SMI.

CONCLUSION

Serum total IS levels are an important predictor for sarcopenia, but serum myostatin levels indicate muscle mass in CKD patients with lower eGFR. Further studies are needed to find new markers related to muscle mass and myostatin such as the myostatin/SMI ratio in CKD patients with lower eGFR.
MO619: Landscape RNA Profiling of Urinary Extracellular Vesicles in Patients with Diabetic Nephropathy
Authors: Feng Songtao , LV Linli , Liu Bicheng , Zhu Xiaoxiao , Jing Jing
Published: May 2022

BACKGROUND AND AIMS

Recent studies have revealed that urinary extracellular vesicles (uEV) are secreted with rich biological information useful for understanding the pathophysiological conditions and identifying potential biomarkers for kidney disease. Diabetic nephropathy (DN) has become the major cause of CKD worldwide, while the features of uEV in DN were poorly understood. The present study aims to provide the landscape and in-depth analysis of the transcriptome characteristics of uEV in DN.

METHOD

Urine was collected from a total of 40 subjects, including healthy controls (HC, n = 14), type 2 DM (T2DM, n = 16), and renal biopsy-confirmed DN (n = 10). uEV was isolated by differential centrifugation and total RNA was extracted for long RNA sequencing. A model based on CIBERSORT was calculated to trace the genetic source of uEV toward resident cells of urinary system. Differentially expressed genes (DEG) between DN and HC and DN and T2DM were applied to gene ontology (GO), Reactome pathway enrichment, as well as gene set enrichment analysis (GSEA). Correlation of the transcriptome profiling between uEV and kidney tissue in DN was also explored.

RESULTS

About 67%∼68% of transcripts in RNA-seq were mRNA, 11%∼12% were LncRNA and 7%∼10% were CircRNA, and the abundance of mRNA was greater than other RNA types. By CIBERSORT model applying marker genes of podocytes, epithelial cells of tubule of different segments, loop of Henle, and collecting duct, and bladder transitional epithelial cells. The uEV was shown to originate mainly from the collecting duct epithelial cells of the kidney and bladder transitional epithelial cells (Fig. 1a). Confocal laser microscopy showed the co-localization of CD63 and AQP2 (Fig. 1b) in kidney tissues. GO and Reactome analysis were further performed in upregulated mRNA between DN and T2DM and DN and HC to explore the mRNA profiling in terms of the biological significance. Impressively, ‘extracellular exosome’ as well as other terms associated with constitution of EV, ‘plasma membrane’ and ‘extracellular space’ were enriched by GO cellular component (CC) analysis in DN. Besides, Reactome analysis identified pathways of ‘immune system’, ‘extracellular matrix organization’ and ‘degradation of extracellular matrix’ reflecting the pathogenesis mechanism of DN (Fig. 1c). Additionally, microarray data of DN glomeruli and tubule from the GEO database were analyzed in comparison to uEV RNA-seq data. GSEA showed that great similarities were found in the top 10 terms of Reactome pathways (Fig. 2).

CONCLUSION

In conclusion, this study provides a landscape transcriptome profile, the genetic trace and the biological function terms of uEV in DN. uEV holds potentials in reflecting the transcriptome characteristics of renal tissue, which is of significance for understanding the pathogenesis of DN and biomarker discovery.
MO642: Comparison of Medium Cut-Off Dialyzer and Post-Dilution Hemodiafiltration on the Removal of Small and Middle Molecule Uremic Toxins
Authors: Chang Seong Kim , Hong Sang Choi , Eun Hui Bae , Seong Kwon M A , Soo Wan Kim
Published: May 2022

BACKGROUND AND AIMS

The medium cut-off (MCO) dialyzer increases the removal of several middle molecules more effectively than high-flux hemodialysis (HD). However, there are no comparable data on the efficacy and safety of MCO dialyzers versus post-dilution hemodiafiltration (HDF) in Korean patients.

METHOD

A total of 9 patients with chronic HD were included in this crossover study. Patients received HD with an MCO dialyzer for 4 weeks, followed by a 2-week washout period, using a high-flux dialyzer to minimize carry-over effects and then crossed over to post-dilution HDF for 4 weeks. Reduction ratios and differences in the values before and after were calculated from the MCO dialysis, post-dilution HDF and high-flux HD. In the in vitro study, EA.hy926 cells were treated with dialyzed serum.

RESULTS

Compared with post-dilution HDF, the MCO dialyzer achieved significantly higher reduction ratios for larger middle molecules [myoglobin, kappa free light chain (κFLC) and lambda FLC (λFLC)]. Similarly, the differences between before and after the last dialysis session of myoglobin, κFLC, and λFLC were significantly greater in MCO dialysis than in post-dilution HDF. The expression of Bax and nuclear factor-κb was decreased in the serum after dialysis with the MCO dialyzer than with HDF.

CONCLUSION

Compared with high-volume post-dilution HDF, MCO dialysis showed no differences in the removal of molecules below 12 000 Da, whereas it was superior in the removal of larger uremic middle molecule toxins in patients with kidney failure. Moreover, these results might be expected to have an anti-apoptotic effect on the human endothelium.
MO643: Haemoperfusion Combined with Standard Haemodialysis May Have a Beneficial Effect on Serum Beta-2 Microglobulin Levels in Chronic Haemodialysis Patients
Authors: Sonikian Makrouhi , Chiras Theodoros , Velentza Aikaterinh , Skarakis Jacob , Biblaki Dimitra , Dagkounaki Paraskevi , Barbatsi Aggeliki , Martsoukou Maria
Published: May 2022

BACKGROUND AND AIMS

Standard haemodialysis (HD) with low-flux membranes does not provide adequate middle molecular weight (MMW) clearance of uraemic toxins [1] and on-line haemodiafiltration (OL-HDF) may not be easily applicable and cost effective in some centres. We investigated whether low-flux conventional HD combined with hemoperfusion (HP) may offer any benefit regarding serum beta-2 microglobulin (β2M) levels as a surrogate of middle molecules in patients haemodialyzed for many years and we compared the method-combination with OL-HDF.

METHOD

We studied 24 stable anuric patients during 6 months, under standard medical therapy, aged 69 years (46–90), M: F = 20:4, on chronic HD for 84 (65–286) months, who formed three groups: A (GrA), B (GrB) and C (GrC). Each group included 8 age- and HD vintage-matched patients respectively. In GrA patients, a type HA130 cartridge for HP was connected in parallel to the low-flux polysulfone dialyzer and this combination of standard HD with HP (HD + HP) was used once a week for the first month, once every 2 weeks for the second month and once a month for the next 4 months. GrB patients underwent only standard HD treatment with low-flux polysulfone membranes and GrC patients were treated with OL-HDF. In all three groups serum β2M levels were determined at months 0 (M0) and 6 (M6), before (pre-dialysis, preD) and after (post-dialysis, postD) the second weekly session.

RESULTS

Serum preD β2M levels ​​were similar in GrA and GrB at M0 (44.1 ± 8.6 versus 34.6 ± 16.2 mg/L;  P = NS) and at M6 (46.1 ± 7.6 versus 41.1 ± 18.9 mg/L;  P = NS). In GrC, preD-β2M values were lower compared with GrA at both M0 (31.1 ± 4.2 mg/L;  P = .008) and M6 (33.8 ± 6.82 mg/L;  P = .02). In GrC, serum postD-β2M levels ​​decreased significantly at both M0 (7.4 ± 1.9 mg/L;  P < .001) and M6 (9.9 ± 3.8 mg/L;  P<.001). The postD reduction was maintained, with no difference between M0 and M6. An improvement/decrease in β2M values ​was observed only in GrA between M0 and M6 (−5.8 ± 7.2 versus 1.8 ± 5mg/L;  P = .03) but not in GBr.

CONCLUSION

OL-HDF is obviously the most effective method for elimination of MMW uraemic toxins and in particular β2M [2–3]. Interestingly, the combination HD + HP seems to be more effective than low-flux HD alone [4] and it could be useful for specific patient cases in daily clinical practice in order to prevent or delay the onset and deterioration of symptomatic amyloidosis. Possible result improvement with a more frequent use of HD + HP needs further investigation.
MO665: 2 Icodextrin (2-ICO) Dwells in Peritoneal Dialysis (PD) Patients: One Center Experience
Authors: Viera Ramírez Elizabeth , Haridian Sosa Barrios R. , Burguera Vion Víctor , Martin Irene , Campillo Trapero Cristina , Fernandez Lucas Milagros , Maite Rivera
Published: May 2022

BACKGROUND AND AIMS

Icodextrin is a soluble glucose polymer used widely as an alternative osmotic agent to glucose-only solutions in PD patients. It provides effective net peritoneal ultrafiltration (UF) and nowadays it is only licensed for once-daily dwells. However, in selected patients it has been described its use in two daily dwells (2-ICO). Our aim was to revise our center experience with icodextrin when prescribed as 2-ICO.

METHOD

We retrospectively analysed all patients with a 2-ICO dwell prescription in our PD unit from January 2018 until June 2021. Clinical data, indication for prescription and outcomes were collected.

RESULTS

CONCLUSION

In selected patients, 2-ICO dwells daily may have a clinical benefit, improving UF significantly and allowing better management of fluid overload and UF failure without relevant adverse events.
MO673: Association of Mean Corpuscular Volume with Mortality in Kidney Failure Patients: Opposite Findings in Chinese and Swedish Kidney Failure Patients
Authors: Lindholm Bengt , Zhang Xiaomeng , Chen Zhimin , Rashid Tony Qureshi Abdul , Danielson Kristin , Mukai Hideyuki , Suliman Mohamed , Heimbürger Olof , Chen Jianghua , Stenvinkel Peter , Peter Barany Franz
Published: May 2022

BACKGROUND AND AIMS

Higher mean corpuscular volume (MCV), a measure of the average size of the circulating erythrocyte used for differential diagnosis of anemia or for monitoring macrocytosis, is associated with higher mortality in various clinical settings including in patients (pts) with kidney failure; however, results are not consistent and a study from Japan (Honda et al. Low rather than high mean corpuscular volume is associated with mortality in Japanese patients under hemodialysis. Sci Rep. 2020; 10(1): 15 663) found that low MCV associated with mortality in 8571 hemodialysis pts (mean age 62.5 ± 12.7 years, 37.2% female, median MCV 96.1 fL) pts. We investigated the relationship between MCV with all-cause and cardiovascular mortality in two cohorts of kidney failure pts from China and Sweden.

METHOD

In 731 incident Chinese peritoneal dialysis pts (median age 50 years, 57% males) and 404 Swedish kidney failure pts (median age 56 years, 62% males), baseline MCV and other biochemical and metabolic biomarkers were analysed in relation to mortality during follow-up period of up to 5 years. All-cause and cardiovascular disease (CVD) mortality risk were analysed with competing-risk regression models with transplantation as competing risk adjusting for age, sex, smoking, diabetes, serum albumin, hemoglobulin and calendar year.

RESULTS

Chinese pts were significantly younger (P < 0.01) and had lower body mass index (P < 0.01) and Framingham risk score (P < 0.01) than Swedish pts while gender distribution was similar. In univariate analysis, MCV was associated with body mass index (P < 0.01) and mean arterial blood pressure (P < 0.01) in both cohorts. ‘Chinese pts’: During median 3.6 years of follow-up, all-cause mortality rate was 16%, and 52 (46%) of 111 deaths were caused by CVD. Low MCV (<94 fL) was associated with significantly higher all-cause [Fig. 1A; sub-hazard ratio, sHR (95% CI) 2.15 (1.14–4.06)] but not CVD mortality (Fig. 2A) when adjusting for all confounders. ‘Swedish pts’: During median 2.1 years of follow-up, all-cause mortality rate was 30%, and 53 (44%) of the 120 deaths were caused by CVD. In contrast to the Chinese cohort, pts low MCV (<94 fL) was associated with lower both all-cause [Fig. 1B; sHR 0.62 (0.39–0.97)] and CVD mortality [Fig. 2B; sHR 0.49 (0.26–0.94)] when adjusting for all confounders.

CONCLUSION

In Chinese kidney failure pts low MCV was associated with higher all-cause mortality risk while in Swedish kidney failure pts low MCV was associated with pts lower all-cause and CVD mortality risk, independently of all confounders. Further studies are needed to explore if this difference may reflect regional differences in factors affecting MCV.
MO684: Dialysis-Network Variability in Home Dialysis use not Explained by Patient Characteristics. A National Registry-Based Cohort Study in France
Authors: Couchoud Cécile , Bechade Clémence , Kolko Anne , Caillette-Beaudoin Agnes , Bayer Florian , Rabilloud Muriel , Ecochard René , Lobbedez Thierry
Published: May 2022

BACKGROUND AND AIMS

Although associated with better quality of life and potential economic advantages, home dialysis use varies greatly internationally and appears to be underused in many countries. This study aimed to estimate the dialysis-network variability in home dialysis use and identify factors associated with (i) the uptake in home dialysis, (ii) the proportion of time spent on home dialysis and (iii) home dialysis survival (patient and technique).

METHOD

All adults ≥18 years old who had dialysis treatment during 2017–9 in mainland France were included. Mixed-effects regression models were built to explore factors including patient characteristics or residence and dialysis network associated with outcomes.

RESULTS: During 2017–9, 7728/78 757 (9.8%) patients underwent dialysis at least once at home for a total of 120 594/1 508 000 (8%) months. The heterogeneity in dialysis networks regarding the uptake or total time spent on home dialysis was marginally explained by patient characteristics or residence and dialysis-network factors. Heterogeneity was less for home dialysis survival. These results were similar when the analysis was restricted to home peritoneal dialysis or home hemodialysis. Income inequity and housing were associated with reduced home dialysis uptake and reduced proportion of time on home dialysis. Home dialysis use was not affected by the number of self-care HD units in the administrative district of residence.

CONCLUSION

Our results suggest that to increase home dialysis use in France, one should focus on home dialysis uptake rather than survival. Financial incentives and a quality improvement program should be implemented at the dialysis-network level to increase home dialysis use.
MO693: Longitudinal Intraindividual Changes of Peritoneal Histology over Time in 37 Peritoneal Dialysis Patients
Authors: Aziz Alan , Kielstein Jan T , Pfister Frederick , Amann Kerstin , Eden Gabriele
Published: May 2022

BACKGROUND AND AIMS

The long-term use of peritoneal dialysis is limited due to changes of the peritoneum. Those can be attributed to both, uremia and the effect of the peritoneal dialysis solution on the peritoneum. Although the effect of peritoneal dialysis on the peritoneal histology has been investigated for more than 40 years, most studies fail to report intraindividual changes of the peritoneum but report cross-sectional data from different patients at different timepoints of their dialysis career. The aim of our study was to investigate the intraindividual changes over time associated with peritoneal dialysis as part of the GRiP (German Registry in PD).

METHOD

Among patients documented by the GRiP study group 37 patients were identified in which two peritoneal samples were collected at least 2 months apart. The median [IQR] patient age was 63.6 [52.8–70.5] years with a median [IQR] BMI of 27.8 [22.4–31.8] kg/m2. The time between the two biopsies was 20.0 [7.2–27.6] months. Removal or change of the PD catheter was due to infection in 20 of the 37 patients (54%). Samples from the parietal peritoneum were collected at prespecified locations. Routine histology using hematoxylin–eosin was performed. The thickness of the submesothelial compacta was analysed with AxioVision SE64 Rel.4.9. software. GraphPad Prism 9 (San Diego, CA, USA) was used for statistical analysis. Comparison between histological parameters at implantation and explantation was done by using a paired t-test using a significance level of P < 0.05.

RESULTS

Comparing the intraindividual thickness of the compacta at the time of implantation and explantation of the peritoneal dialysis catheter we saw a significant increase of the median [IQR] ‘minimum thickness’ from 50.0 [20.5–89.5] µm to 130.0 [42.5–195.5] µm, the ‘average thickness’ from 102.0 [77.75–162.5.5] µm to 181.5 [123.3–265.5] as well as the ‘maximum thickness’ from 148.0 [107.0–208.0] µm to 240 [182.0–381.0] (Fig. 1). Further, the degree of peritoneal fibrosis increased significantly (Fig. 2).

CONCLUSION

The longitudinal, intraindividual assessment of peritoneal biopsies in a sizeable cohort of patients confirms previous cross-sectional data showing an increase in the thickness of the sumesothelial compacta over time.
MO698: Evaluation of Outcomes of Peritoneal Dialysis Patients in the Post-Covid-19 Period: a National Multicenter Case–Control Study from Turkey
Authors: Ozturk Savas , Gursu Meltem , Arici Mustafa , Sahin İdris , Eren Necmi , Yılmaz Mürvet , Ozberk Sumeyra , Karahisar Sirali Semahat , Ural Zeynep , Dursun Belda , Yuksel Enver , Uzun Sami , Sipahi Savas , Ahbap Dal Elbis , Yazici Halil , Altunoren Orcun , Tunca Onur , Ayar Yavuz , Gok Oguz Ebru , Yilmaz Zulfikar , Kahvecioglu Serdar , Asicioglu Ebru , Oruc Aysegul , Ataman Rezzan , Aydin Zeki , Huddam Bulent , Esra Dolarslan Murside , Azak Alper , Bakirdogen Serkan , Ugur Yalcin Ahmet , Karadag Serhat , Sena Ulu Memnune , Gungor Ozkan , Ari Bakir Elif , Riza Odabas Ali , Seyahi Nurhan , Yildiz Alaattin , Ateş Kenan
Published: May 2022

BACKGROUND AND AIMS

There is not enough data on the post-COVID-19 (coronavirus disease 2019) period for peritoneal dialysis (PD) patients affected from COVID-19. We aimed to compare the clinical and laboratory data retrospectively obtained in the follow-up of PD patients after COVID-19 with a control PD group.

METHOD

This study, supported by the Turkish Society of Nephrology, is a national multicenter retrospectively case–control study involving adult PD patients with confirmed COVID-19, using data collected from 21 April 2021 to 11 June 2021. A control PD group was also formed from each PD unit, from patients with similar characteristics but who did not have COVID-19. Patients in the active period of COVID-19 were not included. Data at the end of the first month and within the first 90 days, as well as other outcomes, including mortality, were investigated.

RESULTS

A total of 223 patients (COVID-19 group: 113, control group: 110) from 28 centers were included. The duration of PD in both groups was similar [median (IQR):3.0 (1.88–6.0) years and 3.0 (2.0–5.6)], but the patient age of the COVID-19 group was lower than the control group [50 (IQR:40–57) years and 56 (IQR:46–64) years, P < 0.001]. PD characteristics and baseline laboratory data were similar in both groups, except serum albumin and hemoglobin levels on Day 28, which were significantly lower in the COVID-19 group. In the COVID-19 group, respiratory symptoms, rehospitalization, lower respiratory tract infection, change in PD modality, UF failure and hypervolemia were significantly higher on the 28th day. There was no significant difference in laboratory parameters at Day 90. Only one (0.9%) patient in the COVID-19 group died within 90 days. There was no death in the control group. Respiratory symptoms, malnutrition and hypervolemia were significantly higher at Day 90 in the COVID-19 group.

CONCLUSION

Mortality in the first 90 days after COVID-19 in PD patients with COVID-19 is not different from the control PD group. However, some of these patients continue to experience significant problems, especially respiratory system symptoms, malnutrition, and hypervolemia.
MO712: Involvement of Mitochondrial Dysfunction in the Inflammatory Response in Human Mesothelial Cells from Peritoneal Dialysis Effluent
Authors: Ramil Gómez Olalla , Lopez-Pardo Mirian , Rodriguez-Carmona Ana , Fernandez-Rodriguez Jennifer , Vaamonde-García Carlos , Perez Fontan Miguel , José López-Armada María
Published: May 2022

BACKGROUND AND AIMS

Recent studies have related mitochondrial impairment with peritoneal membrane damage in peritoneal dialysis (PD) therapy. Here we assessed the involvement of mitochondrial dysfunction in the inflammatory response in human mesothelial cells, a hallmark in the pathogenesis of PD-related peritoneal membrane damage.

METHOD

Ex vivo studies of effluent-derived human mesothelial cells were carried out. Mitochondria function was evaluated by analysing the mitochondrial membrane potential with flow cytometry using the fluorescent dye tetramethylrhodamine. Mitochondrial dysfunction was induced with the inhibitors oligomycin and paraquat. The effects of mitochondrial dysfunction on inflammatory mediators were studied. Mitochondrial ROS scavenger (MitoTEMPO) and a NF-κB inhibitor (BAY-117 085) were used to investigate the pathways involved. The natural anti-inflammatory antioxidant resveratrol was also tested.

RESULTS

Our ex vivo studies showed that IL-1β causes a drop in the mitochondrial membrane potential in cells from peritoneal effluent. Besides, when mitochondrial damage was induced by inhibitors of mitochondrial function a low-grade inflammatory response was generated. Interestingly, mitochondrial damage sensitizes mesothelial cells causing a significant increase in the inflammatory response induced by cytokines, in which ROS generation and NF-κB activation are involved since inflammation was counteracted by both MitoTEMPO and BAY-117 085. Furthermore, pretreatment with resveratrol significantly reduced the inflammatory response by reversing the decline in mitochondrial membrane potential and decreasing the expression of IL-8, COX-2 and PGE2 caused by IL-1β.

CONCLUSION

These findings suggest that IL-1β regulates mitochondrial function in mesothelial cells and that mitochondrial dysfunction could induce an inflammatory scenario and sensitize these cells, causing a significant amplification of the inflammatory response induced by cytokines. Resveratrol may represent a promising strategy in controlling the mesothelial inflammatory response.
MO738: Simplified Portable Lung Ultrasound Assessment of Fluid Status among Dialysis Patients
Authors: Ling Grace Tan Feng , Lun Allen Liu Yan , Muang Nyein Chan , Du Tiehua
Published: May 2022

BACKGROUND AND AIMS

Fluid assessment is challenging, and fluid overload poses a significant problem among dialysis patients [1], with pulmonary oedema being the most serious consequence. Detection of B lines on lung ultrasound (LUS) is a reliable method of estimating lung water with higher sensitivity compared with clinical examination [2]. A simplified 8-point LUS has also shown a good correlation with the standard 28-point LUS in assessing lung water [3]. Using a simplified 8-point LUS by a portable hand-held ultrasound can help increase the uptake of LUS fluid assessment in dialysis units.

Our study aims to determine the performance of simplified 8-point LUS using a portable hand-held LUS unit in assessing the fluid status of dialysis patients compared with bioimpedance alone or a combination of bioimpedance and clinical examination.

METHOD

Two independent nephrologists performed a simplified 8-point LUS unit using a portable hand-held US unit. Clinical assessment of fluid status and bioimpedance were used as comparators. Fluid overload was defined as a B-line count of > 5.

Our primary outcomes were the performance of simplified 8-point LUS compared with overhydration (OH) presented as absolute value and by percentage (OH%), with or without the combination of clinical examination of fluid status.

RESULTS

LUS was performed on 50 hemodialysis and 11 peritoneal dialysis patients. A total of 10% of patients were euvolemic, 46% had mild, 42% moderate and 2% severe fluid overload on clinical examination.

The OH and OH% of the area under the curve (AUC) for the receiver operating characteristic curve (ROC) curve were 0.697 and 0.713, respectively, for the performance of LUS compared with bioimpedance alone (Fig. 1). The same assessments were 0.782 and 0.781, respectively for a combination or bioimpedance together with clinical examination (Fig. 1).

CONCLUSION

Simplified 8-point LUS using a portable hand-held LUS unit showed a good performance with the assessment of fluid status using a combination of clinical examination and bioimpedance. This simplified and portable method will help increase the use of LUS in dialysis units.
MO740: Decrease Serum IgG anti-oxLDL Antibodies Levels are Associated with Peripheral Arterial Disease IN PATIENTS WITH PERITONEAL DIALYSIS
Authors: Teng Yi-Yen , Mitra Sari Santi , Wang Chih-Hsien , Kuo Ch , Hsu Bang-Gee
Published: May 2022

BACKGROUND AND AIMS

Antibodies to oxidized LDL (anti-oxLDL antibodies) were found to indicate protection from coronary artery disease and possibly major adverse cardiovascular and cerebral events. Peripheral arterial disease (PAD), defined by a low ankle-brachial index (ABI), is associated with increased mortality in patients on peritoneal dialysis (PD). The present study aimed to determine the relationship between serum IgG anti-oxLDL antibodies level and PAD in PD patients.

METHOD

The present cross-sectional, a single-center study included 90 PD patients. Serum IgG anti-oxLDL antibody levels were determined by available enzyme-linked immunosorbent assays. ABI values were measured using an automated oscillometric device. Patients with ABIs of < 0.9 were categorized into the low ABI group.

RESULTS

In the study cohort, 23 of the 90 patients (25.6%) had low ABIs. The rates of diabetes mellitus (P = 0.010), older age (P = 0.006) as well as the serum levels of fasting glucose (P < 0.001), triglyceride (P = 0.008) and C-reactive protein (P < 0.001) were higher, while IgG anti-oxLDL antibodies (p < 0.001) were lower in the low ABI group compared with the normal ABI group. The multivariable logistic regression analysis revealed that serum levels of IgG anti-oxLDL antibodies [odds ratio (OR) 0.978, 95% confidence interval (95% CI) 0.958–1.000; P = .046) and C-reactive protein (each 0.1 mg/dL increase, OR 1.662, 95% CI 1.151–2.398; P = 0.007) were independently associated with PAD in PD patients. The area under the curve plotted to estimate the optimal level of IgG anti-oxLDL antibodies predicting PAD in PD patients by the receiver-operating characteristic curve analysis was 0.687 (95% CI 0.580–0.780; P = 0.0022).

CONCLUSION

Lower serum IgG anti-oxLDL antibodies together with higher C-reactive protein were associated with PAD in PD patients.
MO764: Type of Vascular Access in Incident Hemodialysis Patients in Morocco: Predialysis Nephrology Care Should be Improved
Authors: Naouaoui Salma , Chettati Mariam , Fadili Wafaa , Laouad Inass
Published: May 2022

BACKGROUND AND AIMS

Current guidelines recommend early placement of an autogenous arteriovenous fistula (AVF) before initiation of chronic hemodialysis therapy. Also, several studies showed that optimal pre-dialysis care is crucial to prepare a functioning permanent dialysis access. However, despite these recommendations, incident patients in Morocco usually initiate dialysis therapy using temporary catheters. Therefore, the purpose of our study was to identify the types of vascular access used by incident hemodialysis patients in Morocco and to determine the effect of pre-dialysis renal care on native AVF utilization.

METHOD

We conducted a cross-sectional study at the nephrology department of Mohammed VI university hospital from January 2019 to January 2021 among adult incident hemodialysis patients. Clinical and demographic characteristics, as well as data on vascular access type and nephrology care prior to dialysis initiation, were recorded.

RESULTS

A total of 210 patients were enrolled in our study. The mean age of the participants was 51.6 ± 12.3 years (19–78) with a male predominance (71.4%). The leading cause of the end-stage renal disease (ESRD) was diabetic nephropathy in 41.4% of the patients. At hemodialysis therapy initiation, 173 patients (82.4%) were dialyzed using a temporary central venous catheter (CVC), 20 (9.5%) with a tunneled hemodialysis catheter (TDC) and 17 (8.1%) with an AVF. Out of all participants, only 81 (38.5%) received prior nephrology care. Patients who reported being seen by a nephrologist at least 1 month before starting hemodialysis therapy (75%) were more likely than those referred later to use an AV access at initiation (22.2% versus 1.5%; P < 0.001). This association remained significant after adjustment for age, sex, geographical origin, education, insurance coverage, comorbidity status and underlying renal diagnosis.

CONCLUSION

Our findings showed a high incidence of CVC use among incident hemodialysis patients which is contrary to all recommendations. Also, we found that patients who received pre-dialysis nephrology care were significantly more likely to start their HD through AVF. Therefore, further efforts to improve both referral patterns and preparation for dialysis after referral are needed.
MO768: The Association among Carotid IMT, Pulse Wave Velocity and Vascular Access Failure in Haemodialysis Patients
Authors: Yoon Jong-Woo , Kim Hyunsuk , Kim Seokhyung , Choi Gwangho , Lee Younh-Ki
Published: May 2022

BACKGROUND AND AIMS

Patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) have an increased risk of cardiovascular mortality and morbidity. We aimed to compare the value of IMT with tests such as coronary CT and pulse wave velocity (PWV) as predictors of cardiovascular risk in ESRD patients undergoing maintenance dialysis and examine their association with cardiovascular disease.

METHOD

We reviewed the participants’ medical records, including height, body weight, smoking status, alcohol intake, medication history, aetiology of ESRD, HD vintage and blood pressure which were measured during haemodialysis. Carotid doppler was performed by a skilled sonographer who was unaware of the aims of the study and blinded to the laboratory findings. For PWV measurement, patients lie down, rest for at least 5 minutes and stop smoking and coffee for 3 h before the measurement. BaPWV is measured by recording pulse waves of both arms and ankles from the pressure signal obtained by measuring 4-extremity blood pressure.

RESULTS

A total of 100 patients were included, of whom 51 (50.5%) were men. The median age was 66 years (interquartile range 58–76 years). The median vintage of haemodialysis was 47.5 months (range 31.3–89.1 months). There were no significant differences between the high IMT group and the low IMT group in sex, haemodialysis vintage, ESRD aetiology and type of vascular access. However, age was significantly older in the high IMT group. IMT was significantly associated with PWV [hazard ratio (HR) 2.109; 95% confidence interval (95% CI) 1.037–4.291, P = 0.039). After adjusting for age, sex and presence of diabetes, IMT was independently associated with PWV (HR 2.110, 95% CI 1.036–4.298, P = 0.040). The risk of recurrent vascular access failure was higher in the high IMT group (HR 1.615, 95% CI 1.460–5.669, P = 0.034).

CONCLUSION

IMT was associated with PWV and recurrent access failure. Thus, IMT may be suggested as a potential predictor of vascular access failure.
MO774: Clean Buttonhole Puncture Prevents Infection
Authors: Shibata Kazuhiko , Shinzato Takahiro , Nakai Shigeru , Toma Shigeki , Kobayashi Yusuke , Hashimoto Tatsuo
Published: May 2022

BACKGROUND AND AIMS

The buttonhole (BH) puncture has been criticized for the problem of infection. We considered that at least one of the causes for the higher infection rate in the BH technique might be insufficient removal of scabs. The scab pushed into the BH by a dull needle provides optimal temperature, moisture and nutrition for the germs, and protects them from immune system attack. We considered that the infection would be established if enough bacteria were inside when the scab was dissolved. Usually, scabs covering the BH entry site are removed with needles or forceps, and this procedure tends to injure the entry site so that scabs stick more firmly to the site after that. We reported the effect of the moist wound healing procedure on the BH entry site to solve this problem from the 49th ERA-EDTA congress. Since that time, we have continued this method to the BH entry site in Yokohama Minami Clinic. After transferring to the Toshin Clinic in 2019, we faced the problem of difficulty in performing the BH method because nurses were not familiar with removing the scab. For this reason, we had to ask patients who wanted the BH procedure to soak the scabs in the bathtub and wash it with a nylon towel until the scab was gone.

METHOD

This study was conducted at Toshin Clinic from April 2021 to November 2021. In most patients, fistula vessels were punctured by either the BH or the rope-ladder method. But, in some patients, however, fistula vessels were punctured by both methods. For the BH method, supercath clump cath P painless needles were used. After hemostasis was achieved, we put a small amount of white petroleum jelly. We instructed patients to wash the puncture site at home, especially when they took a bath, using a nylon towel until the blistered scabs were gone. Patients were also instructed to apply the white petrolatum on the site after washing the site. Thanks to this method, in many patients, scabs could be wiped off easily.

RESULTS

At the end of November 2021 119 patients were punctured by the rope ladder method (79 males/40 females, 70.2 years old, 107 months on dialysis) and 35 patients by the BH method (29/6, 68.9 years old, 93.3 months). We have punctured 66 925 times by the rope-ladder method and 8011 by the BH method. One local infection requiring hospitalization debridement occurred in the rope-ladder group and one local infection occurred in the BH group. There was no significant difference between the two groups (P = 1.0, Pearson's chi-squared test).

CONCLUSION

Infection can be prevented by continued moist treatment of the BH and vigorous self-cleaning. I would like to call this method the "clean buttonhole method" because it keeps the BH clean in appearance, unlike the conventional dirty BH method where the scabs are dried and have to be plucked off.
MO780: Effect of Acupressure Applied to Li4 Point on Fistula Needle Pain Intensity in Haemodialysis Patients
Authors: Turgay Gülay , Çevik Banu , İnanoğlu Işılay , Kaya Semiha , Burak Sayın Cihat
Published: May 2022

BACKGROUND AND AIMS

Arteriovenous fistula (AVF) is the most reliable method for vascular access, which is vital for haemodialysis patients. To perform haemodialysis therapy, AVF cannulation is by puncture with thick needles three to four times a week. Patients usually feel pain while a needle is inserted into the fistula [1]. This acute pain can be relieved by acupressure, which is a non-pharmacological application method. It is stated in the literature that acupressure is especially effective in acute pain management. This study was designed to evaluate the effect of acupressure application to the LI4 point on the severity of acute pain caused by fistula needle insertion in patients with antecubital arteriovenous fistula [2–3].

METHOD

This study was conducted as a randomized controlled experimental study in a total of 64 patients who received haemodialysis treatment between 15 November 2021 and 5 January 2022 in the Dialysis Centre of a foundation university in Turkey. Inclusion criteria for the study; have an antecubital fistula; ≥18 years; can speak Turkish, not using analgesics in the last 6 h; no extremity pain; no bleeding or coagulation problems and volunteering to participate in the study. In the study, data were collected using the patient identification form and the Visual Analogue Scale (VAS) for measuring the pain intensity of the individual. In the experimental group, in the first dialysis session of the week, a needle was inserted into the patient's arteriovenous fistula by the nurse, and the pain intensity was measured with VAS. In the second and third sessions of the same week, finger acupressure was applied for 3 min before the fistula needle insertion and the patient's pain intensity was evaluated with VAS after needle insertion. Fistula needle insertion was performed by the same nurse in all patients. Descriptive statistics, including mean, standard deviation, frequency distribution; Wilcoxon, Mann–Whitney U and Friedman test were used. P < 0.05 was considered as significant level.

RESULTS

In this study, data were found to be similar in terms of age, gender, education level, duration of dialysis treatment and VAS mean score. While there was no decrease in the severity of acute pain during fistula needle insertion of the patients in the control group, there was a significant decrease in the mean acute pain severity scores experienced by the patients in the experimental group, whose LI4 point acupressure was applied during fistula needle insertion (P < 0.05) (Table).

CONCLUSION

The results of this study support the effectiveness of LI 4 acupressure point can be conducted as an effective and low-cost way to reduce the acute pain of needle insertion in fistulas in dialysis patients. In addition, the results provide a practical reference to acute pain management for dialysis nurses.
MO794: Central Venous Catheter-Related Complications in Older Haemodialysis Patients: A Multicentre Observational Cohort Study
Authors: Van Oevelen Mathijs , Heggen Boudewijn , Abrahams Alferso C , Rotmans Joris , Snoeijs Maarten , Vernooij Robin , van Buren Marjolijn , Meijvis Sabine
Published: May 2022

BACKGROUND AND AIMS

Central venous catheters (CVC) remain a commonly used vascular access option in haemodialysis, despite guidelines advising to preferably use arteriovenous fistulae. Compared to younger patients, the risk-benefit ratio of CVC in older patients might be more beneficial, but previous studies mainly focussed on catheter-related bacteraemia and/or assessed tunnelled CVC (TCVC) only. This study's aim was to compare all catheter-related infections and malfunctions in older patients with younger patients using all CVC subtypes.

METHOD

We used data from DUCATHO, a multicentre observational cohort study in the Netherlands. All adult patients in whom a CVC was placed for haemodialysis between 2012–2016 were included. The primary endpoint was the occurrence of catheter-related infections, comparing patients aged ≥ 70 years with patients aged <70 years (reference). As secondary endpoints, catheter malfunctions and catheter removal due to either infection or malfunction were assessed. Using Cox proportional hazards and recurrent events modelling, hazard ratios (HR) with 95% confidence intervals (CI) were calculated with adjustment of prespecified confounders. Additionally, endpoints were assessed for non-tunnelled CVC (NTCVC) and TCVC separately.

RESULTS

A total of 1595 patients with 2731 CVC (66.5% NTCVC, 33.1% TCVC) were included. Of these patients, 1001 (62.8%) were aged <70 years and 594 (37.2%) ≥70 years. No statistically significant difference was found for the occurrence of catheter-related infections (adjusted HR 0.80, 95% CI 0.62–1.02), catheter malfunction (adjusted HR 0.94, 95% CI 0.75–1.17) and catheter removal due to infection or malfunction (adjusted HR 0.94, 95% CI 0.80–1.11). Results were comparable when assessing NTCVC and TCVC separately.

CONCLUSION

Patients aged ≥ 70 years and <70 years have a comparable risk for the occurrence of catheter-related infections and catheter malfunction. These findings may help when discussing treatment options with older patients starting haemodialysis and may inform the current debate on the best vascular access for these patients.
MO805: Combination of Conventional Haemodialysis with Haemoperfusion: Does it Provide any Benefits to Haemodialysis Patients?
Authors: Sonikian Makrouhi , Velentza Aikaterinh , Chiras Theodoros , Skarakis Jacob , Biblaki Dimitra , Dagkounaki Paraskevi , Karakou Eugenia , Trakas Nikolaos , Barbatsi Aggeliki , Martsoukou Maria
Published: May 2022

BACKGROUND AND AIMS

Conventional haemodialysis (HD) with low-flux membranes does not provide adequate middle molecular weight (MMW) clearance of uremic toxins [1]. The potential for better removal of parathyroid hormone (PTH) and β2-microglobulin (β2M) was investigated using a combination of low-flux HD and haemoperfusion (HP) (HD + HP).

METHOD

A total of 16 stable HD male patients, free of infections, malignancies or haematological disorders, under usual medications for anaemia and hyperparathyroidism, treated with low-flux polysulfone membranes, were randomized into two groups: group A (GA) included eight patients under HD + HP and group B (GΒ) included eight patients under HD only. In GA patients, a type HA130 HP cartridge was connected in parallel to the dialyzer, once a week for the first month, once every 2 weeks for the second month and once a month for the next 4 months. A third group C (GC) was also studied, consisting of eight males undergoing online haemodiafiltration (OL-HDF). In all three groups, serum β2M and iPTH levels were determined at months 0 and 6, before (preD) and after (postD) the mid-week session.

RESULTS

Serum preD-β2M levels were similar in groups A and B at month 0 (44.1 ± 8.6 versus 34.6 ± 16.2 mg/L;  P = NS) and at month 6 (46.1 ± 7.6 versus 41.1 ± 18.9 mg/L;  P = NS). In GC, preD–β2M values were lower compared with GA at month 0 (31.1 ± 4.2 mg/L;  P = .008) and at month 6 (33.8 ± 6.82 mg/L;  P = .02), and postD–β2M values decreased significantly at month 0 (7.4 ± 1.9 mg/L;  P < .001) and at month 6 (9.9 ± 3.8 mg/L;  P < 0.001). The reduction was maintained, with no difference between month 0 and month 6. An improvement/decrease in β2M values was observed between month 0 and month 6 only in GA (–5.8 ± 7. 2 versus 1.8 ± 5 mg/L; P = .03) but not in GB. PreD–iPTH values did not differ between groups A, B and C at month 0 (623 ± 432 versus 434 ± 350 versus 710 ± 286 pg/mL, respectively; P = NS) and at month 6 (758 ± 550 versus 383 ± 186 versus 559 ± 296 pg/mL, respectively; P = NS). PostD–iPTH values showed a decrease at month 6 in GA (from 758 ± 550 to 514 ± 474 pg/mL; P = .04) but not in GB and a mild decrease in GC (from 559 ± 296 to 363 ± 295 pg/mL; P = .05), with a marginal reduction improvement between month 0 and month 6 in GC (41 ± 55 versus 196 ± 87 pg/mL; P = .046).

CONCLUSION

OL-HDF is obviously the most effective method for the elimination of MMW uremic toxins [2]. Interestingly, the combination HD + HP seems to be more effective than low-flux HD alone [3], and it could be useful for specific patient cases in daily clinical practice.
MO816: Bone Turnover Markers as Risk Factors of Severe Hypocalcemia After Parathyroidectomy for Secondary Hyperparathyroidism
Authors: Parshina Ekaterina , Kislyy Pavel , Zulkarnaev Aleksei , Tolkach Alexey
Published: May 2022

BACKGROUND AND AIMS

Hungry bone syndrome is a common postoperative complication after parathyroidectomy (PTx) for severe secondary hyperparathyroidism (SHPT). We aimed to evaluate whether preoperative levels of serum alkaline phosphatase (AP) and β-crosslaps (CTX) are associated with the development of severe hypocalcemia after PTx for SHPT in dialysis-dependent patients.

METHOD

The retrospective study included 127 severe SHPT dialysis-dependent patients who underwent subtotal (SPTx) or total parathyroidectomy with autotransplantation of parathyroid tissue (PTx + AT) in a single high-volume centre of endocrine surgery between 2011 and 2014. Severe postoperative hypocalcemia was defined as an ionized serum calcium level <0.9 mmol/L on a day 3 after surgery.

RESULTS

Severe hypocalcemia was observed in 83 (65.4%) patients after PTx. Comparing to those with mild hypocalcemia, hypoCa patients were significantly younger (mean age 44.2 ± 11.3 years versus 49.7 ± 10.4 years in a non-hypoCa group; P = .0089). Patients in two groups did not differ in terms of gender (P = .198), dialysis vintage (P = .24) and type of surgery (TPTx + AT or SPTx; P = .127). Preoperative PTH level was significantly higher in hypoCa group comparing to non-hypo Ca group [134 (Q1–Q3: 103–190) pmol/L versus 93.9 (Q1–Q3: 74.6–124.3) pmol/L, respectively; P < .0001]. In univariate analysis preoperative AP level was associated with the risk of postoperative severe hypocalcemia [363.2 (Q1–Q3: 180.9–726.3) IU in hypoCa group versus 142.1 (Q1–Q3: 97.2–223.7) IU in non-hypoCa group; P < 0.0001) (Figure 1). AP level above the cut-off value of 238.5 IU/L caused a 5-fold increase risk of severe hypocalcemia. We observed a moderate negative correlation between preoperative AP level and serum ionized calcium level on the third postoperative day after PTx {ρ = –0.637 [95% confidence interval (95% CI) –0.51 to –0.74]; P < .0001}. In contrast, preoperative CTX level was not associated with postoperative severe hypocalcemia [5.34 (Q1–Q3: 4.06–6.03) µg/L in hypoCa group versus 4.6 (Q1–Q3: 3.42–5.69) µg/L in non-hypoCa group; P = .191] (Figure 2). Moreover, the correlation between preoperative AP and CTX levels was weak, even though it was statistically significant [ρ = 0.27 (95% CI 0.08–0.44); P = .006]; and we observed no statistically significant correlation between preoperative CTX and PTH levels (P = .07).

The multivariate logistic regression revealed AP level as the only independent risk factor of severe hypocalcemia development after PTx [ОR 1.006 (95% CI 1.002–1.009) per each IU; P = .005].

CONCLUSION

We identified serum AP level, but not CTX, as an independent risk factor of severe hypocalcemia development after surgical treatment of SHPT. The correlation between CTX and other bone turnover markers (PTH, AP) is weak in dialysis-dependent patients with severe SHPT.