bluuebunny/crossref_metadata_2025 huggingface dataset:
MO842SARS-COV-2 INFECTION AMONG PATIENTS RECEIVING MAINTENANCE HAEMODIALYSIS: SINGLE HAEMODIALYSIS CENTER EXPERIENCE FROM BANGLADESH
Authors: E Khoda Mohammad Mehfuz , Rahim Muhammad Abdur , Shimu Ishrat Jahan , Hossain Md Golzar , Mansur Md Abul
Published: May 2021

Background and Aims

Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infections emerged in Wuhan, China in December 2019 and rapidly became pandemic. Unfortunately, there is lack of evidence about the optimal management of corona virus disease-2019 (COVID-19) and even less is available in patients on maintenance haemodialysis. Patient receiving maintenance haemodialysis are at increased risk for infection by SARS-CoV-2 with poor outcome. So, the purpose of this study was to identify the incidence of SARS-CoV-2 infection among end-stage kidney disease (ESKD) patients on maintenance haemodialysis.

Method

A cross-sectional study was conducted at a haemodialysis unit of tertiary care hospital of Bangladesh from April to August 2020. All patients, who were on maintenance haemodialysis, twice or thrice weekly, were screened by reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2, irrespective of symptoms. All data were collected in case record forms and patients were followed-up over phone.

Results

During the study period, a total of 133 patients (males 70, 52.6%) were on regular maintenance haemodialysis in the study centre. Most patients were in 5th and 6th decades of life. Twenty-one (15.8%) patients tested positive for SARS-CoV-2 by RT-PCR with female (16, 76.2%) predominance. Eighteen (18/21, 85.7%) patients had symptoms suggestive of SARS-CoV-2 infection and rest three (3/21, 14.3%) patients were diagnosed during routine screening. Common presentations were fever (42.9%), cough (66.7%) and respiratory distress (66.7%) and most had multiple symptoms. The incidence of SARS-CoV-2 infection in blood group A was 8(38%) and blood group O was 8(38%). There were no significant differences of mortality rate among blood groups. Most patients (16/21, 76.2%) infected by SARS-CoV-2 were referred to COVID-dedicated hospitals, five (5/21, 23.8%) were shifted to intensive care unit (ICU). Outcome was poor; 17 (17/21, 89%) patients died in hospitals and four (4/21, 19%) patients became free of SARS-CoV-2 infection. Caregivers/relative of our patients acquired COVID-19 in course of disease.

Conclusion

One-sixth of patients on maintenance haemodialysis acquired SARS-CoV-2 infection with nearly ninety percent fatality rates. Despite having risk factors for severe infection by SARS-CoV-2, patients on dialysis must visit health care facilities. So, utmost care should be taken to reduce risk of COVID-19 among such vulnerable group of patients.
MO843PREVALENCE AND MANAGEMENT OF HYPERTENSION IN HEMODIALYSIS PATIENTS
Authors: AlSahow Ali , Alyousef Anas , Alhelal Bassam , AlRajab Heba , Bahbahani Yousif , Nawar Hani , Ibrahim Mostafa Mohammed Elsayed Mohammed , Elabbadi Mohamed , Kamel Vivian F , Abdallah Emad , Kumar Rajeev , AlSahu Ebrahim
Published: May 2021

Background and Aims

Hypertension (HTN) is common in hemodialysis (HD) patients & diagnosed by pre-dialysis BP >140/90 mmHg. Causes include high salt intake, volume overload, & loss of residual kidney function. Therapy includes achieving correct dry weight with each session, restricting interdialytic sodium & fluid intake & medications. We review its prevalence, factors associated with it & its management in our patients.

Method

Demographics, HD prescription & medications data collected for patients from 5 dialysis centers.

Results

A total of 1585 files reviewed. Males were 51.8% & mean age was 59. Mean age significantly higher for females (61 vs 57). ESKD cause was DM in 51% & HTN in 35%. However, of files reviewed, adequate data on comorbidities in 1390 patients (table 1), 69% had DM, 92% had HTN, 47% had CVD & 31% had BMI > 25 (which was significantly more frequent in females). HTN was more likely in older patients, diabetics & females with odds of HTN in females nearly twice the odds of HTN in males & odds of HTN with DM is 2.27 times odds of HTN without DM & one-year increase in age would increase odds of HTN by nearly 4%. Mean pre-HD BP for those with HTN was 143/76 mmHg & for those without HTN was 136/75 mmHg. HD frequency was thrice weekly in 94% & HD duration was > 3.5 hours in only 77% of patients. HDF used in 81.5%. Mean interdialytic weight gain (IDWG) was 2.8 kg, with no difference according to gender or presence of DM or HTN (Table 2). Higher IDWG associated with age < 65, Calcium bath of 1.75 & Sodium bath > 138 with 0.638 kg higher IDWG with calcium of 1.75 compared to calcium of 1.25. Higher IDWG was associated with higher BP. Mean volume of fluid removed per session was 2.74, which was less than mean IDWG, with no difference according to gender or DM, however, it was higher in the higher dialysate sodium group, & lower in the shorter session group (with trend towards statistical significance). CCB used to treat HTN in 62% followed by βB in 52%. Number of patients with HTN on 1 drug 21%, 2 drugs 27%, 3 drugs 23%, ≥ 4 drugs 20% & 9% missing data. Number of antihypertensives did not correlate with IDWG.

Conclusion

Interdialytic weight gain in our HD patients is excessive & contributing to HTN. Patients must restrict salt & fluid intake & dialysis centers must regularly & frequently assess dry weight, ensure thrice weekly schedule & 4 hours per session are met, so excess fluid is completely removed. Also, high sodium & high calcium baths need to be avoided.
MO844COVID-19 PANDEMIC IN DIALYSIS PATIENTS IN SWITZERLAND
Authors: Winzeler Rebecca , Ambühl Patrice Max
Published: May 2021

Background and Aims

COVID-19 is an infectious disease that can result from infection with the novel coronavirus SARS-CoV-2. The disease, was first described in Wuhan at the end of 2019 and the first case in Switzerland was discovered in February 2020. This analysis gives an overview of dialysis patients in Switzerland that were tested COVID-19 positive.

Method

All dialysis centers reported their cases with COVID-19 to the Swiss dialysis registry srrqap. All patients reported to the registry between March 5 (1st dialysis patient with COVID-19) and June 30, 2020 were included in this analysis and comparisons were made with COVID-19-free dialysis patients (from 2019).

Results

On March 5, 2020, the first dialysis patient was infected with COVID-19 in Ticino. The number of infected dialysis patients increased rapidly over the months of March and April, with the majority of patients in the cantons of Vaud (23.5%), Ticino (22.3%) and Geneva (18.8%) and together making up almost 65% of the COVID-19-infected dialysis patients in Switzerland. COVID-19 cases represented 2.4% of all prevalent patients on dialysis (as of 31.12.2019).

Twenty-seven (12 female, 15 male) out of 93 dialysis patients died, which corresponds to a mortality rate of 29%. Mortality was highest in patients from Switzerland (together with the Netherlands), and lowest in Romania with 8.5% (K. Jager and A. Kramer, submitted for publication, 2020).

Mortality was associated with advanced age in dialysis patients. In contrast to the general population, male sex, diabetes and hypertension were no major risk factors for mortality in our cohort.

Conclusion

Although dialysis patients from Switzerland in general have a better survival compared to those from other European countries, infection with COVID-19 in Switzerland results in the highest mortality compared to other European countries in this population. In addition, male sex, diabetes and hypertension seem not to be associated risk factors in our dialysis population.
MO846THE SPECTRUM OF CLINICAL AND SEROLOGICAL FEATURES OF COVID-19 IN URBAN HEMODIALYSIS PATIENTS
Authors: Gomá-Garcés Elena , Stock da Cunha Teresa , Avello Alejandro , Pereira Monica , Mas-Fontao Sebastian , Ortiz Alberto , González-Parra Emilio
Published: May 2021

Background and Aims

The inherent immunosuppression of uremia increases the susceptibility of hemodialysis patients to infection. There is still limited evidence on hemodialysis patients and COVID-19. The clinical and analytical spectrum and treatment responses and mortality are poorly characterized.

Method

Clinical and analytical features, chest X-ray, polymerase chain reaction (PCR) and antibodies for SARS-CoV-2, treatment and outcomes were analyzed in 48 patients diagnosed with COVID-19 during March and April 2020 in two coordinated Spanish hemodialysis units.

Results

In 200 haemodialysis patients, COVID-19 was diagnosed in 48, of whom 22 were PCR positive, eight PCR negative but seroconverted and two were diagnosed on typical clinical grounds. Despite a mean age of 72.6 years, the overall mortality rate was 5/48 (10%). Among the PCR positive patients, 21 (55%) required admission and five (13%) died. PCR positive patients were more often symptomatic and hospitalized and had higher troponin I levels than PCR negative patients, but did not differ in lymphocyte counts, D-dimer or interleukin-6 (IL-6) levels. Among PCR negative COVID-19 patients, three out of 10 (30%) required admission, and none died. The most frequent symptom among the 48 patients was fever (31%), followed by asymptomatic patients (23%). A low number of lymphocytes was the only parameter significantly different between hospitalized and ambulatory COVID-19 patients, independently of PCR status.

Conclusion

COVID-19 hemodialysis patients are frequently asymptomatic, and mortality may be lower than previously reported. Diagnosis may be retrospective, based on seroconversion, as PCR may be negative. This information should guide preventive and patient isolation strategies.
MO848PREVALENCE OF COVID -19 IN CHRONIC HEMODIALYSIS PATIENTS AT THE TARIJA DEPARTAMENTAL HEMODIALYSIS CENTER DURING THE PEACK OF THE ANDEMIC JULY - SEPTEMBER 2020
Authors: Zamora Nelson , Molina Andrea , Arduz Jaime
Published: May 2021

Background and Aims

Bolivia was the last country to enter in the list of Latin American countries to report cases for the worldwide pandemic of COVID-19, reporting its first two confirmed cases on March 11, 2020 in the cities of Santa Cruz and Oruro. In Tarija department, the peak of cases was registered in the months of July, August and September. The Departmental Hemodialysis Center during this period had 71 registered patients undergoing chronic hemodialysis sessions. In this article we display the prevalence of patients who were infected with COVID-19 during that period of time.

Method

This is a prospective cohort observational study in which 71 patients were observed, who underwent hemodialysis sessions during the three shifts during the day (morning, afternoon and evening, during the months of July, August and September, months which were the peak of the pandemic in Tarija. Patients suspected of being transmitted with the disease, underwent immunochromatography IgM/IgG, ELISA anti SARS-CoV-2 and RT/PCR tests before confirming the diagnosis of COVID-19. Patients who had hemodialysis sessions for a period of less than 3 months were excluded from the study, and also those who changed their treatment modality for peritoneal dialysis to hemodialysis.

Results

63 patients, 27 men and 36 women, who underwent hemodialysis sessions during the observational period met the inclusion criteria of the study. 7 patients were excluded for not meeting the inclusion criteria, 6 with a period less than 3 months undergoing hemodialysis and 1 patient who had changed the treatment modality from peritoneal dialysis to HD were excluded too. Of the 63 hemodialysis patients, 57 patients remained healthy and 6 were diagnosed with COVID-19 (Table 1). The prevalence of patients who presented COVID-19 in the hemodialysis center was 9%, with 33% of mortality and 83% who were able to recover and receive epidemiological discharge (figure 1). Of the 6 patients who developed COVID-19, 3 were women and 3 were men, 4 patients with previous hepatitis B infection who were dialyzed in the room with machines HBV + and 2 patients without liver infections who were dialyzed in negative machines. Three patients evolved asymptomatic during the SARS-CoV-2 infection, 2 presented thermal rises and mild cough, but without compromise in O2 saturation or ventilatory function, and one patient who died developed mild cough, slight fever and a hemodialysis catheter-related bloodstream infection by Staphylococcus aureus, confirmed in blood culture.

Clinical characteristics of study participants (N=63)

Conclusion

The prevalence of patients infected by SARS-CoV-2 was 9% with a mortality of 17% (1 patient), validating that strict patient control and prevention measures become a great support to avoid massive spread between patient prone to acquire this infectious disease.
MO851INCIDENCE AND MORTALITY OF CORONAVIRUS DISEASE (COVID 19) IN HEMODIALYSIS PATIENTS
Authors: Grujic Nevena , Pešić Snezana , Naumovic Radomir
Published: May 2021

Background and Aims

In December 2019, an outbreak of coronavirus disease 2019 (covid 19) due to SARS Cov2 began in China and spread worldwide. Hemodialysis patients represent a unique group of patients, mostly elderly, imunocompromised, with numerous comorbidities. Patients with end stage renal disease are thought to be at increased risk of disease, severe disease and death from Covid 19 infection. In addition, dialysis centers are a suitable place for an outbreak of the epidemic. All of the above represents a group of hemodialysis patients particularly susceptible to infection and the development of serious disease.

Method

We reviewed data of all maintenance hemodialysis patients in hemodialysis centar of Zvezdara Hospital, Belgrade, Serbia. We include all patients with COVID 19 infection in period between April 1 2020 and January 10 2021.

Results

Of 232 patients undergoing hemodialysis, 68 (29,31%) were infected with Sars-Cov-2. 46 (67,64%) patients were males and 22 (32,35%) females. The age range of the patients was 35 to 87 years, the mean age was 65,25. The underlyind cause of terminal renal failure in 25 patients was hipertensiv nefroangiosklerosis, 14 diabetic nephropathy, 10 opstructiv nephropathy, 9 polycystic kidney disease, and 10 other cause of kidney failure. The average of hemodialysis duration was 70,70 months. The average durations of disease was 15 days. Mortality has been estimated at 33,82% (23 patients). Among patients who died 8 (34,78%) were females, and 15 (65,21%) males.

Conclusion

The mortality among hemodialysis patients diagnosed with Covid 19 is high. Hemodialysis patients typically present with multiple comorbidities and are considered to be a high-risk group for infections. Hemodialysis patients with Covid-19 may have prolonged hospital stays and unfavorable prognoses and should be closely monitored.
MO853SEROLOGICAL RESPONSE AND FACTORS INVOLVED AFTER A VACCINATION PROTOCOL FOR HEPATITIS B VIRUS IN A HEMODIALYSIS UNIT
Authors: Castro Fernández Maria Paz , Piccone Saponara Luis Guillermo , Uribe Heredia Nancy Giovanna , Ferrer García Guillermo , Carreño Parrilla Agustín , Anaya Fernández Sara , Valle Dominguez Casimiro , García Conejo Gloria , Olazo Gutierrez Eliana , Vozmediano Poyatos Carmen
Published: May 2021

Background and Aims

The population with chronic kidney disease (CKD) presents an increased risk of infection by hepatitis B virus (HBV). Usually, the protective immunological response rate (considering HBV titer > 10 mIU/mL) is 90–95% after the 4th dose of vaccine; In CKD the immune response is lower and correlates with the degree of CKD. In dialysis, this response is variable, less than 50% with three-dose regimens and higher with four doses. Cardiovascular risk factors have been implicated in the response rate to vaccination.

The objective of this work is to analyze the efficacy of the HBV vaccine in hemodialysis patients and to identify cardiovascular factors as predictors of response.

Method

Retrospective observational study. We evaluated the response to a 4-dose vaccination protocol (0-1-2-6 months), determining the levels of HBVA 3 months after the last dose. Demographic variables (age, sex), associated comorbidity, etiology of CKD, among others, were collected. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and have been compared using the Chi2 test. The quantitative variables are expressed as mean +/- standard deviation and the T-student was used to compare them. Statistical significance for a value of p <0.05.

Results

89 patients were included; 68.5% are male, with an average age of 65 years. 85.4% had arterial hypertension, and 39.3 were diabetic, the most frequent cause of CKD being renal vascular disease (20.8%), diabetic nephropathy (26.4%) and interstitial (9%). The immune response to HBV vaccination was 79.2%. When making statistical comparisons between the qualitative variables, we have not observed differences between serological response and DM or sex; We did find a trend towards significance when comparing the serological response with the variable HT and etiology of CKD (polycystic kidney disease), pNS. The comparison of means between quantitative variables when performing the Student's T-test did not show differences for any of the study variables.

Conclusion

In our center, HBV vaccination on dialysis achieves a response rate of 79.2%. HT may condition the immune response to vaccination in HD patients, although significance was not reached. Hereditary pathology has been the one that has shown the best serological response with respect to the rest of etiologies, perhaps associated with greater residual renal function.
MO854PHYSICAL ACTIVITY IN CHRONIC HEMODIALYSIS PATIENTS: ABOUT 71 CASES
Authors: Chemli Imen , Ayed Amel , Sinda Ayed , Ben salem Meriem , Ben salah Manel , Handous Insaf , Letaief Ahmed , Hamouda Mouna , Aloui Sabra , Skhiri Habib
Published: May 2021

Background and Aims

physical activity is generally impaired in the chronic hemodialysis patient. Studies confirm the benefit of maintaining or improving physical activity in these patients. For this reason, our study aims to assess physical inactivity in chronic hemodialysis patients using a physical activity score: DIJON score and to identify the factors linked to a decrease in physical activity .

Method

this is a descriptive and analytical cross-sectional study carried out at the hemodialysis center of Fattouma Bourguiba hospital in Monastir. We used the DIJON questionnaire to measure physical activity: daily activities, sports or leisure. The reference values for the level of physical activity are 0-10 (low), 10-20 (medium); and 20-30 (high).

Results

our study included 71 patients. The middle age was 46.62 + - 15.34 years. 69% of patients were male. The overall physical activity level was high at 22.75 + -1.99 in 28.2% of patients, medium at 13.75 + -3.65 in 33.8% of patients and low at 5.56 + -2.91 in 38% of hemodialysis patients. Analysis in multiple linear regression showed that the variables that explained the DIJON score in our population are in order of contribution: pre-dialytic uremia (β = 0.433; t = 2.99; p = 0.005), cardiac diseases(β = 0.305; t = 2.074; p = 0.044), the KT/V ratio (β = -. 858; p = -1.915; p = 0.063), the PRU (β = 1.21; t = 1.885; p = 0.066) , anemia (β = 0.211; t = 1.704; p = 0.096), comorbidity evaluated by Charlson score (β = -. 461; t = -1.414; p = 0.165).

Conclusion

our results showed that the level of physical activity is linked to many factors, some of which are modified. So, prescribing an adapted and personalized program will improve the prognosis and the quality of life of our patients.
MO855PREVALENCE OF SELF-REPORTED KIDNEY DISEASE AMONG THE FIRST DEGREE RELATIVES OF SAUDI PATIENTS ON DIALYSIS AND ITS RELATIONSHIP TO SPECULATIVE VERSUS DEFINITIVE CAUSES OF CKD IN THE INDEX CASE
Authors: Al-Sayyari Abdulla
Published: May 2021

Background and Aims

CKD is common in Saudi Arabia. This study evaluates and compares the prevalence and clinical characteristics of Saudi dialysis patients with a positive family history of kidney disease to those without such a history and to assess certainty of the CKD diagnosis by their physicians.

Method

This is a cross-sectional survey-based study on adult Saudi hemodialysis patients in six dialysis centers in four Saudi cities. The first part of the survey recorded the demographic variables and the degree of diagnostic certainty (completed by the physicians) and the second part (completed by the patients) recorded first degree family history of kidney disease.

Results

A total of 1080 patients were included. The prevalence of positive family history (FH) was 21.5%. The number of relatives affected was 285, (41%) were parents and (57%) were siblings. More relatives of female patients had ESRD than in relatives of male patients (80.2% and 68.9% respectively) (p=0.0001). There were significantly more patients with “unknown” or “hypertensive” diagnostic labels among the patients with FH of kidney disease than in the group without a family history (p=007 and 0.005 respectively). Dialysis vintage was significantly shorter and CKD vintage was significantly longer in positive FH patients (4.9 ±6.4 yrs.) than in patients without FH (5.9 ±5.8yrs) (p=0.03). The duration since the diagnosis of CKD was made was significantly longer in patients with FH of kidney disease (7.5±7.7 yrs.) than in patients without (2.0±4.5) (p=0.0001). Of all the diagnoses given to the patients, more than half (57.8%) were either “unknown” (33%) or only speculative in nature (25.3%). In those with a diagnostic label, the diagnosis was thought to be definitive in only 62.2% of the cases.

Conclusion

The prevalence of FH of kidney disease was 21.5%, and it was more prevalent with patients with “unknown” or “hypertension” (13%) diagnostic labels.
MO856IMPACT OF HEMODIALYSIS TIME PROLONGATION ON BLOOD PRESSURE CONTROL IN PREVALENT HEMODIALYSIS PATIENTS
Authors: Teama Nahla , Elsharabasy Reem , Soliman Heba , ElSharkawy Magdy
Published: May 2021

Background and Aims

Hypertension prevalence among ESRD patients range from 76% to 90%. Sodium & volume overload is among the main mechanisms. Increasing theduration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours.We aim to study the effect of increasing hemodialysis session time on blood pressure control.

Method

This observational study was conducted on 50 adult clinically stable hypertensive prevalent HD patients on thrice weekly maintenance HD. Patients with secondary causes of hypertension and Patients with decompensated medical conditions were excluded from our study.Patients were divided into 2 groups:(A) 25 patients who received longer session hemodialysis session (4.5hour) and (B) 25 patients HD who received the usual 4 hours session.

Revision of antihypertensive medications&dosages,dry weight was reassessed regularly, andthey were instructed to restrict their salt intake as much as possible aiming at BP <140/90mmHg.they werefollowed up for a period of 6 months assess changes of pre-dialysis blood pressure to monitor response.

Results

Patients in both groups were age matched, with male sex predominance (64%in groupA&56% in groupB). Patients in both groups underwent their HD sessions mostly through AVF (68% and 92% for group A and B respectively). Ultrafiltration volume declined significantly with longer HD sessions compared to conventional sessions (p-value <0.001 vs 0.523).

Longer HD session time session was associated with highly significant decline in mean SBP, (p-value <0.001). Longer HD session time session was associated with highly statistically significant decline in mean DBP, (p-value <0.001). The decline in mean perdialysis SBP & DBP was -17.27 &-9 mmHg, respectively and the rate of decline of postdialysis SBP & DBP was -6.45 & -12.38 mmHg, respectively at 6th month compared to values in 1st month of follow up period.

Conclusion

Longer HD session duration is associated with better improvement in UF volume, mean SBP&DBP, pre-dialysis SBP&DBP and post-dialysis SBP&DBP as well.
MO813ANALYSING TRANSITIONS IN THE INTEGRATED MODEL OF RENAL REPLACEMENT THERAPY IN A REGIONAL HEALTH SYSTEM
Authors: Gil-Casares Casanova Beatriz , Portoles Jose , López Paula , Tornero Molina Fernando , Marques Vidas Maria , Rojo Alvarez Jose Luis
Published: May 2021

Background and Aims

Every year 83,000 Europeans and 6,500 Spanish CKD patients require dialysis or transplantation. The choice of renal replacement therapy (RRT) is an important decision that determines the quality of life and survival. A single therapy option might not be adequate across a patient’s entire lifespan and a majority of patients change from one RRT modality to another to adapt RRT to clinical and psychosocial needs. Transitions should be considered as an expected progression in the patient’s treatment options.

In these circumstances, there are new questions about the best sequence of techniques.

Method

This observational study examined a cohort of all incident patients from the Madrid Registry of Renal Patients (REMER), who initiated RRT between January 2008 and December of 2018. This study used the proportional hazards models and competitive risk models to examine the impact of transitions between RRT modalities on survival.

We performed an intention-to-treat (ITT) analysis, according to the initial RRT chosen and an as treated (AT) analysis, by RRT received (Only HD, Only PD, PD then HD or HD then PD).

Results

A total of 8,971 patients started RRT during this period in Madrid (6.6 Million population): 7,207 on hemodialysis (HD), 1,401 on peritoneal dialysis (PD) and 363 received a pre-emptive kidney transplantation (KTX). Incident HD-patients were older and had more comorbidities. They presented higher mortality (HD group 40.9% vs PD group 22.8% vs 8.3% KTX group, p <0.001) and less access to a transplant (HD group 30.4% vs DP group 51.6%; p <0.001). Transitions between dialysis techniques define different groups of patients with different clinical outcomes. Those who change from HD to PD do it earlier (66% in less than 6 months), are younger and behave like those treated only with PD. Those who change from PD to HD do so later (1.5 years on average), are older (61.6 vs 53.5 years) and present higher mortality and less access to kidney transplantation than the group who initiates in HD and transfer to PD. Survival analysis by competitive risks is essential for integrated RRT models, especially in groups such as PD patients, where 58.6% of the patients were considered as lost follow-up (received a KTX after during the first 2.5 years on PD). This analysis reflects how patients who change dialysis modality share more characteristics with the second technique than the original one.

Conclusion

Our data suggest that transitions between RRT-techniques describes different patients, who associate different risks, and should be analyzed in an integrated manner to define improvement actions. This approach should be incorporated into the analysis and repports of renal registries.
MO858BIOCHEMICAL CHARACTERIZATION AND SURVIVAL OF PATIENTS URGENT-START HEMODIALYSIS DURING COVID-19 PANDEMIC: EXPERIENCE IN A GUATEMALAN CENTER
Authors: Mazariegos Celso , Sánchez Polo José Vicente
Published: May 2021

Background and Aims

The Coronavirus Disease 2019 (COVID-19) pandemic has greatly impacted the world health system, affecting almost 20 million people with a high fatality rate, mainly patients with comorbidities including patients with chronic kidney disease (CKD) in all its stages and renal replacement therapy. The aim of the present study was to evaluate the biochemical characteristics of the patients who urgent-start hemodialysis during the pandemic and additionally to evaluate their survival.

Method

Patients urgent-start hemodialysis were taken during the months of August to November 2020, the admission laboratory data was recorded, including the test to determine SarsCov-2, and Kaplan-Meier survival analysis was applied taking in it counts variables such as sex, professional who placed the vascular access, COVID-19 test result and evaluation by nephrology in the pre-dialysis clinic.

Results

92 patients were including in the analysis, 65% male, the nephrologist placed the vascular access in 54% of the patients, 71% had a negative result in the COVID-19 test and 55% had no evaluation in the pre-dialysis clinic. Among the biochemical results was found BUN 95.3mg/dl (SD 38.1), sCr 10.3mg/dl (SD 6.3), Na 130.6mg/dl (SD 7.5), K 5mmol/L (SD 1.1), Ca 7.8mg/dl (SD 1), P 6.5mg/dl (SD 3.3), uric acid 8.3mg/dl (SD 10) and PTH 279pg/ml (SD 267). As prognostic markers of infection by COVID-19, the following results were found WC 12.3k/UL (SD 9.3), hemoglobin 9.35g/dl (SD 2.5), hematocrit 28.7% (SD 9.4), platelets 291mcL (SD 137), sedimentation 75mm/hr. (SD 37), CRP 81.8mg/L (SD 113.8), interleukin-6 232-6pg/ml (SD 838.8), ferritin 1074.3mg/ml (SD 825.3), D dimer 4.3mcg/dl (SD 11.2), lactate dehydrogenase 322U/L (SD 255) and procalcitonin 6.5ng/ml (SD 16.8). When evaluating survival with the Kaplan-Meier analysis, no statistically significant difference was found when analyzing the variable presence of COVID-19 infection (Figure 2 - p: 0.89), sex (Figure 3 - p: 0.54), professional who placed vascular access (Figure 4 - p: 0.1), and the pre-dialysis evaluation (Figure 5 - p: 0.33), having a survival in general of 77% at 3 months (Figure 1).

Conclusion

The present study found a 77% survival rate in patients with urgent-start hemodialysis. There are no other documented data in Guatemala, which is why it provides guidelines for future studies in the country. Among the variables taken, no one was found that would determine a better survival, including SarsCov-2 infection. It will be necessary to carry out more studies with greater follow-up, more patients and more centers to carry out a better analysis.
MO862COVID-19 INFECTION IN HEMODIALYSIS PATIENTS:FINDINGS-EXPERIENCE-OUTCOME
Authors: Griveas Ioannis , Schinas Antonis , Balitsari Anthoula , Asimakopoulos Gerasimos , Pratilas Evangelos
Published: May 2021

Background and Aims

Our Nephrology Department during spring period on the first wave of COVID-19 was the referral Dialysis Unit for Covid-19 positive HD patients in the district area of Athens, Greece. The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing HD and treated under our care

Method

This is an observational study. Our Dialysis Unit has been assigned as a referral unit for Covid-19 positive HD patients. We registered all the data regarding the clinical course of our patients population. Age, primary cause of end stage renal disease, weight, clinical presentation, HD history, outcome, days of hospitalization.

Results

22 Covid-19 positive HD patients were treated under the care of our facility during the period 8 April 2020-17 June 2020. 16 patients were symptomatic at admission and 13 patients admitted with or developed during their stay pleural effusions. 12 patients (8 male) of our group died during their hospitalization. 3 out of 12 were admitted to Intensive Care Unit (ICU). 6 patients were septic, 4 had respiratory failure and 2 developed cardiovascular events. 14.5 days were the mean hospitalization days (range: 1-38 days) for the diceased ones.

2 out of 3 patients that admitted to ICU had quick deterioration, incubated and stayed in ICU for 48 hours. The third one with severe cormobidities (multiple myeloma, cancer of bladder) developed respiratory failure after 8 days of hospitalization, incubated, became septic and died after 20 days in ICU.

Mean age of our patients was 74.5 years. It has to be pointed out that 13 patients were over 75 years old. Mean age was higher in those who died compared with those who were discharged with double negative Covid-19 tests (79 vs 74,5 years old respectively). Median dialysis vintage for our patients was 63 months and for the diceased ones was 89 months. Average weight of our patients was 69 kgrs. Weight of diceased patients was 63 kgrs. 11 out of 22 patients and 5 out of 12 diceased patients were diabetic. 14 patients were hypertensive and 16 had official cardiovascular backround. 10 out of total 22 patients under our care discharged after 43 days of hospitalization (range:35-56 days).

Conclusion

As a conclusion our data provide clues regarding out experience of caring HD patients with COVID-19. Mortality was high. It seems that despite the fact that immune response of this population has not been clearly clarified, age, cormobidities and above all end-stage renal disease by its self is a significant and unpredictable risk factor for clinical outcome of HD patients with COVID-19 infection.
MO863COMPARISON OF ALL-CAUSE-MORTALITY BEFORE AND AFTER COVID-19 PANDEMIC IN A HEMODIALYSIS CENTER: A SUCCESSFUL PREVENTIVE PROTOCOL
Authors: Yavari Vahideh
Published: May 2021

Background and Aims

COVID-19 has exerted a lot of pressure and concern on Hemodialysis ward managers. Being successful in patient education and, simultaneously, protecting the personnel and patients with in-time provision of sanitation and prevention protocols are mandatory to survive the pandemic. The aim of this study was to assess the success of our preventive measures in the dialysis center after application of our self-developed protocols.

Method

Crude and age-adjusted mortality rates of two time frames, i.e. 4th January to 5th December 2019 and the same period in 2020 (before and after the start of pandemic) were compared. The data were processed with SPSS software version 26.

Results

During 4th January to 5th December 2019, the crude all-cause-morality rate of our hemodialysis center was 20.23% (51 out of 252 patients). Likewise, between 4th January 2020 to 5th December 2020, the crude all-cause-morality rate was 18.25% (46 out of 252 patients). Same result was yielded after age adjustment of the morality rates.

Conclusion

Tailoring effective and timely preventive measures along with tireless education of patients can control all-cause-mortality and possibly COVID-19 excess mortality rates in dialysis centers.

It seems that our preventive protocols which included strict patient and personnel screening, early referral to infectious specialist, clear isolation-sanitation protocols of COVID-19 positive cases and repeated patient and personnel education have been successful in surviving the pandemic till present.
MO864PATIENT MEDICATION ADHERENCE ON HEMODIALYSIS
Authors: Omrane Marwa , Babchia Amel , Jaballah Raja , Mahersia Afef , Saidane Olfa
Published: May 2021

Background and Aims

Non-adherence to treatment is a major problem in patients with end stage renal disease and contributes to the significant increase in morbidity, mortality and health costs.

Method

The objective of this work was to assess adherence to treatment prescriptions

for hemodialysis patients and to identify the predictive factors of poor compliance. This is a cross-sectional study of 59 patients on chronic hemodialysis. Adherence to treatment was evaluated by the adherence assessment test.

Results

The mean age of our patients was 51.8 years, with an M/F sex ratio of 1.26.

The socio-economic level was considered low in 83% of cases. The mean duration of hemodialysis was 81.6 months [6 months-252 months]. Causal nephropathy was dominated by vascular nephropathy (13 cases). Forty-two patients had high blood pressure. A total of 23.9% of patients were good observers, 59.5% had minimal compliance problems, and 16.7% were poor observers. Statistical analysis has shown that poor adherence to treatment is associated with male gender, low socioeconomic and intellectual level, the presence of comorbidities, increased medication, number of medications taken per day, and less knowledge of the pathology and risks as side effects of drugs.

Conclusion

Treatment adherence is unsatisfactory in our population of patients on maintenance hemodialysis. Therapeutic education targeting the expected benefit of the treatments, their mode of action, their side effects as well as a simplification of the intake would improve long-term adherence in patients.
MO865SEX HORMONAL PROFILE OF PATIENTS ON MAINTENANCE HEMODIALYSIS AND CORRELATION WITH QUALITY OF LIFE AND DEPRESSION: A CROSS-SECTIONAL STUDY FROM SOUTH INDIA
Authors: Latief Muzamil , Parry Manzoor , Abbas Farhat , Yadla Manjusha
Published: May 2021

Background and Aims

Hormonal abnormalities in haemodialysis (HD) patients contribute to quality of life including sexual dysfunction. Whereas Short Form 36 (SF 36) questionnaire deals with the holistic assessment of the quality of life in patients, it is directly impacted by sexual dysfunction or erectile dysfunction in males. In this study we assessed the sex hormone levels in HD patients and its correlation with quality of life (QOL).

Method

In this single center cross-sectional study, 100 patients (50 males and 50 females) on maintenance HD for more than 6 months were included in the study. In female patients’ sex hormones that included Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Prolactin, Estrogen, Progesterone was assessed in midweek early morning blood sample. In male patients LH, FSH and Testosterone were assessed in midweek early morning samples. QOL assessment was done using SF 36 questionnaire.

Results

Mean age of our study populations was 33.76+/- 7.86 years with male female ratio of 1:1 and mean body mass index of 20.52 ± 2.89 kg/m2. Presumed chronic interstitial nephritis in was the most common cause of end-stage renal disease (76%) in our study followed by Diabetic Kidney disease (21%). In males, mean serum LH, FSH and Testosterone were 8.58 ± 3.56 mIU/ml, 8.9 ± 4.05, 217.46 ± 96.44 ng/dl respectively with 70% patients having testosterone deficiency. In females, mean serum LH, FSH, Prolactin, estrogen and Progesterone levels were 8.61± 3.86 mIU/ml, 8.08 ± 3.70 mIU/ml, 12.35 ± 5.70 ng/ml, 84.56 ± 27.39 pg/ml and 0.31 ± 0.22ng/ml respectively. Mean SF 36 score in our study was 55.37+/-12.22, in males 54.82+/-12.81 and in females 55.93+/-11.70. The prevalence depression was 53% (50% in males and 56% in females) in our study. There was no significant correlation between SF 36 scores and Beck depression inventory (BDI) scores with LH, FSH in both the genders. In males there was positive correlation between SF 36 scores and testosterone level (r= 0.366), and in females positive correlation between SF 36 score and progesterone level in women HD patients (r= 0.549) was seen. There was a negative correlation between BDI score and progesterone level in women (r=0. -510) and negative correlation between BDI score and testosterone in men (r= -0.371).

Conclusion

QOL as assessed by SF 36 in patients on HD is low. There was positive correlation between SF 36 scores and testosterone level in males and between SF 36 score and progesterone in females.
MO866SOLUBLE UROKINASE PLASMINOGEN ACTIVATOR RECEPTOR AND COVID-19 INFECTION IN HEMODIALYSIS PATIENTS
Authors: Griveas Ioannis , Schinas Antonis , Balitsari Anthoula , Asimakopoulos Gerasimos , Pratilas Evangelos
Published: May 2021

Background and Aims

Soluble urokinase plasminogen receptor (suPAR) is a protein in the blood that has been described to reflect the severity status of systemic inflammation. At the same time an elevated level of suPAR has been independently associated with incident chronic kidney disease. We investigated the association between admission suPAR levels and severity and outcome of Hemodialysis (HD) patients with Covid-19 infection.

Method

In an observational study of adult HD patients hospitalized for Covid-19, we measured suPAR levels in plasma samples. The time table for those measurements were as follows: at the beginning of admission, after hemoperfusion (HP) session for those patients that received them, and just before discharge.

Results

Of the 17 patients (7 were male), 13 patients received HP (mean age: 74 years old). The median suPAR level was 12.94 ng/ml. For those who undertook HP median suPAR level was 10.55 ng/ml at the end of each session (p=NS). 3 patients had suPAR level below 7 ng/ml. 2 of them survived without developing pleural effusions. 7 patients discharged from the hospital with median suPAR level 12.94 ng/ml which did not differ significantly from the median suPAR level of the diceased ones (13.68 ng/ml).

Conclusion

Admission of suPAR levels in HD patients hospitalized for Covid-19 do not seem to be predictive for their clinical course in general. Chronic Kidney Disease backround and its relation to suPAR levels independently of patients’ inflammation status may be the key component for our notice. Despite that, in patients where low levels of suPAR combined with absence of pleural effusions the prognosis was excellent.
MO870HYPOCHLOREMIA IS ASSOCIATED WITH A GREATER INCIDENCE OF PNEUMONIA IN CHRONIC HEMODIALYSIS PATIENTS WITH COVID-19: A CENTER'S EXPERIENCE
Authors: Valga Francisco , Monzon Tania , Vega-Diaz Nicanor , Ruiz-Santana Sergio , Diallo-Saavedra Rassoul , Aladro Sara , De la Flor Jose Carlos , Rodriguez-Perez Jose Carlos
Published: May 2021

Background and Aims

Recently, serum chloride has gained greater importance in the assessment of patients with heart failure and sepsis. Hypochloremia has been associated with higher mortality. On the other hand, COVID-19 pandemic continues to be, to date, a threat to public health. Patients with cardiovascular comorbidity or chronic kidney disease are particularly vulnerable. There are some studies that show a trend towards a lower serum chloride concentration in patients with a positive PCR test for SARS-CoV-2. Therefore, the objective of our study was to determine if there is a relationship between serum chloride levels at the time of diagnosis and a greater tendency to develop COVID-19 pneumonia in chronic hemodialysis patients.

Method

Retrospective cohort study. We analyzed the serum chloride, C-reactive protein (CRP), procalcitonin, neutrophil-lymphocyte (NLR) and platelet-lymphocyte (PLR) ratios of 11 chronic hemodialysis patients with a positive SARS-CoV-2 TMA PCR test during the second wave of the pandemic in our hospital (August-December 2020). We collected the length of hospital stay, the diagnosis of pneumonia (yes/no) and the final state of the infection (cure or death). The patients were divided into two groups taking the median serum chloride as the cut-off point (1: <97 mEq / L and 2:> 97mEq / L)

Results

The mean age was 57 ± 13 years and 36.36% (N = 4) were women. All patients required hospital admission and mean hospitalization time was 19 ± 13 days. 3 patients (27.3%) died. The medians of the parameters were the following: serum chloride 97 mEq / L (IQR 94-99); CRP 29.04 mg / L (IQR 8.53-76.13); NLR 4.13 (IQR 2.67-8.48) and PLR 244.06 (IQR 208.08-320). 81.8% (N = 9) had COVID-19 pneumonia. Group 1 patients (Chloride <97 mEL / L) had a higher incidence of pneumonia (p = 0.049) (Figure 1) and a greater tendency to be admitted to the Intensive Care Unit (ICU) (p = 0.029). Despite not reaching statistical significance, there was also a higher mortality in patients with lower chloride levels.

Conclusion

Chronic hemodialysis patients with SARS-CoV-2 infection and lower serum chloride levels at hospital admission were more likely to develop pneumonia.
MO871HEPARIN INDUCED THROMBOCYTOPENIA AND HEMODIALYSIS - SINGLE CENTRE EXPERINCE
Authors: Bulatovic Ana , Maslarevic Radovic Vesna , Markovic Katarina , Bjedov Jelena , Djuric Petar , Jankovic Aleksandar , Paunovic Marina , Damjanovic Tatjana , Stankovic Popovic Verica , Naumovic Radomir , Dimkovic Nada
Published: May 2021

Background and Aims

Heparin-induced thrombocytopenia (HIT) is a potentially fatal adverse reaction after administration of unfractionated or fractionated heparin, which underlies the generation of antibodies to the heparin complex and platelet factor 4 (PF4). It occurs in 5% of patients treated with unfractionated heparin and 0.5 - 1.5% fractionated heparin. The aim of the study is to determine the incidence and outcome of hemodialysis patients with HIT over 4-years period.

Method

This retrospective study analyzed patients who were tested for evidence of positive anti-heparin antibody in the period from 2015 to 2020 in Zvezdara University Medical Center. The diagnosis was confirmed by the 4T clinical scoring system, a positive antiheparin-PF4 ELISA test and a positive platelet aggregation test with heparin.

Results

During observation period, total of 64 tests were performed, out of which 23 patients were positive. Out of them, 14 patients were on HD, 7 patients (geriatric, surgery and cardiology departments) received therapy due to peripheral thrombosis, AIM or arrhythmia and 2 patients during 2020 due to SARS-CoV-2 bilateral pneumonia. All patients treated at nephrology, started hemodialysis (HD) with unfractionated heparin, while others were treated with LMWH. 4T scoring showed that 64% of patients had a moderate risk of developing HIT, while high risk was assessed in 36% of patients. Thrombotic complications in the form of deep venous thrombosis had 53% of patients and pulmonary thromboembolism had 17,5 % of patients. The greatest decrease in Tr was the most commonly observed between 10th and 14th day (61% of patients) and 39% from 4th to 10th day from start of heparin administration. In addition to heparin withdrawal and treatment with alternative non-heparin anticoagulation (fondaparinoux), 7 patients needed plasma treatment. 11 patients on HD were transferred to peritoneal dialysis (PD), and 3 patients recovered renal function. Overall mortality was 52%, and it was below 30% in hemodialysis patients.

Conclusion

HIT should be considered in patients at risk. It is necessary to abolish heparin treatment and use alternative method (PD) or alternative anticoagulation. Hemodialysis patients have better prognosis than other comparable patients
MO872INFLUENCE OF SARS-COV-2 INFECTION ON MORTALITY IN PATIENTS UNDER RENAL SUBSTITUTE TREATMENT
Authors: Ferrer García Guillermo , Piccone Saponara Luis Guillermo , Sanchez Escudero Patricia , Castro Fernández Maria Paz , Uribe Heredia Nancy Giovanna , Olazo Gutierrez Eliana , Carreño Parrilla Agustín , Anaya Fernández Sara , García Conejo Gloria , Ugarte Camara Marina , Vozmediano Poyatos Carmen
Published: May 2021

Background and Aims

Dialysis patients constitute a risk group for coronavirus infection due to their immunosuppressed condition, with the increased risk of morbidity and mortality that this entails. We analyzed the factors associated with mortality from coronavirus infection in a cohort of patients undergoing renal replacement therapy at our center.

Method

Transversal study. We included patients in renal replacement therapy (RRT) in our center. Demographic variables (age, sex), associated comorbidity, RRT technique, clinical and laboratory parameters were collected. Statistical analysis with SPSS 25.0. Categorical variables are expressed in percentages and are compared using the Chi2 test. The quantitative variables are expressed as mean ± standard deviation and compared using Student's T-test. Statistical significance p <0.05.

Results

38 patients, mean age 66 ± 18 years, 51.4% men. 92.1% had arterial hypertension, 39.5% diabetes mellitus (DM). 63.2% on hemodialysis, 2.6% peritoneal dialysis, 34.2% transplanted. 84.2% presented fever, 63.2% cough, 73.7% pneumonia, 34.2% dyspnea, 15.8% digestive symptoms. 21.1% leukopenia, 73.7% lymphopenia, money D 1509 ± 1351, CRP 12.45 ± 19.47, sodium 136 ± 5.5. 81.% were admitted to hospitalization, of which 2.6% required admission to the ICU. 44% died. Mortality was statistically significantly related to DM (56.3% vs 43.8% p = 0.05), and with the need for hospitalization (93.8 vs 6.3% p = 0.054).

Conclusion

In our experience, DM patients and those who required hospitalization had a higher risk of mortality.