bluuebunny/crossref_metadata_2025 huggingface dataset:
MO831: Hepatitis Virus Infection in End-Stage Kidney Disease Patients Treated by Haemodialysis in Romania After 5 Years of Active Antiviral Therapy, Revisited
Authors: Marc Luciana , Lupusoru Raluca , Schiller Oana-Marina , Mihaescu Adelina , Bob Flaviu , Chisavu Lazar , Schiller Adalbert
Published: May 2022

BACKGROUND AND AIMS

After 5 years from the previous national prospective observational study and a modern antiviral program, we aimed to re-evaluate the prevalence of hepatitis virus infection and its impact in end-stage kidney disease (ESKD) patients treated with haemodialysis (HD) in Romania.

METHOD

A total of 1516 ESKD patients (909 men and 608 women, median age 60.1 ± 12.9 years) treated with chronic HD in twelve centres from all the historical regions of Romania have been assigned to this study. Data regarding their HBs Ag and anti-HCV antibodies were recorded.

RESULTS

HBsAg was positive now in 5% (n = 76) patients and it was significantly lower than in 2015 (9.5%, n = 57), P = 0.0001, anti-HCV antibodies were detected in 11.5% (175) versus 27.3% (n = 164), P < 0.0001; and 1.5% (n = 24) versus 5% (n = 30) were positive for both HBV and HCV infection, P < 0.0001. When we split the cohort between the historical regions of Romania (Moldavia 426 patients, Muntenia 321 patients, Transylvania 769 patients), in Moldavia (Eastern Romania), the prevalence of both HBV and HCV infection was significantly lower than 2015 (4.2% versus 16.8%; P < 0.001, respectively for HCV 20% versus 42.9%; P < 0.0001). The prevalence of HBV infection in Muntenia region was 3.1% versus 9.9% in 2015 (P = 0.003), but Muntenia recorded a significant decrease in the prevalence of HCV infection in haemodialysis patients from 2015 until now (9.6% versus 36.4%, P < 0.001). Data from Transylvania are similar, there are no significant differences in terms of HBV infection (3.7% versus 4.7% in 2015; P = 0.455) but the prevalence of HCV infection is significantly <2015 (7.6% versus 13.9%; P = 0.001).

CONCLUSION

This study shows that the systematically nationwide applied measures for significant reduction of infection risk and antiviral therapy significantly decreased HV infection prevalence in HD patients in Romania.
MO836: Patients Receiving Haemodialysis Maintain Sars-Cov-2 Immunity Comparable With Healthy Individuals: A Prospective Cohort Study
Authors: Parshina Ekaterina , Tolkach Alexey , Ivanov Andrey , Kislyy Pavel
Published: May 2022

BACKGROUND AND AIMS

Patients with end-stage kidney disease receiving maintenance haemodialysis (HD) are at increased risk for mortality after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared with the general population. However, it is currently unknown whether the long-term SARS-CoV-2 humoral and cellular immune responses in patients receiving HD are comparable to individuals with normal kidney function. We aimed to investigate the 6-month kinetics of SARS-CoV-2 IgG antibody and specific T-cell levels in patients receiving HD compared with those in healthy individuals.

METHOD

The prospective cohort study included 24 patients treated with maintenance HD and 27 healthy controls with confirmed history of coronavirus disease (COVID-19). Nobody of them received vaccination before and during the study period. In all participants, the levels of specific IgG were quantified at three timepoints: 10, 18 and 26 weeks from disease onset. In a subgroup of patients, specific CD4+ and CD8+ T-lymphocyte responses were evaluated using IGRA test.

RESULTS

The incidence of COVID-19-related symptoms did not differ between the groups, except for the loss of smell, which occurred much more frequently among healthy subjects (70% versus 30.4% in HD group, P = 0.01). The seropositivity rate declined in healthy subjects over time and was 85% and 70.4% at weeks 18 and 26, respectively. All HD patients remained seropositive over the study period. Seropositivity rate at week 26 was greater among patients receiving HD: RR = 1.4 [95% confidence interval (95% CI): 1.17–1.94] (reciprocal of RR = 0.7, 95% CI: 0.52–0.86), P = 0.0064. In both groups, IgG levels decreased from week 10 to week 26, but antibodies vanished more rapidly in controls than in HD group (ANOVA P = 0.0012)—Figure 1. The magnitude of T-cell response was significantly lower in controls than in HD patients at weeks 10 (P = 0.019) and 26 (P = 0.0098) after COVID-19 diagnosis, but not at week 18—Figure 2.

CONCLUSION

Compared with healthy adults, patients receiving HD maintain significant long-term humoral and cellular immune responses following natural COVID-19. SARS-CoV-2 IgG antibodies did not decline more rapidly in patients receiving HD than in healthy controls over 6-months period.
MO842: Maintenance of Humoral Response During a Three-Dose Immunization Program With MRNA SARS-COV-2 Vaccines in the Haemodialysis Population
Authors: Jesus Broseta Monzo Jose , Rodríguez Espinosa Diana , Cuadrado Elena , Guillen-Olmos Elena , Rodríguez Néstor , Maduell Francisco
Published: May 2022

BACKGROUND AND AIMS

The COVID-19 pandemic continues to be a worldwide health issue. Among haemodialysis (HD) patients, many countries opted for a three-dose immunization scheme with mRNA vaccines, as some patients did not produce a sufficient humoral response after the second one, and most developed a rapid decline in antibody levels over the months following vaccination.

METHOD

This observational, prospective, multi-centre study evaluated the humoral response, clinical outcomes (breakthrough infections, hospital admissions, severe COVID-19 and mortality), and their potential associated factors by determining the presence and levels of IgG antibodies to the receptor-binding domain of the S1 spike antigen of SARS-CoV-2 (anti-S1-RBD IgG) before and after each of the three doses of SARS-CoV-2 mRNA vaccines with either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer) in 153 patients from three dialysis units affiliated to Hospital Clínic of Barcelona (Spain).

RESULTS

Unlike the general population, where most individuals seroconverted after one dose, HD patients required two doses to produce a positive anti-S1-RBD IgG response in most of them. Moreover, their antibody levels waned significantly three and 6 months after vaccination (see Figure 1). The decline in antibody levels was accompanied by seroreversion in 32% of patients. Notably, despite the precipitous drop, there was a low incidence of breakthrough infections (5.9%), with only one case of severe COVID-19 that required ICU admission and no deaths up until receiving the third vaccine dose. The administration of the third dose achieved seroconversion in 3 out of 4 non- or weak responders to two doses. Active cancer and immunosuppressive treatment were related to a worse humoral response.

CONCLUSION

Every haemodialysis patient should receive a third-dose vaccination scheme, with a booster dose three or 6 months after receiving the second one. Despite the lack of data, immunosuppressed and active cancer patients may benefit from more frequent vaccine boosters. Further monitoring of antibody levels will be needed to assess the maintenance of the humoral response in these patients.
MO870: The Legacy Effect of a Home Walking Exercise Program in Kidney Failure Patients on Dialysis
Authors: Mallamaci Francesca , D'arrigo Graziella , Manfredini Fabio , Lamberti Nicola , Torino Claudia , Luigi Tripepi Giovanni , Zoccali Carmine
Published: May 2022

BACKGROUND AND AIMS

The EXCITE trial (JASN 28: 1259–1268, 2017) in dialysis patients showed that a 6-month home walking exercise program increases the walking distance covered during the 6 min walking test (6MWT), improves the response to the 5 times sit-to-stand test (5STS) and the cognitive function and quality of social interaction scores of the KDQOLSF-SF™ questionnaire.

METHOD

In this post-trial study embedded in the EXCITE trial, we tested the response to the 6MWT and the 5STS tests and the KDQOLSF-SF™ from the 6th month (end of the trial) to the 36th month.

RESULTS

Among the 227 patients of the EXCITE trial cohort, 162 underwent at least three out four testing visits (baseline, 6, 18 and/or 36 month) contemplated by the study protocol and 89 all four testing visits. In the primary analysis by the linear mixed model, the gain in walking distance achieved at 6th month in the exercise group {between-arms difference: +36 m, [95% confidence interval (95% CI): 22–51]; P < 0.001} was maintained at the 18th month (between-arms difference: +37 m, 95% CI: 19–57; P < 0.001) to reduce to 23 m (95% CI: –4 to 49 m; P = 0.10) at 36th month. Overall, the post-trial difference in walking distance trajectories between the two study arms was highly significant (P = 0.004). Furthermore, the walking distance changes at the 6th (r = 0.34; P = 0.018) and 18th month (r = 0.30; P = 0.043) were directly related with number of structured exercise sessions completed during the trial (i.e. the first 6 months). No such an effect was registered in the response to the 5STS or in quality of life as measured by the KDQOLSF-SF™.

CONCLUSION

In dialysis patients the benefits of a 6-months structured walking program outlast the duration of the intervention and postpone the loss of walking performance, which naturally occurs in this population.
MO879: Prevalence, Recurrence and Seasonal Variation of Hyperkalaemia in Patients Receiving Thrice-Weekly Haemodialysis
Authors: Tsiagka Dimitra , Georgianos Panagiotis , Pikilidou Maria , Vaios Vasilios , Minasidis Elias , Karpetas Antonios , Roumeliotis Stefanos , Metallidis Simeon , Liakopoulos Vassilios , Zebekakis Pantelis
Published: May 2022

BACKGROUND AND AIMS

Prospective cohort studies have shown that among patients on haemodialysis, hyperkalaemia is strongly associated with excess risk for cardiovascular-related hospitalizations and sudden cardiac death [1–4]. However, the actual burden of hyperkalaemia, the rates of its recurrence and seasonality in its variation still remain unclear.

METHOD

Between June 2020 and May 2021, 1786 mid-week predialysis serum potassium (sK) measurements were retrospectively recorded from 149 patients receiving thrice-weekly haemodialysis in a single-centre in Thessaloniki, Greece. The prevalence, recurrence and seasonal variation of hyperkalaemia were assessed using three prespecified sK thresholds (≥5.1, ≥5.5 and ≥ 6.0 mmol/L).

RESULTS

At baseline (June 2020), 60.4%, 42.2% and 13.4% of patients had sK levels ≥ 5.1, ≥5.5 and ≥ 6.0 mmol/L, respectively. At any time-point during the 1-year-long follow-up, 85.2%, 69.8% and 38.9% of patients experienced at least 1 hyperkalaemic episode at the sK threshold of ≥ 5.1, ≥5.5 and ≥ 6.0 mmol/L, respectively. Of the 104 patients experiencing an initial sK elevation ≥ 5.5 mmol/L, hyperkalaemia at the same threshold reoccurred in 60.6% at month-1, in 47.1% at month-2 and in 46.1% at month-3 of follow-up. Seasonal variation was also observed, with the prevalence of hyperkalaemia to be significantly higher in summer. In multivariate logistic regression analysis, shorter delivered haemodialysis < 4 h/session {odds ratio (OR): 2.568; [95% confidence interval (95% CI): 1.045–6.313]} and the use of a high versus a low K concentration in the dialysate (OR: 14.646; 95% CI: 2.727–78.647) were the two factors that were associated with a significantly higher odds of hyperkalaemia at any time-point of the follow-up period.

CONCLUSION

The present study shows that among patients receiving conventional thrice-weekly haemodialysis, the rates of hyperkalaemia prevalence and recurrence are very high, reflecting the large unmet need to identify more effective potassium-lowering therapeutic interventions in this high-risk population.
MO882: Heterologous versus Homologous Triple Anti-Covid-19 Vaccine Regimens in Patients on Maintenance Hemodialysis
Authors: Meijers Björn , Goedgezelschap Annelien , Peeters Domien , van der Veen Annelien , Verbinnen Margo , Vermeersch Pieter , J.F. Stas Koenraad , Kuypers Dirk
Published: May 2022

BACKGROUND AND AIMS

Vaccination against COVID-19 is a promising strategy to reduce the risk for severe COVID-19. Patients on maintenance haemodialysis have a less robust immunoresponse than the general population. Triple vaccination might improve immunogenicity, and might benefit patients having a poor initial response. The aim of the current study was to evaluate the humoral response to heterologous (a combination of different vaccine types) versus homologous (three identical vaccines) triple vaccination against COVID-19.

METHOD

We analyzed serological response to homologous (3 times mRNA-based vaccine) versus heterologous (adenoviral vectored plus mRNA vaccines) triple regimens in samples from patients on maintenance dialysis (NCT04378686). We measured IgG anti–S (spike) SARS-CoV-2 antibody levels using the IgG II Quant assay (Abbott). Samples were collected between 6 and 12 weeks after both the second and the third vaccine dose.

RESULTS

A total of 302 patients received three vaccine doses. 94 patients received a heterologous regimen of the adenoviral vectored AZD1222 (2 doses) and the mRNA-based BNT162b2 (1 dose). The remaining 208 patients received a triple mRNA vaccine regimen of either BNT162b2 (n = 149) or mRNA-1273 (n = 59). Triple vaccine regimens resulted in significant elevation of anti-S titers, as compared with the conventional prime-boost (double) vaccination. A substantially and significantly larger fraction of patients reached the threshold for neutralizing antibodies after triple vaccination, as compared with after double vaccination. The yield of a third dose of mRNA-1273 is less than the yield of a third dose of BNT162b2. This, however, mainly reflects the initial significant better response to mRNA-1273. In multivariate analysis, a past episode of COVID-19 was a strong modulator of the response after double vaccination, and after triple vaccination.

CONCLUSION

Both heterologous and homologous triple vaccine regimens significantly augment the humoral response against SARS-CoV-2. The higher the ininitial response to the double prime-boost regimen, the lower the yield of a third vaccine dose. It seems prudent to prioritize vaccination of dialysis patients using mRNA-based vaccines when available.
MO886: Outcomes in Incident Patients Treated With Incremental Haemodialysis as Compared With Thrice-Weekly Haemodialysis and Peritoneal Dialysis: The Geneva Experience
Authors: Jaques David , Haidar Fadi , Dufey Anne , Ponte Belén , Carballo Sebastian , de Seigneux Sophie , Saudan Patrick
Published: May 2022

BACKGROUND AND AIMS

Preservation of residual kidney function (RKF) in maintenance haemodialysis (HD) patients is associated with better survival and quality of life. RKF may be better preserved with an incremental HD (frequency < 3x/week) regimen in patients starting HD. Since 2013, incremental HD is routinely used at our centre.

METHOD

Incremental HD was implemented in incident HD patients with a urine output of >600 mL/day,  a urea clearance (KRU) ≥2 mL/min and an interdialytic weight gain < 2.5 kg. Patients were clinically assessed every week and a 24-h urine collection was ordered every other month in order to measure RKF.

RESULTS

From January 2013 to December 2020, 296 patients started chronic dialysis, with 162 on thrice-weekly HD, 63 on incremental HD and 71 on peritoneal dialysis (PD). Patients on incremental HD did not differ from those on thrice-weekly HD or PD in terms of age, gender and comorbidity score. Diuresis, eGFR and KRU at incremental HD initiation were 1842 ± 749 mL/day, 6.7 ± 3.1 mL/min and 4.0 ± 1.8 mL/min, respectively. Among patients on incremental HD, four could retrieve a sufficient RKF to become dialysis-independent and two were transplanted. Among the 57 remaining patients on incremental HD, median duration until transition to a thrice-weekly HD regimen or death was 10 (6–20) months. Within the first year of dialysis, median survival and hospital-free days were higher in patients starting with incremental HD as compared with thrice-weekly HD: 91% versus 77%, P = 0.02 and 348 (316–362) versus 338 (295–354) days; P = 0.03.

CONCLUSION

These preliminary results show that incremental HD can be implemented in incident HD patients as long as regular clinical and RKF assessments are found adequate. A median duration of 10 months before transition to thrice-weekly HD can be expected in this setting. Results of randomised clinical trials assessing long-term survival and quality of life in incremental HD are awaited prior to its large-scale implementation.
MO930: Does Oral Sodium Bicarbonate Improve Protein Metabolism and Regeneration in Esrd Patients on Maintenance Hemodialysis?
Authors: Ali Ala , Rashid Zina
Published: May 2022

BACKGROUND AND AIMS

Uremic metabolic acidosis with decreased bicarbonate levels is frequent in hemodialysis patients, and its correction is one of the goals to achieve adequate dialysis. Unfortunately, the bicarbonate delivered through the dialysate may be inadequate to correct the whole acid load. Most hemodialysis data show that about 50% of patients fail to meet a bicarbonate level within the normal range before each dialysis session. Furthermore, low predialysis bicarbonate levels of <22 mmols/L have been linked with increased malnutrition, inflammation and all-cause mortality in hemodialysis patients.

  This study investigates whether oral sodium bicarbonate supplementation in acidotic hemodialysis patients will improve normalized protein catabolic rate (nPCR) and serum albumin as indicators of nutritional adequacy.

METHOD

An interventional study was conducted in a trusted hemodialysis unit in Baghdad, Iraq, from 1 September to 1 December 2021. A total of 50 adult prevalent hemodialysis patients were recruited. Out of 50 patients, 26 patients received oral sodium bicarbonate 500 mg/day, and 24 were matched controls. All patients had no significant residual renal function with thrice/week dialysis through arteriovenous fistulae.

  Serum albumin and the normalized protein catabolism ratio were measured at baseline and 3 months. In addition, anthropometric measures and essential lab data were recorded, including pre-HD arterial pH, serum bicarbonate, serum creatinine, serum Na, k, body weight, interdialytic weight gain, predialysis systolic and diastolic blood pressure and spKt/V.

RESULTS

The mean age of the study group was 48.76 + 16.21 years with 27 females. The median dialysis duration was (3 years). We found no statistically significant difference in the nPCR and serum albumin between the two groups at 3 months.

  There was a significant difference in the serum bicarbonate level in the intervention group with a P-value of 0.00. In addition, there were significant differences in arterial PH (P-value 0.008) and serum potassium (P-value 0.039) at 3 months. Serum potassium decreased in the intervention group to the range of (3.9–5.8 meq/L) in comparison to (4.2–6.7 meq/L) in the control group. There was no statistically significant interdialytic weight gain or change in systolic blood pressure at 3 months between the two groups (P-values 0.4 and 0.07), respectively.

CONCLUSION

Optimal dialysis dose and acidosis correction are not enough to achieve adequate protein metabolism, indicating poor protein intake by Iraqi HD patients, which mandates proper nutritional counseling.
MO935: A Propensity-Matched Study of The Effect of Short Daily Home Haemodialysis With Low Flow Dialysate on Nutritional Status and Body Composition
Authors: Vizcaíno Belén , Molina Pablo , Molina Mariola D , Lopez Herradon Ana , Rincon Bello Abraham , González Moya Mercedes , Beltrán Sandra , Calatayud Emma , Sancho Asunción , Maduell Francisco
Published: May 2022

BACKGROUND AND AIMS

The present study tested the hypothesis that short daily home haemodilaysis (HDD) with low flow dialysate using the NxStage monitor (Fresenius Medical Care) could preserve muscle mass and prevent protein-energy wasting in HD patients, despite using low-flux, lactate-buffered dialysate.

METHOD

This 12-month, prospective, controlled study examined 25 consecutive, non-selected CKD stage 5 patients who initiated short daily HHD with low-flow dialysate (HHD group) in our centre, and were compared with data from 50 patients on high-flux HD (HF-HD group) and 50 patients on on-line haemodiafiltration (OL-HDF group) obtained from the Fresenius Medical Care clinical database EuCliD after matching for clinical characteristics and propensity scores. Changes in body composition were assessed by whole-body bioimpedance spectroscopy (BIS; Fresenius Medical Care) at baseline, months 3, 6 and 12, by experienced research staff blinded to all clinical and biochemical data of the patients. In order to control for potential variability and the effect of overhydration, all BIS analyses were performed before a mid-week dialysis session. Linear mixed-effects models were used for the analysis of the repeated measures data.

RESULTS

Compared with in centre HF-HD, patients assigned to HHD experienced a gradual improvement in LTM. These differences reached statistical significance at Month 6 and Month 12, with a relative difference of 2.76 kg [95% confidence interval (95% CI): 0.53–4.99; P = 0.01] and 3.08 kg (95% CI: 0.68–5.45; P = 0.01), respectively. Changes in fat inversely mirrored those of LTM, with a relative difference between groups of –3.29 kg (95% CI: –6.66–0.07; P = 0.05) at Month 12. No differences in hydration status or dry weight were noted between groups (Table 1). No significant changes in body composition were observed between the HDD and the OL-HDF groups (data not shown).

CONCLUSION

Short daily HHD with the NxStage system for 1 year compared with HF-HD increased muscle mass, supporting the hypothesis that short daily HHD with low-flow dialysate could benefit nutritional status and prevent protein-energy wasting in HD patients.
MO945: Disqualification of Donor and Recipient Candidates from The Living Kidney Donation Program: A German Single-Center Analysis
Authors: Sofia Grigorescu Vlass Melissa , Stangl Manfred , Sajin Isidora , Lemos Cerqueira Tiago , Illigens Ben , Schoenermarck Ulf , Meiser Bruno , Kemmner Stephan , Fischereder Michael
Published: May 2022

BACKGROUND AND AIMS

Kidney transplantation is the best treatment option for patients with end stage kidney disease (ESKD) with a superiority of transplantation after living kidney donation (LKD) compared to deceased donation. However, a large part of potential donors and recipients are ineligible for LKD. Here, we analyze the leading causes for disqualification of prospective living donor-recipient pairs from the LKD program and the health-related consequences for ESKD patients excluded from the LKD program in a German tertiary transplant center.

METHOD

In this single-center retrospective cohort study we evaluated all candidates (potential donors and recipients) presenting for assessment of LKD from 2012 to 2020 at our transplant center. Thereby we focused on candidates excluded from the LKD program. Main reasons for disqualification were categorized as medical (donor-related), psychosocial, immunological, recipient-related and unknown.

RESULTS

Overall, 601 donor-recipient pairs referred to our transplant center for LKD assessment during the observation time. Out of those, 326 (54.2%) discontinued the program with 52 (8.7%) dropouts and 274 (45.6%) donor-recipient pairs being ineligible for LKD. Donor-related medical contraindications were the main reason for disqualification (139 out of 274 (50.7%) potential donors) followed by recipient-related contraindications (62 out of 274 (22.6%) of potential donor-recipient pairs). Only 77 out of 257 (29.9%) potential recipients excluded from the LKD program received a kidney transplant afterwards with a median waiting time of 2 (IQR: 1.0–4.0) years. Overall, 18 (7.0%) ESKD patients initially declined for LKD died in this period.

CONCLUSION

A large percentage of donor-recipient pairs disqualified from the German LKD program, mostly due to medical reasons related to the donor and with partly severe consequences for the potential recipients. For these, we need alternative concepts to make transplantation possible.
MO955: Serum Cystatin C in Renal Transplantation: Beyond GFR Estimation, A Prognosis Marker?
Authors: Ounoughi Lydia , Masson Ingrid , Alamartine Eric , Delanaye Pierre , Maillard Nicolas , Mariat Christophe
Published: May 2022

BACKGROUND AND AIMS

In renal transplantation, death with a functioning graft remains one of the main causes of graft loss. In the general population, renal function impairment is strongly associated with cardiovascular and all-cause mortality. Whether this association holds true for kidney transplant recipients (KTR) is unclear. This uncertainty is likely to be due, in part, to the fact that glomerular filtration rate (GFR) estimation based on serum creatinine (SCr) does not always provide an accurate evaluation of the graft function in KTR. As compared to SCr, we have previously shown in a large cohort of KTR that serum cystatin C (SCysC) is a much better marker of GFR.

Herein, we sought to study the ability of the 1-year-post-transplant renal function to predict all-cause mortality according to the methods used to assess GFR.

METHOD

Four hundred and ten consecutive KTR for whom a measurement of GFR by inulin clearance was available at 1 year post-transplant were included. SCr and ScysC were measured with standardized methods. The association of the 1-year inulin clearance value the 1-year MDRD Study equation value and the 1-year CKD-EPI ScysC equation value with all-cause mortality was studied by ROC analysis and Cox model.

RESULTS

During a median follow-up of 17 years, 131 KTR died. Mean (±SD) inulin clearance at 1-year-post-transplant was 47 (±13) mL/min/1.73 m2. Areas under the ROC curves were similar for inulin and CKD-EPI ScysC equation values (0.62 for both), and were both significantly superior to that of the MDRD equation (0.54, P  < 0.01). In Cox analysis, while all types of GFR evaluations were significantly associated to graft loss, only an inulin and a CKD-EPI ScysC equation values below 45 mL/min/1.73 m2 were associated with an excess risk of mortality (HR of 1.55, 1.45 and 1.01 for inulin, CKD-EPI ScysC and MDRD, respectively).

CONCLUSION

We conclude that ScysC-based GFR estimation might better predict KTR outcome as compared with a traditional SCr-based estimation. The one year-post transplant GFR value given by the CKD-EPI ScysC equation should be further evaluated as a potential surrogate marker for both graft and patient survival.
MO964: High Urgency Renal Transplantation for Patients With Exhaustion Of Vascular Access for Haemodialysis: Experience from A Tertiary Center
Authors: Marques Filipe , Gameiro Joana , Jorge Sofia , Sofia Henriques Pereira Marta , Santana Alice , Oliveira Guerra José , António Lopes José
Published: May 2022

BACKGROUND AND AIMS

When faced with exhaustion of vascular access for haemodialysis (EVAH), allocation for High Urgency Renal Transplantation (HURT) is the appropriate solution. Patients with EVAH usually have multiple comorbidities and an increased risk of cardiovascular and thrombotic events. The aim of this study is to analyze the characteristics and outcomes of patients undergoing HURT due to EVAH.

METHOD

Data from the Renal Transplant Unit since January 2006 were retrospectively analyzed. Eleven patients undergoing HURT were identified.

RESULTS

In the population studied, 45.5% (n = 5) were male, 63.6% (n = 7) were Caucasian and the mean age at the time of transplantation was 41.6 ± 7.8 years. Ninety % (n = 10) were hypertensive, 27.3% (n = 3) were diabetic and 27.3% (n = 3) had previous cardiovascular disease. Patients were on renal replacement therapy for 5.8 ± 2.7 years prior to transplantation. The mean transplant time was 75.5 ± 53.7 months. The mean follow-up period was 90.6 ± 51.9 months. During this period, 63.6% (n = 7) of patients lost their renal graft and mortality was 63.6% (n = 7). Renal graft survival was 81.8% (n = 9) at the first year, 72.7% (n = 8) at the third year and 63.6% (n = 7) at the fifth year of follow-up. At discharge, mean creatinine was 1.8 ± 1.1 mg/dL. At the first year, mean creatinine was 1.9 ± 0.8 mg/dL, at the third year was 2.3 ± 1.9 mg/dL and was 1.6 ± 0.4 mg/dL at the fifth-year post-transplant. The mean time to graft loss was 54.1 ± 49.3 months. Overall survival was 90.9% (n = 10) at the first year, 90.9% (n = 10) at the third year and 81.5% (n = 9) at the fifth-year post-transplantation. Two patients died from a cardiovascular event, one from neoplasia and other from an infectious cause. Two patients died with a functioning kidney allograft.

CONCLUSION

Kidney graft survival in patients undergoing HURT was significantly lower. Portuguese Transplantation Society reporting an overall graft survival of 92.9% at the first year and 85.0% at the fifth year. The mortality of these patients is quite high; however, the fact that they are patients with EVAH, whose life expectancy would be greatly reduced if they were not transplanted, makes HURT continue to be an indicated option in this population of more vulnerable patients.
MO967: Lymphocele After Renal Transplantation: Management, Risk Factors and Impact on Transplant Survival
Authors: Zaghbib Selim , Chakroun Marouene , Saadi Ahmed , Boussaffa Hamza , Bouzouita Abderazzak , Derouiche Amine , Ben Slama Riadh , Bacha Mongi , Abdallah Taieb Ben , Ayed Haroun , Chebil Mohamed
Published: May 2022

BACKGROUND AND AIMS

Lymphocele after renal transplantation remains a common complication, despite all the technical precautions taken, in particular the ligation of lymphatic vessels. Its incidence varies according to the series, depending on the diagnostic methodology, and whether or not it is systematically screened.

This study aims to investigate the risk factors for lymphocele and its impact on transplant survival.

METHOD

We performed a retrospective longitudinal descriptive study including all patients who had a kidney transplant in a Urology department from 1986 to 2017. Clinical presentation and management of lymphocele were studied. Then, the characteristics of patients who presented a lymphocele were compared with those of the rest of the population including characteristics related to the recipient, the donor, the transplant and the procedure to identify risk factors. The impact of lymphocele on patient and transplant survival was then studied.

RESULTS

A total of 720 patients were included with a mean age of 32.7 years. The transplant was from a living donor in 79% and a brain-dead donor in 21%. Lymphocele occurred in 51 patients (7.1%). The lymphocele was asymptomatic in 80%, and clinical manifestations were related to the compression of the transplant or its important size, requiring active treatment, most often percutaneous (13.7%). The lymphocele did not require treatment in 42 cases (82.4%) with disappearance in 90.5%. Revision surgery for a lymphocele was necessary in two cases.

The risk factors for lymphocele were a cadaveric donor (P = 0.003) and an advanced age of the recipient (P  < 0.001). No predictive factors related to the transplant (vascular anatomy), or procedure (location and type of anastomoses, ischemia time) were identified.

Transplant survival was 77.9% at 5 years, with a median survival of 15.9 years. The occurrence of a lymphocele did not influence the survival of the transplant (P = 0.25) (Figure 1).

CONCLUSION

Our study showed that lymphocele is usually asymptomatic, not requiring a specific treatment in most cases with a high rate of spontaneous disappearance with no impact on transplant survival. Risk factors were a cadaveric donor which may reflect the absence of careful ligation of the transplant's lymphatic vessels in the context of urgent, sometimes multi-organ, cadaveric procurement and advanced recipient age.
MO969: Chronic Hypotension in Dialysis Has A Negative Impact on Kidney Transplant Outcomes
Authors: Auñón Rubio Pilar , Cavero Escribano Teresa , García Santiago Ana , Pascual Julio , Andrés Belmonte Amado
Published: May 2022

BACKGROUND AND AIMS

Persistent chronic hypotension affects 5–10% of dialysis patients, and it is associated with high morbidity and mortality [1]. Although data regarding the influence of this hemodynamic condition on kidney transplantation are scarce, some studies suggest a negative impact on kidney transplant outcomes [2-3]. We decided to analyze the evolution of patients with chronic hypotension in dialysis who undergo kidney transplantation in our center.

METHOD

A retrospective observational study was conducted. We evaluated 2308 consecutive kidney transplants performed at Hospital Doce de Octubre between 2004 and 2020. Sixty-six patients with chronic hypotension (defined as systolic blood pressure ≤ 100 mmHg at the time of transplantation) were identified. A control group of 66 non-hypotensive patients was assigned, matched for the source of organs and age (using as control, whenever possible, the recipient of the other kidney from the same donor). The evolution of both groups was compared in terms of primary graft function, graft thrombosis, delay in graft function, serum creatinine at the end of follow-up and renal graft survival.

RESULTS

Patients with chronic hypotension had higher rates of primary non-function (18.2% versus 6.1%, P = 0.033) mainly due to venous thrombosis of the renal graft (15.2% versus 3%, P = 0.015). Delayed graft function was also more common in patients with chronic hypotension (68.2% versus 50%, P< 0001). Mean graft survival was lower in the group of patients with chronic hypotension (81.1 months) compared to the control group (104.1 months) (P = 0.012). At the end of follow-up, there were 67.7% of functioning grafts within the hypotensive group compared with 86.4% in the control group (P = 0.013). Serum creatinine at the end of follow-up was slightly higher in patients with chronic hypotension (1.76 ± 0,70mg/dL versus 1.50 ± 0.49 mg/dL, P = 0.04). Median follow-up time was 37 months (1–122). In multivariate analysis, chronic hypotension was an independent risk factor for renal graft loss [RR = 2.8 (1.3–6.4), P = 0012].

CONCLUSION

Chronic hypotension in dialysis has a negative impact in short and long-term kidney transplant outcomes. It is associated with higher rates of primary non-function due to venous graft thrombosis, higher rates of delayed graft function, a higher serum creatinine at the end of follow-up and a worse renal graft survival.

It seems crucial to identify this subgroup of patients in order to implement measures aimed to ameliorate transplant results.
MO976: Recurrence of Immune Complex And Complement-Mediated Membranoproliferative Glomerulonephritis in Kidney Transplantation
Authors: Caravaca-Fontán Fernando , Inmaculada Polanco Fernandez Natalia , Andres Amado , Praga Manuel
Published: May 2022

BACKGROUND AND AIMS

Membranoproliferative glomerulonephritis (MPGN) represents a histologic pattern of glomerular injury which may be due to several etiologies. Few studies have comprehensively analyzed the recurrence of MPGN according to the current classification system.

METHOD

We collected a multicenter, retrospective cohort of 220 patients with biopsy-proven native kidney disease due to MPGN between 1981 and 2021 in 11 hospitals. Demographic, clinical and histologic parameters of prognostic interest were collected. The main outcomes were time to kidney failure, time to recurrence of MPGN, and disease remission after recurrence.

RESULTS

The study group included 34 complement-mediated and 186 immune complex-mediated MPGN. Eighty-one patients (37%) reached kidney failure in a median follow-up of 79 months. The main predictors of this event were the development of rejection episodes, and disease recurrence. Fifty-four patients (25%) had a disease recurrence in a median of 16 months after kidney transplantation. The incidence of recurrence was higher in patients with dysproteinemia (67%) and complement-mediated MPGN(62%). In the multivariable model, complement-mediated MPGN emerged as a predictor of recurrence. Thirty-three patients reached kidney failure after recurrence. The main determinants of no remission were: early time to recurrence (<15 months), eGFR <30 mL/min/1.73 m2 and serum albumin <3.5 g/dL at the time of recurrence.

CONCLUSION

One-fourth of patients with native kidney disease due to MPGN developed clinical recurrence in the allograft, especially in cases with complement-mediated disease or in those associated with dysproteinemia. The kidney outcomes of disease recurrence with currently available therapies are heterogeneous and thus, more effective and individualized therapies are needed.
MO978: Survival for Waitlisted Kidney Failure Patients Receiving Transplantation Versus Remaining on the Waiting List: A Systematic Review and Meta-Analysis
Authors: Chaudhry Daoud , Chaudhry Abdullah , Peracha Javeria , Sharif Adnan
Published: May 2022

BACKGROUND AND AIMS

Kidney transplantation is acknowledged as the treatment modality of choice for eligible kidney failure patients versus dialysis. However, evidence for survival benefits in marginal kidney transplant candidates is limited. We aimed to investigate the survival benefit of transplantation versus dialysis for waitlisted kidney failure patients with a priori stratification.

METHOD

Design: Systematic review and meta-analysis.

Data sources: Online databases MEDLINE, Ovid EMBASE, Web of Science, Cochrane Collection and ClinicalTrials.gov were searched between database inception and 1 March, 2021.

Eligibility criteria for selecting studies: All comparative studies that assessed all-cause mortality of transplantation versus dialysis for kidney failure patients waitlisted for transplant surgery were included. Two independent reviewers extracted the data and assessed the risk of bias of included studies. Meta-analysis was performed using the DerSimonian-Laird random effects model, with heterogeneity investigated by sub-group analyses, sensitivity analyses and meta-regression.

RESULTS

Our search identified 48 observational studies with no randomized controlled trials (n = 1 245 850 patients). In total, 92% of studies (n = 44/48) reported a long-term (≥1 year) survival benefit associated with transplantation compared with dialysis. However, 11 of those studies identified stratums in which transplantation offered no statistically significant benefit over remaining on dialysis. In 18 studies suitable for meta-analysis, kidney transplantation showed survival benefit (hazard ratio: 0·45, 95% CI: 0·39–0·54, P  < 0·0001), with significant heterogeneity even after sub-group/sensitivity analyses or meta-regression analysis.

CONCLUSION

Kidney transplantation remains the superior treatment modality for most kidney failure patients to reduce all-cause mortality, but some subgroups may lack a survival benefit. Given the continued scarcity of donor organs, further evidence is necessitated to better inform decision making for kidney failure patients.
MO979: Influence of BK Virus Plasma Viral Load in Kidney Transplant Outcomes
Authors: Alonso Marta , Villanego Florentino , Orellana Cristhian , Alberto Vigara Luis , Montiel Natalia , Aguilera Aurora , Manuel Amaro Jose , Garcia Teresa , Mazuecos Auxiliadora
Published: May 2022

BACKGROUND AND AIMS

BK virus infection (BKi) is an important cause of kidney transplant (KT) loss. Besides to reducing immunosuppression, the rest of the therapies have not shown a clear benefit. Our purpose is to analyze the risk factors for BKi and the influence of BK plasma viral load on KT outcomes.

METHOD

Prospective cohort study of KT with BKi, defined by the presence of BK viremia in ≥3 consecutive determinations, from 01 January 2010 to 31 December 2020. BK viremia was determined every 10 days during the first 3 months, at 6th month, 12th month and in case of impaired renal function. In patients with positive viremia, immunosuppressive therapy was changed (reduction/discontinuation of mycophenolate and/or switching to everolimus). Patients with high-level viremia (≥10 000 copies/mL) and low-level viremia (<10 000 copies/mL) were compared. To identify risk factors for BKi, for each KT with BKi, we selected two matched controls and performed a logistic regression analysis. Graft survival was analyzed according to BK viremia (high-level, low-level and negative) using Kaplan–Meier and Cox regression analysis was performed to determine risk factors for graft survival.

RESULTS

849 KT were performed, of which 67 (7.9%) presented BKi. Six KT were excluded due to incomplete data. Finally, 61 KT BKi (n = 27, high-level viremia; n = 34 low-level viremia) and 122 controls were analyzed. The median post-KT time to BKi was 2 months. In the multivariable analysis, male recipient, older age and re-KT were risk factors for BKi.

Proven BK-associated nephropathy was diagnosed in five KT recipients and nine patients had persistent BK viremia, all of them from the high plasma viral loads group. Only one patient lost the graft due to BK-associated nephropathy.

Patients with low-level viremia had worse renal function one month after KT than controls but without differences at the first year. Patients with high-level viremia had worse renal function one year after KT and worse graft survival than recipients with low-level viremia and controls (P = 0.037). In the multivariable analysis, when we analyzed exclusively patients with BKi, high-level viremia was a risk factor for kidney graft survival (HR: 16.31; P = 0.034).

CONCLUSION

BKi is not an uncommon complication after KT. Only high BK viral load was associated with BK-associated nephropathy, persistent viremia, and poorer graft survival. BK viremia <10 000 copies/mL did not affect KT outcomes. Therefore, monitoring BK plasma viral loads and changes in immunosuppression to reduce viremia are effective strategies to minimize the impact of BK virus on graft survival.
MO1007: Intestinal Permeability in Patients After Kidney Transplantation Treated with Two Different Formulations of Extended-Release Tacrolimus
Authors: Kolonko Aureliusz , Słabiak-Błaż Natalia , Pokora Patrycja , Piecha Grzegorz , Jan Wiecek Andrzej
Published: May 2022

BACKGROUND AND AIMS

A prompt achieving of adequate tacrolimus blood exposure is crucial in early period after kidney transplantation. A gut epithelial barrier integrity may play a role in tacrolimus absorption. The aim of this study was to investigate the intestinal fatty acid binding protein (I-FABP) concentrations as a marker of intestinal permeability in recent kidney transplant recipients (KTRs) treated with two different tacrolimus extended-release formulations.

METHOD

48 pairs of consecutive KTRs were analyzed. Within each pair, an early conversion was performed from twice-daily (Prograf) to a once-daily tacrolimus formulation: Advagraf or Envarsus. On the day of discharge from the hospital, I-FABP plasma levels were measured and the tacrolimus concentration-to-dose (C/D) ratio was calculated. Tacrolimus exposure was assessed with an area under the curve (AUC) based on blood trough level and 3-h post-dose measurement.

RESULTS

There were no differences in recipient age, dialysis vintage, BMI and residual diuresis between the Advagraf and Envarsus groups. The median I-FABP plasma levels [Advagraf: 1450 (750–2100) versus Envarsus 1200 (600–1790) pg/mL; P = .18] and mean tacrolimus AUC [154 (143–164) versus 145 (132–158) ng.h/mL, respectively; P = .30] were similar. As expected, C/D ratio was significantly greater in the Envarsus group [2.06 (1.32–3.09) versus 1.16 (0.72–1.52) in the Advagraf group; P < .001]. Interestingly, log I-FABP correlated inversely with tacrolimus AUC only in the Envarsus group (r = –0.431; P < .01) but not in the Advagraf group (r = 0.05; P = .72).

CONCLUSION

Our findings suggest that destabilization of the enterocyte membrane integrity may influence the intestinal tacrolimus absorption, which may cause lower tacrolimus exposure in KTRs treated with Envarsus. However, explanation of this phenomenon needs further investigation.
MO1014: The Effects of a 6-Month Exercise Training Programme on Glycemic Control, Lipid Profile and Functional Capacity of Diabetic Kidney Transplant Recipients
Authors: Michou Vasiliki , Nikodimopoulou Maria , Kouidi Evangelia , Deligiannis Asterios
Published: May 2022

BACKGROUND AND AIMS

The effects of exercise training in kidney transplant (KT) recipients with diabetes mellitus remain unclear [1]. This randomized controlled trial aimed to investigate the effects of a 6-month home-based exercise training programme on functional capacity, glucose levels and lipid profile of diabetic KT patients.

METHOD

A total of 21 type II diabetic KT recipients were randomly assigned into two groups: exercise (n = 11, aged 52.9 + 10.1 years) and control (n = 10, aged 53.01 + 9.5 years). All participants at baseline and at the end of the study underwent biochemical tests for fasting plasma glucose (FPG) levels, glycated haemoglobin (HbA1c) and lipid profile and cardiopulmonary exercise testing for maximum oxygen uptake (VO2peak) estimation. The exercise group followed a 6-month supervised home-based aerobic and progressive resistance exercise programme of moderate intensity, 3 times/week, while the control group continued to receive usual care.

RESULTS

At the end of the 6-month study, the exercise group had significantly lower values in FBG by 13.4% (P = .01), HbA1c by 1.5% (P = .01) and triglycerides by 8.5% (P < .05) and higher values in high-density lipoprotein by 10.2% (P < .05) and VO2peak by 4.7% (P = .02) than the control group. Moreover, there were statistically significant differences between the two groups at the end of the study for FBG, triglycerides and VO2peak. Finally, after training there was a moderate, positive linear relationship between VO2peak and HbA1c in the exercise group (r = 0.408, P = .03).

CONCLUSION

The results of this study demonstrated that a 6-month home-based mixed-type exercise training programme can improve the functional capacity, levels of glucose and lipid profile of diabetic KT recipients.