bluuebunny/crossref_metadata_2025 huggingface dataset:
P1549TREATMENT BURDEN AND ITS IMPACT ON QUALITY OF LIFE AMONG CHRONIC KIDNEY DISEASE PATIENTS WITH DIABETES MELLITUS IN QATAR
Authors: Al-Ali Fadwa , Ibrahim Rania , Mathew Mincy , Kheir Nadir , Awaisu Ahmed , Izham Mohamed , Almansouri Asmaa , Hamad Abdullah
Published: June 2020

Background and Aims

Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) and on of its top comorbidities. Its management places significant burden on patients and results in impairment of their health-related quality of life (HR-QOL). Little is known about diabetes mellitus treatment-related burden in patients with CKD. This study aimed to investigate the impact of diabetes mellitus on treatment-related burden and HR-QOL among CKD patients in Qatar.

Method

This was a mixed-method, sequential explanatory study conducted at Fahad Bin Jassim Kidney Center in Qatar on hemodialysis and pre-dialysis (GFR<20 but not on dialysis yet) patients. Treatment-related burden and HR-QOL were assessed quantitatively using the Treatment Burden Questionnaire (TBQ) and the Kidney Disease Quality of Life (KDQOL™) questionnaire, respectively. To gain a deeper insight, qualitative one-to-one semi-structured interviews were conducted among the CKD patients. Quantitative data were analyzed descriptively and inferentially using SPSS version 24. Thematic content analysis was performed for the qualitative data.

Results

Two hundred-eighty CKD patients (hemodialysis = 223 and pre-dialysis (GFR <20) = 57) were included. 157 has DM and 66 were non-DM (in hemodialysis) while 32 patients had DM vs 25 non-DM (in pre-dialysis). In general, 35% of patients reported moderate to high burden. Hemodialysis patients experienced significantly higher treatment burden compared to pre-dialysis patients with median (IQR) of 45 (36) versus 25 (33), respectively (p<0.001). DM patients expressed significantly higher TBQ score compared to non-DM (47(40) vs. 36(27) p<0.001). Retinopathy was associated with worsened treatment burden (TBQ 46.5(29) vs. 40(38) p=0.019). Medication burden and lifestyle change burden were the highest perceived treatment-related burden, followed by administrative, social, and financial burden. The presence of antidiabetic medications correlated with worse TBQ score (0.207 p<0.001). There was a strong, negative correlation between TBQ score and KDQOL-36™ score [rs (251) = -0.616, p <0.001]. Presence of DM was associated with worse KDQOL (2110(1055) vs. 2685(1170) p<0.001). Thematic content analysis identified religion and faith in God as well as quality of the care provided as factors that reduce perceived treatment burden and improve patients’ HR-QOL. Conversely, medication burden, lifestyle changes, challenges with international travelling, financial burden, and empathy were factors that worsen perceived treatment-related burden and HR-RQOL.

Conclusion

This study suggests that diabetes mellitus and its treatment negatively impacts treatment-related burden and quality of life in CKD patients. This result should be considered in management strategies when designing healthcare interventions directed to CKD patients with diabetes mellitus.
P1552CAN WE GET ADEQUATE DIALYSIS WITH LIQUID AT 300 ML/MIN ?
Authors: Barril Guillermina , Sobrino Pedro , Giorgi Martin , Nuñez Almudena , Santos Begoña , Pascual Natalia , Sanz Pilar , Cano Francisco , Nogueira Angel , Sanchez Tomero Jose Antonio
Published: June 2020

Background and Aims

The portable HD monitors achieve a good adaptation with HD dialysate at 200ml / min using the concept of saturation of the HD dialysate. We decrease from 800ml / min to 500ml / min with good adaptation some years ago.

To assess the effectiveness of HD in both HD-standard and HDF-online with dialysate flow at 300ml / min by establishing approximate mathematical model of clearance.

Methods

We conducted an HD session with dialysate flow at a speed of 300ml / min, half week session to 52 patients in our unit. We value vascular access, session time, liters of blood-purified and total infusion in HDF online. We review HD monitor and dialyzer.

We perform pre and postHD blood determinations: Urea, B2microglobulin, P and uric acid, assessing urea reduction rate (PRU), b2microglobulin reduction rate (PR2microg) with both dialysate flows at 300ml / min and 500ml / min. We also have evaluated the differences between the two methods.

In the HD dialysate flow we determine at 300ml / min at 5, 10, 30, 45 and 60min (total dialysate collection in the first hour with sample of the mixture) urea, B2microg, Uric acid and P and at 2, 3 and 4 hours establishing a mathematical model with an approximation curve in both HD and online HDF.

Results

Five patients in standard HD (4h), 35 HDF online (4h) (x Liters infused 24.87 ± 2.79 l) and 12 short-daily HD (2h30min). 18 catheter and 34 FAV. Xliters purified blood = HD daily 54.41 ± 5.63l, HD standard 87.38 ± 6.01 and HDFonline 82.02 ± 16.13l.

The xPRU = 76.17 ± 10.49%, PRB2microg = 73.82 ± 13.49, Kt / V = 1.52 ± 0.28. By scheme at 300ml / min of HD fluid flow: HDFonline xPRU = 81.54 ± 5.25, Standard HD = 78.01 ± 3.03, Daily HD = 60.19 ± 6.71; xPRb2microg HDFonline = 76.70 ± 14.76%, Standard HD 65.44 ± 11.81, Daily HD = 69.16 ± 6.49.

Comparing the xPRU at 300ml / min of liquid vs 500ml / min we didn´t found significant differences, nor in the x preHD of urea and B2microglobulin.

With the dialysate samples we obtain a polynomial model of order 7 allowing cuantitative adjustment of the curve.R2 0.9, observing in the first 2 hours the greater removing.

Conclusions

1. The results are sufficient to consider the result of the removing in each scheme adequate. 2. The decrease in costs would be important (40% of water + energy saving and longer duration elements water treatment. 3. Further study are necessary.
P1560ANXIETY AND DEPRESSION AMONG HEMODIALYSIS PATIENTS
Authors: Fadwa Helaoui
Published: June 2020

Background and Aims

Procedure of haemodialysis (HD) treatment is associated with an impaired quality of life in chronic kidney disease patients. It is due to changes in family, social and professional relationships. These changes can also lead to mental health problems. The purpose of our study is to determine the prevalence of depressive and anxiety disorders in hemodialysis patients.

Method

Fifty chronic hemodialysis patients were enrolled in our cross-sectional study during four months (September -October- November- December 2019). The HADS (Hospital Anxiety and Depression Scale) survey was used to assess depressive and anxiolytic disorder in our hemodialysis population. Were excluded patients aged less than 18 yearsold as well as kidney transplant patients and psychiatric patients.

Results

The mean age of our patients was 49.5 range (24-79).The sex ratio was 1.27. The prevalence of anxiety syndrome was 40% with a female predominance of 54.5% versus 54,5%. Depressive syndrome was noted in 48% of our patients with a male predominance of 58.3% versus 41,7%.

48% of our HD patients have shown depression in various degrees. It was about mild depression of 20,8% of pts, moderate depression of 41,6% of pts and severe depression of 37,5% of pts. Somatic symptoms of depression in our population were respectively noted in 52,8% of loss of energy, 57,5% fatigue, 63,4% sleep disturbances, and 38,5% changes in appetite. The most common psychological symptoms were: pessimism (79,1%), loss of interest in appearance (41,6%), psychomotor retardation (75%).

On the other hand, 37, 5% of patients felt cheerful and 16,6% still enjoy doing some activities. For patients with anxiety syndrom, we noted: concentration disturbance (45,4%), palpitations (50%), abdominal pain (59,09%) and headache (81,8%).

With regard to psychological symptoms, the most emphasized were: sudden feelings of panic (54,5%), worrying thoughts (72,7%),77,2% are feeling restless and 59,09% are feeling wound up.

On the other hand, 68,1% feel relaxed especially after the hemodialysis session. It seems that gender, marital status and HD duration did not influence significantly in occurrence of depression with respectively (p=0,08, p=0.1 and p= 0.08). Older patients were significantly more depressed in compared to younger patients (p= 0.003). Unemployed patients were significantly more depressed in relation to employed patients(p=0.01). Finally, as the educational level of patients increased, level of depression significantly decreased (p=0,04).

Conclusion

Depression is the most frequent psychological complication of hemodialysis (HD) patients. Our results showed a high prevalence of depressive symptoms among the study group. The exact prevalence of depression in dialysis patients is unclear because of different criteria utilized for diagnosis of depression. A close collaboration between nephrologists and psychiatrists is needed to ensure a better quality of life in HD patients.
P1563THE ANALYSIS OF RISK FACTORS FOR THE PATIENTS EXPERIENCED VENOUS NEEDLE DISLODGEMENT OR BLEEDING DURING DIALYSIS
Authors: Wu Hsiu Wen , Lin HsuanMing , Chen KuanYu , Lin YuChih , Hu HsiangWei
Published: June 2020

Background and Aims

A puncture of vascular access is commonly used in clinical treatment, such as hemodialysis or central venous catheters. At this time, leakage or infection associated with Venous needle dislodgement(VND) is a high risk of fatality, especially for patients with restlessness, impaired cognition, isolation, or home dialysis. At present, a few studies believe that many risk factors are associated with venous needle dislodgment and bleeding, including difficult needle fixation, restlessness, unconsciousness, or abnormal movement. However, only a few studies are focusing on patient disease, medication, and other risk assessments. Therefore, this study aims to explore the risk factors of patients with venous needle dislodgment and bleeding and hope to establish the risk classification.

Method

This study was a prospective study conducted in the hemodialysis room of Tainan Regional Hospital. Before starting to collect the venous needle dislodgment and bleeding data, we performed a training program for medical and nursing staff, including venous puncture, fixation, puncture site assessment, and management. During the three months from July 2019 to 2019/9, we collected clinical data were collected, including patient sex, gender, diseases, records of dialysis access blockage, anticoagulant dose, and a high-risk assessment record (eight risk factors). Finally, we analyzed the data and compared the data between the two groups of patients who experienced needle dislodgement and bleeding. We applied statistical software STATA, chi_square, z-test. P<0.05 was defined as significant.

Results

Seventy patients were included in this study, with an average age of 63.23 (± 1.2 years) and 45 males (64.28%). In 2019 / 7-9, there were a total of 32 patients with 72 venous needle dislodgment and bleeding. The patients with the condition as below were considered high-risk patients. In terms of gender, whether it is a high risk, diabetes, high blood pressure, whether to use sleeping pills, diabetic hypotension, whether to use warfarin or to use anticoagulant doses are all not statistically significant. The proportion of patients with vascular-access and undergoing percutaneous transluminal angioplasty was 35.2% (11) in high-risk patients and 10.3% (4) in low-risk patients, p <0.01.

Conclusion

Before data collection in this study, a standardized training program was performed for medical care and vascular access monitoring. However, there were no new risk factors were found. This research model can provide a new direction for further research.
P1567THE ANNUAL VARIATION OF CRA/ALBUMIN RATIO IS AN ACCURATE PROGNOSTIC FACTOR IN DIALYSIS PATIENTS
Authors: Yasuda Kaoru , Takahashi Hiroshi , Morozumi Kunio , Maruyama Shoichi
Published: June 2020

Background and Aims

Protein energy wasting (PEW) is a distinctive malnutrition status in hemodialysis(HD) patients, and it is closely related to poor prognosis. We previously reported that CRP/Alb ratio is useful marker for assessment of malnutrition status in HD patients. However, the value of CRP/Alb ratio calculated by CRP and serum albumin level is considered to be varied over time, and correlation between the amount of change and the prognosis is uncertain. The purpose of this study is to investigate the effect of the changing in CRP/Alb ratio within a certain period of time on prognosis of dialysis patient.

Method

320 patients who were received stable dialysis therapy were enrolled in the study. It was analyzed that the relation between the changing in CRP/Alb ratio within one year and the prognosis. Furthermore, patients were divided by the values of CRP/Alb (>0.35) and ΔCRP/Alb ratio (>0.05) as a threshold (4 groups of 2 × 2), and analyzed for the prognostic value.

Results

During the observation period (median 71 months), 138 patients were died (43.1%). Baseline CRP/albumin ratio, both of continuous value and cut-off value of 0.34 as median, was identified as an independent predictor for 7-year mortality. The CRP / Alb ratio at one year increased from 0.40 (0.46-1.7) to 0.47 (0.22-1.48) (p = 0.0040). The 7-year survival rate was 44.7% in the group with increased ΔCRP / Alb ratio and 57.0% in the group with non-increased (p = 0.020). The adjusted hazard ratio was 1.45 (95% CI 1.02-2.06, p = 0.037, increase group vs non-increase group). On combined setting of each predictors, mortality risk was clearly stratified, and patients with high and increased CRP/albumin ratio had 2.84-fold (95%CI 1.65-5.03) higher risk of mortality compared to patients with low and no-increased CRP/albumin ratio

Conclusion

The increasing rate of CRP/Alb ratio were strong predictors of mortality as well as the baseline CRP/Alb ratio levels, and both of them additively improved the predictability for mortality in chronic HD patients.
P1569ADIPONECTIN IS ASSOCIATED WITH DECLINE IS SKELETAL MUSCLE MASS AND BONE MINERAL CONTENT IN PATIENTS ON HEMODIALYSIS
Authors: Ogawa Hiroshi , Koga Toshimitsu , Fuwa Daisuke , Tamaki Hirofumi , Nanbu Takayuki , Kojima Yuko , Ota Yoshihiro , Sato Azumi , Kindaichi Akihiro , Hiraga Keiko
Published: June 2020

Background and Aims

Patients on hemodialysis are prone to undernutrition, malnutrition-inflammation-atherosclerosis (MIA) syndrome, and protein-energy wasting (PEW). One of the major adipocytokines adiponectin (ADPN) is involved in anti-arteriosclerotic and anti-inflammatory processes. However, ADPN is implicated in muscle weakness and loss of muscle mass in the elderly in addition to sarcopenia.

At the 2019 ERA-EDTA Congress, we announced that total plasma ADPN levels in patients on hemodialysis (HD) showed a significant inverse correlation with BMI, body fat in percentage, mass and estimated skeletal muscle mass, and ADPN may be involved in sarcopenia in patients on HD. Herein, we investigated the association of ADPN level with sarcopenia in patients on HD using a method different from the one used in our previous study. We examined the relationship between total plasma ADPN level and the rate of change in estimated skeletal muscle mass, bone mineral content, and body fat mass over 5 years after the plasma ADPN measurement. Furthermore, we analyzed whether an elevated ADPN level was predictive of a subsequent decline in these parameters.

Method

Total plasma ADPN levels were measured using ELISA (Bio Vendor-Laboratorni Medicina a.s., Czech Republic) in 42 male patients on HD (age: 51.1 ± 9.0 years, dialysis vintage: 144.8 ± 99.2 months, BMI: 21.8 ± 3.2, dry BW: 62.0 ± 10.9 kg, dialysis time: 15.6 ± 3.1 hours/week). The estimates of skeletal muscle mass, bone mineral content, and body fat mass were made using multi-frequency bioelectrical impedance analysis (MFBIA) within the same year when total plasma ADPN level were first measured in 2011 as well as in 2016. We then calculated the rates of change in the estimated skeletal muscle mass, bone mineral content, and body fat mass over the 5 years and correlated these parameters with the total plasma ADPN measurements.

Results

Conclusion

Total plasma ADPN levels inversely correlate with larger rates of decrease in estimated skeletal muscle mass and bone mineral content in patients on HD. This suggests that ADPN may play a role in the decline in skeletal muscle mass and bone mineral content over time in patients on HD.
P1571WEEKLY VERSUS MONTHLY ORAL CHOLECALCIFEROL ON OXIDATIVE STRESS AND INFLAMMATORY MARKERS IN HEMODIALYSIS PATIENTS: A PROSPECTIVE RANDOMIZED TRIAL
Authors: Alshahawey Mona , ElWakeel Lamia , El Said Tamer , Sabri Nagwa
Published: June 2020

Background and Aims

Vitamin D deficiency is now considered a global problem in general population, but it seemed to be more prominent in chronic kidney disease (CKD) patients, especially those on regular hemodialysis. Being a key regulator in mineral metabolism, there’s also emerging evidences linking vitamin D deficiency with inflammation and oxidative stress, which are both recognized as constant threats to cardiovascular outcomes in hemodialysis patients. However, data is still limited regarding an exact treatment protocols or regimens for vitamin D supplementation in such category.

Method

A prospective, randomized trial was carried out to evaluate the effect of weekly versus, monthly oral cholecalciferol, on vitamin D (25(OH)D) levels, oxidative stress markers, inflammatory markers and secondary hyperparathyroidism in hemodialysis patients. Fifty eligible hemodialysis patients were randomly assigned to either Group A (Oral 50.000IU Cholecalciferol, once weekly) or Group B (Oral 200.000IU Cholecalciferol, once monthly), for 3 months. Serum levels of (25(OH)D), serum malondialdehyde (MDA), serum superoxide dismutase (SOD), serum high sensitive (hsCRP), calcium, phosphorus, and parathormone (PTH) levels, were all assessed at baseline and at the end of the study.

Results

Cholecalciferol significantly increased serum levels of 25(OH)D in both groups, with a higher significant increase (p = 0.003) in Group A vs. Group B. Only Group A had a significant decrease in both serum MDA and serum hsCRP levels (p <0.001), while it had a significant higher increase (p = 0.011) in serum SOD when compared to Group B. Regarding PTH levels, a significant higher change from baseline ( -30 pg/mL vs. -3 pg/mL) was noticed in Group A vs. Group B. However, neither calcium nor phosphorus levels had a significant difference in both groups. No side effects were reported from both study groups.

Conclusion

Weekly (50.000 IU) oral cholecalciferol seems to be an effective safe option to replenish vitamin D levels in hemodialysis patients, with an ameliorating effect on oxidative stress, inflammation and PTH levels.
P1573EFFECT OF INFLAMMATION ON MUSCLE-BONE INTERACTIONS IN HEMODIALYSIS PATIENTS
Authors: Królikowski Jerzy , Górczewska-Królikowska Bogumila , Nowicki Michal
Published: June 2020

Background and Aims

Chronic hemodialysis patients show decreased muscle mass, low physical activity and chronic weakness. Hemodialysis treatments results in increased risk of inflammation, which impairs physical activity. The calcium-phosphate and bone metabolism, as well as muscle mass, are regulated by a range of factors like FGF-23 and its co-factor Klotho protein, myostatin, follistatin and sclerostin. Complex interactions between these cytokines and inflammation have been described.

The aim of the study was to assess the influence of inflammation on plasma concentrations of factors that regulate muscle and bone-mineral metabolism

Method

55 hemodialysis patients were divided into study group (32 patients) and the reference group (23 patients). The former were the patients who had inflammation confirmed by plasma CRP >50 mg /L. Blood was collected before and after hemodialysis during the inflammation, and before hemodialysis after the resolution of inflammation

Results

Mean CRP in study group was 105.9±73.9 mg/l. The mean period between blood sampling during inflammation and resolution of inflammation was 15±7.9 days. Statistically significant increase of plasma cFGF-23 concentration was observed after hemodialysis. Its median concentration increased from 1992.8 RU/ml; IQR = [1350; 4320 RU/ml] before hemodialysis to 2421.3 RU/ml IQR = [1351; 7348 RU/ml] after HD (p = 0.001). Significant increase of sclerostin was observed after hemodialysis. Serum sclerostin increased from 1346.2 pg/ml IQR = [1034; 2243 pg/ml] before HD to 1583.8 pg/ml IQR = [1198; 2559 pg/ml] after HD (p = 0.002). Follistatin concentration increased from 2669 pg/ml IQR = [2129; 5702 pg/ml] before HD to 4220.5 pg/ml IQR = [2583; 6727 pg/ml] (p = 0.009). Hemodialysis had no significant effect on plasma Klotho protein, iFGF-23, FGF-21, and myostatin. After the resolution of inflammation there was statistically significant decrease in FGF-21 from 3591.4 pg/ml. IQR = [1174.3; 6,537.3 pg/ml] to 2454 pg/ml IQR = [1221.1; 3448.4 pg/ml] p = 0.006). There were significant changes of the concentration of Klotho protein, cFGF-23, iFGF-23, sclerostin, myostatin, follistatin after the resolution of inflammation vs. baseline.

Conclusion

Hemodialysis modulates the concentration of factors involved in regulation of calcium-phosphate metabolism, bone turnover and muscle growth and strength. The resolution of inflammation in hemodialysis patients leads to the decrease of plasma FGF-21 concentration.
P1574EFFECTS OF BRAZILIAN GREEN PROPOLIS EXTRACT (EPP-AF) ON INFLAMMATION IN HEMODIALYSIS PATIENTS
Authors: Silveira Marcelo , Teles Flavio , Melo Erica , Borges Valeria , Miranda Filipe , Dutra Fábio , Berretta Andresa , Cezar Rodrigo , Silva Jéssica , Santos Hayna , Benigno Paulo , Passos Rogério
Published: June 2020

Background and Aims

End-stage chronic kidney disease is associated with the condition of chronic inflammation, impacting increased cardiovascular mortality in this specific population. Patients on hemodialysis are known to be predisposed to several factors that predispose to inflammation: dialysis membranes, central venous catheters, oxidative stress, fluid overload, sodium overload, uraemic toxins. Propolis, a natural resin produced by bees from plant materials, has anti-inflammatory, immunomodulatory, and anti-oxidant properties. The aim of this study was to evaluate the impact of Brazilian green propolis extract on inflammation in hemodialysis patients. Here we present preliminary results of the trial NCT04072341.

Method

We performed a prospective trial, open-label 9-week crossover study examining the effect of Brazilian green propolis (250mg/day, in capsules) on inflammation in hemodialysis patients. We included patients over 18 years, under intermittent hemodialysis (thrice per week), on hemodialysis for at least 1 month and until now 37 patients were included. We excluded pregnant women, cancer carried and patients who developed infection or underwent any surgical procedure during the study period. Each period was 4 weeks in duration with a 1-week washout period in between. The primary end point was change in serum level of high-sensitivity c-reactive protein (HsCRP). Secondary end point evaluated the safety of propolis use in hemodialysis patients.

Results

Their mean age was 58.6 ± 15.2 years (mean ± SD), and 22 (59.4%) were men. The proportion of patients with hypertension was 14 (37.8%) and diabetes was 9 (24.3%). The number of patients using arteriovenous fistula were 26 (70.2%). The HsCRP presented (mean ± SE) 5.31 ± 1.02 mg/L at baseline, 4.26 ± 0.76 mg/L after propolis period and 4.56 ± 1.32 mg/L in control period, p = 0.0042. Safety parameters were analyzed such as amylase, aspartate aminotransferase (AST) and creatine phosphokinase (CPK); there was no difference between them before and after the use of propolis. None of the participants reported any adverse effects or allergic reactions during the treatment.

Conclusion

Patients on hemodialysis have an increased inflammatory state. For the best of our knowledge it was the first clinical trial who demonstrated the safety of propolis in hemodialysis patients. Brazilian green propolis demonstrated a tendency to reduce inflammation in these patients.
P1579PREVALENCE OF PROTEIN-ENERGY WASTING IN HEMODIALYSIS PATIENTS IN THE EUROPEAN REGION OF THE RUSSIAN FEDERATION
Authors: Jakovenko Alexander , Rumyantsev Aleksander
Published: June 2020

Background and Aims

One of the complications of hemodialysis therapy (HD) is the development of protein-energy wasting (PEW), which is an independent predictor of morbidity and mortality in this cohort of patients. The prevalence of PEW in hemodialysis patients in different regions of the world varies from 15% to 75% but has not been practically studied in the Russian Federation.

To assess the prevalence of protein-energy wasting in hemodialysis patients in the European region of the Russian Federation.

Method

645 hemodialysis patients were examined in 9 hemodialysis centers in 5 regions of the European part of the Russian Federation. Among the patients there were 345 women and 300 men, the average age was 56.8 ± 12.8 years. The duration of hemodialysis therapy was 8.4 ± 5.3 years. The diagnosis of PEW was established in accordance with the criteria: biochemical criteria (serum albumin < 3.8 g per 100 ml; serum prealbumin (transthyretin) < 30 mg per 100 ml; serum cholesterol < 100 mg per 100 ml); low body weight, reduced total body fat, or weight loss; a decrease in muscle mass; and low protein or energy intakes. The level of blood albumin was determined using the BCG method (bromocresol green). Estimation of protein and calorie intake was performed using 3-day food diaries filled out by patients.

Results

Insufficient protein intake according to the International Society of Renal Nutrition and Metabolism (ISRNM) recommendations was observed in 5.5 % of patients, calories in 4.1 %, combined deficiency in protein and calorie intake in 2.7% of patients. The prevalence of PEW was 51.2 %. The relationship between age and gender was not identified. The lowest prevalence of PEW is observed in patients with a hemodialysis therapy experience of fewer than 5 years (25,4 %) and gradually increasing by 2.5 times in patients with survival rates on HD for more than 10 years (χ2 = 22,580 р = 0.0001).

Conclusion

The prevalence of protein-energy wasting in hemodialysis patients in the European region of the Russian Federation is 51,2 %.
P1586SARCOPENIA IN HEMODIALYSIS PATIENTS
Authors: Negri Armando Luis , Abdala Ruben , Del Valle Elisa , Bridoux Pablo , Gonzalez Paganti Luciana , Bravo Marina , Sintado Luis , Di Rienzo Paula , Schiavelli Omar R , Zanchetta Maria B
Published: June 2020

Background and Aims

Sarcopenia is the loss of skeletal muscle mass and function that occurs with aging. These modifications lead to greater morbidity and mortality as a result of falls, hospitalization, depression and dependence among others. Chronic Kidney disease (CKD) and hemodialysis (HD) produce a favorable environment for the development of sarcopenia. Objective: to study the prevalence of sarcopenia and its different components (muscle mass, strength and physical performance) using EWGSOP 2018 proposed criteria.

Method

cross-sectional study evaluating 100 adult HD patients. We evaluated: Grip strength (GS) with Jamar Hydraulic Hand Dynamometer (three determinations in the arm without fistula); Appendicular lean mass (ALM) by DXA (GE LUNAR Prodigy Advance) and physical performance: Gait-speed (Time needed to perform a 4-meter walk on a flat surface) and the sit-stand test

Results

58 males (M) and 42 females (F). Mean age for M was 54.3 years and 58 years for F. The prevalence of sarcopenia was 18% in the whole group, 10% in M and 20% in F. In M 33% had low GS and 26% low ALM. In M GS correlated with ALM, Albumin and weight p<0.05 (R 2 0.41); ALM correlated with weight r 0.75, height r 0.64 and GS r 0.46 (p<0.05). In F, 27% had low GS, 54% low ALM, and 17% poor physical performance. In F, GS correlated positively with ALM; ALM correlated positively with: weight r 0.78, height r 0.66, GS r 0.59 and sit-stand r 0.40 (p<0.5). Patients with lower grip strength had a higher prevalence of falls in the last year (40% two or more falls) p=0.03.

Conclusion

A significant proportion of dialysis patients had sarcopenia. Low hand grip strength was associated with a higher prevalence of falls. Recognizing sarcopenia in dialysis patients would allow us to develop strategies to prevent falls and other complications.
P1587EFFECT OF INTERMITTENT FASTING IN RAMADAN ON BODY COMPOSITION AND NUTRITIONAL PARAMETERS IN PATIENTS ON MAINTENANCE HEMODIALYSIS
Authors: Nassar Mohammed Kamal , El-kannishy Ghada , Abdelrazik Eman , Sayed-Ahmed Nagy
Published: June 2020

Background and Aims

Intermittent fasting has been demonstrated to have many potential health-promoting effects. Intermittent fasting regimens were proven to influence metabolic regulation and chronic inflammation. Fasting during the month of Ramadan can be considered as a model of intermittent fasting among Muslims. In general, there is a shortage of studies in the context of the effect of Ramadan fasting in patients on maintenance hemodialysis (HD). The present study aimed to assess the effects of fasting in Ramadan on body composition as well as nutritional and inflammation parameters in patients on chronic HD.

Method

This prospective observational study included 68 patients on maintenance HD for more than six months in Mansoura Nephrology and Dialysis Unit (MNDU). The study was performed in Ramadan 1440 Hijri when the fasting hours ranged from 15 to 16 hours. Patients’ nutritional status was assessed by malnutrition inflammation score (MIS). Anthropometric measurements, including body weight, height, mid arm circumference (MAC) and triceps skin fold thickness (TSF), were measured. Body composition was assessed by bioelectrical impedance. All of the aforementioned methods were performed before start of Ramadan and repeated three weeks after the end of the holy month in patients who fasted.

Results

Forty–five patients (66%) fasted more than 18 days during the month of Ramadan. The mean age of patients who fasted was 47.33±14.86 years with a median duration of HD of 35 months (IQR 14.5-74.5). After Ramadan, weight gain was observed in patients who fasted. However, the increase in body mass index (BMI) was statistically insignificant (28.7±6.06 vs 29.04±6.09kg/m? p=0.073). On the other hand, visceral fat was significantly reduced after Ramadan (p<0.0001). MIS score improved with lower score estimated after Ramadan; however, the difference was insignificant (p=0.059).

Conclusion

Fasting in Ramadan in HD patients was associated improvement of the metabolic profile evident by decrease in visceral fat. The effect of intermittent fasting on inflammation and nutritional parameters in patients on maintenance hemodialysis needs further investigations.
P1594INSULIN-LIKE GROWTH FACTOR-1 IS ASSOCIATED WITH MUSCLE STRENGTH IN PATIENTS ON HEMODIALYSIS
Authors: CHANG YU-KANG , Lim Paik Seong
Published: June 2020

Background and Aims

Muscle strength is a solid predictor of outcome for hemodialysis (HD) patients. In this study, our aim is to investigate the relationship between muscle strength and six potential muscle biomarkers including irisin, myostatin, myonectin, antichymotrypsin, urotensin II and insulin-like growth factor 1 (IGF-1).

Method

The cohort of prevalent HD patients in Tungs’ Taichung MetroHarbor Hospital were participated in our cross-sectional clinical study. The serum muscle markers were determined using standardized enzyme-linked immunosorbent assay methods. The muscle strength was accessed by handgrip strength (HGS) on arm without vascular access before dialysis session.

Results

A total of 175 patients were enrolled in this study with an average age of 59.2 and among them 84 were males (48.0%). Among the six potentially associated with muscle strength viz HGS, we found that only IGF-1 level (r=0.180, p=0.017) correlated positively with HGS. In the multivariate regression analysis, IGF-1 was also significantly correlate with HGS after adjusted for patients’ demographics [RR (95%CI)=0.091 (0.015-0.167)]. In addition, increased IGF level was correlated positively to irisin levels.

Conclusion

Our study suggested that IGF-1 was associated with HGS. The role of IGF-1 signaling in the induction of muscle atrophy in uremic patients is not fully understood.

Figure

Future research is required to obtain more detailed insight and may help to alleviate skeletal muscle atrophy in these patients.
P1602MICROVASCULAR INFLAMMATION WITHOUT DSA OR C4D: AN ORPHAN CATEGORY IN BANFF CLASSIFICATION WITH INTENSE CAPILLARITIS AND CYTOTOXIC T-CELL INFILTRATION
Authors: Buxeda Anna , Llinàs Laura , Gimeno Javier , Arias Cabrales Carlos , Burballa Tarrega Carla , Redondo Pachon Dolores , Raïch Regué Dàlia , Pérez-Sáez Maria José , Pascual Julio , Crespo Marta
Published: June 2020

Background and Aims

Antibody-mediated rejection (ABMR) associated with donor-specific HLA antibodies (DSA) is the leading cause of late allograft failure after kidney transplantation. Microvascular inflammation (MVI) without detectable circulating DSA or C4d + cannot be classified as ABMR according to Banff-2017. The involvement of intragraft lymphocyte subsets in the development of humoral damage in kidney transplantation (KT) is relevant. We aimed to analyze lymphocyte subset distribution in kidney transplant biopsies (KTBx) with ABMR compared with MVI and with normal KTBx.

Method

KTBx with ABMR, MVI (g+ptc≥2, without DSA) or normal findings were included. DSA were identified with Luminex single antigen assays. Intragraft lymphocyte subsets’ characterization was performed by immunohistochemistry: T-lymphocytes (CD3, CD4, CD8, Foxp3), B-lymphocytes / plasmatic cells (CD20, CD138), NK cells (CD56), macrophages / monocytes (CD68), cytotoxic cells (TIA1) and activated cells (PD1) were evaluated.

Results

We analyzed 34 KTBx: 21 ABMR, 5 MVI and 8 KTBx with normal findings. KT with ABMR and MVI had more proteinuria at the time of the biopsy compared with the normal group (575 mg/24h and 964 mg/24h vs 147 mg/24h, p=0.002 and p=0.005 respectively). DSA were more frequently detected in patients with ABMR (95.2% vs 0% and 37.5%, p<0.001 and p=0.003 respectively). KTBx with ABMR and MVI had increased cytotoxic T-cell infiltration apparently corresponding to NK cells in peritubular capillaries (ptc) compared to normal group. Moreover, both groups showed a greater number of macrophages and monocytes in glomeruli. KT with MVI but not with ABMR had a significantly increased activated cell infiltration (PD1+) in ptc compared to the normal group, and showed an increased cytotoxic T-cell infiltration in glomeruli compared to ABMR and normal groups.

Conclusion

ABMR and MVI have an increased infiltration of NK cells with cytotoxic activity in ptc that differs from the normal group. However, KT with MVI show greater infiltration of activated cells in ptc and cytotoxic T-cell in glomeruli compared to ABMR suggesting the possibility of different activation pathways.
P1603INVOLVEMENT OF SUCCINATE DEHYDROGENASE (SDH) IN DECEASED RENAL TRANSPLANT DONORS' INFAMMATION AND FIBROSIS
Authors: Guillén-Gómez Elena , Silva Irene , Galano Carla , Arce Yolanda , Caballero Francisco , Guirado Lluis , Diaz Encarnacion Montserrat Mercedes
Published: June 2020

Background and Aims

Succinate is a Krebs cycle intermediate that is converted to fumarate by succinate dehydrogenase (SDH). SDH is part of the electron-transport chain of inner mitochondrial membrane (complex II) and its activity depends indirectly on the oxygen availability. Low oxygen states, such as ischemia, can increase circulating succinate levels due to low SDH activity. In renal transplantation, ischemia and hypoxia can increase renal succinate formation and induce the infiltration of immune cells producing TNF-α, increasing inflammation, renal epithelial apoptosis, as well as leukocyte recruitment, binding and migration, which can lead to renal graft damage.

Method

Samples of pre-implantation renal tissue, 17 from living donors and 40 from deceased donors were analyzed by Real-time PCR.

Results

In kidneys from deceased donors SDH expression is downregulated before transplantation and it lasts for at least the first year. Low SDH gene expression at 4 months after kidney transplant is positively correlated with graft renal function (CKD-EPI) at 12 and 24 months (p=0.046, r= 0.6511 and p= 0.0351, r= 0.4731; respectively). In kidneys from deceased and living donors, SDHD is negatively associated with monocyte recruitment (MCP-1) and activation (IL-1β) and positively with the expression of SOD1. Moreover, only in deceased donors, SDHD gene expression correlates inversely with pro-fibrotic (TGF-β1 and vimentin) and inflammatory (TNF-α) molecules, as well as with M1 (CD80, CD86) and M2 (CD163) macrophage markers, all of which are found to be higher expressed in deceased donor kidneys than in living donor ones.

Conclusion

Our results indicate that low gene expression of SDH in kidneys from deceased donors could result in reduced activity of SDH that would reduce the ability to transform succinate to fumarate resulting in succinate accumulation, increasing inflammation and reparation through fibrosis worsening transplant outcome.
P1643TORQUE TENO VIRUS FOR RISK STRATIFICATION OF SUBCLINICAL GRAFT REJECTION AFTER KIDNEY TRANSPLANTATION- A PROSPECTIVE STUDY
Authors: Doberer Konstantin , Böhmig Georg A , Puchhammer-Stöckl Elisabeth , Bond Gregor
Published: June 2020

Background and Aims

Non-invasive monitoring strategies are insufficient to detect patients at risk for subclinical graft rejection after kidney transplantation. The highly prevalent and non-pathogenic Torque Teno virus (TTV) reflects the immunocompetence of its host: high level viraemia indicates strong and low level viraemia weak immunosuppression, respectively. Thus TTV replication might serve as a candidate for immunologic monitoring.

Method

To analyze the association between TTV and subclinical kidney graft rejection, an interim analysis of the prospective “TTV POET” cohort study (DRKS00012335) was performed including data available until 31/01/2019. All consecutive kidney graft recipients transplanted at the Medical University Vienna since 01/12/2016 (n=308) with a protocol biopsy 12 months after transplantation (n=47; median 12.4 months) and stable graft function were included. Biopsy results according to current BANFF classification were analyzed in the context of peripheral blood TTV levels quantified by PCR.

Results

Graft function was excellent (median eGFR MDRD: 57 ml/min/1.73m2, urinary PKR: 92 mg/g). Twenty recipients (43%) had subclinical rejection (borderline TCMR, n=16; ABMR, n=3; TCMR type I, n=1). TTV level quantified at the date of biopsy was lower in recipients with rejection compared to recipients without rejection. The risk for rejection increased by 11% with each log level decrease in TTV copies/ml (RR 0.89, 95% CI 0.85-0.93; p<0.001). Differences in TTV levels were evident not only at the date of biopsy, but already 6 weeks earlier. Patients with biopsies showing chronic leasons, suggesting ongoing allo-reactivity, had a longer period of time with TTV levels <1x106 copies/ml.

Conclusion

Our data suggests an association between TTV level and subclinical graft rejection at 12 months after kidney transplantation. Future clinical trials are necessary to test the potential of TTV guided immunosuppression to reduce subclinical rejection.
P1645VITAMIN K DEPENDENT PROTEINS AFTER KIDNEY TRANSPLANTATION: RESULTS FROM PROSPECTIVE STUDY
Authors: Fusaro Maria , Khairallah Pascale , Aghi Andrea , Plebani Mario , Zaninotto Martina , Cosma Chiara , Aponte Farias Maria A , Cortez Natalia E , Tripepi Giovanni Luigi , Nickolas Thomas
Published: June 2020

Background and Aims

Two Vitamin K-dependent proteins (VDKPs) link bone and vasculature in CKD-MBD: Bone Gla Protein (BGP) and Matrix Gla Protein (MGP). In ESKD, Vitamin K deficiency is highly prevalent and leads to increased levels of inactive VKDPs (undercaboxylated (ucBGP and dephosphorylated (dp)-uMGP), which are linked to greater risk of fractures and severity of vascular calcification. We hypothesized that kidney transplantation (KT) would improve Vitamin K status and lower levels of inactive VKDPs.

Method

Between 2014-2017, we conducted a study in 34 patients to assess changes in VKDPs during the 1st year of KT. In a specialized lab we determined VKDPs pre- and 1-year post-KT: total BGP, uc BGP, total MGP, and dp-uc MGP. We determined the prevalence of Vitamin K deficiency based on levels of uc BGP and dp-uc MGP.

Results

Our cohort had a mean +/- SD age of 48+/-14 years, 32% were female and 97% were Caucasian. 1 year post-KT, there was a decrease in the levels of all VKDPs and the prevalence of Vitamin K deficiency (Table 1 and Figure 1). Patients with greatest severity of Vitamin K deficiency pre-KT had the largest decreases of inactive VDKPs post-KT.

Conclusion

KT was associated with improvement in Vitamin K status as manifested by decreased levels of inactive VKDPs. These are the first prospective data on VKDPs in CKD patients pre- and post-KT. Studies are needed to assess the impact of improvement in VKDP status after KT on CKD-MBD outcomes.
P1653METABOLIC SYNDROME-RELATED DIETARY PATTERN AND RISK FOR MORTALITY IN RENAL TRANSPLANT RECIPIENTS
Authors: Cai Qingqing , C.J. Osté Maryse , Dekker Louise H , Gomes-Neto António W , Bakker Stephan , De Borst Martin , Navis Gerjan
Published: June 2020

Background and Aims

The metabolic syndrome (MetS) is an important risk factor for premature mortality in renal transplant recipients (RTR). Diet plays an important role in MetS development. Although an unhealthy diet may affect the long term outcome in RTR, no specific dietary patterns have been established that are linked with MetS in RTR. Reduced rank regression (RRR) has emerged as a method that identifies linear functions of predictor variables (food groups) that explain maximized variation in the response variables (biomarkers). We aim to identify a MetS-related dietary pattern (MetS-DP) in RTR, and to test its association with all-cause mortality.

Method

We included 432 adult RTR who had a functioning graft ≥1 year and were free of diabetes at baseline. The MetS-DP was constructed at baseline using dietary information derived from a 177-item food frequency questionnaire by reduced rank regression (RRR). In the RRR model, six components of MetS were used as response variable (age- and sex- adjusted waist circumference, systolic blood pressure, diastolic blood pressure, serum triglycerides, HbA1c, and HDL cholesterol), and 48 food groups were made as predictor variables. Using Cox proportional regression, we evaluated the association between the Met-DP score and all-cause mortality in RTR.

Results

The MetS-DP was characterized by a high intake of fat processed meat and desserts, and a low intake of vegetables, tea, rice, fruits, milk and vegetarian products. During a mean follow-up of 5.2 ±1.2 year, 64 RTRs (14.8%) died. Multivariate analysis showed that RTR in the highest tertile of MetS-DP score had a higher risk of all-cause mortality (hazard ratio [HR]=2.38; 95% confidence interval [CI],1.16-4.91, P=0.018) compared to the lowest tertile, independent of potential confounders.

Conclusion

The results suggest that the MetS-DP is significantly associated with all-cause mortality in RTR. Dietary measures may be useful to prevent MetS and reduce mortality in RTR.
P1654INCIDENCE AND RISK FACTORS OF THROMBOTIC MICROANGIOPATHY AFTER KIDNEY TRANSPLANTATION
Authors: Futamura Kenta , Norihiko Goto , Fukuhara Hiroki , Nawano Takaaki , Kanda Akiko , Tomosugi Toshihide , OKADA Manabu , Tsujita Makoto , HIRAMITSU Takahisa , Narumi Shunji , Watarai Yoshihiko
Published: June 2020

Background and Aims

Thrombotic microangiopathy (TMA) is characterized by mechanical hemolytic anemia, thrombocytopenia, and renal impairment. TMA that occurs in kidney transplant recipients has multiple etiologies and may be de novo or recurrent. Main causes of TMA among recipients are atypical hemolytic uremic syndrome (aHUS), immunosuppressive drugs, ischemia-reperfusion injury (IRI), viral infections, and antibody-mediated rejection (ABMR). Pathological findings of TMA with thrombosis in glomeruli and arterioles are not rare in graft biopsies, but the clinical signs vary widely by etiologies, and incidence and risk factors for each are uncertain. The purpose of this study is to clarify the current status of TMA after kidney transplantation.

Method

The subjects were 1,336 patients (5,425 biopsy specimens) who underwent kidney transplantation (851 ABO-compatible and 485 ABO-incompatible) at Japanese Red Cross Nagoya Daini Hospital and Masuko Memorial Hospital from January 1, 2000 to June 30, 2018. We investigated patient characteristics and graft survival in 69 patients with pathological findings of TMA (12 with symptomatic TMA and 57 with asymptomatic TMA) and 1,207 patients without findings of TMA. Sixty patients were excluded because of incomplete data or biopsy specimens. TMA patients with acute kidney injury (AKI) were defined as symptomatic TMA in this study.

Results

The incidence of post-transplant TMA was 5.2% (symptomatic TMA : 0.9%, asymptomatic TMA : 4.3%) in our cohort. Multivariate analysis revealed significant risk factors for TMA were presence of donor specific antibodies (DSA) and use of cyclosporine (odds ratio [OR] 3.52; 95% confidence interval [CI] 1.58-7.88; p=0.002 and OR 3.70; 95% CI 1.68-8.11; p=0.001, respectively). Causes of symptomatic TMA were ABMR : 66.7% (5 patients with ABO-incompatibility, 3 with preformed DSA), aHUS : 16.7%, cytomegalovirus and adenovirus infection : 8.3%, and causes of asymptomatic TMA were drug-induced: 40.4% (21 patients with calcineurin inhibitor, 2 with everolimus), ABMR: 31.6% (10 with ABO-incompatibility, 8 with de novo DSA), IRI : 14.0 %. Onset of post-transplant TMA was significantly associated with lower graft survival (Figure A), with a stronger correlation in symptomatic TMA than in asymptomatic TMA (Figure B and C).

Conclusion

TMA with AKI that occurred after kidney transplantation had a poor graft prognosis. Therefore, avoiding transplantation, changing donors or using tacrolimus instead of cyclosporine should be considered for patients with DSA or ABO-incompatibility.