bluuebunny/crossref_metadata_2025 huggingface dataset:
P1265INTRA-DIALYTIC RELEASE OF EXTRACELLULAR VESICLES (EVS) IS INDEPENDENT OF THE MODE OF DIALYSIS A COMPARISON BETWEEN STANDARD HEMODIALYSIS (SHD), COOL HD (CHD), LOW-VOLUME HEMODIAFILTRATION (LVHDF) AND HIGH-VOLUME HDF (HVHDF): THE HOLLANT STUDY
Authors: Rootjes Paul A , De Roij van Zuijdewijn Camiel , Nubé Menso J , Wijngaarden Gertrude , Nieuwland Rienk , Hajji Najat , Hau Chi , Grooteman Muriel
Published: June 2020

Background and Aims

Treatment with high-volume HDF is associated with a better survival than standard HD. The underlying mechanism is unknown, but may depend on a lower level of intra-dialytic tissue damage. We compared tissue injury, as measured by the release of EVs during four dialysis treatment modalities.

Method

Chronic hemodialysis (CHD) patients were included in an open, cross-over, randomized fashion (n=14). EV release was measured by a calibrated flow cytometer (Apogee A-60) after antibody labeling. EVs are defined as cell-derived particles with a diameter <1.000nm and a refraction index (RI) <1.42. Two HD modalities were studied: sHD, t dialysate 36,5°C (sHD) and cHD, t dialysate 35,5°C and two HDF modalities (t dialysate 36,5°C): lvHDF with a convection volume (CV) <15 L/session and hvHDF with a CV >23 L/session.To establish the cellular origin of EVs, EVs were labelled with (anti-) CD45 (leukocytes), CD62e (activated endothelial cells), CD62p (activated platelets), CD144 (vascular endothelial cadherin), CD61 (platelets), CD235a (erythrocytes) and connexin-43 (myocardial and endothelial cells), and with the general EV marker lactadherin. Differences between the 4 dialysis modalities were investigated by comparing pre- and post-dialysis and the delta (post- minus pre-dialysis) EV concentrations by Friedman’s test.

Results

As shown in the figures below, CD61, lactadherin and CD144 increased during the 4 modalities (1=sHD,2=cHD,3=lvHDF,4=hvHDF). The overall increase (sum of all modalities) in connexin-43. In Table 1, the concentrations of EVs before- and after dialysis are shown with a p-value for the difference (post- minus pre-dialysis). No significant differences were found in pre- and post-dialysis and delta EV concentrations between the 4 dialysis modalities (data not shown).

Conclusion

From this analysis the following conclusions can be drawn: 1) except for CD62e, which declined, all measured EVs increased significantly during dialysis (Table 1). 2) Although not all EVs increased similarly during the 4 modalities (Fig 1), in terms of tissue damage no modality appears more advantageous than the other.
P1270INCREASED SCLEROSTIN, BUT NOT DKK-1 PROTEIN, IS ASSOCIATED WITH ELEVATED PULSE WAVE VELOCITY IN HEMODIALYSIS SUBJECTS
Authors: STAVRINOU EIRINI , Sarafidis Panteleimon , Koumaras Charalampos , Loutradis Charalampos , Giamalis Panagiotis , Tziomalos Konstantinos , Karagiannis Asterios , Papagianni Aikaterini
Published: June 2020

Background and Aims

Sclerostin and Dickkopf-1 (Dkk-1) protein are inhibitors of the canonical Wnt/β-catenin bone pathway. Pilot data suggest that sclerostin may be involved in vascular changes in CKD, but data on Dkk-1 effects are scarce. This is the first study investigating simultaneously the associations of sclerostin and Dkk-1 with arterial stiffness in hemodialysis patients.

Method

80 patients on chronic hemodialysis had carotid-femoral pulse wave velocity (PWV), central BP and wave reflections evaluated with applanation tonometry (Sphygmocor) in a mid-week non-dialysis day. Serum levels of sclerostin and Dkk-1 were measured with ELISA. A large set of demographic, co-morbid, laboratory and drug parameters were used in the analyses.

Results

Subjects with PWV>9.5 m/sec (high arterial stiffness group, n=40) were older, had higher BMI, higher prevalence of hypertension, diabetes and coronary-heart-disease and higher peripheral SBP, central SBP, C- reactive protein and serum sclerostin (p=0.02), but similar Dkk-1 compared to subjects with low PWV. When dichotomizing the population by sclerostin levels, those with high sclerostin had higher PWV than patients with low sclerostin levels (10.63±2.71 vs 9.77±3.13, p=0.048). Increased sclerostin (>200 pg/ml) was significantly associated with increased PWV (>9.5 m/s) (HR:2.778, 95%CI:1.123-6.868, per pg/ml increase); this association remained significant after stepwise adjustment for Dkk-1, iPTH and calcium x phosphate product. In contrast, no association was noted between Dkk-1 and PWV (HR: 1.000, 95%CI: 0.416-2.403).

Conclusion

Serum sclerostin is associated with PWV independently of routine markers of CKD-MBD in hemodialysis patients. In contrast Dkk-1 has no association with arterial stiffness and is rather not pathophysiologically involved in relevant vascular changes.
P1284DIASTOLIC DYSFUNCTION IS A STRONG PREDICTOR OF MORTALITY IN DIALYSIS PATIENTS
Authors: Rista Elvana , Cadri Vilma , Akshija Ilir , Thereska Nestor , Strakosha Ariana , Barbullushi Myftar , Harja Endri
Published: June 2020

Background and Aims

The prevalence of cardiovascular disease in dialysis patients is quite high. This is the leading mortality cause and the main reason for hospital admissions in this population. Diastolic dysfunction is an important predictor of cardiovascular events.

The aim of this study is to calculate the prevalence of diastolic dysfunction (DD) and to identify any significant association of mortality and the grade of DD in chronic dialysis patients with preserved systolic function

Method

This is a prospective study of 310 consecutive patients who were enrolled from 2012-2019. All patients are dialysis dependent for chronic kidney disease (CKD) getting treatment at Nephrology-Dialysis &Transplantation Unit at Hygeia Hospital Tirana. LVH, diastolic dysfunction and cardiac valve pathology contributing to this were diagnosed by transthoracic echocardiography (TTE) criteria. DD was graded as: grade I (mild), grade II (moderate) and grade III (severe). The survival rate was analysed by Kaplan-Meier curves and Cox regression analysis.

Results

Mean age was 51.9±15.6 years; 62.6 % of pts were male, with a mean dialysis vintage of 49 months. 85 % of pts had preserved ejection fraction 50 % or more. LVH was observed in 79.1% of pts. LVED diameter (mm) 52±7 LVESd (mm) 33.7±6.8. Cardiac valve changes were diagnosed as follows: Aortic valve- 35% of patients resulted normal on ultrasound examination, 47% and 17% of pts had leaflet sclerosis and calcifications respectively with normal valve function. 25 % and 7% had some degree of aortic valve regurgitation and stenosis. Mitral valve examination resulted in 9% normal and in 84% of pts with some degree of regurgitation. Arterial hypertension was found in 95.1% of the patients. Diastolic dysfunction was detected in 55% of pts. Of them, 64.5% were deemed to have grade I diastolic dysfunction, 26.7% grade II, 8.7% grade III. During follow up, 25.5% of the patients with DD, died. The analysis of survival curve showed that grade III, 5.2 CI [3.86; 6.64], was associated with higher mortality compared with grade I 11.06 CI [10.01; 12.04] and grade II 11.65 CI [8.5; 14.8], p<0.001.

Conclusion

Diastolic dysfunction is ubiquitous echocardiography finding in patients treated with hemodialysis. Grade of diastolic disfunction tend to predict mortality of dialysis patients. 7-year survival analysis shows grade III to be associated with high mortality rates. A multidisciplinary approach is needed in order to predict, prevent and treat these conditions to improve outcomes.
P1293WARFARIN INCREASES THE RISK OF VASCULAR CALCIFICATION IN HAEMODIALYSIS PATIENTS: A MULTICENTER CASE-CONTROL STUDY
Authors: Eren Sadioğlu Rezzan , Üstüner Evren , Ergün İhsan , Ecder Tevfik , Nergizoglu Gökhan , Keven Kenan
Published: June 2020

Background and Aims

Vascular calcifications (VC) are highly prevalent in maintenance haemodialysis patients and it is a recognized risk factor for increased mortality. Previous experimental studies showed the relation between warfarin which has been prescribed frequently in dialysis patients and VC. The aim of this study is to investigate the association between VC and warfarin use in haemodialysis patients.

Method

This was a cross-sectional, observational, multicenter study. VC were assessed using Adragao (AS; pelvis and hands) and Kauppila (KS; lateral lumbar spine) scores in 76 haemodialysis patients from six centers. There were 32 patients (4.5%) being treated with warfarin for at least 1 year out of a total 711 haemodialysis patients and we included 44 control patients with matching parameters of age, sex and dialysis vintage to the study. Clinical characteristics, concomitant treatments, laboratory results were recorded and possible risk factors related to VC were analyzed.

Results

Of the patients, 47% were females, mean age was 65.8 ± 9 years, 23% were diabetics, their mean dialysis vintage was 68.39 ± 38.5 months and mean Kt/V 1.66 ± 0.27. No significant differences in clinical characteristics and basic laboratory results were found between control and warfarin group. In warfarin group, median Kauppila score was higher than control [11 vs 6.5, (25%-75% percentile, 5 vs 15), P=0.032] and percentages of Kauppila score >6 patients were higher, as well (76,6% vs 50%; P=0.029). Median Adragao score was not significantly different between two groups [7 vs 6, (%25,%75 percentile 6 vs 8), P=0.177]. Logistic regression analysis revealed that warfarin treatment was independently associated with Kauppilla scores of >6 (OR 3.28, 95% CI 1.17-9.22, P=0.024).

Conclusion

The results of this study showed that warfarin is a strong risk factor for vascular calcifications, especially in aorta of haemodialysis patients.
P1300CARDIOVASCULAR COMPLICATIONS IN HEMODIALYSIS PATIENTS
Authors: Fadwa Helaoui
Published: June 2020

Background and Aims

Cardiovascular complications are the leading cause of morbidity and mortality among dialysis patients. We aim to determine the cardiac damage showed by trans-thoracic ultrasound and to identify the various factors associated with it.

Method

Fourty chronic hemodialysis patients have benefited of transthoracic ultrasound during this year (2019). Clinical findings were collected from patients’ medical files. Data collected included demographics, Clinical Status and echocardiographic parameters. All the patients included in this study gave their consent. Data were collected and analysed using SPSS software. Chi-squared test with a level of significance of 0.05 was used for the qualitative variables.

Results

The mean age of our population is 53.1 (range: 26-78) with a sex ratio equal to 0.9. 72.5% of patients are hypertensive; 27.5% of patients are diabetic. Only 2 patients to be coronary. In this study, 11 patients remained asymptomatic while 29 patients (75.5%) presented with cardiac symptomatology: 39.7% complained of chest pain, 27.5% presented with acute dyspnea and 24,1% a pericardial rub. Rhythm disorders were objectified in electrocardiography in 3 patients (1 ventricular extrasystole and 2 cardiac arrhythmia by atrial fibrillation). Twenty percent of the cardiac ultrasounds performed are without abnormalities. Cardiac ultrasound revealed the presence of valvulopathies in 40% with 20% valve calcifications. Left ventricular hypertrophy is evident in 55% of patients, 45% of whom are hypertensive. Segmental hypokinesia was observed in 27.5% and pulmonary hypertension was observed in 37.5%. Cardiac ultrasound also showed dilated right cavities in 22.5% of cases and dilated left cavities in 32.5%. Dilatation of the inferior vena cava is observed only in 3 patients. Pericarditis is highlighted in 37.5% of which 36.3% are of medium abundance and 18.1% are of great abundance without signs of compression. Clinical data were correlated with echocardiographic findings. A correlation was found between left venticular hypertrophy and hypervolemia (p=0.001) and between perdialytic hemodynamic instability and ischemic cardiopathy (p=0.04) as well as pulmonary hypertension and vascular access dysfunction (p=0.02).

Conclusion

Cardiovascular complications are very common in chronic hemodialysis population. The left ventricular hypertrophy is the main cause of heart disease with predominance of high blood pressure as an associated comorbidity.
P1307HEMORRHAGIC VERSUS ISCHEMIC RISK IN PATIENTS WITH ATRIAL FIBRILLATION ON HEMODIALYSIS
Authors: Sousa Mariana , Bravo Pedro , Santos Cristina , Ramos Aura
Published: June 2020

Background and Aims

Patients with renal replacement therapy and atrial fibrillation (AF) have a particularly high risk of both stroke and bleeding, but no high-quality evidence-based recommendations exist to properly manage these patients. Therefore, we aim to evaluate the ischaemic versus the haemorrhagic risk in a hemodialysis (HD) population.

Method

We selected patients that started hemodialysis in our hospital between 2011 and 2015. Only incident patients that were on regular hemodialysis treatment for more than 3 months were considered. Both patients that already had AF before HD, or developed AF during the follow-up, were included. At the time of AF diagnosis or beginning of HD, the risk factors were analyzed based on CHA2 DS2 -VASC and HAS-BLED scores. The outcomes were hemorrhagic events (only the events that needed hospitalization were taken into account), ischaemic events (i.e. that result from embolic arterial ischaemia) and death related to any of these events.

Results

From 302 incident patients on hemodialysis, 46 (15.23 %) were included. Mainly man (65%), with a mean age of 75 ± 10 years old. Most of the patients (63%) already had AF when they started hemodialysis. There was no significant difference between the incidence of ischaemic and haemorrhagic events (p=0.219). Three patients died of an ischemic event and two of haemorrhagic shock.Twenty one patients (45.6%) started oral anticoagulation. No difference was found between the proportion of haemorrhagic events between patients with oral anticoagulation and patients with no anticoagulation (p=0.157). Similarly, oral anticoagulation was not associated with any effect on the incidence of ischaemic events (p=0.366). The results after adjustment for the risk factors included in the HAS-BLED and CHA2 DS2-VASC scores were the same.

Previous stroke, transient ischaemic attack or thromboembolic event significantly increased the risk of an ischaemic event, when adjusted to oral anticoagulation, age, diabetes, vascular disease and hypertension (OR 6.78, C.I 95% 1.236-37.278, p=0.028). This risk factor was not associated with an increase of haemorrhagic events. No other risk factor included in the scores was associated with any significant effect in the outcomes.

Conclusion

As we know, AF increases the risk of ischaemic events in general population. However, in hemodialysis patients, we didn’t observe any difference between the incidence of ischaemic and haemorrhagic events. Therefore, the benefit of oral anticoagulation in such patients remains questionable. It is worth noting that patients with previous stroke, transient ischemic attack or thromboembolic event seem to have higher risk of new ischaemic events. In these patients, there may be some advantage in oral anticoagulation. Since this is a single center, retrospective, observational study, these results should be interpreted with caution.
P1310STUDY OF RISK FACTORS AND PREVALENCE OF PULMONARY HYPERTENSION IN CKD 5D PATIENTS ON HEMODIALYSIS
Authors: Nagaraju Shankar Prasad , Paramasivam Ganesh , Prabhu Ravindra Attur , Rangaswamy Dharshan , Rao Indu Ramachandra , Shenoy Srinivas Vinayak , Bhojaraja Mohan V , Guddattu Vasudeva
Published: June 2020

Background and Aims

Pulmonary hypertension (PH) in chronic kidney disease stage 5D (CKD5D) patients on haemodialysis (HD) is associated with increased morbidity and mortality. We studied the risk factors and prevalence of PH in patients on HD at our centre. We also studied its association with oxidative stress and markers of inflammation.

Method

After ethics committee clearance, we conducted a cross-sectional study on CKD5D patients at our centre from June 2016 to May 2017. Patients on maintenance HD for at least 3 months were included. Demographic, clinical, biochemical and trans-thoracic echocardiography details were collected. PH was defined as estimated mean pulmonary artery pressure (mPAP) greater than 25 mm Hg at rest. PH was further categorized into mild (mPAP b/w 25-40mmHg), moderate (mPAP b/w 40-60mmHg) and severe PH (mPAP > 60mmHg). Serum thiol and C Reactive protein (CRP) were studied as markers of oxidative stress and inflammation respectively. Data was analysed using SPSS version 16.

Results

Out of 52 patients, 28 (54%) had PH. Twenty four out of these patients had mild PH (Figure 1). None had severe PH. The baseline characteristics of patients with and without PH are shown in Figure 2. No clinical or biochemical factors (p>0.05) were found as significant risk factors in our study. CRP (p-0.76) (inflammatory marker) and Thiol levels (p-0.36) (oxidative stress marker) did not had any relationship with occurrence of PH. (Table 1).

Conclusion

CKD 5D patients on HD have high prevalence of PH. There were no identifiable risk factors. The prevalence of PH was not influenced by dialysis vintage, ultrafiltration, paratharmone levels, presence of co-morbidities, oxidative stress or inflammation.
P1327STATUS OF AV FISTULA AFTER SUCCESSFUL RENAL TRANSPLANT ; A SINGLE CENTRE STUDY
Authors: Sengupta Pratim , Sasmal Tarpan , Biswas Sumanta
Published: June 2020

Background and Aims

Functioning AV-Fistula is considered the Achilles hill of ESRD patients. After successful renal transplantation considering the risk of graft failure or recurrence of disease all attempts are made to preserve the functional AV fistula except few clinical situations like high output cardiac failure, steal phenomenon or large aneurysm with risk of rupture where voluntary closure of AVF is preferred. Even with care and attention a significant number of AV-Fistula closes spontaneously. In this retrospective study we analyzed the fate of AVF after successful renal transplantation.

Method

The medical records 800 renal transplant recipients in last 15 years were analyzed with the objective to find out the outcome of AVF after transplant. Data were systematically charted and analyzed by SPSS V.23.01

Results

Out of 800 renal transplantation in last 15 years, excluding patients on CAPD or temporary catheter or AVgraft; 680 patients data were finally analyzed. Out of this 680 functioning AVF, 86 patients lost follow up and hence status of AVF could not be retrieved. Among rest 594 recipients, AV fistula was closed spontaneously in 184 cases (31.1%), and only 5 patients required planned AVF closure due to large aneurysm (2 cases), trauma and impending rupture (2 cases), cosmetic reason (1 cases). Incidence of spontaneous fistula closure was significantly higher among females than male recipients (p=0.001). Majority (62%) of the spontaneous closure occurred immediate post transplant period (within 7 days after transplant) and rest 26.4% within 1month and 9.2% in between 1 and 4 month. Only 2.4% fistula closed after 4 month of transplant. In the Tacrolimus era there is no significant difference in the rate of spontaneous closure with the patients who received cyclosporine (p=0.78). However among patient who received injectable cyclosporine the spontaneous closure was significantly higher (p=0.001). Factors which could be attributable to the rate of closure are, need of peripheral cannulation in perioperative period in the fistula arm (r2=0.89), operative time more than 2and half hr (r2=0.78), more than 2 unit of blood transfusion (r2=0.85) during operation and dialysis vintage through AVF less than 6 month (r2=0.77). There was no observed difference in rate of spontaneous closure among patients who received induction and who don’t (p=0.08). In subgroup analysis among induction with basiliximab or thymoglobulin there was no significant difference in spontaneous fistula closure (p=0.07).

Conclusion

Spontaneous closure of AV fistula observed in 31.1% patients with successful renal transplantation. It is more common in female recipients and 97.6% of spontaneous closure takes place within 4month of transplant. The factors which are attributable for spontaneous closure are cannulation in the fistula arm, injectable cyclosporine use, operative time more than 2and half hr, blood transfusion more than 2 units, during operation.
P1345CATHETER FAILURE AND MORTALITY IN HEMODIALYSIS PATIENTS WITH THE TUNNELLED-CUFFED CATHERTER TIP POSITIONED IN THE INFERIOR VENA CAVA
Authors: Cheng Lu , Gou Shen-Ju , Yi Jing , Ren Qian , Cui Tian-Lei , Fu Ping
Published: June 2020

Background and Aims

For patients with multiple central vein obstruction (CVO) and exhausted all options for arteriovenous accesses, how to establish a new effective vascular access is an urgent problem, and the key point to solve this problem is where to locate the tip of catheter. This study focused on these patients and investigated the safety and efficient of tunnelled cuffed catheter (TCC) with the tip placed in the inferior vena cava (IVC).

Method

Thirty-three maintenance haemodialysis patients with vascular access malfunction presented to West China Hospital of Sichuan University from March 2013 to December 2016 were included in this retrospective study and followed up until their catheter failure or death or until June 30, 2019. The short-term efficacy and safety of the procedure placing TCC tip in IVC were observed. The survival rates of TCC with catheter tip in IVC and patients were analysed.

Results

All thirty-three patients achieved adequate blood flow to complete the first session of haemodialysis after catheterization procedure and no obvious complications, such haemorrhage, arrhythmia and pulmonary embolism. The mean survival time of the TCC with catheter tip in IVC was 58.5 (95% CI 48.8–63.4) months by Kaplan–Meier analysis. The survival rates of TCC with catheter tip in IVC were 87, 83, 75, 71% in 1, 2, 3, 4 years, respectively. The highest incidence of catheter dysfunction was at 12 months after catheterization. The mean survival time of patients was 56.2 (95% CI 46.9–65.4) months by Kaplan–Meier analysis. The patient survival rates were 88, 82, 70, 67 % in 1, 2, 3, 4 years, respectively. The highest mortality was at 12 months after catheterization.

Conclusion

Our study suggested that placement of the tunnelled-cuffed catheter tip in the IVC was safety and efficacy in the end-stage haemodialysis patients who has exhausted vascular resources with CVO. The TCC with tip in the IVC was feasible to be a long-term vascular access for these patients.
P1367THE RELATIONSHIP OF SERUM PHOSPHORUS LEVEL AND ARTERIOVENOUS FISTULA DYSFUNCTION IN MAINTENANCE HEMODIALYSIS
Authors: Kim Hyung-Jong , Lee Mi Jung
Published: June 2020

Background and Aims

It is known that maintenance of function of arteriovenous fistula (AVF) is very important in the management of hemodialysis (HD) patients. Therefore, identifying a risk factor for decreased vascular access flow has a clinical relevance in real world practice. Although hyperphosphatemia plays a crucial role in the pathogenesis of vascular calcification, there is lack of studies evaluating the effect of hyperphosphatemia on AVF. This study investigated the impact of serum phosphorous (P) on vascular access flow in HD patients.

Method

Sixty-two maintenance HD patients who visited dialysis unit of Bundang CHA Medical Center from November 2016 to December 2017 were included in this study. Serum P levels were determined every month and time-averaged serum P was calculated. All patients had left arm AVF (side to side anastomosis) and vascular access flow was assessed by Transonic HD 03. Decreased vascular access flow was defined as less than 600 mL/min.

Results

The mean age was 57.9 ± 12.1 years, 32 patients (51.6%) were men. The mean serum P levels were 5.1 ± 1.1 mg/dL and the vascular access flow was 1,071.4 ± 504.2 mL/min. Decreased vascular access flow was observed in 14 of 62 patients (22.6%). In univariate analysis, higher serum P was significantly associated with decreased vascular access flow (odds ratio [OR]=2.089, 95% confidence interval [CI]=1.159-3.766, P=0.014). But there was no significant association of dialysis blood flow rate, ejection fraction on echocardiography and serum calcium (Ca) levels with vascular access flow. Multivariable analysis indicated that higher serum P was independently associated with greater risk of decreased vascular access flow (OR=4.012, 95% CI=1.651-9.711, P=0.002). Old age, reduced EF, low dialysis blood flow rate and higher serum Ca was not associated with vascular access flow.

Conclusion

This study demonstrated that higher serum P was the independent risk factor for decreased vascular access flow in maintenance HD patients. Serial monitoring of serum P may be helpful to stratify the risk of vascular access dysfunction in these patients.
P1396EFFECT OF MIXED VERSUS ANIMAL-BASED LOW PHOSPHORUS DIETS IN DIALYSIS PATIENTS ON INTACT FGF23 LEVELS: A RANDOMIZED CLINICAL TRIAL
Authors: Ramirez-Sandoval Juan C , Atilano-Carsi Ximena , Sánchez-Silva Jorge , Arce-Santander Celene , Cruz Cristino , Basulto-Sosa Pamela , Tamez-Pedroza Luis , García de León Miguel , Espinosa-Cuevas Ángeles , Correa-Rotter Ricardo
Published: June 2020

Background and Aims

The FGF23-lowering effect of different phosphate-sources (vegetable versus animal) in low-phosphorus diets are scarcely known. In this trial, we assess the effect on intact FGF23 (iFGF23) of two low-phosphorus diets, animal versus mixed (vegetable + animal), in dialysis patients.

Method

A randomized, two-center, open-label, clinical trial was performed. Subjects on stable dialysis for >6 months with P>4.5 mg/dL were randomized into a mixed-based (3 ounces equivalent of animal protein + 3 ounces equivalent of legumes) vs. animal-based (6 ounce equivalent of animal protein) low phosphorus diet with equivalent nutrients (phosphorus <1000 mg/day; protein=1.3 g/kg/day). The primary outcome was the difference in serum iFGF23 change (ELISA) after 12 wks. We excluded patients who modified their dialysis dose, phosphate binder, or vitamin D prescription during trial.

Results

556 subjects were screened, only 57 subjects (37 hemodialysis[HD] and 18 peritoneal dialysis[PD]) were randomized. Age, sex, phosphate-binders use, and other baseline characteristics were similar between groups. Baseline iFGF23 levels were 7394 (IQR 2379-16629) and 6859 (1543-17521) ng/mL in mixed-based and animal-based groups respectively (p=0.62). Both groups had a significant decrease in iFGF23 after 12 weeks of intervention (iFGF23 change: -285 [IQR -3002 to 227] ng/mL, p<0.001, and -182 [IQR -9323 to 228] ng/mL, p<0.001); there were not significant differences in iFGF23-decrease between both diets (Figure, p:0.78). Serum phosphorus in the mixed-based and the animal-based declined by -0.66 (95% confidence interval [95% IC], -1.39 to -0.04] mg/dL and -0.21 (95% IC -0.81 to 0.38) respectively (p=0.14). There was a trend between the decrease in observed phosphorus and iFGF23 (rho = 0.265, p=0.058). There were no differences between groups in the change of serum Ca, albumin, PTH, and other biochemical parameters.

Conclusion

Dietary phosphorus restriction for 12 weeks with animal-based or mixed-based phosphorus sources similarly decreases iFGF23 concentration in HD or PD patients.
P1429EVALUATION OF PARATHYROIDECTOMY IN PERSISTENT HYPERARATHYROIDISM AFTER RENAL TRANSPLANTATION: A SINGLE-CENTER RETROSPECTIVE STUDY
Authors: Zhang Ping , Lu Hulin , Chen Jianghua
Published: June 2020

Background and Aims

To investigate the efficacy of parathyroidectomy (PTX) in the treatment of persistent hyperparathyroidism (PHPT) after renal transplantation and the effect of PTX on renal allograft function.

Method

This single-center retrospective study enrolled 31 patients who underwent PTX for the treatment of PHPT after renal transplantation in the Kidney Disease Center of the First Affiliated Hospital of Zhejiang University from May 2010 to Oct. 2018. The changes of serum calcium, serum phosphorus, alkaline phosphatase, parathyroid hormone(PTH), serum creatinine, and estimated glomerular filtration rate (eGFR) in the preoperative and postoperative periods (1w, 1m, 3m, 6m,12m) were compared. The operative successful rate (12 m) and postoperative complications were calculated.

Results

The serum calcium before PTX was (2.78±0.18) mmol/L, which decreased significantly to (2.19±0.34) mmol/L at 1 week postoperatively (P<0.01). The serum phosphorus before PTX was (0.76±0.16) mmol/L, which decreased significantly to (0.97±0.26) mmol/L at 1 week postoperatively (P<0.01). The PTH before PTX was (276.00±200.60) pg/mL, which decreased significantly to (46.62±104.36) pg/mL at 1 week postoperatively (P<0.01). The alkaline phosphatase before PTX was (261.59±236.95) U/L, which decreased significantly to (154.90±117.37) U/L at 3 months postoperatively (P<0.01). No significant difference was found in postoperative serum creatinine or eGFR levels compared with the baseline. The operative successful rate was 90.3% at 12 months postoperatively. The incidence rates of postoperative transient hypocalcemia, persistent hypoparathyroidism, and hoarseness were 35.5%, 3.2% and 3.2% respectively. No persistent hypocalcemia, incision hemorrhage, incision infection, or surgery-related death happened.

Conclusion

PTX can quickly and effectively alleviate high calcium, low phosphorus, high PTH and high alkaline phosphatase after renal transplantation. PTX is effective and safe in the treatment of PHPT after renal transplantation, and has no effect on renal allograft function.
P1458CONSERVATIVE MANAGEMENT VERSUS DIALYSIS IN ESKD PATIENTS WITH HIGH COMORBIDITY AND FRAILTY
Authors: Oliveira João , Tavares Joana , Sala Inês , Freitas Joana , Santos Lascasas Josefina , Cabrita António
Published: June 2020

Background and Aims

ESKD population is increasingly older, frail and with cumulative comorbidities. Conservative management (CM) is a valid approach in selected cases but less well studied than the dialytic or transplant treatment. The objective of our study was to characterize our CM population and compare it with those who induced dialysis.

Method

We present a retrospective study from a tertiary hospital, from 2014-2019. A total of 379 patients presented with dialytic indication at hospital admission and out of these 15.3% (G1, n=58) were managed conservatively. They were characterized using the modified Charlson comorbidity index (mCCI) and Clinical Frailty Scale (CFS). A survival comparison was made between CM population (G1), those who were placed on dialysis (G2, n=321) and a subset of these (G3, n=43) who were older (≥75 years) and with higher level of disability (CFS >4 and mCCI > 4).

Results

CM population was older (G1 vs G2 p <0.01, G1 vs G3 p <0.5), more frail (G1 vs G2 p <0.01, G1 vs G3 p <0.44), and with a higher comorbidity index (G1 vs G2 p <0.01, G1 vs G3 p <0.06). The option for CM was based on the existence of comorbidities associated with less than 6 month survival (n=13, 22.4%), functional detriment (n=33, 56.9%), cognitive status (n=15, 25.9%) or self-choice (n=12, 20.7%); 10.3% (n=6) already had an autologous vascular access implanted. There is a statistically significant (p<0.01) survival benefit among those who begin dialysis even among the subgroup G3. The comparative survival rates between G1 and G3 was 19% (n=11) vs 86% (n=37) at 3 months, and 1.7% (n=1) vs 60.5% (n=26) at 1 year, respectively (p<0.01).

Conclusion

In our study, dialysis prolonged survival for elderly ESKD patients with significant comorbidity and frailty. The choice between modalities was not an unmodifiable decision as evidenced by the number of patients in the CM group who had a vascular access. Despite these results we still believe that CM is an appropriate treatment option for whom dialytic therapy or transplantation is not expected to bring out benefit. A future focus on quality of life, psychosocial impact, and symptom burden, is needed to establish the true benefits of dialysis in these population.
P1469HOW LONG ELDERLY ESRD PATIENTS CAN UNDERGO DIALYSIS TREATMENT?; A NATIONWIDE POPULATION-BASED COHORT STUDY
Authors: Yang Yu Mi , Lee Seung Woo , Kwon Soon Kil , Nam Sang Won , Kim Hye-Young , Cho Hyunjeong , Kim Sun Moon
Published: June 2020

Background and Aims

Elderly population is increasing and the age starting dialysis treatment is also increasing.

It could be an ethical issue that we should do or not do start dialysis treatment in the oldest old people such as 10th decade.

We investigated duration of dialysis therapy via patients age using National Health Insurance calim data to know dialysis survival of patients via their age.

Method

Korean National Health Insurance Database was used and excerpted data from the insurance claim of ICD code of dialysis. We included all new patients starting dialysis more than 3 months between 2004 and 2013 and compared dialysis duration among the age group.

Patients on dialysis before 2003 were excluded, and patients on kidney transplantation were also excluded.

Results

Total 208,202 dialysis patients were included via dialysis insurance calim code from about 50,000,000 South Korean population during the year 2003 to 2015. 126,448 patients were excluded due to dialysis before 2003, < 3 months of dialysis duration, kidney transplatation, and to have missing data.

Among the final 81,754 patients, 73,969 were hemodialysis and 7,785 were peritoneal dialysis. 47,798 were men and 33,956 were wemen.

Observed median dialysis duration of each aged group of 20-40, 41-50, 51-60, 61-70, 71-80, 81-90, and >90 were 5.4 (2.2 - 18.3), 5.0 (1.8 - 17.7), 4.2 (1.5 - 15.1), 3.5 (1.2 - 12.6), 2.7 (0.9 - 10.1), 1.8 (0.5 - 7.1), 1.3 (0.3 - 4.9) years, respectively (p < 0.0001).

Comparing with age under 40, dialysis survival hazard ratio of > 40, > 50, > 60, > 70, > 80, and > 90 were 1.493, 2.452, 3.762, 6.113, 9.787, and 15.326, respectively (p < 0.0001). Survival probability of the patients by the age was demonstrated in the figure 1.

Lowest socio-econonic status and highest Charson-Comorbidity group showed highest hazard ratio of dialysis mortality, and peritoneal dialysis showed longer dialysis duration (HR 0.704, 95% CI of 0.69 - 0.74, p < 0.0001).

Conclusion

We concluded that dialysis durability by the age was rapidly decreased after 70 years old. As the longest patients survival of > 90 years were less than 5 years, we should consider patients’ general performance when starting dialysis of oldest old patients.
P1478LOWERING PREVALENCE OF ALKALOSIS AND IMPROVING ADHERENCE TO BICARBONATE TARGETS AMONGST HAEMODIALYSIS PATIENTS THROUGH THE USE OF REDUCED DIALYSATE BICARBONATE
Authors: Tulley Caroline , Hull Richard , Ford Martin
Published: June 2020

Background and Aims

There is evidence that metabolic alkalosis in haemodialysis patients is harmful. Bommer et al demonstrated association between extremes of bicarbonate and clinical outcomes with significantly increased risk of mortality and hospitalisation with pre-dialysis serum bicarbonate >27mmol/L and <17mmol/L. No overall increased mortality risk was observed with moderate pre-dialysis acidosis (serum bicarbonate 19.1-23.0mmol/L).

2015 Renal Registry Data demonstrated 64.3% of haemodialysis patients overall had bicarbonates within target (18-24mmol/L) compared to 65.7% within our centre. Our reported mean pre-dialysis bicarbonate of 23.7mmol/L was above the mean serum bicarbonate 23.2mmol/L seen nationally. In addition, 33.7% of patients were alkalotic, with bicarbonates >24mmol/L. Given concerns of adverse patient outcomes with extremes of bicarbonate, we aimed to investigate whether reducing our dialysate bicarbonate would culminate in overall attainment of bicarbonate targets.

Method

Mid-week pre-dialysis bicarbonate levels were measured from in centre haemodialysis patients once monthly, from May to August 2017, across 7 dialysis units within our renal service. Following this, in early 2018, we reduced dialysate bicarbonate concentration from 32mmol/L to 31mmol/L. Monthly midweek pre-dialysis bicarbonate levels were then re-measured in March and April 2019.

Results

Initial analysis of 2103 pre-dialysis bicarbonate levels across May to August 2017 demonstrated median monthly bicarbonate levels of 24.0–25.0mmol/L. 40.7–54.2% (n=199-322) were alkalotic with pre-dialysis bicarbonates >24mmol/L across this period. Of note, 15-23% (n=66-120) had bicarbonate levels associated with increased mortality and hospitalisation (i.e. <17mmol/L or >27 mmol/L.

Subsequent analysis of 1070 bicarbonate levels in March and April 2019 demonstrated a reduction in median pre-dialysis bicarbonate to 22.0mmol/L. Similarly, the proportion of alkalotic patients fell to 11.9–15.3% (n=71-91). 5-9% (n=26-46) bicarbonates were <17 or >27mmol/L. In March 2019, 77.9% of patients had serum bicarbonates in target range compared to 65.7% reported in 2015 overall.

Conclusion

Initial findings demonstrated substantial alkalosis amongst our dialysis population. A simple measure of altering dialysate by 1mmol/L achieved reductions in overall alkalaemia, and in turn, reduced the percentage of patients with bicarbonate values theoretically correlating with increased mortality and hospitalization risk.

We have demonstrated that a small change in dialysate bicarbonate increased concordance with bicarbonate targets, without subsequent increased acidaemia. The extent to which adherence with such targets impacts on patient survival and morbidity remains an ongoing debate.
P1483INCIDENCE TRENDS IN CHRONIC DIALYSIS: AN IMPORTANT ASPECT, STILL UNDER-REPORTED
Authors: Mancini Elena , Santoro Antonio , Registro Emilia Romagna Gruppo di Lavoro
Published: June 2020

Background and Aims

Whereas the progressive increase in the incidence of advanced age patients on chronic dialysis is widely described, the incidence trend concerning younger age patients, a potentially useful datum for the health services programming, has been little investigated.

Method

The Regional Dialysis Registry of Emilia-Romagna (a region in the north of Italy, near 4,460,000 inhabitants) has been active for 24 years. We analysed the changing incidence in dialysis over time, as a function of 6 different age brackets (excluding the extreme ages, <20 and >90, due to the small numbers involved).

The study considered only hemodialysis patients, not peritoneal dialysis, due to small numbers, and in order to collect data from a more homogeneous population.

For each year from 1994 to 2017, we extracted the percentage incidence on dialysis of each age bracket [(number of cases per bracket/overall number of incident patients)%].

We then carried out a correlation analysis as a function of time.

Results

The incidence on dialysis turned out to change over time with statistical significance in each one of the age brackets except 70-80. The incidence-time association was positive for the brackets 70-80 and 80-90, and negative for the remaining age brackets (Table 1).

A scissor-like trend appeared evident when comparing the most advanced ages with the youngest ones (Figure 1).

Conclusion

Besides the well-known increase in old patients on chronic dialysis, it should be noted that, on the contrary, younger patients have tended to decrease significantly, at least in our Region. Even bearing in mind the limits of a Registry study, these data may support the value of health programs for the early diagnosis of nephropathy, because prompt pharmacological treatment (at least for glomerular or post-infective, or congenital/hereditary diseases) could reduce the attainment of ESRD and account for the results observed in the lower age-brackets.
P1488RECOVERY OF LOW TRIIODOTHYRONINE CAN IMPROVE MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Lee Hong Joo
Published: June 2020

Background and Aims

Low circulating triiodothyronine (T3) levels are the most frequently encountered thyroid functional test derangement in end-stage renal disease (ESRD) patients on hemodialysis. Low T3 is known as independent predictive value for all-cause mortality and, particularly, for cardiovascular-related death in patients with ESRD on hemodialysis. This study investigated that recovery of low T3 level to normal can lower mortality in ESRD patients on hemodialysis.

Method

We have constructed the 500 K-cohort of ESRD patients attending the hemodialysis center of 6 tertiary hospitals of South Korea to evaluate the mortality of the ESRD patients since 2016. From this prospective cohort, we invited patients with ESRD from June 2016 to May 2019 The participants were divided into four groups based on the change of the T3 level: normal group showed the normal T3 continuously, low group showed the low T3 continuously, recovery group showed the low T3 change to normal and decrease group showed the normal T3 change to low. We evaluate relationships between change of the T3 level and mortality. Statistical analysis was carried out by using SPSS. 

Results

Of the total 500 patients in K-cohort, 333 patients were enrolled with detailed thyroid hormone profile including T3 level. 167 (50.2 %) patients out of the 333 patients showed low T3 level initially. Normal group include 126 patients(37.8%), low group include 135 patients(40.5%), recovery group include 32 patients(9.6%) and decrease group include 40 patients(12.0%). Patients with the low T3 level were older and more diabetic compare to those with normal T3 level. They had lower K-MMSE score than the others, Low T3 group had lower free T4 level but thyroid stimulating hormone(TSH) showed no significant different comparing normal T3 group. The mortality of normal group was lowest and that of decrease group was highest. The mortality of recovery group recovered to similar with that of the normal group and mortality of decrease group was highest. Lowering of T3 level would affect to mortality than low T3 level continuously.

Conclusion

Therefore, the change of T3 level is significantly associated with the mortality. Recover lower T3 to normal level can lower the mortality.
P1489HEPATITIS B AND C IN DIALYSIS UNITS IN ALMATY
Authors: Yespotayeva Arina , Kabulbayev Kairat , Gaipov Abduzhappar , Amreyeva Zauresh , Mursalova Zhanar
Published: June 2020

Background and Aims

Patients getting maintenance haemodialysis (HD) are at higher risk for acquiring Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections than the general population. Strict infection control measures are essential to prevent nosocomial transmission. We aimed to investigate the incidence and prevalence of HBV and HCV infection in the HD population of Almaty dialysis units as well as risk factors for infection.

Method

All adult patients getting maintenance HD (n=700) in Almaty dialysis centres (n=4) were studied between May 2016 and December 2019. Testing for Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies was performed at initiation of dialysis and every 3–6 months thereafter. Serological markers for HBV and HCV were determined with immunoenzymatic assay (ELISA).

Results

Participant median age was 40 years and 58% were male. 110 patients (34.9%) were sero-positive for HBV and/or HCV (anti-HCV positive 31.1%; HBsAg positive 2.6%; both positive 1.2%). Of the sero-positive patients 4.7% were known to be infected before the initiation of HD. The prevalence of HBV±HCV infection varied widely between HD centres from 0% to 75.9%. Sero-positive patients were younger, had longer time on dialysis and more previous blood transfusions. Wide variation in rates of newly acquired infections was observed between dialysis centres. All new HBV cases were referred from centres already treating HBV infected patients. New HCV infections were reported in most centres but the rate of HCV sero-conversion varied widely from 1.5% to 31%. Duration of dialysis, history of previous renal transplant and history of receiving HD in another centre in Almaty were significantly associated with sero-conversion. Major risk factors identified by a standard questionnaire in 302 of 270 patients were the number of blood transfusions individuals had received and duration of dialysis, the latter including patients who received no blood transfusions

Conclusion

HBV and HCV prevalence in our HD patients is still high. These data emphasize the need for stricter adherence to infection control, barrier precaution and preventive behaviors with all patients. In summary, the prevalence of HBV and HCV in our HD patients is still high. These data emphasize the need for stricter adherence to infection control, barrier precaution and preventive behaviors with all patients.
P1491INTRADIALYTIC HYPOTENSION AND PROGOSIS IN HEMODIALYSIS PATIENTS
Authors: Takenaka Yuto , Kishi Satoru , Nishio Kyosuke , Masaki Kazunobu , Hashiba Toyohiro , Huruse Satoshi , Mise Naobumi , Ogura Yoshiyasu
Published: June 2020

Background and Aims

The aim of this study was to investigate the prognostic impact of intradialytic hypotension (IDH).

Method

This study comprised 237 hemodialysis patients (158 males, 64±13 years old, dialysis vintage:110±88 months) in a community-based dialysis center. IDH was recorded in 12 consecutive hemodialysis sessions from February to April in 2014. The patients were divided into 2 groups: Group A, patients with IDH, and Group B, those without IDH, and all-cause mortality rates for 4 years were examined. IDH was defined as a rapid symptomatic fall of systolic blood pressure by at least 30 mmHg or that required medical intervention. Logistic regression was used to investigate the association between IDH and mortality.

Results

IDH was observed in 123 patients (52 %). The frequency of IDH was 3.8±3.1 times during 12 hemodialysis sessions in Group A. Mortality rates from all causes of death were significantly higher in Group A than in Group B (40 % and 17 % at 4 years, respectively, p < 0.05). Univariate analysis showed that IDH, age, female, dry weight, ultrafiltration rate (UFR), serum albumin level, and serum hemoglobin level were significantly associated with all-cause mortality. In multivariate analysis, IDH, age, UFR, and serum hemoglobin level were independent risk factors for all-cause mortality (Table).

Conclusion

In our population, IDH was associated with a poor prognosis at 4 years.
P1500SEASONAL VARIATIONS AND VARIATIONS DUE TO OTHER CAUSES IN CLINICAL AND LABORATORY PARAMETERS IN HEMODIALYSIS PATIENTS
Authors: KAWAHARA KAZUHIKO
Published: June 2020

Background and Aims

In hemodialysis patients, seasonal variations and changes in dialysis prescription affect laboratory data, blood pressure, and body weight. We examined whether these fluctuations were due to seasonal variations or other causes. Although there are some reports on seasonal changes in hemodialysis patients, there are few reports on observations over multiple years in the same stable patients.

Method

We studied 65 patients on hemodialysis (36 males and 29 females; average age, 67.7 years; average duration of HD therapy, 13.8 years). The observation period was three years from January 2016 to December 2018; laboratory data and dialysis-related indicators, blood pressure, dry weight, and interdialysis weight gain were examined retrospectively. We excluded cases with dialysis time less than 4 h and patients who were hospitalized during the observation period. Differences in statistical analysis were tested with repeated-measures ANOVA or Friedman test.

Results

Factors that showed an influence on the laboratory parameters in hemodialysis patients more than twice in the same season in the three-year observation period were serum urea nitrogen (UN), serum creatinine (Cr), serum potassium (K), serum inorganic phosphorus (IP), and serum total bilirubin (T-Bil), serum creatine kinase (CPK), serum glycoalbumin (GA), normalized protein catabolic rate (nPCR), % creatinine production rate (% CGR), systolic blood pressure (sBP), diastolic blood pressure (dBP), and inter-dialytic weight gain (p<0.05). In contrast, the serum albumin concentration (Alb), serum magnesium (Mg), serum parathyroid hormone-INTACT (iPTH), and standardized dialysis amount of urea (KT/Vurea) exhibited gradual changes during the observation period (p<0.05).

Conclusion

There were indeed seasonal variations with UN, Cr, K, IP, T-Bil, CPK, GA, nPCR, %CGR, sBP, dBP, and inter-dialytic weight gain. However, Alb, Mg, iPTH, KT/Vurea changed owing to dialysis prescription and medicines.