bluuebunny/crossref_metadata_2025 huggingface dataset:
MO859: Factors Affecting Immune Response to Hepatitis B Vaccination Among Chronic Hemodialysis Patients in Saudi Arabia
Authors: Belarbia Anis , Ekrikpo Udeme , S. Moussa Ayman , Dridi Afef , Jubran Ibrahim , Alobaili Saad , Alahmadi Salwa , Albadr Wisam
Published: May 2022

BACKGROUND AND AIMS

It is well established that patients on chronic hemodialysis (HD) have an increased risk of hepatitis B virus (HBV) infection and reduced response to HBV vaccines compared with the general population.1 While advances in immunology and vaccinology have evolved several HBV vaccine modifications to enhance immunogenicity2; there is need to identify modifiable clinical factors that may help enhance response to HBV vaccines in the chronic HD population. This multi-center study aims to document the response to HBV vaccine among chronic HD patients across DaVita centers in Saudi Arabia and to identify the factors that independently affect the response of HD patients to the HBV vaccine.

METHOD

Patients eligible for HBV vaccination among our patient cohort who had received a full course of HBV vaccination (Engerix-B®, GlaxoSmithKline, United Kingdom) in all DaVita Clinics in Saudi Arabia were included in the analysis. We excluded patients who did not complete the vaccine protocol or had missing data and who were treated by immunosuppressive drugs. Levels of the antibody to the surface antigen (anti-HBs) were measured about 2 months after the last dose of the vaccine using enzyme-linked immunoassay methods. The age (in years), dialysis vintage, hepatitis C infection, diabetic status, mean albumin, parathyroid hormone (PTH), ferritin and hemoglobin levels 2 months prior to and during the 6 months of completing the vaccination protocol were recorded. Response to HBV vaccine was recorded as ‘no response’ if anti-HBs was < 10 mIU/L; ‘weak response’ if the anti-HBs level is between 10–99.9 mIU/L, and ‘good response’ when ≥ 100 mIU/L. Univariate and multivariate ordinal logistic regression models were used to identify the factors independently associated with response to HBV vaccine.

RESULTS

We had 509 patients with a mean age of 54.1 ± 15.1 years, 252 (49.5%) being female. Diabetes mellitus was the etiology of kidney failure in 60.5% of the patients. Most (91.1%) had concomitant hypertension and 4.3% were positive for hepatitis C virus infection. BMI was at least 30 kg/m2 in 26.1% of the study population. Immune response occurred in 374 {73.5%, [95% confidence interval (95% CI) 69.4–77.3%]}. Good response occurred in only 53.1% (95% CI 48.6%–57.4%). The factors independently associated with response to HBV vaccination were age, mean albumin, PTH, ferritin levels and BMI (Table 1). Diabetic status and Kt/v did not predict vaccine response.

CONCLUSION

A complex interaction of inflammatory markers, nutritional status, bone mineral disease parameters affects the response to HBV vaccines. Improving chronic dialysis patients’ albumin and PTH levels may increase the likelihood of achieving a good response to HBV vaccines.
MO864: Sleep Disorders in a Haemodialysis Unit
Authors: Laura Fuentes Sanchez Maria , Jimenez Salcedo Tamara , Vázquez Teresa , Ruiz-Esteban Pedro , Hernández Domingo
Published: May 2022

BACKGROUND AND AIMS

There is a high prevalence of sleep disorders in patients with CKD. Sleep apnea, restless legs syndrome and daytime sleepiness are much more common in haemodialysis patients than the general population.

OBJECTIVE

To know the prevalence of sleep problems in patients in our hospital haemodialysis unit through surveys carried out on patients.

METHOD

We designed a cross-sectional study on the prevalence of sleep disorders.

Exclusion criteria age under 18 years.

We gave 4 questionnaires to the patients in our unit: restless legs, Epworth daytime sleepiness, Berlin and Pittsburg Sleep quality.

We collected demographic and clinical variables, dialysis parameters and laboratory data that could be related.

Student's t-test and X-squared were applied for qualitative variables. SSps Version 15.0.

RESULTS

Of those surveyed, 12 had criteria for restless leg syndrome. The difference between ferritin and CRP among the RLS group was striking. Excessive daytime sleepiness is met in 10 patients. Only the CRP values were significantly higher in the group with the normal test. When associating the Epworth test and the Berlin questionnaire, we had a total of 3 patients with high risk of OSAS. 15 patients meet the criteria for poor quality of sleep in the Pittsburg questionnaire where we assess: quality, latency, efficacy and duration of sleep as well as use of medication and daytime impairment.

CONCLUSION

Highlight the high prevalence of sleep disorders: 24% restless leg syndrome, 20% daytime sleepiness and 30% with poor sleep quality.

We must assess sleep disorders in haemodialysis patients since they present a significant deterioration in quality of life.
MO881: Predictors of Mortality of COVID-19 in Haemodialysis Patients
Authors: Rista Elvana , Cadri Vilma , Saliaj Kristi , Akshija Ilir
Published: May 2022

BACKGROUND AND AIMS

The COVID-19 pandemic has disproportionately affected patients with pre-existing comorbidities, particularly dialysis patients. These patients appear to be more susceptible to severe forms of the infection, due to underlying, coexisting pathologies and their immunocompromised status. The aim of this study was to determine predictors of mortality in this population.

METHOD

We conducted an observational, retrospective, cohort study collecting data from the electronic medical records of a single dialysis centre at Hygeia Hospital Tirana, Albania. Baseline patient characteristics, including demographic, clinical and laboratory data were recorded. The receiver operating characteristic (ROC) analysis was used to determine predictors of mortality, their respective sensitivity, specificity and cut-off values.

RESULTS

Of 170 haemodialysis patients, 52 were diagnosed with COVID-19. The prevalence of COVID-19 infection in haemodialysis patients in our study was 30.5%. The mean age was 61.5 ± 12.3 years and 65.4% were men. The mortality rate in our cohort was 19.2%. Mortality rates were higher in patients with Diabetic Nephropathy (P < 0.04) and Peripheral Vascular Disease (P < 0.01). High BMI (P < 0.024), high RDW (P < 0.03), elevated C-reactive protein (P < 0.018) and elevated serum ferritin (P < 0.021) levels, were found to be risk factors for severe COVID-19 disease. ROC analysis identified lymphopenia and eosinopenia as the strongest predictors of mortality. AUC for lymphopenia was 0.739. It showed a sensitivity of 80% and a specificity of 85.7%, at a cut-off value of 13.15%. AUC for eosinopenia was 0.814. At a cut-off value of 0.185%, it revealed a sensitivity and specificity of 72.7% and 75%, respectively.

CONCLUSION

Our study revealed that risk factors for the development of severe COVID-19 infection were high BMI, high RDW, elevated levels of C-reactive protein (CRP) and serum ferritin. Lymphopenia and eosinopenia were determined as the most important predictors of mortality, in our cohort. Early recognition during the course of the infection, of a declining tendency of lymphocyte and eosinophil counts is paramount, in identifying high-risk patients for severe disease and poor outcomes among haemodialysis patients.
MO887: Humoral Response to the Pfizer BNT162b2 Vaccine Booster Dose in Patients Undergoing Maintenance Hemodialysis
Authors: Cohen Hagai Keren , Shashar Moshe , Nacasch Naomi , Shitrit Pnina , Grupper Ayelet , Erez Daniel , Sela Yaron , Benchetrit Sydney
Published: May 2022

BACKGROUND AND AIMS

COVID-19 is associated with increased morbidity and mortality in maintenance hemodialysis (MHD) patients. Recent breakthrough infection in vaccinated people has led some authorities to recommend a booster dose to patient fully vaccinated 5–8 months ago. The recent emergence of the Omicron (B.1.1.529) variant has heightened this issue.

We aimed to assess, the humoral response following a booster dose with the BNT162b2 vaccine in MHD patients.

METHOD

The study included 102 MHD patients vaccinated with 2 doses of the BNT162b2 (Pfizer-BioNTech) vaccine. A third dose (booster) was recommended to all MHD Patients in our center and was given to all patients that opt to receive it, resulting in a booster group and a control group that did not receive the booster. Previous exposure was excluded by testing for the presence of the Anti-Nucleocapsid Antibody (SARS-CoV-2) or positive PCR. We assessed the humoral response before and after the booster dose.

RESULTS

98.5% (65/66) subjects in the booster group developed a positive antibody response (472.7 ± 749.5 to 16 336.8 ± 15 397.3 AU/mL) as compared with a sustained decrease in the control group (n = 22, 695.7 ± 642.7 to 383.6 ± 298.6 AU/mL), P < 0.0001 (Figure 1). No significant adverse effects were reported. Prior antibody titers were positively correlated to IgG S1 levels following the booster dose. There was a significant association between malnutrition-inflammation markers and the humoral response.

CONCLUSION

The vast majority of MHD patients developed a substantial humoral response following the booster dose administration, it was significantly higher than levels previously reported for MHD patients following administration of 2 doses alone. Further studies and observations are needed in order to determine the exact timing and dosing schedule.
MO907: Predictors of Negative Outcomes in HDF-OL Patients: A Cohort Study
Authors: Zaria Iana , Gurevich Konstantin , Plavinsky Svyatoslav , Stuard Stefano
Published: May 2022

BACKGROUND AND AIMS

Haemodiafiltration on-line (HDF-ol), an effective mode of replacement therapy for stage 5 chronic kidney disease (CKD 5D), cannot be considered sufficiently studied in terms of its effect on the outcomes. Our main aim was to identify a possible association between individual anthropometric, laboratory data and parameters of the prescribed treatment regimen with the best survival rate when using the HDF-ol mode.

METHOD

A retrospective1 year analysis of the EuCliD database of 9986 patients treated with HDF-ol in 27 Fresenius Medical Care centres in Russia was carried out. All patients got post-dilution HDF-ol procedures at least 3 times a week, for at least 12 h a week with Kt/V at least 1.4. Data on alive (9616) and deceased (370) patients were compared by gender, age, treatment experience, body weight (BW), body mass index (BMI), body surface area (BSA), total body water volume (TBW), volume of urea distribution (V Urea BCM), presence of diabetes mellitus (DM), ischemic heart disease (CHD), chronic heart failure (CHF), as well as parameters of the procedure: effective weekly dialysis time, Kt/V, effective infusion volume (EIV) and effective convection volume (ECV).

RESULTS

Differences in groups were found only for a part of parameters (Table 1).

CONCLUSION

Association of risk of death in patients with CKD 5D treated with HDF-ol included male gender, older age, concomitant diseases (CHD, CHF, DM), lower BW and BMI, shorter effective weekly dialysis time, lower values of EIV and ECV, Kt/V, higher values of hypercalcemia, hypoalbuminemia, lower haemoglobin levels, higher levels of b2-microglobulin and CRP. Such indicators as TBW, VUrea BCM, BSA and the length of treatment on dialysis did not reached statistical significance when comparing alivе and deceased patients.
MO911: Prevalence of SARS-COV-2 Cellular and Humoral Immunity in Dialysis Patients After 8 Months of Vaccination Campaign in Portugal
Authors: Duarte Rui , Luz Ivan , Ferrer Francisco , Gonçalves Hernâni , Lopes Karina , Sofia Flora , Vila Lobos Ana
Published: May 2022

BACKGROUND AND AIMS

Immunization of dialysis dependent patients remains the single most important protective approach in prevention of serious COVID-19 infection. This study aims to characterize the prevalence of humoral and cellular immunity in maintenance dialysis patients (MDP) in a Nephrology Centre, 8 months after vaccination onset.

METHOD

A single-center cross-sectional study enrolling patients on peritoneal (PD) and haemodialysis (HD) from a public-funded Portuguese Nephrology Centre. This study evaluated both humoral and cellular immunity to the COVID-19 vaccination. Humoral response was measured as specific IgG (S-RBD IgG), and cellular response as T-cell reactivity through IFN- γ quantification as response to antigen (IGRA). Further demographic and clinical variables were obtained to assess the risk factors of low immunity.

RESULTS

Of the 86 patients enrolled, 79.4% and 84.1% showed humoral and cellular immunity, respectively. Quantitatively, IgG S-RBD titers correlated with specific T-cell reactivity (ρ = 0.58, P < 0.001). Vaccination before dialysis initiation was associated with an absent cellular response (P = .006). Subgroup analysis associated high comorbidity burden (quantified through the Charlson comorbidity index) and low serum albumin levels as predictors of immunity (P < 0.05, variable). PD patients showed lower cellular response (297.1 mUI/mL versus 695.4 mUI/mL, P = 0.03) at 8 months following BNT162b2.

CONCLUSION

The prevalence of humoral and cellular immunity against SARS-CoV-2 in vaccinated Portuguese MDP is high. Vaccination in imminent pre-dialysis patients, high comorbidity burden and low serum albumin are some of the identified risk factors for absent immunity. PD-associated effector memory T-cell changes are suggested as contributing to the difference verified in cellular response.
MO912: Different Immunogenicity of Previous SARS-COV-2 Infection or Comirnaty Vaccine (BNT162B2, BioNTech/Pfizer) in Haemodialysis Patients
Authors: Gembillo Guido , Edoardo Giuffrida Alfio , Labbozzetta Vincenzo , Siligato Rossella , Spallino Eugenia , Sposito Giovanna , Ferlazzo Guido , Cuzzola Felicia , Lipari Antonella , Calabrese Vincenzo , Santoro Domenico
Published: May 2022

BACKGROUND AND AIMS

The pandemic emergency deriving from the SARS-CoV-2 infection has made it necessary to find effective strategies to preserve high-risk populations with severe comorbidities like haemodialysis patients. Adequate vaccination coverage is of vital importance, representing the main weapon to counter the spread of the virus.

The purpose of our study was to evaluate the antibody response of our dialysis patients vaccinated with the Comirnaty-BioNTech/Pfizer vaccine in comparison with those with previous infection.

METHOD

We retrospectively analysed 52 patients referried to the Dialysis Unit of University Hospital G. Martino, Messina, from 2020 to 2021. Of these, 41 patients had never contracted SARS-CoV-2 (group A), while 11 patients had contracted the infection (group B). Serum samples were taken before vaccine administration, 3 months and 6 months after administration. A linear mixed model was performed on the measurements to analyse the difference in antibody response, comparing the values ​​of neutralizing IgG and anti-COVID-19 antibodies during time (Fig. 1).

RESULTS

The results showed a statistically significant higher titre of anti-spike antibodies in patients with a previous infection (P = 0.003), with a stronger association at 6 months after infection. The linear mixed model showed a significant association over time between infection and antispike (ln U/L) in the univariate model, which was confirmed in the multivariate model {adjSlope: 2.9, [95% confidence interval (95% CI) 1.3–4.6]; P =.001}. No other variables were related to antispike.

CONCLUSION

These findings can raise novel questions on the role of natural immunity and antibody titre in the haemodialysis population.
MO917: Self-Reported Perceptions of Haemodialysis Patients´ Cognitive State––The Goodrenal Project
Authors: Mesa-Gresa Patricia , Elena Marin Alexandra , Avesani Carla , Clyne Naomi , Garcia-Testal Alicia , Kouidi Evangelia , Van Craenenbroeck Amaryllis , Antonio Lozano-Quilis José , Lindholm Bengt , Yang Kevin , Kougioumtzidou Ourania , Cana-Poyatos Alicia , Moscoso Paula , Moura Reboredo Maycon , Lauer Andreas , Segura Eva
Published: May 2022

BACKGROUND AND AIMS

Patients with chronic kidney disease have an increased risk of developing cognitive impairment and neurocognitive disorders including Alzheimer's disease that affect their quality of life. Changes involve deterioration of domains such as learning and memory, language, attention, executive function, perceptual motor or social cognition. We explored the subjective perception that the patients have regarding their cognitive state.

METHOD

This study is part of the GoodRENAL project, which is funded by the European Community Erasmus + and involves four countries: Belgium, Greece, Spain and Sweden. Exploratory questionnaires regarding patients’ cognitive state were answered by 38 patients (mean age 58 ± 0.5 years; 50% women) randomly allocated to this study from the dialysis shifts. The questionnaire had 10 questions with answers rated as 1 (never), 2 (sometimes), 3 (half of the time), 4 (more than half of the time) and 5 (almost all the time), plus 1 open question about main barriers, difficulties or needs related to their cognitive state.

RESULTS

To analyse the descriptive data, the response frequency was grouped into items based on the frequency of the occurrence (almost all the time and all the time). The table below summarizes answers received from patients.

CONCLUSION

The patients’ perception of their attention capacity, memory function and learning capacity was in general positive. However, further studies using validated questionnaires regarding different aspects such as attention, memory or learning functionality are needed to confirm these findings.
MO938: Variability of Serum Phosphate in Incident Hemodialysis Patients: Association With All-Cause Mortality
Authors: (Janice) Ye Xiaoling , Ter Meulen Karlien , Usvyat Len A , Van Der Sande Frank , Konings Constantijn , Kooman Jeroen , Kotanko Peter , Maddux Frank
Published: May 2022

BACKGROUND AND AIMS

In maintenance hemodialysis, both low and high serum phosphate levels are related to patient outcomes. We aimed to further explore the relation between serum phosphate (P) variability and all-cause mortality.

METHOD

All adult incident hemodialysis patients treated in U.S. Fresenius Kidney Care clinics between January 2010 and October 2018 were included. The first 6 months on hemodialysis were defined as baseline, months 7–18 as the follow-up period. All-cause mortality was recorded during follow-up. We quantitated variability as directional range (DR), a metric that describes during baseline the difference between the largest and the smallest value; the DR is positive when the smallest value precedes the largest; otherwise, the DR is negative. Cox proportional hazards models with spline terms were applied to explore the association between DR and SD of serum P and all-cause mortality. Additionally, tensor product smoothing splines were computed to study the interactions of P with the DR and SD of P and their joint associations with outcomes. All analyses were adjusted for demographics, comorbidities and nutritional parameters.

RESULTS

A total of 281 356 patients were included, 258 741 patients were studied. The average age was 62.3 years, 58% were males, 68% were diabetic, 10% with COPD and 25% with CHF. Baseline mean serum P was 5.07 mg/dL, the median DR was + 1.7 mg/dL and the median SD was 0.97. Our results indicate that both higher and lower levels of DR are associated with a higher risk of mortality (Fig. 1). With higher levels of serum P, both lower (negative) and higher levels of DR of serum P were associated with a higher risk of mortality (Fig. 2). In patients with lower levels of serum P, a negative level of DR is associated with a high mortality risk, while the association is attenuated in patients with higher (positive) levels of DR (Fig. 2). On all levels of serum P, higher SD is associated with a higher risk of mortality.

CONCLUSION

Stable serum P levels between 4 and 6 mg/dL are associated with the best outcomes. Negative DR of serum P is associated with particularly high HR for all-cause mortality in the presence of serum P levels <3 mg/dL, possibly because patients are generally malnourished or inflamed, and a further reduction of serum P indicates nutritional deterioration. Serum P > 8 mg/dL is associated with increased all-cause mortality, irrespective of DR.
MO960: Sarcopenia: An Overlooked Diagnosis in Kidney Transplant Recipients
Authors: Gül Özcan Şeyda , Sonmez Ozge , Akman Zafer , Karaca Cebrail , Atli Zeynep , Trabulus Sinan , Seyahi Nurhan
Published: May 2022

BACKGROUND AND AIMS

Sarcopenia is characterized by an involuntary loss of skeletal muscle mass, strength, and function and is usually associated with older age. However, sarcopenia may also be seen at younger ages in patients with chronic kidney disease. The European Working Group on Sarcopenia in Older People (EWGSOP) recently proposed a standardized definition of sarcopenia. We aimed to investigate the incidence of sarcopenia and associated factors in renal transplant recipients.

METHOD

We examined consecutive adult (age >18 years) renal transplant recipients under regular follow-up in our outpatient clinic during December 2021. We assessed the muscle strength with a handgrip test using a dynamometer and with a chair stand test. Using the Sergi formula, we used bioimpedance analysis to estimate the appendicular skeletal mass. Finally, we measured the gait speed to assess physical performance. Probable sarcopenia was defined as the presence of low muscle strength. Following that, sarcopenia was diagnosed with low muscle quantity in patients with probable sarcopenia according to the revised criteria by the EWGSOP. We retrieved the clinical and laboratory data from the patients’ medical records.

RESULTS

We recruited a total of 93 kidney transplant recipients (mean age: 59 ± 1.4, male gender 58.1%). About 15.0% of the patients were cadaveric transplants. Probable sarcopenia was found in 31 patients (33.3%), of which 14 (15.0%) were diagnosed with sarcopenia. Diabetes mellitus and lower albumin levels were the significant factors associated with the presence of probable sarcopenia (P = 0.01, P = 0.015, respectively; Table 1). On the other hand, sarcopenia was significantly associated with cadaveric transplantation (P = 0.02; Table 2).

CONCLUSION

We found that probable sarcopenia and sarcopenia were highly prevalent in our relatively young renal transplant recipients. We recommend active screening for the presence of sarcopenia in renal transplant recipients, especially in the cadaveric ones.
MO966: Elective JJ Stent Removal (Ejjr) in Kidney Transplantation: is Routine Ultrasound (US) Useful?
Authors: Haridian Sosa Barrios R. , Burguera Vion Víctor , Viera Ramírez Elizabeth , Eduardo Villa Hurtado Daniel , Galeano Álvarez Cristina , Elías Triviño Sandra , Martin Irene , Fernandez Lucas Milagros , Rivera Maite
Published: May 2022

BACKGROUND AND AIMS

Transplantation (KTx) is considered the best renal replacement therapy nephrologists can offer and improving its outcomes remains a primary challenge in our field. KTx ureteral JJ stenting has been used to prevent urological complications, but there is no consensus about its elective removal timing and literature regarding routine US imaging after EJJR to detect complications is lacking. Our aim was to define the incidence of urological complications diagnosed by routine US after EJJR in KTx, determine US utility and best time interval to perform it.

METHOD

We retrospectively analyzed all routine KTx US performed in our Unit from 2016 until 2020 by an experienced interventional nephrologist. US post EJJR findings were compared with previous patient US. KTx characteristics, treatment and outcomes were recorded.

RESULTS

CONCLUSION

Routine US after EJJR allowed a timely diagnosis and early treatment of urological complications, a key factor for successful transplantation.

KTx US is a cost-effective and reproducible test that provides crucial information to guide clinical decisions, being most efficient when performed 10 days post elective removal. Interventional nephrologists could do this examination promptly.
MO970: Humoral Response After Successive Doses of Mrna Vaccine Against Sars-Cov-2 in Stable Kidney Transplant Recipients
Authors: Manuel Cazorla López Juan , Villanego Florentino , Trujillo Soto Teresa , Antonio Rodríguez Iglesias Manuel , Mazuecos Auxiliadora
Published: May 2022

BACKGROUND AND AIMS

The poor humoral response after vaccination against SARS-CoV-2 in kidney transplant (KT) patients led to the approval of a third dose. Recent data show an increase in the antibody titer, although lower than in the general population. Our aim is to analyze the humoral immune response after the third dose a mRNA vaccine against SARS-CoV-2 and the evolution of the antispike antibody (antiS) titers in KT recipients.

METHOD

We performed a prospective cohort study of stable KT patients from our center who received three doses of a mRNA vaccine from March to November 2021. KT recipients with less than 6 months after transplantation and with active oncological or hematologic disease were excluded. We determined antiS titers (Abbott SARS-CoV-2 IgG chemiluminescent microparticle immunoassay) at baseline, one month after the second dose and one month after the third one. We compared those KT patients who seroconverted with 2 and with 3 doses of vaccine and those who did not seroconvert. To identify risk factors for no seroconversion, a logistic regression analysis was carried out.

RESULTS

We included 83 KT. Mean age was 59.3 years and 62.7% were male. The median time from KT to the first vaccine dose was 94 months and between the second and third dose median time was 4 months. Seroconversion rate was 63.8% after 2 doses and 85.5% after the third one (P  < 0.001). Twelve KT did not develop antibodies (Table 1). Patients who did not seroconvert were older (P = 0.047), had a worse renal function (P = 0.009) and had fewer lymphocytes than those that developed antibodies (0.013). Besides, they almost half of them received a KT from a non-heart-beating donor (P = 0.026) and were treated with thymoglobulin in the 2 years prior to the vaccine more frequently (P = 0.007). In patients who seroconverted after 2 doses, we observed a 10-fold increase in the antiS titer after the third vaccine (82 [34–350] UI/mL versus 814 [205–2415] UI/mL; P  < 0.001). No patients had neither acute rejection nor serious adverse effects. In the multivariable analysis advanced age, a worse kidney function and recent treatment with thymoglobulin were risk factors for no seroconversion (Table 1).

CONCLUSION

The third dose of a mRNA vaccine against SARS-CoV-2 significantly increased the seroconversion rate and the antiS titers in stable KT patients. Advanced age, poorer kidney function and immunosuppressive treatment are risk factors for no seroconversion.
MO992: Is It Safe to Receive Kidneys from Deceased Kidney Donors Who Tested Positive for Covid-19 Infection?
Authors: Kaies Ibrahim Elsayed Ali Hatem , Mohamed Mahmoud , Briggs David , Krishnan Nithya
Published: May 2022

BACKGROUND AND AIMS

Our modern world is facing extraordinary circumstances while passing through a serious pandemic caused by the novel coronavirus (COVID-19) which may lead to multi-organ system failure and death. COVID-19 deaths may provide a potential source for kidneys available for transplantation. In our study, we are discussing the safety of receiving kidneys from donors who tested positive for the novel coronavirus.

METHOD

All renal transplant recipients registered in UNOS database who had their transplants between 1 March 2020 and 1 June 2021 were retrospectively reviewed. Patients who received kidney transplants from a deceased donor with positive PCR of COVID-19 test were included in our study. Patients were followed up till 1 July 2021. Data about recipient factors (age, sex, ethnicity, diabetes and date of renal transplant), transplant factors (type of induction therapy, maintenance immunosuppressive therapy, delayed graft functions, early post-operative rejection episodes, HLA mismatch, PRA level and cold ischemia time) and donor factors (age, sex, ethnicity, diabetes, hypertension, date of COVID-19 test and type of COVID-19 test) were collected. Outcome measured were post-transplant hospitalisation, acute rejection, delayed graft function, patient, and graft survival till the end of the follow-up.

RESULTS

Eighty-six transplant patients received kidneys from deceased donors who tested positive for COVID-19 infection using PCR test. Sixty patients received kidneys from deceased patients who tested positive for COVID-19 within 30 days pre-transplant. Twenty-six patients received kidneys from deceased patients who tested positive for COVID-19 between 30 and 90 days pre-transplant. Number of post-transplant hospitalisation and acute rejection episodes were nil. 19.76% of the patients had delayed graft functions. Graft loss occurred in one patient due to graft vein thrombosis. Patient survival was 100%.

CONCLUSION

Receiving kidneys from deceased donors who tested positive for COVID-19 infection seems safe and does not affect hospitalisation, acute rejection rates, graft or patient survival. Longer follow-up is needed to confirm our results.
MO995: Survival Benefits of Kidney Transplantation for Waitlisted Patients in the Contemporary Era
Authors: Chaudhry Daoud , Peracha Javeria , Sharif Adnan
Published: May 2022

BACKGROUND AND AIMS

BACKGROUND. Kidney transplantation is recognised as the treatment of choice for people living with kidney failure who are suitable for surgery. However, with evolving donor-recipient characteristics, survival benefits attributed to kidney transplantation warrants validation in the contemporary era. Therefore, this national cohort study aimed to examine survival of waitlisted hemodialysis-maintained kidney failure patients from the last two decades, comparing those who proceed with transplantation versus those who did not.

METHOD

A retrospective cohort study was undertaken of prospectively collected registry data of all waitlisted kidney failure patients receiving hemodialysis in the United Kingdom. From 1 January 2000 until 30 September 2019 inclusive, all patients listed for their first single kidney transplant were included. The primary outcome was mortality, with survival analysis conducted according to the intention-to-treat principle. Time-to-death from listing was modelled using weighted estimation of Cox regression to account for non-proportional hazards.

RESULTS

A total of 40 887 waitlisted kidney failure patients formed the study cohort, of whom 31 037 (75.9%) underwent transplantation. Transplant recipients were younger with lower proportion of females, minority ethnics, and diabetes. In a weighted Cox regression model, mortality risk was higher within 30 days of surgery, risk equivalent between 31 and 180 days with survival benefit thereafter. Hazard ratios for mortality within 1 year (HR: 0.575, 95% CI: 0.531–0.623, P< 0.001) and 1–5 years (HR: 0.129, 95% CI: 0.116–0.143, P  < 0.001) of surgery favor transplantation. Survival benefit was retained for every donor type in sub-group analysis, but no survival benefit was observed for patients aged ≥70 within 5 years of transplant surgery.

CONCLUSION

In the contemporary era, kidney transplantation remains the superior treatment modality for waitlisted kidney failure patients from a survival perspective but not among older recipients.
MO1020: Alkaline Phosphatase to Prevent Ischemia Reperfusion Injury in Living Kidney Transplantation—A Safety Pilot Study
Authors: van Duin Robert , Steenvoorden Thei , Vogt Liffert , van der Heijden Joost , Rood Janneke
Published: May 2022

BACKGROUND AND AIMS

Ischemia-reperfusion injury (IRI) during kidney transplant procedures can induce acute kidney injury (AKI) [1]. Extracellular ATP is a key player of pro-inflammatory processes during IRI in the kidney [2], whereas conversion of ATP into adenosine has protective effects to the kidney. Alkaline phosphatase (AP) is the only enzyme that converts ATP directly into adenosine by dephosphorylation[3]. In earlier clinical trials of AP in sepsis-associated AKI (SA-AKI), it was suggested that AP has a protective effect on endogenous creatinine clearance and mortality [4]. With the pathophysiologic similarity between SA-AKI and IRI, we aimed to evaluate the effect and feasibility of periprocedural AP to improve kidney function in living donor kidney transplantation.

METHOD

We conducted a pilot, phase II, double-blinded and randomized controlled trial comparing medicinal AP (tradename: `bRESCAP’, courtesy Alloksys Life Sciences) and placebo. All consecutive recipients of living donor kidneys were asked for informed consent. After randomization, intravenous AP (bolus 1000IU and 9000IU continuously) or placebo was administered at the start of the procedure and continued for the following 24 h. Graft function was measured with measured GFR (using an iohexol distribution curve) after 12 months. Plasma creatinine and a panel of novel injury biomarkers and systemic inflammation markers were measured in both urine and serum during the 7 days after the procedure. Drug reactions and adverse events (AEs) were monitored in the first 7 days. Secondary outcomes included all-cause mortality and dialysis dependency.

RESULTS

Between June 2019 and October 2019, 11 patients were enrolled. Patients did not differ between groups, bRESCAP (n = 5) and placebo (n = 6) at baseline: 36% were male; the median age was 58 [interquartile range (IQR) 40–65] years; and the median eGFR 12 (10–15) mL/min/1.73 m2. After 1 year, median measured GFR was similar in the bRESCAP group [52.2 (40.5–61.4)] and placebo group [52.4 (37.6–66.1)] (P = 1.000). Mixed model analysis showed no difference in the fall of plasma creatinine or cystatin-C over the first 7 days after the procedure. There were no adverse events observed in the bRESCAP group.

CONCLUSION

These pilot data indicate that bRESCAP can be administered safely but offers no benefits to recipients of kidneys from living donors. This study opens the way to study recipients of kidneys from deceased donors, where IRI plays a much more prominent role and frequently leads to delayed graft function.
MO1026: Performance of Creatinine and Cystatin-Based Estimates of GFR in Paediatric Kidney Transplant Recipients. Comparison of the CKD-EPI Age- Adjusted Creatinine eGFR with Previous Formulas
Authors: Vilaça Joana , Ferreira Ana , Luisa Carvalho Ana , Cohombo Josefa , Tavares Joana , Rocha Liliana , Teixeira Ana , Costa Liane , Matos Paula , Costa Teresa , Do Sameiro Faria Maria , Conceição Mota Maria
Published: May 2022

BACKGROUND AND AIMS

Estimation of glomerular filtration rate (GFR) is essential for renal function evaluation and the surveillance of kidney transplant recipients. We aimed to compare the GFR estimation by different formulas using creatinine and/or cystatin C, in paediatric kidney transplant recipients and to compare the chronic kidney disease-epidemiology collaboration (CKD-EPI) equation with age-adjusted creatinine values for height-independent estimated GFR (eGFR) calculation. We also intend to evaluate the impact of body mass index (BMI) influence on eGFR.

METHOD

Data on paediatric renal transplant patients (n = 35) with stable graft function for more than 6 months post-transplantation were enrolled. eGFR was calculated using the revised Schwartz (bedside Cr), CKD-EPI (Cr), CKiD (CysC), Zappitelli (CysC), combined Schwartz (Cr/CysC) and combined Zappitelli (Cr/CysC) formulas. The estimation by CKD-EPI formula used age and sex-adjusted creatinine values to adult levels with 40 as assigned age (CKD-EPI40).

RESULTS

A total of 35 patients were included, 26 (76%) were male, with a median age of 16 (4–18) years and a median BMI of 21.27 (15.20–32.29) with a Z-score median of 3.26 (2–5). The median eGFR obtained by the Schwartz [64.39 (23.96–115.16) mL/min/1.73 m2] and by the CKD-EPI40 equation [64.99 (13.98-141.80) mL/min/1.73 m2] was similar (P = .176). When compared with the Schwartz estimation, Cys-based eGFR were significantly lower (by CKiD-CysC, 49.48 (25.47–84.68) (P < .001), by Zappitelli formula 51.31 (24.74–92.61) (P < .001), by combined Schwartz 51.37 (24.07–85.31), (P < .001), by combined Zappitelli 54.83 (20.64–109.68).The correlations between eGFR by all formulas were strong and statistically significant, especially between the combined Schwartz and the combined Zappitelli (r = 0.97). The same pattern of differences between the eGFR estimations was observed when BMI groups (normal versus overweight) were analysed separately, with all formulas being significantly different for Schwartz except for CKD-EPI.

CONCLUSION

As expected, formulas with creatinine were similar to each other but significantly different when compared with formulas that included cystatin. As demonstrated in previous studies, the combined formulas appear to be the closest estimates of the GFR calculated by exogenous methods. Thus, estimates that consider only creatinine may overestimate the GFR. The eGFR obtained by the adjusted CDK-EPI formula is similar to that obtained by the Schwartz bedside, unlike the other formulas. In this study, we did not find differences regarding the BMI, probably due to the number of this sample.
MO1032: Assessing the Effectiveness of Ready Steady Go—Peeer Project Youth Work in Meeting the Psychosocial Needs of Children and Young People
Authors: Nagra Arvind , Shameti Sarah , Stubbs Eleanor , Gilbert Rodney , Haq Mushfaquar , Anderson Caroline , Preka Evgenia , Recio-Saucedo Alejandra , Darlington Anne-Sophie
Published: May 2022

BACKGROUND

Studies show that young people (YP) with chronic kidney disease do less well than their well peers in terms of mental health and employability. In the UK 30% of YP on renal replacement therapy have mental health issues compared to 15% of the general population and more are unemployed compared with their well peers. Many of the issues start in childhood as studies show that children with chronic kidney disease have significant psychosocial issues including:

To address these issues, we developed the PEEER project to help improve Patient Empowerment, self-Esteem, Employability and Resilience.

Pre-coronavirus disease (COVID-19) PEEER youth worker support was delivered face-to-face (F2F) in a 1:1 setting or group sessions in the hospital, youth spaces, or educational settings.

With the onset of lockdown due to the COVID-19 pandemic from 23 March 2020 PEEER youth worker support was adapted to be delivered virtually on the ZOOM platform to meet the needs of CYP.

AIMS

To assess the effectiveness of PEEER youth work project in meeting the psychosocial needs of children and young people with kidney disease when delivered virtually compared with F2F.

METHOD

Group 1: Pre-COVID-19 lockdown: 1 January 2020–23 March 2020 CYP and their families received youth worker support F2F. Group 2: During COVID-19 lockdown: 23 March 2020–31 December 2020 youth work was delivered virtually.

CYP in Groups 1 and 2 received 1:1 sessions, fun group activities and workshops. Feedback was collected on the effectiveness of these sessions.

RESULTS

CYP: Group 1 n = 105. Group 2 n = 639. In Group 2 there was a 102% increase/month in CYP accessing PEEER events. In both Groups, 100% said they enjoyed the sessions, would like to attend future sessions. CYP in both Groups felt part of a friendship group, said the sessions allowed them to socialize with their peers. CYP in both Groups felt more confident, more independent and good about themselves. (See Table 2.)

CONCLUSION

PEEER youth worker support is effective and can meet the psychosocial needs of CYP when delivered virtually and F2F. More work is needed on a hybrid approach of F2F and virtual delivery.
MO1040: Idiopathic Nephrotic Syndrome After 10 Years of Age: Is Systematic Renal Biopsy Appropriate?
Authors: Smith Anna , Dossier Claire
Published: May 2022

BACKGROUND AND AIMS

Renal biopsy (RB) is recommended at diagnosis for children presenting with isolated nephrotic syndrome (NS) after the age of 10–12 years, unlike in younger children, because of a higher frequency of other diagnoses than MCD or FSGS. Recent reports, local practices and new serological biomarkers for membranous nephropathy now question this approach. Therefore, the objective of our study was to evaluate the causes of NS and indications for RB in a population-based cohort of adolescents with NS.

METHOD

We conducted a retrospective multicenter study, including children aged 10–18 years diagnosed with Idiopathic-like NS between December 2007 and June 2020 in 35 paediatric and 3 paediatric nephrology (PN) departments of the Paris area (NEPHROVIR network) and patients with Idiopathic-looking NS biopsied in the three PN departments.

RESULTS

A total of 103 children were included (54 males). The mean age at diagnosis was 13.4 ± 2 years. A renal biopsy was performed in 76 patients: at presentation because of atypical symptoms (such as hypertension, macroscopic haematuria, organic renal failure) in 15 or for no other reason than age in 39 and after 4 weeks for steroid resistance +/– atypies in 22 patients. Histological findings were MCD (n = 49), FSGS (n = 13), mesangial proliferation (n = 3), membranous nephropathy (n = 6) and IgAN (n = 5). 

CONCLUSION

NS was secondary in only 11% of adolescents presenting with Idiopathic-like NS, and first-line treatment with oral prednisone was appropriate in all cases.  In addition, more than 40% of RB could have been avoided in steroid-sensitive NS patients. Finally, we propose that RB should only be performed in case of atypical clinical or biological history or steroid resistance after 4 weeks, as in the younger population.
MO1043: Influenza Vaccine Awareness and Acceptance Among Individuals with Glomerulonephritis and Renal Vasculitis During the Corononavirus Disease 2019 Pandemic
Authors: Lim Cynthia , Hong Liew Zhong , Zhuan Tan Hui , Mok Irene , Jie Leeu Jun , Choo Jason
Published: May 2022

BACKGROUND AND AIMS

Patients with glomerulonephritis may have an increased risk of influenza infection and morbidity, but vaccine coverage remained low with little data on acceptance in glomerulonephritis. We aimed to assess influenza vaccine awareness among patients with glomerulonephritis and identify determinants of vaccine acceptance.

METHOD

Single-center cross-sectional study of patients with glomerulonephritis who completed a survey in the clinic or over the telephone between June and August 2021. Sociodemographic data, health literacy measured by HLS-EU-47 questionnaire, influenza and the coronavirus disease (COVID-19) vaccine awareness and determinants of vaccine acceptance according to the World Health Organization framework.

RESULTS

Among 86 patients who completed the survey, influenza vaccine awareness was lower than COVID-19 vaccine awareness (75.6% versus 100%). After adjusting for the survey type, use of English language at home and at healthcare settings, higher income and professional or executive occupation were significantly associated with influenza vaccine awareness, while older age and lower education level were associated with reduced awareness. The healthcare provider was the most frequent information source and > 90% trusted that healthcare providers and the government considered the patients’ best interests and gave correct information. Only half thought their medical condition and medications would affect their vaccine decision while a quarter to half did not understand how the vaccine worked and thought there were better ways to protect against infection.

CONCLUSION

Healthcare providers can actively identify and advocate influenza vaccines to the unaware and overcome potential barriers to reduce influenza infections and morbidity in glomerulonephritis.
MO1055: Effect of Duration of Adjuvant Chemotherapy for Patients with Colorectal Cancer on the Deterioration of Glomerular Filtration Rate
Authors: Gładyś Aleksandra , Kozak Sylwia , Gisterek Iwona , Chudek Jerzy
Published: May 2022

BACKGROUND AND AIMS

Six-month adjuvant chemotherapy (CTH) is the current standard of care in locally advanced colorectal cancer (CRC). Recent studies have shown that shortening the treatment to 3 months results in moderately worse (0%–4% difference) overall survival. A longer duration of CTH may pose a risk of nephrotoxicity. We aimed to assess the effect of the duration of adjuvant CTH for CRC on kidney excretory function.

METHOD

We retrospectively studied medical records of 96 patients aged 38–83 (51% males) treated with adjuvant CTH for CRC. Patients underwent CTH either with regimens containing oxaliplatin and 5-fluorouracil/capecitabine (FOLFOX—31.3%; or XELOX—18.8%) or regimens containing 5-fluorouracil only (5-FU/LV; 50%). Glomerular filtration rate (calculated with the CKD-EPI formula) was analysed in three time points: before CTH, after 3 and 6 months of therapy. The deterioration of eGFR by 1.5 mL/min/1.73 m2 or more after 3 months and by 3 mL/min/1.73 m2 or more after 6 months was considered clinically significant.

RESULTS

We observed a clinically significant loss of eGFR after 3 months in 56.3% of patients. The risk of eGFR loss after 3 months was not related to gender, CTH regimen, clinical stage, initially low eGFR or comorbidities (P > 0.05). However, the clinically significant loss of eGFR was related to age (mean age 65.1 versus 61.3 years without eGFR loss; P = 0.03).

Two-thirds (66.8%) of all patients were assessed in a 6-month time point. In this group, a significant eGFR loss was present in 42.4% of cases. Similarly, eGFR deterioration after 6 months was not related to proposed risk factors such as gender, CTH regimen type, clinical stage, low eGFR or comorbidities (P < 0.05), but was associated with age (mean age 66.3 versus 60.9 years without eGFR loss; P = 0.04). We observed a significant deterioration of eGFR more frequently in patients treated with 5-FU/LV regimens than with FOLFOX or XELOX (P = 0.03). However, patients, who underwent CTH with 5-FU/LV were older (P < 0.001), had lower initial eGFR (P = 0.02) and had hypertension more often (P = 0.03) than patients treated with oxaliplatin-containing regimens.

In 92.9% of patients with significant eGFR loss after 6 months, we were able to observe rapid eGFR loss earlier, in a 3-month time point. However, one-third (31.6%) of patients with significant eGFR loss after 3 months did not present it after 6 months (P < 0.001). In patients with significant loss after 3 months, further deterioration after the next 3-month period occurred in 8 cases (21.1%), with a mean loss of 7.7 mL/min/1.73 m2.

CONCLUSION

Adjuvant CTH for CRC may cause a rapid loss of eGFR. The assessment of eGFR after 3 months of CTH is a predictor of further eGFR decline. Further investigation is needed to conclude if the shortage of CTH duration from 6 to 3 months may be beneficial for older patients in the context of nephrotoxicity.