bluuebunny/crossref_metadata_2025 huggingface dataset:
#50 The relationship between pre-dialysis plasma endothelin-1 and the intradialytic decline in blood pressure
Authors: Pstras Leszek , Correa Simon , MC Causland Finnian R
Published: May 2024

Background and Aims

Endothelin-1 (ET-1), a potent vasoconstrictor, may play an important role in the blood pressure (BP) response to hemodialysis (HD). Patients receiving maintenance HD have higher concentrations of plasma endothelin-1 than non-HD patients with advanced chronic kidney disease or patients receiving peritoneal dialysis. We wished to examine the association between the pre-HD level of ET-1 and the magnitude of intradialytic systolic BP decline.

Methods

Data was collected in a prospective study of 50 patients receiving maintenance HD admitted to Brigham and Women's Hospital in Boston, MA, USA. BP was measured before and every 15 min during a single HD session using an automated BP cuff. The systolic BP decline was calculated as the pre-HD minus the lowest intradialytic systolic BP. Blood samples were collected pre-HD. Patients with missing data, HD <3 h, or pre-dialysis BP <85/55 mmHg were excluded from the analysis (n = 8). Spearman's rho (ρ) was used to assess the correlation between pre-HD ET-1 and intradialytic systolic BP decline.

Results

Of the 42 included patients, 17 were females, median age 62 [25th, 75th percentile: 50, 70] years. The median HD duration was 232 [210, 242] min and median ultrafiltration was 2.1 [2, 3] L. Before HD, the median ET-1 was 2.4 [1.9, 3.0] pg/mL, the median systolic BP was 141 [119, 167] mmHg, and the median diastolic BP was 68 [63, 84] mmHg. A moderate negative correlation was observed between the baseline ET-1 and the intradialytic decline in systolic BP (ρ = –0.34, P = 0.03). This correlation was stronger in patients with baseline systolic BP >120 mmHg (ρ = –0.51, P = 0.004, n = 30) and much stronger in patients with baseline systolic BP >140 mmHg (ρ = –0.66, P = 0.001, n = 21). Almost all cases (8 out of 9) with an intradialytic decline in systolic BP of >50 mmHg occurred in patients with baseline ET-1 below the pre-HD median level.

Conclusions

Our results suggest that hospitalized patients with pre-HD systolic BP >140 mmHg and lower baseline ET-1 may be more likely to experience larger intradialytic declines in systolic BP. Whether measurement of pre-HD ET-1 could help identify hypotensive-prone patients requires further investigation in larger studies.
#1678 The relationship between national dialysis catheter rates and kidney transplantations
Authors: Hofmann Amun
Published: May 2024

Background and Aims

Vascular access for chronic hemodialysis is either achieved by an arteriovenous fistula or graft (AVF/G) or central venous catheter (CVC) and AVF/Gs have been repeatedly reported to be superior to CVCs and guidelines usually recommend it as the preferred vascular access. AVF/Gs are associated with better quality of dialysis, less complications, and a lower mortality than CVCs. This has led to initiatives such as Fistula First that aimed at maximizing AVF/Gs rates and national healthcare systems now frequently evaluate their efficiency of care for end-stage renal disease (ESRD) patients based on this metric. However, transplant activity might be a significant confounding factor since high transplant rates and therefore limited transition phases might contribute to a higher acceptance of CVCs in patients awaiting kidney transplantation.

I aimed at investigating the relationship between CVC rates and transplant activity in different countries by analyzing data from national dialysis and transplant registries.

Method

Data was obtained from national transplant and dialysis registries including Argentina (2012-2021), Australia (2004-2022), Austria (2005-2022), New Zealand (2005-2022), Sweden (2011-2022), Turkey (2004-2022), and the USA (2012-2021). Population estimates were obtained from the World Bank. The conducted analyses included unadjusted correlation analysis as well as multivariate regression analysis.

Results

The study sample included data from 7 different countries spanning from North and South America, over Europe and Asia to Oceania covering data from 107 annual reports. CVC rates and transplant activity per million showed a weak positive correlation (0.283, 95% CI: 0.093–0.454) within the same year (Fig. 1). When correlating catheter rates with transplant activity of the previous year, the association increased slightly (0.357, 95% CI: 0.173–0.517). The change of incidence of ESRD or hemodialysis patients (depending on data availability) showed a moderate correlation with the change of catheter rates (0.507, 95% CI: 0.272-0.685). A regression model including the incidence of ESRD improved model fit compared to a model that uses only transplant activity to estimate catheter rates.

Conclusion

Even though most healthcare systems, clinicians, and epidemiologists recommend low CVC rates, a thorough evaluation of the care of ESRD patients requires the adjustment of several contributing factors, primarily kidney transplantation activity. Higher kidney transplantation rates are associated with higher CVC rates which might be due to reduced waiting times until transplantation. An increase in kidney transplantations might especially increase CVC-based dialysis in the subsequent year. There is some evidence that the incidence of ESRD in general or hemodialysis in specific additionally affects CVC rates. Increasing incidence of ESRD is associated with increasing catheter rates, indicating that healthcare systems might struggle to adapt to short-term changes regarding access demands.
#1956 Effect of hemodialysis modalities on infection-related mortality
Authors: Zhang Yan , Alejos Belen , Winter Anke , Carioni Paola , Arkossy Otto , Usvyat Len , Maddux Franklin
Published: May 2024

Background and Aims

A growing body of evidence have suggested hemodiafiltration (HDF) provide survival benefit for dialysis patients. HDF may improve immune modulation with enhanced clearance of azotemic toxins, compared to high-flux hemodialysis (HD). We therefore assess the effect of dialysis modalities on infection-related mortality in patients treated in real-world settings.

Method

We conducted a retrospective cohort-study based on 85,117 adult haemodialysis (HD) patients who were treated in EMEA NephroCare Clinics between January 1, 2019 and December 31, 2022. All patients’ data were extracted from the European Clinical Database (EuCliD®), including mortality from any infection, viral infection, and COVID-19 infection. The definition of mortality cause is based on ICD-10 codes. Any infection related mortality includes a broad range of infection disease types, such as viral, bacterial, parasitic, and fungal infections. The associations between dialysis modality and infection-related mortality were analyzed by multivariable Cox regression models, with both dialysis modality and COVID-19 infection as time-dependent covariates. To account for potential impact of difference in patients’ characteristics, we adjusted for multiple confounding factors. Competing risk analyses with death from non-infection as the competing event were performed by cause-specific and Fine-Gray subdistribution hazard models.

Results

At baseline 45.0% patients were treated with HDF, which changed to 52.6% by the end of follow-up. Of all HDF treatments in post-dilution mode (account for 98.4% HDF treatments) during follow-up, the average convection volume was 25.7 liters (median [interquartile range], 25.8 [23.9–28.0]). Patients treated with HDF at baseline were younger, with less comorbidities and longer dialysis vintage, compared to patients with HD (Table 1). During a median follow-up of 22.6 months, death from any infection occurred among 6.9% patients, of which 40.1% died from COVID-19 infection. Compared to HD, HDF was associated with a reduced risk of dying from any infection (hazard ratio [HR], 0.89 [95% CI, 0.82–0.97]), which however disappeared if excluding death from COVID-19 infection (Table 2). Similar pattern was also observed for death from viral infection. Association of HDF with death from COVID-19 infection persisted after controlling for multiple confounders (HR, 0.81 [95% CI, 0.71–0.93]). Similar results yielded from competing risk analyses.

Conclusion

In this large, unselected patient population, the beneficial effect of HDF for infection-related mortality was confined to mortality from COVID-19 infection. Further studies are needed to unravel the relation between dialysis modalities and death from different types of infection.
#2801 Which patients may benefit most from hemodiafiltration compared with hemodialysis: prediction of the individualized treatment effect
Authors: Vernooij Robin Wm , van Kruijsdijk Rob , Blankestijn Peter J , Bots Michiel L
Published: May 2024

Background and Aims

Haemodiafiltration (HDF) with an appropriate dosing reduces death from any cause based on an individual participant data meta-analysis and aggregated data meta-analyses of available randomized trials. No differences in treatment effect are reported for specific patient populations when defined on a single characteristic in subgroup analyses. Yet, it is unclear to what extent individual patients, characterized by a combination of clinical characteristics, may benefit from HDF. This study aimed to develop and internally validate a treatment effect prediction model to determine which individual patients would benefit most from well dosed HDF, compared with haemodialysis (HD), in terms of survival.

Method

Individual participant data from five randomized controlled trials (CONTRAST, ESHOL, Turkish HDF study, French HDF study, CONVINCE) comparing HDF with HD on all-cause mortality were used to derive a Royston-Parmar model for exploring the prediction of absolute treatment effect of HDF based on pre-specified patient and disease characteristics, notably age, sex, body mass index, diabetes mellitus, history of cardiovascular disease, creatinine levels, and c-reactive protein levels. Internal validation of the model was performed using internal-external cross validation.

Results

Among 4153 participants, with a median follow-up of 30 months (Q1-Q3: 24-36), death from any cause occurred in 558 patients (27.2%). The median predicted survival benefit of HDF compared with HD was 6.9 (Q1–Q3: 5.6–9.0) months, with a range of 2 to 42 months. Patients who were predicted to benefit most from HDF were younger, less likely to have diabetes or a cardiovascular history and had higher serum creatinine levels. Internal-external cross validation showed adequate discrimination and calibration.

Conclusion

All-cause mortality is reduced by HDF compared with HD in ESKD patients. Yet, the absolute survival benefit seems to considerably differ between individual patients. Our results suggest that the effects of HDF on absolute survival can be predicted accurately using a combination of readily available patient and disease characteristics. This prediction model approach exemplifies the potential of prediction algorithms in supporting clinical decision-making for the choice of treatment options. Validation and potential updates to the presented algorithm are necessary, along with a preferable randomized evaluation of its clinical impact before widespread implementation.
#3099 Time dependent evolution of patient perception of care in a large dialysis population
Authors: Santos Carla , Pearce Suzanne , Lucas Carlos , Silva Eliana , Silva Israel , Haarhaus Mathias , Macário Fernando
Published: May 2024

Background and Aims

Patient perspectives about the level of attention provided in chronic hemodialysis (HD) are increasingly considered cornerstones in individualization of true patient-centred and high-value care. The objective of our work was to evaluate the time dependent evolution of the level of patient perception of care (PPC) in a large dialysis provider.

Method

A multicenter retrospective observational study in HD patients was conducted in 19 countries. Responses to an anonymous PPC survey were collected, in all eligible patients, in 2021, 2022 and 2023 and analyzed using Kruskal-Wallis method. PPC survey is composed of several questions covering 12 areas, considered fundamental in hemodialysis care: “Access”, “Communication”, “Fluid intake and diet”, “Information”, “Needling”, “Privacy and dignity”, “Scheduling and planning of your appointments”, “Sharing decisions about your care”, “Support”, “Tests and investigations”, “The environment” and “Transport”. The level of satisfaction about medical staff interactions and level of care before, during and after dialysis, are individually graded from 0 and 7 obtaining a final average PPC score, with a higher score representing a better perception of the level of care provided. Additionally, a Net Promoter Score (NPS) is calculated with a single-question survey and valued between −100 to +100. Results were presented as means and a p-value below 0.05 was considered statistically significant.

Results

All HD patients from 19 countries, with valid responses in the PPC surveys performed in 3 years were included. The response rate increased throughout the period of evaluation: 89.2% in 2021, 86.8% in 2022 and 93.8% in 2023. Generally, an improvement in mean PPC score was observed: 6.30 in 2021, 6.36 in 2022 and 6.43 in 2023 and NPS score also increased over time: 62% in 2021, 66% in 2022 and 68% in 2023. Along the time, the three areas with higher and lower scores were fairly stable: “Fluid intake”, “Information” and “Privacy and dignity” in the top three, and “Needling”, “Transport” and “Sharing decisions about your care” in the bottom three valued parameters. With the exception of “The environment” and “Transport”, all the scores presented an average equal or higher than 6.

Conclusion

PPC scores in our dialysis population showed a good level of perception of the level of care provided and improved throughout the 3 years of the study evaluation. Despite this, the survey consistently identified three main areas of improvement and motivated the creation and implementation of oriented programs in our population. Re-evaluation of the effect of these interventions in the next survey will be fundamental to guide further actions.
#1751 Validation of the ReDO Death Score in a Portuguese cohort
Authors: Pais Telma , Teixeira Beatriz , Carrilho Miguel , Costa Cláudia S , Branco Carolina , Da Silva Bernardo Marques , Fonseca José Agapito , Jorge Sofia , Outerelo Cristina , Resina Cristina , Lopes José António , Gameiro Joana
Published: May 2024

Background and Aims

Mortality within the first year after dialysis start is estimated to be 20-30%, and it is mostly due to cardiovascular disease. Prognostic assessment after starting hemodialysis is challenging. Clark et al. developed the Recovery and Death Outcome risk score, which accurately predicted the likelihood of renal recovery to dialysis independence and of death within 1 year after discharge from in-hospital dialysis initiation. These models can be used at discharge or soon after patients start outpatient dialysis. We aimed to validate the Death Outcome risk score to predict one-year mortality after dialysis start in our population.

Method

.Retrospective analysis of hospitalized patients who initiated hemodialysis in a tertiary care hospital (Unidade Local de Saúde Santa Maria), from January 1st of 2016 to December 31st of 2019, and were discharged to outpatient dialysis. The risk of death within one year of discharge was calculated according to the ReDO score. We evaluated all-cause mortality within one year of hospital discharge. We classified patients into death outcome risk groups (labeled D1 to D4) according to the ReDO predictive score. Cox regression method was used to determine if the risk score was predictive of mortality within the first year after discharge. The discriminatory ability for the ReDO score to predict mortality was determined using the receiver operating characteristic (ROC) curve.

Results

369 patients were included, with a mean age of 71.1 ± 14.3 years. The majority were male (59.9%, n = 221) and 87% were Caucasian (n = 321). The median Charlson score was 7 ± 3. The mortality rate within one year after discharge was 22.2% (n = 82). The one-year survival was significantly lower in patients with the highest probability of death (D4 = 61.3% vs. D3 = 67.6% vs. D2 = 81.3% vs. D4 = 97.3%, p < 0.001). The ReDO Death score accurately predicted the one-year risk of mortality, with an area under the ROC curve of 0.741, [95% CI (0.687–0.794), p < 0.001] (Fig. 1). The optimal REDO Death risk cut-off was >30%, with a hazard ratio of 6.57 [95% CI (3.48–12.2), p < 0.001] for one year risk of death, with a sensitivity of 78.0% and specificity of 60.6%.

Conclusion

We validated the ReDO score for 1-year mortality prediction after starting hemodialysis during hospitalization in a Portuguese population. This score can be used as a tool to inform goals of care discussion at the time of transition to out-of-hospital care, involving the in-hospital nephrology care team, the patient, and, if applicable, the future care team, as it can enlighten clinical decisions and, in some cases, lead to better end-of-life planning.
#3078 The utility and cost-effectiveness of embedding geriatric expertise in a tertiary referral renal clinic
Authors: Mooney Andrew , Relton Sam , Winterbottom Anna , Howdon Dan , Aylett Virginia
Published: May 2024

Background and Aims

The demographic of people receiving dialysis is changing with an increasing prevalence of frailty, co-morbidity and geriatric syndromes. To address this, we initiated routine, embedded, consultant geriatric review of a selected group of patients (frail/living with frailty syndromes, age>80 preparing for dialysis, undecided between treatment options, patient/family judged by MDT to have unrealistic perception of treatment benefit) in our renal low clearance (pre-dialysis) clinic alongside our already-established palliative care service to support decision-making about treatment options for end stage kidney disease

Method

Starting in 2018, 77 patients were reviewed before suspension enforced by the Covid-19 pandemic in March 2020 and a further 56 since resumption between July 2021 and January 2023. We present the short-term results of all 133 patients immediately following geriatric review, plus long-term outcome data for the first 77 patients for whom we have 3 years’ follow up, including health economic analysis and ANOVA of frailty and treatment choice.

Results

Initially the cohort included 10 patients who had already chosen conservative management (CM) of their renal failure, but after one PDSA cycle only patients choosing dialysis or undecided about treatment choices underwent review in the service (mean age 78 [range 62-92]; 70% male).

Following geriatric review, the number of patients uncertain about their future renal treatment plan changed from 43 to 3; the number choosing to have dialysis reduced from 80 to 44 and the number choosing CM increased from 10 to 74. The number of advance care plans made among the group reviewed by the geriatrician increased from 0 to 77, and the number of DNACPR records increased from 6 to 43; there were increased referrals to falls, memory and continence clinics. Overall, 57% of patients left clinic with a different management plan.

36 months after geriatric review, the survival rate in the group choosing dialysis was 46% and in the CM group was 33%; the majority of deaths were unrelated to renal failure.

ANOVA indicated that clinical frailty scores impacted outcome more than treatment choice; health economic analysis showed the costs of providing this review (average 193 GBP per patient) were highly likely to be more than off-set by reductions in unnecessary fistula formation alone (average 288 GBP per patient)

Conclusion

Routine, protocol-supported geriatric review in a tertiary referral renal service is cost effective and associated with increased dialysis decision-making, reduced dialysis uptake, increased advance care-planning, increased CPR decision-making plus recognition and appropriate referral of geriatric syndromes. Outcomes in the group suggest little difference in survival among those choosing dialysis vs CM, and that frailty is more indicative of prognosis than treatment choice.
#1008 Prognostic impact of low skeletal muscle quality on 3-year mortality in initial-dialysis patients
Authors: Wang Yao , Yuan Li
Published: May 2024

Background and Aims

Myosteatosis represents the infiltration of fat into the skeletal muscle in the early stages of sarcopenia, and has been suggested to be associated with adverse outcomes in patients undergoing dialysis. Skeletal muscle density (SMD) determined by computed tomography (CT) is commonly used to assess myosteatosis, but SMD is affected by contrast resulting in inaccurate measurements. Recently, indices for muscle quality measurements determined by muscle area have been developed. Thus, We aimed to investigate the relationship between a novel muscle area index and mortality in initial-dialysis patients and analyse variables related to myosteatosis using the cutoff values.

Method

This 3-year multicentric retrospective study enrolled a total of 782 initial-dialysis patients from four centres between 2014 and 2019 in China. SMD skeletal muscular area (SMA) normal attenuation muscle area (NAMA) intermuscular adipose tissue area (IMAT) was measured and skeletal muscle index (SMI) total attenuation muscle area (TAMA) NAMA/TAMA index was calculated on CT images at the level of the first lumbar vertebra. The relationship between NAMA/TAMA index and all-cause and cardiac death outcomes was analyzed. And the sex-specific optimal cut-off values of L1-NAMA/TAMA index were determined in relation to all-cause mortality. Univariate and multivariate Cox regression models were applied to evaluate potential risk factors for death.

Results

A total of 782 patients were enrolled. The optimal cut-off values of NAMA/TAMA index were 48.76 for males and 58.02 for females. Pearson's correlation coefficient between L1-NAMA/TAMA index and L1 SMD was 0.589 (P < 0.001), no significant association between L1-NAMA/TAMA index and L1 SMI was observed (P > 0.05), similarly, no significant association between L1 SMD and L1 SMI (P > 0.05). Multivariate regression analysis revealed that the low L1-NAMA/TAMA index group had lower risks of all-cause death (hazard ratio 0.988; 95% confidence interval 0.977–0.999, P = 0.041) and cardiac death (hazard ratio 3.74; 95% confidence interval 1.43–9.79, P = 0.007).

Conclusion

Our findings demonstrate that L1-NAMA/TAMA index acquired via CT scan is of great prognostic value on all-cause and cardiac death in patients undergoing initial-dialysis.
#659 Analysis of functional brain connectivity in patient with end-stage kidney disease undergoing peritoneal dialysis
Authors: Kim Yang Wook , Park Bong Soo , Yi Jiyae , Heo Chang Min , Park Sihyung , Lee Yoo Jin , Bae Hoyoon , Son Sung Hyun
Published: May 2024

Background and Aims

Neurological complications are common in patients with end-stage kidney disease (ESKD). However, the mechanisms underlying neurological complications of ESKD are poorly understood. Research on brain connectivity in patients undergoing peritoneal dialysis (PD) is limited. In this study, we aimed to examine alterations in functional brain connectivity in patients with ESKD undergoing PD compared to the control group using functional near infrared spectroscopy (fNIRS).

Method

We prospectively enrolled 20 patients with ESKD who had been receiving PD for more than 6 months and had no prior history of psychiatric or neurological diseases, along with 20 healthy controls. The fNIRS data were obtained using an NIRSIT Lite instrument. After processing all the data, we used Pearson correlation analysis to create a weighted connectivity matrix. Functional connectivity measures were derived from the connectivity matrix using graph theory. Functional connectivity measures were compared between the controls and patients with ESKD undergoing PD.

Results

The average degree, average strength, and small-worldness were significantly lower in patients with ESKD undergoing PD than in the controls (9.333 [8.000∼11.433] vs. 12.733 [9.600∼13.400], p = 0.030; 6.865 [4.768∼7.560] vs. 8.432 [6.593∼9.432], p = 0.036; 0.836 [0.724∼0.900] vs. 0.949 [0.882∼0.972], p = 0.025, respectively).

Conclusion

This study demonstrated significant alterations in functional brain connectivity in patients with ESKD undergoing PD, suggesting that functional brain connectivity is significantly reduced in patients with ESKD undergoing PD when compared with that in healthy controls.
#1298 Combination of clinical frailty score and biomarkers as mortality predictor in hemodialysis patients
Authors: Sophie Cornet , Kevin Quinonez , Xavier Warling , Jouret François , Cavalier Etienne , Delanaye Pierre
Published: May 2024

Background and Aims

Frailty is common among hemodialysis (HD) patients. Its assessment is usually based on clinical criteria. In the present work, we evaluated the interest of combining clinical frailty score and biomarkers to predict mortality of chronic HD patients. Three biomarkers were assessed: myostatin, insulin-like growth factor-1 (IGF-1) and dehydroepiandrosterone sulfate (DHEA-S)

Method

Prevalent HD patients were enrolled from September 2016 to October 2017 in two centers in Liège, Belgium in this observational prospective study and followed up for 5 years. Myostatin, IGF-1 and DHEA-S levels were measured at baseline. Frailty was assessed using Fried's five points frailty score (≥3 indicates frailty). The ability to predict mortality was assessed by calculating areas under the curve (AUC). AUCs were compared by Hanley & McNeil test.

Results

We included 125 HD patients with the following characteristics: median age was 67 [53; 78] years; 60% of men; 41% of diabetic and median dialysis vintage of 30 [16; 54] months. Among them, 46% were classified as “Frail” according to Fried. The median follow up was 49 [19; 60] months (Table 1). The ability (AUC) of Fried score, myostatin, IGF-1 and DHEA-S to predict mortality was significant and comparable: 0.72 (95% CI: 0.63 to 0.80), 0.72 (95% CI: 0.64 to 0.80), 0.68 (95% CI: 0.59 to 0.76) and 0.73 (95% CI: 0.64 to 0.80), respectively (Fig. 1). Combining (by logistic regression) one biomarker with Fried score improved significantly the AUC with myostatin (AUC = 0.79, 95% CI: 0.71 to 0.86, p = 0.0049), IGF-1 (AUC = 0.78, 95% CI: 0.70 to 0.85, p = 0.0099) and DHEA-S (AUC = 0.79, 95% CI: 0.71 to 0.86, p = 0.0018) compared to Fried score alone. Compared to biomarker alone, the combination also improved significantly AUC for myostatin and IGF-1 (p = 0.035 and p = 0.011 respectively) but not for DHEA-S. The combination of several biomarkers with Fried score did not significantly improve mortality prediction compared to the combination of a single biomarker with Fried score.

Conclusion

The study suggests that combining Fried frailty score with either myostatin, IGF-1 or DHEA-S concentration improves the prediction of five-year mortality in chronic HD patients.
#2701 Prevalence of chronic kidney disease associated pruritus among hemodialysis patients in Switzerland
Authors: Helou Nancy , Nobre Dina , Pruijm Menno
Published: May 2024

Background and Aims

Chronic Kidney Disease Associated Pruritus (CKD-aP) is a frequent symptom in patients with end-stage renal disease. The reported prevalence differs between countries and is estimated between 20-40%; data on the prevalence of CKD-aP in Switzerland are lacking. This ongoing study aims to determine the prevalence and severity of CKD-aP among patients on hemodialysis in the French-speaking part of Switzerland and to investigate its association with demographic and clinical factors.

Method

Patients aged ≥18 years, on hemodialysis for ≥6 months, and free of cognitive impairment were recruited. Clinical, laboratory and dialysis prescription characteristics were collected by an independent research nurse, who also performed CKD-aP assessment using the Visual Analog Scale (VAS, numeric score 0-10) and the Verbal Rating Scale (VRS, 0 = no itch - 4 = extremely severe itch). Multiple linear regression analysis was carried-out to investigate associations of CKD-aP with demographic and clinical factors.

Results

Preliminary data from 401 participants (mean age 69.4 years, SD 13.6; 65% men) showed a CKD-aP prevalence of 24%. Most participants with CKD-aP (69%) reported generalized itching and 35% waking-up at night because of the itching.

Mean VAS in participants with CKD-aP was 4.78 (SD 2.02) during the last 24 hours and 6.65 (SD 2.2) for the worst intensity itching during the last 24 hours. According to the VRS, most participants with CKD-aP suffered from moderate (60%) to severe itching (23%), and 72% experienced at least one severe to extremely severe episode of itching during the last 24 hours.

Conclusion

Despite high dialysis standards and easy access to medications, CKD-aP affected around 24% of patients on hemodialysis in the French-speaking part of Switzerland, and its intensity was moderate to severe. Results may help to increase clinicians’ awareness of CKD-aP, improve its regular screening, severity reporting and treatment.
#129 Impact of Ramadan fasting on bone mineral metabolism in hemodialysis: a multi-center prospective study
Authors: Elshabrawy Nehal , Elhadedy Muhammed Ahmed , Abdalbary Mohamed , Sobh Mahmoud , Tawfik Mona , Abdelsalam Mostafa , Sabry Alaa , Refaie Ayman F , Fathi Amr M , Almenshawy Ahmed , Hendawy Shimaa R , El-Husseini Amr
Published: May 2024

Background and Aims

Fasting is fundamental in several major religions and cultural traditions worldwide. In Islam, Ramadan fasting is characterized by daily complete eating and drinking abstinence from the dawn to sunset for an entire lunar month. Sick patients, including patients with advanced chronic kidney disease are not required to fast, however the majority of them are still choose to fast. The Impact of Ramadan fasting on bone health has not been studied prospectively. This study aims to examine the effect of Ramadan fasting on parameters of bone mineral metabolism in patients on hemodialysis.

Method

: This is a multi-center prospective study on 138 patients with ESKD who are maintained on intermittent hemodialysis for at least six months. Ninety-three (67%) were fasting while 45 patients (33%) did not fast. All patients' demographics, clinical and laboratory parameters were compared before and after the holy month of Ramadan. Serum biochemical parameters included serum sodium, potassium, bicarbonate, chloride, albumin, calcium, phosphorus, magnesium, intact parathyroid hormone (iPTH), FGF23, klotho, sclerostin, bone-specific alkaline phosphatase (BSAP), and tartrate-resistant alkaline phosphatase 5b (TRAP5b).

Results

The two groups exhibited comparable demographics and clinical parameters at baseline, except for the mean age, which was significantly lower in the fasting group (45.5 vs. 54.4 years, p-value = 0.003) and the non-smoker habit was significantly higher in the fasting group (71% vs. 56%, p-value = 0.02). There was no change in the clinical parameters by the end of Ramadan in both groups including intra-dialytic hypotension, inter-dialytic weight gain, and hypoglycemia. The basic biochemical parameters did not change significantly at the end of Ramadan in both groups, except there was an increased serum albumin level (p-value = 0.04). The BSAP levels significantly went down by the end of Ramadan in the fasting group (p-value = 0.01). The other novel serum biomarkers (FGF23, klotho, sclerostin, and TRAP5b) did not change significantly in both groups.

Conclusion

This multi-center prospective study demonstrates that Ramadan fasting does not significantly alter the clinical and biochemical parameters in hemodialysis patients, highlighting its safety in this population. Moreover, our findings reveal a noteworthy reduction of the higher BSAP towards normal levels in fasting patients, suggesting a potential benefit of fasting in improving high bone turnover. Further research is warranted to elucidate this phenomenon's underlying mechanisms and long-term implications, which may hold promise for managing bone health in hemodialysis patients during Ramadan fasting.
#1999 Retrospective observational study of uremic pruritus prevalence on dialysis
Authors: Santos-Alonso Carlos , Jiménez Miguel Ángel Navas , Botella Mario , Garrote Pablo Luis Sánchez , Gomez Astrid Rodriguez , Garcia Leonardo Calle , Varas Carmen Martin , Luis Maria Jose Fernandez-Reyes , Garcia Laura Alvarez , del Peso Gilsanz Gloria , Rubio María Auxiliadora Bajo
Published: May 2024

Background and Aims

In Spain, the prevalence of moderate-severe Uremic Pruritus (UP) was 46% and 40% in the DOPPS I and DOPPS. This symptom is usually underdiagnosed and could worsen the quality of life, as some recent studies have revealed. The last reports regarding UP prevalence date back to 2004, hence we decided to assess its current frequency of this while exploring the degree of recognition along with other UP-associated factors.

Method

This study includes 192 patients in renal replacement therapy (RRT), retrospectively recruited from our centre. Data were collected from revisit medical records in 2021. UP was evaluated using a visual analogic scale (VAS). In addition, age, time on dialysis, UP treatment, haemoglobin, eosinophils, plasma levels of calcium, phosphorus, urea, parathyroid hormone, c-reactive protein (CRP), and clearance (measured by KT/V) were also recorded.

Results

Average patient age was 61.3 years old, with an average time in dialysis of 37.4 months. The most common group of chronic kidney disease was glomerular diseases (25.5%). The patient distribution by RRT was: 51.9% in haemodialysis (HD), 36.5% in peritoneal dialysis (PD), and 11.6% in home haemodialysis (HHD). UP average prevalence was 56.7% (50% in HHD, 55.2% in HD and 60.9% in PD), of which 69.8% had a VAS ≥ 5. UP was statistically associated with older age (p = 0.017) and higher plasmatic phosphorus (p = 0.015). Notably, only 51.9% UP patients had been prescribed specific drugs for itching. Among UP treated patients, 70.9% improved 3 or more VAS points (with no differences among drugs). Interestingly, this improvement was associated with lower calcium levels (p < 0.0001), the absence of peripheral artery disease (PAD) (p = 0.035), and the shortest time on dialysis (p = 0.001).

Conclusion

Despite the advances made in HD techniques and the recent incorporation of biocompatible solutions in PD, UP remains a frequent symptom among dialysis patients, without relevant prevalence improvements over the last 20 years.

UP was misdiagnosed and mistreated in our unit, since just 51.9% of patients with UP were under treatment. In addition, clinical response to treatment was appropriate in 70.9% of patients, and our results suggest that calcium, PAD, and time on dialysis could predict the response to the treatment. Therefore, our study supports previous data, highlighting UP as a frequent underdiagnosed symptom among dialysis patients; and opens the path for new research in the identification of novel prognosis markers.
#2879 Residual kidney function is more than urinary output alone in PD patients: insights derived from tubular functional Na MRI of the kidney
Authors: Lemoine Sandrine , Akbari Alireza , Dorie Justin , Tamasi Tanya , Jain Arsh , Mcintyre Christopher
Published: May 2024

Background and Aims

Maintenance of a cortico-medullary concentration gradient (CMG) is required for urine concentration and is one of most important tubular functions. We have previously demonstrated that the CMG can be quantified in both healthy controls and patients receiving HD, using 23NaMRI of the kidney. Peritoneal dialysis (PD) patients, in general, are considered to have better preservation of residual renal function (RKF), than comparative haemodialysis (HD) patients. We aimed to investigate if this was evident with respect to functional imaging of the CMG, to explore the concept that glomerular and tubular function may be dichotomized in patients with chronic kidney disease (CKD) requiring maintenance dialysis.

Method

We conducted an exploratory pilot study for 8 PD patients and 21 HD patients. Patients were instructed to fast from midnight before scanning. Urines samples were collected to measure osmolarity after fasting and a first MRI scan- performed to acquire baseline anatomical and sodium images. All MR imaging was carried out on a GE MR750 3T (GE Healthcare, WI) instrument. A custom-built two-loop (18cm in diameter) butterfly radiofrequency surface coil tuned for 23Na frequency (33.786 MHz) was used to acquire renal 23Na images.

Results

PD participants were 60 ± 10 years old, 50% male, mean body mass index (BMI) was 26.7 ± 4.6 kg/m2 and dialysis vintage was 20 ± 13 months, mean creatinine and urea clearance was 12 ± 7 mL/min/1.73 m2; HD participants were well matched, 60 ±18 years old, 52% men, BMI 27 ± 6 kg/m2 and dialysis vintage was 33 ± 25 months respectively. Urinary osmolarity was 284 ± 66 mosm/L and 239 ± 72, p = 0.1; mean medulla to cortex ratio was 1.2 ± 0.2 and 1.2 ± 0.1, p = 0.2 between PD and HD participants respectively.

7/8 PD participants were able to perform 24 hrs urine collection. Mean urine volume was substantial at 1525 ± 594 mL. We found no correlation between urine volume and corticomedullary gradient (Fig. 1A). Fig. 2C illustrates a 75 year old male, with medulla to cortex ratio at 1, urine volume 2100 mL, CLcrUr 18 mL/min/1.73 m2 and Fig. 1C showed a 55 years old patients, male, medulla to cortex ratio at 1.4, urine volume 2100 mL, CLcrUr 18 mL/min/1.73 m2.

Conclusion

These results underscore residual kidney function currently estimated by urine volume provides an incomplete assessment. Despite PD patients retaining higher degrees of RKF than HD patients, as assessed by urinary volume and small solute clearance, both patient groups have very similar degrees of directly imaged tubular function. The clinical importance of a focus on functional tubular mass to outcomes in dialysis patients is currently under further investigation.
#1832 Unraveling enteric peritonitis risk factors: the role of nutrition
Authors: Mompó-Ramos Mar , Viejo-Boyano Iris , Soldevila-Orient Amparo , Peris-Fernandez Maria , Such Ramon Devesa , Sánchez-Pérez Pilar , Jaras Julio Hernandez
Published: May 2024

Background and Aims

Malnutrition estimated to have a prevalence of 30-50% among peritoneal dialysis (PD) patients. It independently correlates with increased patient morbidity and a lower technique survival, and it is exacerbated by protein loss through peritoneal fluid. Enteric-origin peritonitis in PD patients represents a severe complication also linked to elevated morbidity, hospitalizations, and inferior technique survival.

However, the association between both is not well established. This study aims to analyze malnutrition-related as well as general risk factors and their association with peritonitis type (enteric/cutaneous).

Method

A longitudinal and retrospective observational analysis was conducted on PD patients with peritonitis at Hospital La Fe from 2012 to 2023. Demographic data (age, gender, obesity, diabetes, immunosuppression, polycystic kidney disease), analytical parameters (albumin, total proteins, potassium, phosphorus), number of exchanges, adequacy, surgical interventions, and/or catheter placement 6 months prior were analyzed for their association with peritonitis type (Cutaneous/Enteric/Mixed). Recurrences and peritonitis without microbial isolation were excluded.

Results

We collected data about 109 peritonitis cases; 59.6% cutaneous, 38.5% enteric, and 1.8% mixed, from 61 predominantly male patients (68.9%) with a mean age of 61.35 years. Common germs were S. epidermidis in cutaneous peritonitis and E. coli in enteric peritonitis.

Obesity (27.9% of the sample), immunosuppression (16.4%), and hypoalbuminemia (56%) were statistically significantly associated with enteric peritonitis development (p 0.08, p 0.039, and p 0.036, respectively).

No statistically significant differences were found for peritonitis type and gender, diabetes, residual renal function, hypokalemia, hypophosphatemia, and underdialysis.

85.3% of peritonitis cases involved manual exchanges, and 14.7% automated PD. While no statistically significant association was found between modality and peritonitis type, more manual exchanges correlated with increased peritonitis cases.

Peritoneal catheter insertion and other surgical interventions in the previous 6 months were not significantly related to peritonitis type.

Conclusion

The presence of malnutrition-related factors such as hypoalbuminemia and obesity increases the risk of developing enteric peritonitis, likely linked to digestive bacterial translocation to peritoneal fluid facilitated by malnutrition. Ensuring preventive nutritional strategies is imperative for these patients.
#1722 Shared decision making and dialysis choice: an observational longitudinal cohort study
Authors: Finderup Jeanette , Hansen Pernille , Jensen Victoria , Bergum Maria , Mose Frank , Khatir Dinah Sherzad
Published: May 2024

Background and Aims

Shared decision-making is recommended for dialysis choice, whereby patients are supported in making decisions regarding dialysis modality together with healthcare professionals. The intervention ‘Shared decision making and dialysis choice’ has been a part of usual care at two hospitals in Denmark since 2018. The aim of this study was to describe the choice of dialysis modality and the outcomes for patients with kidney failure, who received a Shared decision-making intervention.

Method

An observational longitudinal cohort study was conducted. Data was collected retrospectively from 2018 to 2023 involving 484 patients with kidney failure from two Danish hospitals one regional hospital and one university hospital. Fisher's exact tests and Wilcoxon rank-sum tests were used to assess whether choice of dialysis modality differed significantly. Additionally, Aalen-Johansen estimation assessed time from the shared decision making intervention to treatment initiation, concordance between chosen and initiated treatment, and mortality before treatment initiation. Logistic regression and Cox proportional hazards evaluated the patient characteristics predicting these three outcomes.

Results

After the intervention, 68% chose home-based treatment, while 32% chose hospital-based treatment. With significant difference, more patients age ≤70 years, at university hospital and living with a partner chose home-based treatment. Half of the patients initiated treatment within 11 months, and predictors for initiating dialysis later than 11 months after the intervention were age ≥70 years (OR 2.52) and eGFR >15 ml/min/1.73 m² (2.80). 83% of the patients received the treatment chosen and predictors for concordance were center-based dialysis (HR 1.54), regional hospital (HR 1.52) and very mild to mild frailty (HR 1.55). Furthermore, 12% of the patients died before treatment initiation predicted by very mild (HR 3.67) to severe frailty (HR 6.42) and BMI <25 kg/m² (HR 2.84).

Conclusion

A high proportion of patient chose a home-based treatment after receiving the intervention ‘Shared decision making and dialysis choice’ and also initiated the dialysis choice chosen. Patients received the intervention timely and only few patients died before initiating dialysis. Our study has demonstrated that many factors influence patient choices and outcomes. Maybe routinely assessment of frailty and BMI prior to shared decision making intervention could improve the patient pathway.
#546 Decline of kidney function before and after start of peritoneal dialysis (PD)
Authors: Björksten Markus , Qureshi Abdul Rashid Tony , Stenvinkel Peter , Heimbürger Olof
Published: May 2024

Background and Aims

Residual kidney function (RKF) is a key component for PD adequacy and associated with improved volume status, nutrition and quality of life as well as with increased survival. The aim of the present study was to compare decline of kidney function before and after start of PD.

Method

We studied patients starting PD (during 2000-2019) in an ongoing prospective study of patients starting dialysis. Study inclusion in almost all PD patients coincided with PD catheter insertion. Patients were included in the present analysis if they had at least one urinary collection before, and one after PD initiation (a), PD initiation less than six months after study inclusion (b) and > 6 months PD treatment (c). P-creatinine to calculate eGFR was retrospectively collected for 12 months before start of PD. During a large part of the study period, it was a clinical routine to collect 24-hour urine collections regularly in CKD5 patients, and these data were retrieved when available. After start of PD, regular 24-hour urine collections were part of the clinical routine to follow up and were retrieved for up to 12 months after PD start. eGFR was measured using the CKD-epi 2021 equation and GFR was calculated as the average of urinary creatinine and urea clearance corrected for BSA. The decline of eGFR before start of PD, the decline of GFR from 24-hour urine collections and the decline of GFR after start of PD were compared to each other.

Results

We studied 138 patients starting PD. The mean age was 55 ± SD13 years, and there were 80 males and 58 females. The mean blood pressure was 153 ± SD21/89 ± SD11 mmHg and BMI was 25 ± SD4 kg/m2. The etiologies of end stage kidney disease were nephrosclerosis 17%, diabetic nephropathy 22%, glomerulonephritis 25%, polycystic kidney disease 14% and other 22%. The GFR at PD start was 8.5 ± SD 2.3 mL/min/1,73 m² and eGFR was 5.8 ± SD 1.9 mL/min/1,73 m². The results show a significantly slower kidney function decline rate after start of PD, with an average of −0.59 mL/min/1,73 m²/month before PD initiation compared to −0.34 mL/min/1,73 m²/month after.

Conclusion

Decline of GFR was slower after start of PD suggesting that earlier initiation of dialysis may be beneficial for the preservation of RKF. Notably, there was a marked attenuation after 3 months of dialysis. Furthermore, the decline rate of GFR before PD start was similar using eGFR or GFR from 24-h urine collection, though for eGFR at somewhat lower levels. However, there were pronounced differences between those two methods in individual patients demonstrating that eGFR is unreliable with very low GFR. Further study will be performed to analyze what factors that are associated with better preservation of RKF.