bluuebunny/crossref_metadata_2025 huggingface dataset:
#2982 Shifts in SGLT2 inhibitor initiation in CKD non-dialysis patients
Authors: Mcclatchy Ellie , Snyder Justin , Weiss Meghan
Published: May 2024

Background and Aims

KDIGO guidelines have changed since 2020 with the introduction of SGLT2 inhibitors to CKD care. As the agents have become more standard of care in CKD, this research assesses how the treatment of more than 2000 CKD non-dialysis patients in the EU5 aligns with the KDIGO guidelines.

Method

Data from 1062 patient charts were collected in partnership with 265 EU5 (Germany, United Kingdom, Italy, France, and Spain) nephrologists via an online survey from December 2022-February 2023. Additionally, data from 1282 patient charts were collected from 263 EU5 nephrologists from December 2021-February 2022 via an online survey.

Results

Nephrologists often report that they strongly rely on the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines when making treatment decisions for their patients. Globally recognized, the KDIGO guidelines are created and periodically updated based on a rigorous scientific process to create an all-encompassing set of clinical practice recommendations.

Over the past several years, SGLT2 inhibitors have become a fundamental part of CKD treatment and eGFR management. While the agents are primarily used in CKD patients with diabetic kidney disease (DKD), treatment rates among non-diabetic CKD patients have increased year-over-year. According to 2023 audited patient chart data, approximately one-half of DKD patients in the EU5 are on an SGLT2 inhibitor, while there has been a notable increase in treatment rates among non-diabetic CKD patients, from 11% in 2022 to 23% in 2023.

Despite the recent change in the KDIGO guideline, which lowered the recommended eGFR level for SGLT2 inhibitor initiation to 20 mL/min/1.73 m2, 71% of patients who are treated with an SGLT2 inhibitor were initiated on therapy in CKD Stage 3 (eGFR 30-50), indicating that EU5 nephrologists have not yet conformed to the revised guidelines.

Notably, participating EU5 nephrologists elicit increased comfort prescribing SGLT2 inhibitors to both their DKD and non-diabetic CKD patients year-over-year. In 2023, nearly all physicians reported that they expect to increase their use of SGLT2 inhibitors in their CKD patients, regardless of their diabetes status, indicating that there is potential for further adoption of the revised KDIGO guidelines into clinical practice.

Conclusion

As the treatment of CKD patients continues to evolve with SGLT2 inhibitors and newer therapies, KDIGO guidelines will adjust to accommodate evolution. Increased awareness of guideline changes will be paramount in ensuring that patients are receiving top quality care based on treatment recommendations.
#2019 Comparing survival outcomes between hemodialysis and hemodiafiltration using real-world data from Brazil
Authors: Da Rocha Erica Pires , Wagner Carolina S , Kojima Christiane Akemi , Costa Daniel Monte , Magalhães Andrea Olivares , Rocha Whelington Figueiredo , de Vasconcelos Júnior Leonardo Nunes , Rosa Maria Gabriela , de Andrade Luis Gustavo Modelli
Published: May 2024

Background and Aims

The CONVINCE trial and others studies, demonstrates that high-dose hemodiafiltration offers a survival advantage and benefits in reducing cardiovascular complications for patients in high-flux hemodiafiltration group compared to hemodialysis.

Method

We compared the outcomes of hemodialysis and hemodiafiltration using real-world data. We conducted an analysis on a cohort of patients who underwent hemodiafiltration therapy (HDF) at a single center, NefroStar Clinics from 28/06/2021 to 30/05/2023. The results obtained were then compared with data from patients receiving hemodialysis (HD) therapy within the Brazilian Public Health System (SUS). Baseline data, type of access for dialysis and adequacy tests obtained through the average of monthly tests were collected. The HDF data were obtained through automatic extraction of electronic medical records and the HD data were obtained by Datasus. The primary outcome was mortality from any cause.

Results

85 patients undergoing hemodiafiltration were compared with 149,372 patients receiving hemodialysis through the Brazilian Public Health System (SUS). Using a 2:1 propensity score, we compared the 170 best-match HD patients along with 85 HDF patients. The percentage of vascular access and male sex were similar in both groups. The mean age of HDF and HD patients was 54 [41-67] and 58 [46-68] years, p=0.054, respectively. The adequacy tests show higher hemoglobin values and mores PTH values in the HDF group. In the Cox analysis, HDF therapy showed a reduced risk of mortality with an HR of 0.29 [0.11 – 0.77]. The propensity score analysis showed a HR of 0.32 [95% CI: 0.11 – 0.91]. This analysis was adjusted for age, type of access, KT/v, hemoglobin, and phosphorus. The Kaplan-Meier analysis showed respective survival rates for HDF and HD at the end of one year, 92.1% and 79.9%, p<0.001.

Conclusion

These results suggest high flux hemodiafiltration had survival advantages over hemodialysis in real word scenario.
#704 Albumin, inflammation and nutrition in hemodialisis patients in Colombia: a cohort study
Authors: Castillo Juan Carlos Mario , Sanabria Mauricio , Vesga Jasmin , Aldana Andrea , Sánchez Ricardo , Buitrago Giancarlo , Oliveros Henry , Rivera Angela , Rutherford Peter
Published: May 2024

Background and Aims

Hypoalbuminemia is a well-identified risk factor for mortality in chronic hemodialysis patients. As a negative acute phase reactant, albumin levels could be associated with several factors that affect the patient on hemodialysis (HD), such as alterations in the rate of hepatic synthesis, an increase in the rate of catabolism, or an increase in losses due to the dialysis process.

The objective of the present study is to analyze serum albumin values in repeated measurements over time in two cohorts, one with expanded HD (HDx) enabled by the medium cut-off membrane (MCO) Theranova and the other with high flux (HF) HD and estimate the relationship with other relevant variables.

Method

Cohort study, one with HDx enabled by Theranova® and the other with HF HD, adult prevalent HD patients (> 90 days) at Baxter Renal Care Services Colombia starting between September 1, 2017, and November 30, 2017, with follow-up for up to 48 months. Sociodemographic and clinical characteristics were summarized descriptively, and a mixed linear model with repeated measures was performed to evaluate the association between dialysis membrane and albumin levels, controlling for confounding variables.

Results

We evaluated 1092 patients (62% male): 533 in HF-HD vs. 559 in HDx (Table 1); the median age was 61 years, 42% had a history of diabetes, and 19% had cardiovascular disease. We found no differences in albumin levels over time when comparing Theranova versus HF HD patients, p-value = 0.789 (see Fig. 1). No association between serum albumin levels and the Theranova dialyzer was found with the linear mixed model with repeated measures when controlling for confounding variables, p-value= 0.198. On the other hand, we found that serum albumin was associated with inflammatory and nutritional variables such as C reactive protein, Ratio platelets/lymphocytes, and Protein Energy Wasting (PEW) (Table 2).

Conclusion

Variables including nutritional status and inflammation, age, and hospitalization events are associated with serum albumin levels varying over time. Variation in serum albumin levels over time are not associated with type of dialyzer (Theranova® vs HF).
#857 How low can we go with dialysate flow? Does that mean we can make nephrology green?
Authors: Glowinska Irena , Kakareko Katarzyna , Rydzewska-Rosołowska Alicja , Pietruczuk Adam , Hryszko Tomasz
Published: May 2024

Background and Aims

Green nephrology encompasses all initiatives in kidney care that have a positive impact on the climate and environment. We know that environmental impact of dialysis is particularly high, considering water consumption and disposable waste production during each session. All that suggests a great opportunity where many improvements should be made.

To prepare the dialysate 240 liters of water are needed for one four-hour session with a dialysate flow (Qd) set at 500 ml/min. Including additional water needed to rinse and sterilize the system, this gives approximately 500 liters of water used for one hemodialysis. Lower dialysate flow rate is associated with a significant reduction in the amount of water used for the hemodialysis procedure.

An increase in Qd from 500 ml/min to 800 ml/min has been recommended to increase dialysis efficiency. It's benefit was not confirmed in in vivo studies which suggested that increasing the dialysate flow rate offers no benefit in terms of delivered Kt/V. Similarly, studies with a Qd of 400 ml/min showed comparable efficiency. If hemodialysis could be performed equally effectively with less dialysate consumption, water could be significantly saved.

The aim of this study was to check whether change of dialysate flow from 500 ml/min to 300 ml/min has a significant impact on dialysis adequacy (measured by Kt/V).

Method

The study was a retrospective analysis. During the COVID19 surge in January 2022 due to administrative issues in a satellite dialysis center the dialysate flow was reduced to 300 ml/min. The center again increased Qd to 500 ml/min in February 2022. We analyzed laboratory data from 3 months before dialysate flow reduction, in the month with reduced Qd to 300 ml/min, and from 3 months thereafter with Qd set at 500 ml/min.

Results

26 patients (10 men and 16 women – all dialysis patients from a satellite dialysis center) were enrolled in the study. Two of them died during observation, therefore 24 people were included in final analysis. Their median age was 72 (66-78) years. ANOVA with repeated measures showed lack of differences between three time points in terms of Kt/V (Qd 500 ml/min - 1.285±0.202, Qd 300 ml/min - 1.275±0.192 and Qd 500 ml/min - 1.337±0.199; p=0.093). Change in serum potassium during hemodialysis did not depend on dialysate flow (ΔK Qd 500ml/min - 1.5±0.5 mmol/l, Qd 300 ml//min - 1.7±0.5 mmol/l, Qd 500 ml/min - 1.6±0.4 mmol/l; p=0.197). Serum phosphorus was comparable between three time points (Qd 500 ml/min - 5.99±1.68 mg/l, Qd 300 ml/min - 5.65±1.4mg/l, Qd 500 ml/min - 6.01±1.67 mg/l; p=0.066).

Conclusion

Reduction in dialysate flow rate to 300 ml/min is safe for the patients and probably does not cause any short-term negative effects. Thus we can achieve the same therapeutic effect saving water consumption. Larger, long-term studies are needed to confirm the efficacy of this approach.
#1340 Validation of artificial intelligence algorithm classifying arteriovenous access aneurysms in hemodialysis: a blinded multicenter prospective study
Authors: Dong Zijun , Zhang Hanjie , Wang Lin-Chun , Ren Sarah , Tisdale Lela , Han Maggie , Bittencourt Valeria G , Rosales Merlo Laura , Prakash-Polet Sindhuri , Douglas Denzil , Starakiewicz Piotr , Shtaynberg Norbert , Fuca Nicholas , Kozyra Andrzej , Thijssen Stephan , Preddie Dean C , Kotanko Peter
Published: May 2024

Background and Aims

In hemodialysis (HD) patients, arteriovenous (AV) access aneurysms may lead to severe and potentially life-threatening consequences, such as rupture. To address this issue, we developed an artificial intelligence-based application that utilizes images of the AV access to classify AV aneurysms [1].

We conducted a blinded, multicenter, prospective pilot study to assess the correlation between the classification results generated by the aneurysm classification application and the independent clinical examination conducted by physicians specializing in vascular access care.

Method

AV accesses were photographed using tablets. These images were then uploaded to the cloud, where they were classified as either "Advanced" or "Not Advanced" by a convolutional neural network algorithm [1] (Fig. 1A). The study compared AV aneurysm classifications generated by our application to those made by vascular access physicians blinded to the app results. The physicians’ classifications served as the ground truth for our analysis.

Results

The study was conducted at two vascular access care centers in New York, NY, USA. A total of 121 patients were included in the analysis (Table 1). The physicians’ assessment identified a 21% prevalence of advanced aneurysms.

The application accurately classified 84 out of 95 aneurysm images as “Not Advanced” and 20 out of 26 as “Advanced,” resulting in an accuracy of 86.0% (95% CI: 78.5% to 91.6%), a sensitivity of 76.9% (95% CI: 56.4% to 91.0%), a specificity of 88.4% (95% CI: 80.2% to 94.1%), and an area under the receiver operating characteristics curve (AUROC) of 0.87 (95% CI: 0.78 to 0.94) (Fig. 1B).

Conclusion

Our results demonstrate that an AI-powered application exhibits actionable accuracy in classifying AV aneurysms within a demographically diverse HD population. These findings align with Zhang et al., where a team of vascular access experts classified 1,093 out of 1,341 (81.5%) images as “Not Advanced” aneurysms and 248 (18.5%) as “Advanced,” resulting in an AUROC of 0.96 in the validation set (n = 402) [1]. The difference in AUROCs can be attributed to the fact that, in Zhang et al., vascular access experts evaluated only AV access images, whereas in the present study, they performed a physical examination of the patient.

Our tool may have the potential to support aneurysm monitoring processes, enabling timely detection, decision-making, and interventions.
#2331 Distal arteriovenous fistulas for hemodialysis – too many interventions?
Authors: de Faria Vitoria Paes , Fernandes Luis Diogo , Dias Joana Pereira , Pereira Susana , Ventura Ana , Martins Victor Pereira , Nogueira Clara , Canedo Alexandra , Almeida Clara
Published: May 2024

Background and Aims

Distal arteriovenous fistula (dAVF) for haemodialysis (HD) is preferred due to lesser complications, despite greater risk of maturation failure. In HD patients, age and comorbid conditions increased the risk of access failure and number of procedures necessary for fistula patency. Preferred location for AVF poses a challenging decision. Advantages of dAVF must be taken into account although these may lead an unreasonably high number of interventions. Our aim was to determine time to functioning distal AFV in our centre and number of procedures necessary to achieve such status.

Method

Single centre retrospective analysis was performed on a cohort of patients submitted to distal AFV construction from 2015-2021. Success rate was defined as AFV patency in time for dialysis.

Results

Of 528 patients submitted to AVF construction from 2015 - 2021, 110 radiocephalic fistulas were seen, 59% male patients, mean age 68.5±12,0 yrs. Comorbidities were prevalent (80.9%, n=89), DM (54.6%) and HF (41.1%).

Outcomes at 6 weeks were adequate maturation in 4.5% (n=59), 31.8% (n=35) late maturation (LM) and 14.5%(n=16) primary failure (PF). Causes of LM included inflow and outflow stenosis, 34.3% and 37.1%, respectively. LM (> 6 weeks) requiring no further intervention was seen in 28.6%. PF patients had smaller artery diameters on pre-operative US, with no statistical significance (0.23±0.07; 0.30 ± 0.2; p=0,375). Assisted patency rate was 78.2%.

Number of procedures for access permeability was 1, 2 e 3 in 40%, 25.5% and 6.4%, respectively. Mean of 1,5±0,7 interventions per patient. Median time-to-adequate AFV was 2.0 (IQR 2,0 - 6,45) months. Success rate was 72,8%.

Conclusion

Outcomes at 6 weeks in our cohort were similar to those reported in literature. Timely referencing may increase access patency with resort to vascular intervention. Individualized management is essential, discussing risks and benefits taking into account the treatment burden associated with numerous procedures. Patency rates and outcomes after HD initiation and even cost analysis are essential to guide recommendations.
#3144 Improving care for patients on maintenance haemodialysis effectiveness: a novel multidisciplinary approach
Authors: Althaf Mohammed Mahdi , White Carla
Published: May 2024

Background and Aims

Care for patients receiving maintenance haemodialysis (MH) is critically dependent on multi-professional coordination of care for multimorbidity and complex care needs. Design and coordination of care models is an important clinical concern (Kharbanda et al., 2020). We developed the Biannual Comprehensive Haemodialysis Multidisciplinary Team meeting (BCHMDT), a weekly meeting in which patients receiving MH are reviewed biannually. This study aimed to assess the efficacy of the BCHMDT in improving the provision of care for patients receiving MH.

Method

This single-centre retrospective study collected data from documentation from 146 patient encounters with the BCHMDT during from two separate time periods: August-December 2020, when the meeting had just been introduced (63 patient encounters) and February to July 2022 (83 patient encounters). Meetings involved a renal physician, haemodialysis specialist nurse, renal dietician, dialysis access nurse specialist, renal transplant coordinator, renal counsellor, and palliative care physician. Meetings were structured around a specially designed proforma Fig. 1.

Results

Actions generated by the MDT included investigations planned (41%), referrals made to other specialists (33%), changes to dialysis prescriptions (37%), medication changes (39%), dialysis access issues picked up (26%) and new RESPECT discussions (25%).The breakdown of data by time period (2020 group and 2022 group) is shown in Fig. 2 (option 1) OR “the data collected is summarized inFigure 2”(option 2). The proportion of patients achieving their prescribed Kt/V was 63% (2020 group) and 77% (2022 group). The proportion of patients who were eligible for transplant referral but had not yet been referred was 13% (2020 group) and 10% (2022 group).

Conclusion

The BCH MDT is an worthwhile method to improve coordination of dialysis care, and multi-professional staff in our centre use it as an opportunity to review and improve care. The meeting results in high numbers of actions and adjustments to patient care. Furthermore, in this uncontrolled observational study, there was improvement over time in the proportions of patients achieving adequate Kt/V, and in referral rates for transplant assessment, suggesting a positive impact on MH care.
#586 Effects of nursing facility residency on mortality in incident HD patients
Authors: Kim Hyunsuk , Yoon Jong-Woo
Published: May 2024

Background and Aims

As the elderly population increases and nuclear families are formed, the number of elderly people who are managed in nursing facility is increasing. We investigated whether dialysis performed while residing in a nursing facility before dialysis affects the mortality rate of dialysis patients.

Method

We enrolled 2,597 patients who visited the hemodialysis clinics of 17 teaching hospitals and surveyed the characteristics of underlying diseases, laboratory findings, and medication between patients who started dialysis while admitted to a nursing facility and those who did not. Then, multivariate survival analysis was performed to see if starting dialysis after entering a nursing facility increased mortality.

Results

9.1% (n=237) of the subjects underwent dialysis while admitted to a nursing facility. This group was predominantly female and older. Also the prevalence of diabetes, dementia, heart failure and atrial fibrillation was higher. There were many users of anti-platelet agents, warfarin, dementia drugs, and antidepressants. Additionally this group showed lower weight, lymphocyte, iPTH, albumin, phosphorus, and total cholesterol and higher duration of diabetes, and alkaline phosphatase. In multivariate analysis controlling for age, sex, access type, dementia, malignancy, ischemic heart disease, cerebrovascular accident, heart failure, atrial fibrillation, liver cirrhosis, fracture, coronary artery disease, ejection fraction, lymphocyte, platelet, BUN, Cr, albumin, phosphorus, total cholesterol, RAS blockade, B-blocker, calcium channel blocker, warfarin, hyperlipidemia drugs, Calcium-based phosphate binder, sevelamer, anti-depressant, and dementia medication, the HR of group receiving dialysis after being admitted to a nursing facility was 1.658 [1.309, 2.100].

Conclusion

In summary, the current study suggests a correlation between starting dialysis in a nursing facility and a higher mortality rate among dialysis patients.
#477 Risk factors for the mortality among hemodialysis patients with COVID-19 infection in 28 hemodialysis centers, South Korea
Authors: Seo Moon Jeong , Kim Hwa Jeong , Ko Sung Min , Yoon Jeong Min , Lee Shin Yeong , Chung Shi Jung , Lee Eun Ah , Kim Ki-Hyun
Published: May 2024

Background and Aims

Understanding mortality risk factors in hemodialysis patients with COVID-19 is critical for effective management. This study aimed to identify the factors influencing mortality risk and to evaluate the efficacy of COVID-19 vaccines in this specific population.

Method

This retrospective study analyzed clinical data from patients with COVID-19 who underwent hemodialysis at 28 affiliated centers of the Yeolin Medical Foundation between January 2020 and December 2022. Risk factors contributing to mortality were assessed through comparative analysis between survivors and deceased patients using R statistics.

Results

Of the 1,983 (ive study analyzed clinical data from patients with COVID-19 who underwent hemodialysis at 28 affiliated centers of the Yeolin analysis comparing survivors and deceased individuals revealed significant associations between mortality risk and several factors such as the omicron dominance period, age om patients with COVID-19 who underwent hemodialysis at 28 affiliated centers of tation, except for one dose, showed a decreasing trend in mortality risk with increasing doses. In the multivariable analysis, age ≥65 years(OR 1.04;95% CI[1.00 - 1.09],p=0.028), dyspnea(OR1.13;95% CI [1.07 - 1.19],p<0.001), and multiple doses of COVID-19 vaccination{2 doses(OR 0.91;CI[0.86 - 0.96],p=0.001), 3 doses(OR 0.88;CI[0.84- 0.92],p<0.001), 4 doses(OR 0.88;CI [0.84 - 0.93],p<0.001), 5 doses(OR 0.87;CI[0.81 - 0.93],p<0.001)} retained significance. Mortality did not appear to be significantly affected by sex, duration of ESRD, BMI, pneumococcal vaccination status, type and total number of comorbidities, or use of immunosuppressants.

Conclusion

Hemodialysis patients with COVID-19 infection have a high mortality rate per se, and comorbidity had no effect on mortality. Age(>65) and dyspnea were associated with higher mortality rates, and the lower ORs with increasing number of vaccines suggest that vaccination is a crucial protective factor in dialysis patients.
#1561 A tool for the “screening” of the dialysis facilities environmental impact
Authors: Perrotta Adolfo Marco , Mazzaferro Sandro , Rotondi Silverio
Published: May 2024

Background and Aims

The great number of resources needed for hemodialysis treatment can be a limiting factor in the perspective of access to care, especially in developing Countries, and may have a negative impact on the environment.

The aim of the study was to develop a questionnaire that is easy and informative of the ecologic impact (energy costs and waste production) of a single dialysis center. The questionnaire's goal is to highlight potentially modifiable factors that are responsible of the ecologic footprint of dialysis.

Method

A team of 8 people, 3 nephrologists, 3 representatives of dialytic equipment companies and 2 of water treatment systems, developed the questionnaire.

The items have been decided after two meetings in person. The completed questionnaire included 49 items divided into three sections, exploring the organization techniques of the dialysis center, its consumption and its water treatment system's characteristics. The questionnaire was then submitted to 11 dialysis centers and made available from 30 September 2022 to 1 February 2023, and included data collected in May 2022. An investigator assisted within filling in the form and collecting feedback on the comprehension of the questions and on any problems that may have surfaced during the compilation of the questionnaire.

Results

The questionnaires were completed by the center's managers who, unanimously, thought that the form was easily understandable and without significant problems during the compilation. The data collected evidenced that there is almost no real knowledge of the center's consumptions and that also many data about power and water consumption and of waste production are ignored and are therefore missing. No center is fueled by renewable energies.

Data refers to a total of 10337 dialysis treatments, with an average 940 treatments per center. Electrical consumption and waste production are in line with the literature, with an average of 13 KwH and 1,9 kg consumption per treatment, respectively. The average water consumption in our sample (550 L per treatment) seems to be higher than expected. Standard dialysate flow was greater than or equal to 500 ml/min in both HD and HDF, except in two centers. Five centers had a water treatment system which is more than eight years old. Average values of each center are reported in the Table 1.

Conclusion

Our questionnaire appears to be an easily fillable option to carry out consumption “screenings” of each dialysis center. The form could also prove itself useful for a large-scale investigation, to collect an adequate amount of data and to conduct a thorough research to highlight critical issues that could affect the center's consumption. A wider spread of this questionnaire could improve the awareness of nephrologists about their dialysis structure's consumption, taking part in the cultural revolution which is needed to develop a “greener” nephrology.
#620 Remaining life expectancy of Korean hemodialysis patients: how much longer can they live?
Authors: Lee Young-Ki , Park Hayne Cho , Kim Do Hyoung , Cho Ajin , Yoon Jong-Woo
Published: May 2024

Background and Aims

Hemodialysis (HD) patients have a higher mortality rate compared to general population. However, no study has investigated life expectancy in Korean HD patients so far. Therefore, this study aimed to calculate the remaining life expectancy among Korean maintenance HD patients and compare it to those of general population as well as HD patients from other countries.

Method

Baseline data were retrieved from HD quality assessment data from October to December 2015. Among the total number of patients who were alive at the beginning of 2016 (20,537 men and 14,404 women), a total of 22,439 (12,848 men and 9,591 women) were still alive at the end of 2021 while 12,502 (7,689 men and 4,813 women) were deceased during 6 years of follow-up. We used the life table method to calculate the expected remaining years of life in two-year increments.

Results

The mean age of the patients was 60.5 ± 12.4 years, and 58.7% were male. The average duration of HD was 5.63 ± 5.11 years. The most common cause of end-stage kidney disease was diabetes mellitus (42.0%), followed by hypertension (27.1%) and glomerulonephritis (10.9%). The remaining life expectancy for 60-year-old patients were 11.64 years for men and 14.64 years for women. The average remaining lifetimes of the HD population were only about a half of the general population (Fig.). Diabetic patients demonstrated shorter life expectancy compared to the patients with hypertension or glomerulonephritis. The remaining life expectancy of Korean HD patients was similar to that of Japanese and was almost double that of HD patients in Western countries such as Europe and United States.

Conclusion

HD population showed shorter life expectancy compared to the general population. Asian HD population seemed to demonstrate better patient survival compared to other countries. Longitudinal analysis should be warranted to analyze the effect of advanced dialysis technology upon improved survival rate among HD population.
#1625 Influence of polymorphisms in genes for interleukin-6 and interleukin-10 on dialysis patients survival
Authors: Pavlovic Svetlana Jovicic , Simic-Ogrizovic Sanja , Pavlovic Natalija , Bukumiric Zoran , Novakovic Ivana
Published: May 2024

Background and Aims

Chronic inflammation is an important non-traditional risk factor for morbidity and mortality in patients with terminal kidney disease. Associated occurrence of malnutrition, inflammation and atherosclerosis was observed in patients on dialyses and marked as MIA syndrome, a vicious circle in which pro inflammatory cytokines play a key role. It is known that there were individual differences in creation of cytokines, and it is assumed that polymorphisms in the promoter regions of cytokine genes can have a key role in the predisposition to chronic inflammation and its consequences.

We investigated association between interleukin-6 -174 G>C, interleukin-10 -1082 G>A, inteleukin-10 -819 T>C genotypes with the survival of patients with terminal renal failure.

Method

In this study, a total of 128 patients were examined, 77 on the regular hemodialysis (HD) and 51 on the peritoneal dialysis (PD) program of the UKCS Nephrology Clinic in Belgrade. Age, gender, BMI, duration of HD/PD, C-reactive protein (CRP), albumin and IL-6 and IL-10 concentration in serum were analyzed. Analysis of IL6 -174G>C and IL10 -819T>C polymorphisms was performed by the allele-specific PCR method, and analysis of the IL10 -1082G>A polymorphism by the PCR/RFLPs method.

The patients were followed for 36 months and during that time 37 patients died.

Results

Univariate analysis showed that significant predictors of mortality were age (OR= 1.16,95%CI 1.061-1.269, p=0.001), albumin concentration (OR= 0.81, 95%CI 0.656-0.999, p=0.049), CRP (OR= 1.06, 95%CI 1003-1.124, p=0.039) and IL-6 (OR= 1.12, 95%CI 1.038-1.216, p=0.004), as well as IL-6176G>C gene polymorphism (OR= 0.82, 95%CI 0.097-0.805, p=0.018), while in multivariate logistic model separated only the concentration of IL-6 and the polymorphism in the gene for IL-6 -174 G>C. Estimated arithmetic mean of survival in subjects with the IL-6 -174GG genotype was 33.1 months (95%CI 30.8-35.3), GC 34.6 months (95% CI 33.6-35.7) and CC 26.1 (95% CI 20.0-32.2). There is statistically significant difference in survival time in relation to IL-6 -174 G>C genotype (chi-square=11.398; p=0.003). Estimated arithmetic mean survival in patients with the IL-10 -1082 GG genotype was 32.6 months (95% CI 30.5-35.2), in GA 31.5 (95% CI 29.2-33.8) and in AA 36.0 (95% CI 35.9-36.1). Exists statistically significant difference in survival time in relation to 1082G>A genotype (chi-square=9.669; p=0.008).

Conclusion

Monitoring of survival in 128 patients during 36 months showed that significant worse survival was experienced in patients with IL -6 -174 CC genotype, while polymorphisms in IL 10 gene-1082 G>A and -819T>C did not significantly affect survival. In this group of patients, beside IL-6-174 CC genotype, concentrations of IL-6, C reactive protein and albumin were significant predictors of mortality as well as Kt/V.
#843 Methylation of HMGCR gene promoter in patients on hemodialysis
Authors: Mokrejsova Magdalena
Published: May 2024

Background and Aims

Patients with chronic kidney disease (CKD) exhibit a pronounced risk for cardiovascular mortality; the most vulnerable group enrolls patients on hemodialysis. Unfortunately no meaningful decrease of cardiovascular risk after cholesterol lowering medication – inhibitors of HMGCR - was demonstrated in hemodialysed patients. The incidence of complications in CKD patients correlates with changed epigenetic mechanisms, the most studied epigenetic phenomenon is DNA methylation.

The aim of this study was to elucidate the methylation status of HMGCR gene and evaluate its impact on cardiovascular morbidity and mortality in patients receiving hemodialysis.

Method

We analyzed DNA in plasma of 21 hemodialyzed patients before and after dialysis. Then bisulfite conversion was carried out to distinguish methylated and unmethylated form of DNA. The primers of HMGCR genes promoters were designed, after that methylation specific PCR and sequential analysis of PCR products were performed.

Results

Although the methylation rate of HMGCR gene dropped 9 patients during the hemodialysis session, no statistical significance of this demethylation was confirmed. No correlation of methylation status of HMGCR gene and cholesterol or phosphorus was confirmed. Hypomethylated promoter of HMGCR gene was found in 6 patients, who either underwent amputation of lower extremity due to arterial ischemia or has deceased due to cardiovascular event during next 6 month of follow-up period.

Conclusion

This study suggests that both DNA demethylation and consecutive increased expression of HMGCR gene could be predictors of high risk of cardiovascular morbidity and mortality in hemodialyzed diabetic patients.
#3007 Association between sarcopenia and clinical outcomes in patients on maintenance hemodialysis
Authors: Dimitrijevic Zorica , Randjelovic Jelena , Paunovic Karolina , Kostic Emina , Tasic Danijela , Cvetkovic Tatjana , Mitic Branka
Published: May 2024

Background and Aims

Sarcopenia is a generalized skeletal muscle disorder characterized by the progressive loss of skeletal muscle mass, strength, and function, resulting in worse quality of life and increased mortality. Chronic kidney disease and hemodialysis (HD) favor the development of sarcopenia; however, factors associated with sarcopenia in HD patients have not been well-studied. This study aimed to determine the prevalence and risk factors for sarcopenia in HD patients and to analyze the relationship between sarcopenia and overall morbidity and mortality.

Method

We conducted short-term follow-up prospective cohort study among maintenance HD patients. Hand Grip Strength was measured by a resisted hand-held dynamometer to identify muscle strength and Bioimpedance Spectroscopy to calculate appendicular skeletal muscle mass (ASM). Finally, appendicular skeletal muscle index (ASMI) was calculated as ASM (kg) divided by weight squared (m2). Patients were categorized as sarcopenic or non-sarcopenic using Revised European Working Group criteria (EWGSOP2). Low muscle mass was defined as an ASMI value of<7.00 kg/m2 for men and<5.40 kg/m2 for women; low muscle strength was defined as a hand grip strength of<28 kg for men and<18 kg for women.

Results

Our study enrolled 176 adult HD patients (60% male, 56.1 ± 14.8 years of age). Median follow-up was 15.9 (interquartile range [IQR] 8.6–21) months. Sarcopenia was present in 32.5 % of males and 28% of female patients and associated with older age (55.2 ± 13.4 vs. 64.0 ± 7.3, p<0.001), lower body mass index (25.3 ± 1.3 vs. 22.8 ± 3.1 kg/m2, p<0.05), longer dialysis vintage (9.2 ± 1.1 vs. 6.2 ± 1.9 years, p<0.001) lower Kt/V and lower serum phosphorus and albumin levels (p = 0.037, p = 0.042 and p = 0.048, respectively). In the multivariate analysis, the sarcopenic group had a significantly higher risk for all causes hospitalization than the non-sarcopenic group after adjusting for age and gender (OR 3.92, (95%CI 1.21–12.53, p = 0.031)). Sarcopenia was significantly associated with higher mortality risk (adjusted OR 1.76 (95% CI 1.32 to 2.67)), cardiovascular (adjusted OR 3.31 (95% CI 1.55 to 9.22)) and cerebrovascular events (adjusted OR 2.67 (95% CI 1.52 to 6.03)). Kaplan–Meier survival analysis showed a twelve-month survival rate of 82.1% in sarcopenic patients, which was significantly lower than the non-sarcopenic group (p = 0.034). Finally, both ASM and low muscle strength were independently related to increased mortality risk in dialysis patients (OR 1.86; 95% CI 1.31 to 2.62 and OR 2.31 95% CI 1.49 to 3.93, respectively).

Conclusion

Our study demonstrated that sarcopenia was highly prevalent among HD patients and was shown to be a significant predictor of poor patients outcomes. Future research should address whether the early diagnosis and treatment of sarcopenia improve outcomes.
#2579 Chronic pain in chronic kidney disease: differences between stages and replacement therapies
Authors: Pedrón Miriam Garrigós , Martínez Maria Dolores Arguisuelas , Mauro Juan Carlos Julián , Costantino Flavia , Monnier Victor , Valtueña-Gimeno Noemi , Caballer Vicente Benavent , Martínez-Olmos Francisco José , Ferrer-Sargues Francisco José , Reboredo Maycon Moura , Simó Vicent Esteve , Segura-Orti Eva
Published: May 2024

Background and Aims

Pain is one of the most common symptoms among patients with End-Stage Renal Disease (ESRD), often going unrecognized or inadequately managed in people undertaking hemodialysis. Over 50% of people on hemodialysis experience pain, with 75% of them being ineffectively treated due to healthcare professionals' lack of awareness of this symptom. Managing pain in this population is a complex and challenging task for healthcare professionals. Variables related to chronic pain can influence the patient's response to pain.

There is a gap in the literature on this topic, as it has not been studied whether patients with ESRD undergoing hemodialysis exhibit characteristics of chronic pain that may be influencing their pain response.

The objective of this study is to evaluate the presence and characteristics of variables related to chronic pain in hemodialysis patients with ESRD to assess whether including the management of chronic pain is relevant in the holistic treatment of these patients.

Method

This is a cross-sectional observational study that is currently ongoing. Participants included subjects that were willing to participate, with chronic kidney disease (CKD) stages 3 and 4, CKD stage 5 in hemodialysis and transplanted patients. Several questionnaires were recorded to report different aspects related to chronic pain. The Kruskal-Wallis test was used to assess differences between groups.

Results

Preliminary results on 26 subjects are shown in Table 1. No significant differences were found between groups. Transplanted and hemodialysis patients (in the hospital) experience more sleep disturbances and more pain catastrophizing. Transplanted and hemodialysis patients (in the hospital) present higher belief in their abilities to handle stressful situations in daily life, but they also suffer more headaches. Hemodialysis patients (hospital and home) present higher levels of anxiety and depression. Hemodialysis patients (at home) and transplanted patients exhibit higher levels of stress conditions. Finally, patients undergoing hemodialysis (in the hospital) and CKD stages 3 and 4 present higher levels of chronic pain.

Conclusion

A bigger sample is needed. However, based on the data, it seems that patients with CKD exhibit characteristics of chronic pain that should be addressed by healthcare professionals.
#2914 Impact of COVID-19 on the mortality of hemodialysis patients
Authors: Pešić Snežana , Đurić Živka , Bajcetic Sanja , Davidovic Zeljko , Filipović Danijela , Simovic Nikola , Sakic Verica Todorov , Markovic Dragana , Đuđić Sanja , Ačimović Jovana , Todorović Sara , Naumovic Radomir
Published: May 2024

Background and Aims

Hemodialysis patients belong to the category of immunocompromised patients with numerous comorbidities. Infection with the SARS˗CoV˗2 virus (COVID-19) in this group of patients had a significantly higher mortality compared to the general population. During the COVID-19 pandemic, approximately 30%–35% of dialysis patients infected with SARS-CoV-2 had a fatal outcome.

Method

The study included chronic hemodialysis patients at the Zvezdara University Clinical Center, in order to determine the impact of COVID-19 on mortality. Mortality in patients during two years before the COVID-19 pandemic (2018/2019) and two years during the pandemic (2020/2021) was compared. The existence of differences during these two periods was also examined, in relation to age, the presence of comorbidities and the length of dialysis treatment of these patients.

Results

The study included 127 (61.1%) men and 81 (38.9%) women, average age 68.4 ± 11.4 years. The average dialysis experience of the examined patients was 76.6 months (1 to 418). The main cause of terminal renal failure was hypertensive nephroangiosclerosis and diabetic nephropathy 66.5% (41.9%, 24.6%). During the two years before the pandemic, a total of 73 patients died, while during the first two years of the pandemic, almost twice as many patients died, 135. Mortality is statistically significantly higher in the years of the pandemic. During the pandemic, mortality was significantly higher in patients who were on HD longer (p<0.05). The most common cause of death in years was SARS-CoV-2 infection (43.7%).

Conclusion

SARS-CoV-2 infection had a significant impact on the mortality of hemodialysis patients. The mortality of hemodialysis patients who were diagnosed with Covid 19 was extremely high. In the years of the COVID-19 pandemic, the number of deaths was almost twice as high as in previous years. Hemodialysis patients can be considered a high-risk population for illness and increased mortality from respiratory infections in pandemic conditions, both due to the impossibility of isolation during dialysis procedures and the specific organization of transportation to the dialysis center.
#510 Evaluating tolvaptan as a protective agent for cardiac insufficiency in peritoneal dialysis patients
Authors: Oikonomaki Theodora
Published: May 2024

Introduction

Peritoneal dialysis serves as a highly effective renal replacement therapy, offering prolonged preservation of residual renal function, improved blood pressure regulation, and enhanced quality of life. While diuretics are generally considered safe and beneficial in this context, their efficacy may be limited in certain cases.

Background and Aims

The rationale behind investigating the potential benefits of tolvaptan in peritoneal dialysis stems from existing studies in Asia, where the use of tolvaptan has been approved in this population. These studies, conducted on patients undergoing peritoneal dialysis, indicate notable improvements in urine output and key heart failure indicators such as Left Ventricular Mass Index (LVMI) and Brain Natriuretic Peptide (BNP).

Materials & Methods

Recognizing the significance of these findings, a recent meta-analysis was conducted to comprehensively assess the collective data. The meta-analysis encompassed data from five pertinent studies involving a total of 70 peritoneal dialysis patients, with an average age of 66.1 ± 15 years. Participants received tolvaptan in doses of up to 15 mg, and the mean follow-up period was 8.2 ± 3.9 months.

Results

Results from the meta-analysis revealed a significant increase in urine volume in two out of four instances (Mean Difference [MD]= +554.5 cc [379,730], I²=61.5). While most studies did not indicate substantial changes in body weight or renal kt/V, a notable reduction in Left Ventricular Mass Index was evident in two studies (MD= -43.28 [-84.9,-1.6], I²=80.6%). Additionally, a substantial reduction in BNP was reported in one study, with no documented adverse events across the studies.

Conclusion

As an adjunct therapy, tolvaptan exhibits potential benefits in volume control, potentially contributing to improved cardiac function in peritoneal dialysis patients. The findings of this study align with existing research, highlighting the positive impact of tolvaptan on heart failure markers. Nevertheless, further high-quality studies are imperative to consolidate and validate these observed benefits in the peritoneal dialysis population.
#2650 A novel approach for exit site care reduces peritoneal dialysis catheter related infections
Authors: Ben-Bassat Orit Kliuk , Soetendorp Hila
Published: May 2024

Background and Aims

Peritoneal dialysis (PD) related infections, including peritonitis and catheter related infections, are associated with significant morbidity and technique failure. Various exit site care protocols are available, most allow to shower in running water after the exit site is well healed. Following an increase in exit site infections (ESI) in our dialysis unit, partially resulting from water derived organisms, we implemented a novel exit site care protocol. The protocol included complete avoidance of water exposure using stoma bag during shower; and change in antibiotic treatment from gentamycin to mupirocin. We aimed to evaluate its efficacy to decrease ESI episodes.

Method

A prospective single center trial. Study group included PD patients between June 2018 - May 2021 who implemented the new exit-site care protocol. They were compared to a historical control group that included all PD patients between January 2016 to May 2018. In the control group, exit-site care included a daily shower with a bactericidal cleanser containing chlorhexidine 4%, thereafter local gentamycin 0.1% was applied with sterile gauze dressing. In the study group, water exposure during daily wash was avoided using a stoma bag sealed around the catheter exit-site and the tubing. Thereafter, the exit-site was cleaned with a chlorhexidine 0.5%- alcohol 70% solution and local mupirocin 2% was applied with a sterile gauze cover. Primary outcome was catheter related infections, including ESI and tunnel infection. Secondary outcomes were peritonitis and technique loss.

Results

A total of 113 patients were included, 58 patients in control and 55 in study group. Mean follow up time was 13.28 ± 9.5 months in control and 16.4 12.7 months in study group. ESI rate was significantly lower in study group (0.11/patient year) compared to control group (0.71/ patient year), p<0.001. Time to first ESI was significantly longer in study group, χ² (1) = 25.104, p < 0.001 (Fig. 1). On multivariate logistic regression analysis confirmed the protective effect of the intervention on ESI risk (p <0.001). Longer PD vintage and active cancer predicted ESI (p = 0.01 and 0.02, respectively).

There were no tunnel infections during study period compared to 3 episodes during control.

Peritonitis rate was significantly lower in study group (0.19/patient years) compared to control group (0.40/patient years), p=0.011. There was no difference in time to first peritonitis episode between groups χ² (1)=2.32, p=0.128.

Nine patients were lost to PD due to PD related infection in control group, compared to 5 in study group. Peritonitis related mortality occurred in one patient in control group.

Conclusion

Protection of exit site from water exposure in conjunction with local Mupirocin cream reduced significantly ESI and peritonitis episodes in peritoneal dialysis patients. This protocol may be more beneficial in areas of poor water quality.