bluuebunny/crossref_metadata_2025 huggingface dataset:
MO686: Effectiveness of SARS-CoV-2 Vaccination in Peritoneal Dialysis Patients
Authors: Donato Beatriz , Mateus Catarina , Matias Patricia , Branco Patricia
Published: May 2022

BACKGROUND AND AIMS

Chronic kidney disease (CKD) patients, especially those on renal replacement therapy, have a higher risk of infection and worse clinical outcomes after coronavirus disease 2019 (COVID-19) than the general population. Thus, this population must be promptly immunized against COVID-19. We aimed to assess the humoral response after two doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccine in peritoneal dialysis (PD) patients. We also aimed to identify potential factors associated with vaccine response and the prevalence of COVID-19 in a PD unit.

METHOD

We conducted a single-center, retrospective study to evaluate the immunogenicity in terms of antibody response after COVID-19 vaccination. Three types of vaccine [BNT162b2 messenger RNA vaccine (Pfizer-BioNTech), messenger RNA-1273 (Moderna) and ChadOx1 nCoV-19/AZD1222 (AstraZeneca)] were administered in the PD unit. The detection of anti-spike IgG antibodies (with a cutoff of 0.8 U/mL) was done at least after 21 days of the two vaccine doses. We also evaluated the presence of COVID-19 infections, hospital admissions (including in intensive care unit) and deaths.

RESULTS

This study enrolled 70 prevalent patients. We excluded patients with only one vaccine dose (n = 4), those who did not consent to the collection (n = 5) or were vaccinated before starting PD (n = 11). Among the 50 patients included, the mean age was 59 $ \pm $ 15 years, 60% were male and the dialysis vintage was 22.1 (IQR 6–34.3) months. Six (12%) patients were receiving immunosuppressive therapy and 16 (32%) had diabetes. The mean interval between administration of the second vaccine dose and antibodies evaluation was 7.2 $ \pm $ 0.7 months. Overall, after two doses, there was a significant increase in antibody level, with median of 1495 (IQR 37.8–546.8) U/mL. Only two (4%) patients did not increase their antibody level (remained seronegative). History of immunosuppressive therapy was associated with no response after two doses (91.7% versus 8.3%, P = 0.012). There were two COVID-19 infections after the complete vaccination, with mild symptoms (one with hospital admission). Furthermore, there were no intensive care unit admissions or deaths.

CONCLUSION

We found that immunization against COVID-19 was effective in generating an overall humoral response and in preventing severe disease in CKD patients on PD, which emphasizes the importance of the vaccination against COVID-19 in this population. These results also suggest the impact of the immunosuppressive therapy on vaccine response in PD patients.
MO695: Phase Angle: Clinical and Prognostic Value in Peritoneal Dialysis
Authors: Calças Marques Roberto , Morgado Nuno , Borges Henrique , Afonso Rita , Malho Guedes Anabela , Bernardo Idalécio , Silva Ana
Published: May 2022

BACKGROUND AND AIMS

Malnutrition–inflammation–atherosclerosis syndrome is common in chronic kidney disease and is associated with high mortality, particularly in dialysis patients. Bioimpedance analysis (BIA) is a simple and non-invasive method for nutritional assessment. The aim of this study was to evaluate the relationship between phase angle (PA) and other nutritional parameters and establish its role as predictor of mortality in peritoneal dialysis (PD) patients.

METHOD

Prevalent PD patients were enrolled in the longitudinal prospective study in a single tertiary center between 2015 and 2020, with a simultaneous BIA assessment and a modified peritoneal equilibration test. Spearman's correlation test was used to assess relevant clinical associations. Survival analysis was performed using the Kaplan–Meier test and univariate and multivariate Cox analysis to determine the predictive factors of all-cause mortality.

RESULTS

A total of 49 PD patients were included with mean age 55.9 ± 16.2 years, 57.1% male, Charlson comorbidity index 4.9 ± 2.3, Kt/V 2.5 ± 0.7, with a mean follow-up of 39.9 ± 26.3 months. The Spearman's correlation test showed a very strong positive association between PA and extracellular mass/body cell mass (r = 0.939, P < 0.001). It also showed a moderate positive association between PA and albumin (r = 0.524, P < 0.001) and normalized protein catabolism rate (r = 0.437, P = 0.002). Furthermore, PA was negatively correlated with age (r = −0.477, P = 0.001). In the Kaplan–Meier analysis, patients with PA < 4.9° had a lower survival rate (log rank = 4.77; P = 0.029). Using the multivariate Cox regression, forward model, PA (HR = 0.243; 95% CI 0.079–0.753), the number of cardiovascular events (HR = 11.236; 95% CI 1.286–98.211) and neutrophil–lymphocyte ratio (HR = 1.360; 95% CI 1.033–1.790) were predictors of all-cause mortality.

CONCLUSION

Lower PA appears to be associated with a decline in nutritional status, so monitoring it can be useful to identify patients at higher risk of malnutrition. PA was also validated as an independent predictor of mortality in our PD patients.
MO697: FGF-21 Correlates with Overhydration: Is There a Role for Peritoneal GLUT-1?
Authors: Ribeiro Brigitte , Malho Guedes Anabela , Fernandes Mónica , Faísca Marília , Calças Marques Roberto , Silva Ana , Bragança José , Rodrigues Anabela , Krediet Raymond
Published: May 2022

BACKGROUND AND AIMS

FGF-21 is a hepatokine that stimulates glucose uptake through GLUT-1. The presence of this glucose transporter in peritoneal fibroblasts is driven by peritoneal glucose exposure and is related to impaired ultrafiltration, predisposing to overhydration. The study was designed to determine FGF-21 levels in peritoneal effluent and serum, and its possible association with overhydration.

METHOD

Prevalent and incident peritoneal dialysis (PD) patients without diabetes were included. FGF-21 (dialysate and serum) was obtained during a 3.86% glucose peritoneal equilibration test. Peritoneal glucose load was calculated. The presence or absence of local peritoneal production was assessed by comparing the dialysate to plasma (D/P) ratio of FGF-21 (MW 32 kD) with that of albumin (MW 67 kD). Hydration status was assessed by bioimpedance. Spearman's correlations were performed.

RESULTS

A total of 58 patients (38 incident, 20 prevalent) were included, mean age 54 years, 67% males, PD duration from 1 to 75 months, mean 10.4. Residual GFR was 6.4 ± 3.5 mL/min/1.73 m2 and D/P creatinine 0.65 ± 0.12. Peritoneal glucose load was 110.5 g/day (range 40.8–226.9). Dialysate FGF-21 was 42.5 ± 47.0 pg/mL and serum FGF-21 943.9 ± 1164.8 pg/mL, giving a D/P ratio of 0.07. D/P albumin was 0.009, indicating that dialysate FGF-21 concentrations can be explained by transport from the circulation, without local peritoneal production. Serum FGF-21 was positively correlated with dialysate FGF-21, extracellular water excess and total peritoneal glucose load (all P < 0.01). Some association was present with PD duration (P < 0.05). No relationship was found between plasma FGF-21 and plasma insulin, D/P creatinine, or residual kidney function.

CONCLUSION

FGF-21 in peritoneal effluent is likely not locally produced, but caused by transport from the circulation. The associations between plasma FGF-21 levels with PD duration, peritoneal glucose load and overhydration, all indicate an effect of peritoneal glucose absorption from the peritoneal cavity into the interstitium with an insulin-independent storage into interstitial adipocytes, where it may stimulate the expression of GLUT-1.
MO702: Etiology and the Impact of Refractory Peritonitis on Clinical Outcomes of Patients on Peritoneal Dialysis—12 Years’ Single-Center Experience from Turkey
Authors: Berke Mentese Ilay , Barutcu Atas Dilek , Hakki Arikan Izzet , Tugcu Murat , Velioglu Arzu , Asicioglu Ebru
Published: May 2022

BACKGROUND AND AIMS

The outcomes of refractory peritonitis in peritoneal dialysis (PD) patients have been reported to be inferior to those of solitary peritonitis. The current study aimed to examine the factors associated with treatment failure in PD patients experiencing refractory peritonitis.

METHOD

This single-center retrospective study included all episodes of refractory peritonitis in adult PD patients in Marmara University Hospital, Turkey, between 2009 and 2020. Patient characteristics, microbiological data, outcomes and factors associated with refractory peritonitis were analysed. The primary outcome was peritonitis-related catheter loss. Secondary outcomes were hospitalization and peritonitis-related death.

RESULTS

Overall, 236 episodes of refractory peritonitis occurring in 135 patients were included. Gram-positive, gram-negative and fungal infections accounted for 44.1%, 20.4% and 2.4% of all peritonitis episodes, respectively. Forty-seven patients (34.8%) needed catheter removal, 2 patients (1.5%) died due to peritonitis complications and 59 episodes (25%) needed hospitalization. Mean fifth day PD fluid cell count was significantly greater among patients who required PD catheter removal (3621.3 $ \pm $ 3144.1 versus 1589.4 $ \pm $ 2316.6 P < 0.001). Furthermore, patients with >1000/mm3 cell count on the fifth day had higher rate of catheter removal (72.3% versus 37.6%, P < 0.001) as compared to patients with cell count under 300/mm3. Treatment failure was more common in peritonitis episodes caused by gram (−) organisms (31.9% versus 14.8%, P:0.012). Pseudomonas and fungi-associated peritonitis were also significantly correlated with catheter loss (P:0.001 and P: <0.001) (Table 1). When peritonitis episodes with more and <1000 cells/mm3 on the fifth day were compared, there were more episodes with gram (−) bacteria (29.7% versus 12.9%, P:0.003) and hospitalization (41.9% versus 11.4%, P: <0.001) in the group with more than 1000 cells/mm3. In the multivariate analysis, factors associated with catheter loss were a cell count of >1000 on the fifth day and hospitalization, while presence of gram (+) bacteria related peritonitis was inversely correlated with catheter loss (Table 2).

CONCLUSION

Our study shows that the PD cell count on the fifth day of peritonitis can be used as a prognostic tool to determine the prognosis of refractory peritonitis episodes. Although we were unable to show the adverse prognostic effect of gram (−) bacteria related peritonitis, gram (+) bacteria related peritonitis was associated with better outcome. Prospective studies are needed to assess the risk factors for adverse outcomes of patients with refractory peritonitis, as the evidence in this area is sparse.
MO704: Prognostic Factors of Serological Response to the Sars-Cov 2 Vaccine in Peritoneal Dialysis: Our Experience
Authors: Burguera Vion Víctor , Haridian Sosa Barrios R. , Sánchez Iglesias Jorge , Campillo Trapero Cristina , Gutiérrez Martín Yolanda , Viera Ramírez Elizabeth , Fernandez Lucas Milagros , Rivera Maite
Published: May 2022

BACKGROUND AND AIMS

The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic has had a massive impact in health systems worldwide, taking an important toll on dialysis patients as they are more comorbid, have higher mortality and an impaired immune system. Vaccines against SARS-Cov-2 proved to reduce mortality and hospitalization, but serological response in the dialysis population is weaker. Therefore, predictors of response would be useful to assess their level of protection and evaluate the need for further booster doses of the vaccine.

METHOD

RESULTS

CONCLUSION

In our experience, PD patients have an adequate serological response to the SARS-Cov-2 vaccines, being previous COVID exposure the main predictor of a good response. Conversely, longer duration of PD treatment was a prognostic factor of seroconversion failure. We believe this should be kept in mind to assess the need for booster vaccination doses in those patients.
MO710: Longitudinal Effects of Different Biocompatible Peritoneal Solutions on Membrane Function
Authors: Balafa Olga , Duni Anila , Tseke Paraskevi , Pavlos Rapsomanikis Karolos , Alekos Ioannis , Pavlakou Paraskevi , Oikonomou Margarita , Tatsis Vasileios , Ntounousi Evangelia
Published: May 2022

BACKGROUND AND AIMS

Peritoneal biocompatible dialysates (low GDPs, neutral pH) seem to sustain more steady peritoneal membrane characteristics compared to conventional ones. However, various brand biocompatible dialysates have different composition (e.g. in lactate concentration) and there is no published study comparing their effects on membrane characteristics in long peritoneal dialysis (PD). Our PD unit has been using solely two brands of biocompatible dialysates (Balance, Fresenius© and Physioneal, Baxter©) since 2000. The aim of our study was to compare longitudinal data on peritoneal membrane function between these two different brand solutions

METHOD

Membrane characteristics were assessed by uni-peritoneal equilibration test (uni-PET, a combination of modified and mini PET), which is performed at least annually on every patient. Patients with no less than two PETs were included. We estimated dialysate to plasma (D/P) creatinine, ultrafiltration (UF) at 4 h, sodium seiving expressed as Dip/DPNa = [(dialysate sodium time 0/plasma sodium)–(dialysate sodium time 1 h/plasma sodium)], sodium removal (in 1 h) and free water transport (FWT). We collected clinical and lab data of the patients too.

RESULTS

A total of 85 patients (age 61.1 ± 15.1 years) were included—38 patients on Balance and 47 on Physioneal. The main characteristics of the patients are shown in Τable 1. Baseline membrane characteristics presented no differences between the two groups (D/Pcre 0.75 ± 0.125 versus 0.745 ± 0.11, P = 0.71—UF 660 ± 285 mL versus 651 ± 252 mL, P = 0.86—DipDPNA 0.05 ± 0.03 versus 0.047 ± 0.046 P = 0.54—sodium removal 30 (15.7, 42.3) mEq versus 38 (17.3, 46)mEq, P = 0.31—FWT 149 ± 85 mL versus 140 ± 109 mL, P = 0.69).

The patients were followed up for a median of 36 months (range 2.4–143). A total of 219 PETs were performed. Analysis for repeated PET tests was performed by using generalized linear regression models. The membrane characteristics (D/Pcre, Dip/DPNa, FWT and UF) of both groups remained stable longitudinally and overall no differences between the two different solutions were observed (Fig. 1). Only at the fourth year of follow-up, patients on Balance solutions had lower D/Pcre compared to Physioneal (0.62 versus 0.72, P = 0.003).

CONCLUSION

Different biocompatible solutions had no differences on peritoneal membrane characteristics longitudinally.
MO723: Ankle-Brachial Index is Associated with Subendocardial Viability Ratio in Chronic Hemodialysis Patients
Authors: Piko Nejc , Bevc Sebastjan , Hojs Radovan , Petreski Tadej , Knehtl Masa , Ekart Robert
Published: May 2022

BACKGROUND AND AIMS

Ankle-brachial index (ABI) is a marker of peripheral arterial disease and is associated with increased cardiovascular morbidity and mortality. Structural alterations in the arterial walls lead to functional central haemodynamic changes, potentially impacting pulse wave reflection and, consequently, myocardial perfusion.

The aim of this study was to determine the association between ABI and subendocardial viability ratio (SEVR) as a non-invasive measure of coronary perfusion in chronic haemodialysis patients.

METHOD

We measured ABI using an automated non-invasive waveform analysis device (MESI®, Slovenia) and SEVR using applanation tonometry (Sphygmocor, Atcor Medical, Sydney, Australia). All the measurements were performed on a non-dialysis day and SEVR on the non-arteriovenous fistula (non-AVF) hand. ABI was calculated as the ratio between systolic blood pressure on the non-AVF hand and systolic blood pressure on the calves of both legs. Mean ABI of both sides was used in the statistical analysis.

RESULTS

A total of 29 patients (mean age 63.6 ± 10.5 years, 69.0% male) were included. In Table 1, descriptive parameters are presented.

Of those, 4 patients (13.8%) have an ABI <0.9 and the other 25 patients (86.2%) have a normal ABI between 0.9 and 1.3. Using the independent-samples T-test, patients with a lower ABI have a statistically significant lower SEVR compared with patients with normal ABI (109 versus 142%; P = 0.039).

CONCLUSION

Low ABI is independently associated with decreased subendocardial perfusion in chronic haemodialysis patients, suggesting that both methods of ABI and SEVR measurement may reflect an atherosclerotic process in peripheral and coronary arteries.
MO732: Circulating Omentin-1 and Subclinical Atherosclerosis in Chronic Haemodialysis Patients: A Pilot Study
Authors: Presta Pierangela , Bolignano Davide , Coppolino Giuseppe , Crugliano Giuseppina , Arena Roberta , Ruosi Federico , Tripodi Loredana , Carullo Nazareno , Zicarelli Mariateresa , Comi Alessandro , Comi Nicolino , Cianfrone Paola , Andreucci Michele
Published: May 2022

BACKGROUND AND AIMS

Chronic haemodialysis (HD) patients are notoriously at high risk for cardiovascular mortality and morbidity. Omentin-1 (OME-1) is an adipocytokine produced by adipose tissue, whose levels are altered in various dysmetabolic conditions, such as obesity and type 2 diabetes mellitus. Beyond this, nowadays there is evidence indicating that this cytokine plays a crucial role in the genesis and progression of systemic atherosclerosis since it may inhibit plaque formation. With this background in mind, we run a pilot investigation to evaluate the possible correlation between circulating OME-1 levels and mean intimal thickness (IMT) in a small, homogeneous cohort of patients treated by HD (‘HD patients’).

METHOD

From a source cohort of 45 HD patients, we selected 27 individuals suitable to be enrolled. These patients had a dialysis vintage > 6 mo.,  were on a regular 4 h/3 times week HD regimen and had stable clinical conditions. OME-1 levels were measured in their blood by the ELISA together with common laboratory and clinical parameters before starting a mid-week HD session. All the patients then underwent carotid Doppler ultrasound for IMT measurement. A total of 18 healthy subjects were the controls.

RESULTS

In the whole cohort, mean IMT values were 0.75 ± 0.12 mm. However, 8/27 patients (29.6%) presented a pathological IMT (>1 mm). Circulating OME-1 levels in the whole HD cohort were increased as compared with controls [763 (367–1423) versus 371 (228–868) ng/mL; P = 0.03]. However, HD patients with pathological IMT presented, on average, lower OME-1 levels as compared with others [483.25 (168.7–1743) versus 1155 (286–2324); P = 0.05]. In ROC analyses, OME-1 values ≤ 840 ng/mL held an 83.3 sensitivity and 66.7 specificity (AUC 0.716, 95% confidence interval 0.506–0.946) in identifying HD patients with pathological carotid thickening.

CONCLUSION

OME-1 may play a direct role in the atherosclerosis process also in HD patients. Further studies on larger and more heterogeneous HD cohorts are needed to confirm the usefulness of OME-1 plasma levels as potential biomarkers for diagnosing subclinical atherosclerosis and for stratifying the risk of atherosclerosis progression in high-CV risk in HD patients.
MO734: High Serum Oxalate Concentration Associated with Coronary Artery Calcification and Lanthanum Carbonate in Hemodialysis Patients
Authors: Nishizawa Yoko , Hirasawa Eriko , Tosaka Mai , Hosoda Yumi , Horimoto Ai , Omae Kiyotsugu , Nitta Kosaku , Ogawa Tetsuya
Published: May 2022

BACKGROUND AND AIMS

Oxalate is an organic acid found in abundance in plants and can also be synthesized as a terminal metabolite by the organic acid metabolism systems in humans. As a major excretion pathway of oxalate is urine, serum oxalate (SOx) concentration elevates in end-stage renal disease (ESRD) patients and causes calcium oxalate deposition to tissues. We previously reported that calcium oxalate might be one of the major components of coronary artery calcification (CAC) in ESRD patients; however, the association between SOx and CAC is unknown. This study aimed to demonstrate the relationship between SOx and CAC in haemodialysis patients.

METHOD

A total of 77 patients undergoing maintenance haemodialysis at a single facility who underwent an atherosclerosis check-up from 2011 to 2012 were enrolled and measured SOx retrospectively in 2021. Of those, 17 extremely outlying SOx patients were excluded, and 60 patients including 42 males were analysed. The median age was 64 (35–85) years, and median dialysis duration was 87.5 (17.1–410) months. Gender, Agastston's CAC score, major artery calcification volume, laboratory data and medications around the atherosclerosis check-up date and new-onset cardiovascular disease (CVD) events and deaths during the 10-year observation period were recorded. A CVD event is defined as an admission due to non-fatal myocardial infarction, coronary artery disease or heart failure. SOx level was measured by the commercial colorimetric oxalate assay kit, and the normal SOx level was 181 µmol/L.

RESULTS

The median SOx was 267 (221–563) µmol/L and new-onset CVD events, all-cause deaths occurred in 28 (47%) and 22 (37%) patients, respectively. In univariate analysis, SOx was associated with males (r = 0.27, P = 0.03), serum albumin (r = –0.25, P = 0.05), uric acid (r = 0.29, P = 0.02), phosphate (r = 0.26, P = 0.04), alkaline phosphatase (r = –0.28, P = 0.03), lanthanum carbonate (r = 0.32, P = 0.01), major artery calcification volume (r = 0.28, P = 0.03) and CAC score (r = 0.29, P = 0.02). In multivariate regression analysis, SOx was associated with lanthanum carbonate (F = 5.96, P = 0.02) and CAC score (F = 4.47, P = 0.03, Table 1). Receiver operating characteristic curve showed SOx = 269.5 µmol/L was the best cut-off for predicting CVD events. We divided subjects into two groups by this cut-off SOx value and revealed SOx was associated with new-onset CVD events (N = 60, P = 0.01) even after adjusted by age under 75 years (N = 52, P = 0.03) or both age under 75 years and CAC score under 1000 (N = 28, P = 0.04) by the Kaplan–Meier method (Fig. 1).

CONCLUSION

SOx was associated with CAC score, lanthanum carbonate and CVD events in ESRD patients undergoing haemodialysis.
MO744: Evaluation of Epithelial to Mesenchymal Transition in Peritoneal Functional Decline and Cardiovascular Disease
Authors: Maria Arriero Pais Eva , Sandoval Pilar , González Guadalupe , Albar Patricia , del Peso Gilsanz Gloria , Auxiliadora Bajo Rubio María , Selgas Rafael , López-Cabrera Manuel
Published: May 2022

BACKGROUND AND AIMS

Prior results demonstrated preliminary in peritoneal dialysis (PD) patients that mesothelial cells are able to undergo mesothelial to mesenchymal transition (MMT) by differential genomic reprogramming, correlating with local damage of the peritoneum and a final ultrafiltration failure [1].

Therefore, our main goal is to find biomarkers with prediction and diagnosis value of all PD-induced MMT changes and CVD outcomes in PD effluents, biopsies or plasma from a longitudinal retrospective study of a European patient cohort of CKD, PD and HD, correlating them with cardiovascular disease (CVD), systemic inflammation, patient outcomes and animal models along with the IMPROVE-PD consortium.

METHOD

Analysis of EU biobanks: interrelation of MMT and CVD markers by qRT-PCR, immunohistochemistry, 3D-transwell models, citometry (Magpix) and echocardiography.

Statistical analysis and machine learning (MA): correlograms, PCA modelling, K-means clustering, decision trees.

RESULTS

CONCLUSION

Despite the rising awareness of the need for the improvement of the PD-MMT process, patients still carry a heavy burden of CVD and low survival rates of 5 years. IMPROVE-PD intends to combat them from different clinical and research fronts.
MO746: Marinobufagenin, Left Ventricular Geometry and Cardiac Dysfunction in End-Stage Kidney Disease Patients
Authors: Patella Gemma , Presta Pierangela , De Rosa Salvatore , Greco Marta , Crugliano Giuseppina , Sabatino Jolanda , Cianfrone Paola , Andreucci Michele , Indolfi Ciro , Foti Daniela , Coppolino Giuseppe , Bolignano Davide
Published: May 2022

BACKGROUND AND AIMS

Left ventricular hypertrophy (LVH) is remarkably prevalent among end-stage kidney disease (ESKD) on chronic dialysis and has a strong prognostic value for adverse outcomes. In experimental models, the endogenous cardiotonic steroid Marinobufagenin (MBG) promotes cardiac hypertrophy and accelerates uremic cardiomyopathy. In this study, we investigated the possible relationships between MBG, LV geometry and cardiac dysfunction in the clinical setting of ESKD.

METHOD

Plasmatic MBG was measured in 46 prevalent ESKD patients (n = 30 HD, n = 16 PD) together with a thorough laboratory, clinical, bioimpedance and echocardiography assessment. Different patterns of LV geometry were defined by left ventricular mass index (LVMi) and ventricular morphology. Diastolic dysfunction was diagnosed by the ASE/EACVI criteria.

RESULTS

MBG levels were significantly higher in ESKD patients than in healthy controls (0.89 ± 0.45 versus 0.59 ± 0.19 nnmol/L; P = 0.001) and more elevated in PD than in HD (1.09 ± 0.22 versus 0.78 ± 0.55 nnmol/L; P = 0.02). At univariate analysis, MBG was directly correlated with LVMi (R = 0.63; P < 0.001), LAVi (R = 0.57; P < 0.001), E/e’ (R = 0.57; P < 0.001), RAVi (R = 0.42; P = 0.01) and NT-proBNP (R = 0.37; P = 0.01), whereas a significant inverse correlation was observed with extracellular volume at bioimpedance (R=–0.33; P = 0.02). At multivariate analyses, E/e’ (β=0.38; P = 0.009) and LVMi (β = 0.42; P = 0.02) remained the sole independent predictors of MBG. A statistically significant trend in MBG levels (p=0.01) was noticed across different patterns of LV geometry, with the highest values found in eccentric LVH (Fig. 1). MBG levels were higher in the presence of diastolic dysfunction (P = 0.01) and this substance displayed a remarkable diagnostic capacity in distinguish patients with normal LV geometry, LV hypertrophy and, particularly, eccentric LVH (AUC 0.888; P < 0.0001) and diastolic dysfunction (AUC 0.79; p=0.001).

CONCLUSION

Deranged plasma MBG levels in ESKD patients on chronic dialysis may reflect alterations in LV structure and function. MBG may thus candidate as a novel biomarker for improving cardiac assessment in this high-risk population.
MO771: Haemodialysis Access Flow Measurement: Comparison of Ultrasound Dilution and Ultrafiltration Method on Nikisso DBB-EXA™ Dialysis Machine
Authors: Kosmadakis Georgios , Isnard Rouchon Myriam , Baudenon Julien , Deville Clemence , Enache Ioana , Gueret Claudine , Haskour Abraham , Necoara Aura , Rance Nicole
Published: May 2022

BACKGROUND AND AIMS

The regular measurement of the haemodialysis vascular access (VA) flow demonstrates a protective effect over thrombotic complications [1]. Transonic® Ultrasound dilution technique was first introduced in 1995 and progressively became a method of reference for recirculation and blood flow measurement on haemodialysis VA [2].

It is based on the technique of haemodilution with a certain volume of 0.9% NaCl and the measure of recirculation with inversed lines using the ultrasound technique. Consecutively the VA flow is estimated with a certain formula. Nikisso DBB-EXA™ dialysis machine has the capacity to measure the VA recirculation rate by photometry performing a controlled rise on ultrafiltration rate.

The aim of the present study is to compare the VA flow rate between the Transonic® Ultrasound dilution technique and the Nikisso DBB-EXA™ Ultrafiltration method.

METHOD

The primary outcome of the study is the association of VA flow measured by Transonic® and the Nikisso DBB-EXA™. During the first half of the same dialysis session, we measured the VA recirculation and flow rate twice with the two methods under a constant dialysis blood pump flow of 250–300 mL/min with the ultrafiltration and haemodiafiltration interrupted during the procedure after having reversed the dialysis lines.

RESULTS

The values are represented as mean ± SD. A total of 18 chronic haemodialysis patients (13 male: 5 female, mean age: 70 ± 14 years) participated in the study. They were haemodynamically stable without acute clinical conditions and were dialysed with a well-functioning arteriovenous fistula for at least 6 months. The mean value of recirculation with inverted dialysis lines for the Transonic® method was 20.79 ± 7.58% and for the Nikisso DBB-EXA™ was 24.43 ± 7.77. The mean values of VA blood flow with the Transonic® method were 1229 ± 588 mL/min and for the Nikisso DBB-EXA™ 1096 ± 490 mL/min. The measured values of the two methods presented a significant positive correlation (by Pearson) (R = 0.920, P < 0.001) (Figure).

CONCLUSION

There is a significantly positive correlation concerning the VA flow measurement between the reference method of Transonic® and the Ultrafiltration method offered by the Nikisso DBB-EXA™. Larger studies are needed to confirm this correlation with an additional comparative analysis of the reproducibility of measurements.
MO772: Elevated C-Reactive Protein Level and Vascular Access Failure in End-Stage Renal Disease Patients: A Systematic Review and Meta-Analysis
Authors: Lai Yu , Fangning Wei , Liu Xusheng , Bao Kun , Qin Xindong
Published: May 2022

BACKGROUND AND AIMS

Vascular access (VA) failure is common and can be fatal in hemodialysis (HD) patients with arteriovenous fistula (AVF) or arteriovenous graft (AVG). Most recent studies found that elevated C-reactive protein (CRP) level was associated with VA failure of AVF or AVG, although this is controversial, and have not been systematically reviewed.

METHOD

We systematically searched PubMed, Web of Science and Cochrane Library from inception until June 2021 for cohort and case-control studies on elevated CRP levels and VA failure in hemodialysis patients with AVF or AVG. We conducted a meta-analysis on the relative risk (RR) of VA failure and elevated CRP levels. An additional search of the Science Citation Index Expanded on the Web of Science and references lists were reviewed.

RESULTS

Of 2974 reports identified, 24 studies met inclusion criteria, most with high quality. We included 24 studies in the VA failure systematic review and 15 studies in the meta-analysis. A total of 12 cohort studies providing data for 4011 patients and 3 case-control studies providing data for 473 patients were reflected in the present meta-analysis. The risk of VA failure was higher [RR:1.14, 95% confidence interval (95% CI): 1.07–1.22] in the subjects with elevated CRP levels than in those with normal levels.

CONCLUSION

Elevated CRP level was associated with a higher risk of VA failure in hemodialysis patients with AVF/AVG.
MO777: The Impact of Morphological and Haemodynamic Characteristics of Blood Vessels on the Arteriovenous Maturation
Authors: Gjorgjievski Nikola , Dzekova-Vidimliski Pavlina , Rambabova- Bushljetik Irena , Dejanov Petar , Gerasimovska Vesna , Selim Gjulsen , Stojanoska Ana , Petronijevic Dzvezdana , Janevski Zoran , Severova- Andreevska Galina , Nikolov Igor , Spasovski Goce
Published: May 2022

BACKGROUND AND AIMS

Doppler Ultrasound (DUS) is a superior tool for the assessment of arteriovenous fistula (AVF) functionality. The aim of the study was to determine the association between morphological and haemodynamic characteristics of the blood vessels with AVF maturation.

METHOD

The study was prospective that analysed 80 patients with chronic kidney disease (CKD) stage 4/5 and CKD stage 5 on haemodialysis (CKD5D) with newly created radio cephalic AVF. Haemodynamics and morphological evaluation of blood vessels by DUS was performed in all patients. The diameter of the cephalic vein, radial and brachial artery was measured: before creation, on the first day (24-h after creation) and at 4 weeks. The blood flow (BF) rate of AVF was calculated by DUS on day 1, at 4 and 8 weeks. The successful maturation of AVF was defined with BF ≥ 600 mL/min.

RESULTS

The mean age of the patients was 59.9 ± 13.5 years, of which 46 (57.50%) were males. Successful AVF maturation at 4 weeks was 43.75% and 62.5% at 8 weeks. The results of six adjusted models in multivariate analyses showed BF rate on day 1 was a predictor for AVF maturation at 4 (P <0.001) and 8 weeks (P <0.001). The receiver operating characteristic (ROC) analyses showed that the highest sum of sensitivity and specificity for the BF on day 1 was 395 mL/min (sensitivity 0.714 and specificity 0.889) for the outcome at 4 weeks; and 344 mL/min (sensitivity 0.860 and specificity 0.867) for the outcome measured at 8 weeks. The diameter of the blood vessel was AVF significantly larger in patients with mature AVF compared with patients with non-mature AVF. Male gender was significantly associated with AVF maturation of AVF at fourth week (P < 0.001) and at eighth week (P = 0.001) compared with the female gender.

CONCLUSION

Our study showed that BF rate of AVF on day 1 was a predictor for AVF maturation at 4 and 8 weeks. The diameter of blood vessels and male gender were statistically associated with AVF maturation.
MO822: Humoral Response and Breakthrough Infections With SARS-COV-2 B.1.617.2 Variant in Vaccinated Maintenance Hemodialysis Patients
Authors: Cohen Hagai Keren , Wand Ori , Nacasch Naomi , Shashar Moshe , Grupper Ayelet , Erez Daniel , Shitrit Pnina , Benchetrit Sydney
Published: May 2022

BACKGROUND AND AIMS

Breakthrough COVID-19 may occur in vaccinated people and may result from declining vaccine effectiveness or highly transmittable SARS-CoV-2 variants, such as the B.167.2 (delta) variant. The recent emergence of the Omicron (B.1.1.529) variant has heightened this issue.

We investigated risk factors and outcomes for infection with the delta variant among vaccinated hemodialysis patients.

METHOD

Patients on maintenance hemodialysis who received two doses of the BNT162b2 (Pfizer-BioNTech) vaccine were categorized into the study group who developed COVID-19 and controls who did not in retrospective, observational and comparative study.

We compared risk factors for developing COVID-19 between two study groups and assessed clinical outcomes, including 30-day mortality rates.

RESULTS

A total of 25 cases of breakthrough SARS-CoV-2 infection were compared with 91 controls without. Breakthrough infection was associated with chronic immunosuppressive treatment, hematological malignancies and low antibody levels against SARS-CoV-2 spike protein (P = 0.001, 0.006 and 0.4, respectively). All COVID-19 cases occurred at least 5-months after vaccination and were caused by the B.1.617.2 variant in at least 23/25 cases. COVID-19 was categorized as severe or critical disease in 11/25 patients (44%) and 52% required hospitalization and COVID-19-directed treatment. The source of infection was nosocomial in 6/25 cases (24%), and healthcare-related in additional 3/25 (12%). Mortality rate was 20%, and overall mortality was significantly higher in subjects who developed COVID-19 than in controls (odds ratio for all-cause mortality 7.3, 95% confidence interval 1.6–33.2; P = 0.004).

CONCLUSION

Breakthrough COVID-19 with the B.1.617.2 variant can occur in vaccinated hemodialysis patients and is associated with immunosuppression and a weaker vaccine immune response. Infections may be nosocomial and result in significant morbidity and mortality.
MO830: Evaluation of Physical and Emotional Symptoms in Chronic Hemodialysis Patients
Authors: Akagun Tulin , Kavraz Tomar Ozdem , Usta Murat , Baylan Süleyman
Published: May 2022

BACKGROUND AND AIMS

Hemodialysis patients experience physical and psychosocial symptoms caused by comorbid illnesses and the psychosocial impacts of living with end-stage renal disease. The Dialysis Symptom Index (DSI) is the most frequently used instrument to assess symptoms of end-stage renal disease. The aim of this study was to evaluate the frequency and severity of symptoms experienced in patients on maintanence hemodialysis.

METHOD

Data were collected using a face-to-face interview method with a dialysis symptom index. Laboratory tests were recorded from the patients’ file.

RESULTS

A total of 97 patients from our dialysis unit were enrolled. Clinical findings and laboratory findings were shown in Figures 1 and 2. Prevalance and severity of symptoms were shown in Figure 3.

CONCLUSION

Physical and emotional symptoms are prevalent, can be severe, and are correlated directly with impaired quality of life and depression in maintenance hemodialysis patients.
MO845: COVID-19 Sequels in Nephrology CKD Patients More Prone to Fatality
Authors: Likaj Erjola , Shehaj Larisa
Published: May 2022

BACKGROUND AND AIMS

This strange, prolonged, very exhausting and costly pandemic still is remaining in our world showing us that we are so weak, so unprotected, so fragile. It initiated and continued mostly like a respiratory syndrome but soon after it was seen that it has a systemic impact and consequences in our body. There were patients presented with hematuria, proteinuria and deteriorating of kidney function after the infection. Direct kidney involvement, cytokine storm, coagulopathy, rhabdomyolysis, antibiotic use, sepsis and haemodynamic instability then acute tubular necrosis, all of these factors contribute in this picture of kidney failure. Very difficult to treat and to rehabilitate a part of these patients are going through kidney replacement therapy and a part are dying.

METHODS

We studied a population of 77 patients that had passed the COVID-19 infection, confirmed by RT PCR. Males 58% and females 42%. Mean age was 67.1 years old, the BMI 29.6. Comorbidities were present in our cohort in 59.7% only one comorbidity and in 31.1% of patients two comorbidities. Mean time from COVID-19 infection was 56 days. There were CKD 70% patients and 30% non-CKD. Diagnoses of CKD patients were: hypertensive nephrosclerosis 49%, diabetic nephropathy 32%, chronic glomerulonephritis 9%, ADPKD 8% and transplanted patients with CAN 1%.

RESULTS

It resulted that our patients had higher D dimer (mean 3660 mcg/dL = 7-fold higher), PCR (mean 35 mg/dL, 7-fold higher) and ferritin (mean 634 ng/dL). Levels of lymphocytes remained lower (mean 13.9%). Proteinuria was found in 92% and hematuria was found in 88% of our patients. There were a significant correlation between need for KRT and diabetic nephropathy was p = 0.037 and also between need for KRT and proteinuria presence was P = 0.048. It was seen that higher the BUN levels lower the lymphocytes counts (P = 0.028) and lower the time post COVID lower the albumin levels (P = 0.007). It was seen that patients with CKD were more prone to need for haemodialysis treatment during the hospitalization and the mortality rate was higher in this group of patients.

CONCLUSION

COVID-19 infection and its short term sequels play an important role on morbidity and mortality of CKD patients. It was a decisive factor for KRT in these patients. CKD patients with their immunosuppression, several drugs used, anemia, hypertension, diabetes are more prone for post COVID-19 complications, hospitalizations, dialysis and then death. Being aware of this dangerous infection and being vaccinated are the mainstay and crucial things for being healthy and being alive.
MO850: Casirivimab/Imdevimab in Vaccinated Chronic Haemodialyzed Patients With Acute Mild Covid-19: Safety And Efficiency
Authors: Monge Matthieu , Henriquez Soledad , Humbert Caroline , Guiard Elsa , Allouache Mahmoud , Yhuel Jean-Marc , Lavollay Marie , Richaud Clemence , Gohari Afsaneh
Published: May 2022

BACKGROUND AND AIMS

Casirivimab/imdevimab (C/I) is a combination of two neutralizing human monoclonal antibodies against the SARS-CoV-2. It has been approved for primary prophylaxis or acute SARS-CoV-2 infection in patients with a poor vaccine response. Chronic haemodialyzed (CHD) patients are a high-risk population for both severe COVID-19 and impaired vaccine response. We herein report the safety and efficiency of C/I in CHD patients with acute mild COVID-19.

METHOD

In a single-centre haemodialysis facility, all 56 CHD patients received 3 injections of anti-COVID-19 mRNA BNT162b2 vaccine, with anti-S protein antibodies response assessed 7 months after the last injection. During follow-up, patients who presented an acute mild SARS-CoV-2 infection without the need for oxygen therapy and a poor vaccine response received within 5 days after diagnosis 600mg/600mg of C/I. The combination of monoclonal antibodies was infused only once after the end of the dialysis session during 20 min. Patients were kept under surveillance during 1 h before discharge. Efficiency was assessed by RT-PCR 7 days after C/I infusion and clinical evaluation.

RESULTS

Six CHD patients had an acute COVID-19 without oxygen therapy requirement and four had a vaccine response < 264 BAU/mL. Among them three had the Delta variant (L452R mutation), and received C/I. Two of them had the opportunity to have a fourth vaccine injection, but got infected within 2 weeks after the boost. Clinical data are summarized in Table 1. No patient presented any adverse effect within the time in the dialysis facility. During follow-up, all patients remained asymptomatic and all control RT-PCR performed 7 days after infusion were negative.

CONCLUSION

600 mg/600 mg of C/I is a safe and efficient treatment for CHD patients with a poor vaccine humoral response presenting mild acute Delta variant COVID-19 without oxygen requirement.
MO852: Predialysis Blood-Pressure Control Based on Antihypertensive Guidelines Should Deteriorate Cardiovascular Prognosis in Patients on Maintenance Dialysis
Authors: Omae Kiyotsugu , Ogawa Tetsuya , Kyono Ai , Nishizawa Yoko , Hosoda Yumi , Hirasawa Eriko , Tosaka Mai
Published: May 2022

BACKGROUND AND AIMS

Guidelines of KDOQI for dialysis patients on blood-pressure (BP) targets proposed blow 140/90 mmHg at predialysis and < 130/80 mmHg at postdialysis. On the other hand, in dialysis patients, many reports have shown an association between predialysis hypotension and poor prognosis. Moreover, it has been reported that low systolic blood-pressure (SBP) is associated with poor prognosis in non-dialysis patients with heart failure. Therefore, predialysis BP controlled according to KDOQI guideline should worsen survival rate in dialysis patients, especially with any cardiac disease. This time, we investigated the difference on cardiovascular survival-rate between the group complied with KDOQI guidelines and the group complied with them for diastolic blood-pressure alone, by using Yoshikawa clinic dialysis-database (YCD).

METHOD

A total of 455 dialysis patients (264 males and 176 females) registered in YCD enrolled in this study from April 2006 on. From these patients, we extracted two groups, group G, strictly lowering on systolic and diastolic blood-pressure and group D, lowering on diastolic blood-pressure (DBP) alone, in accordance with antihypertensive guidelines. According to calculated propensity score on group G, patients were extracted by 1: 1 matching from each group. Their survival analysis was estimated by Kaplan–Meier method, and a log-rank test was used to examine the differences between the cardiovascular survival curves. The prognostic factors for cardiovascular mortality were extracted from background factors, including blood-pressure level, using Cox regression model.

RESULTS

In 455 patients, mean predialysis SBP and DBP were 143.3 mmHg and 73.1 mmHg, respectively. 141 patients were extracted as group G and 219 were as group D. According to calculated propensity-score, 116 pairs (group Gp and Dp) were extracted from group G and D. There was no significant difference in matching covariates except predialysis blood-pressure between the two groups. During mean-observational period of 5.8 years, 111 patients died, among that 59 were cardiovascular death (CVD). The survival curve on cardiovascular mortality in the group Gp showed significantly poor prognosis. In multivariate analysis of Cox proportional hazard model, SBP < 140 mmHg was extracted as a prognostic factor for CVD, and the hazard ratio was 1.892. On the other hand, in group Dp, non-cardiovascular prognosis was poor, especially in those < 70 years old.

CONCLUSION

Blood-pressure control in maintenance dialysis-patients based on current antihypertensive guidelines (KDOQI) should worsen their cardiovascular prognosis. Therefore, it is necessary to set SBP control for each case. This study is a cohort study with a single institution, and a prospective study with multiple institutions will be needed in the future.
MO853: The Incidence of Peripheral Neuropathy Using Paindetect Questionnaire in Chronic Kidney Disease Patients on Hemodialysis in a Dialysis Center in Davao City
Authors: Rose Pasaylo Riza
Published: May 2022

BACKGROUND AND AIMS

Peripheral neuropathy is considered a common complication among hemodialysis (HD) patients. However, there is no diagnostic tool designed to evaluate peripheral neuropathy among these patients. Neuropathic pain is reported to be associated with disrupted quality of life (QOL) in hemodialysis patients. Peripheral neuropathy is overlooked, unassessed and insufficiently treated in these patients. Unfamiliar to the majority is a questionnaire on peripheral neuropathy called ‘painDETECT’, a self-reported instrument that classify profile of those presenting with neuropathic components. This study is the first to utilize the painDETECT Questionnaire in determining the incidence of peripheral neuropathy in HD patients and its association with QOL.

METHOD

This is single—center prospective cross-sectional study performed in a free-standing hemodialysis center in Davao City. The participants included hemodialysis patients enrolled from June to November 2021. Assessment was done using painDETECT Questionnaire (English/Tagalog version) to assess neuropathic pain, while the Short Form 36 (SF-36) quality of life scale was used to evaluate the correlation of pain and quality of life.

RESULTS

A total of 350 patients were enrolled, only 169 participants were included, majority were females 87 (51%), with mean age of 47.42 years. Among the patients, 149 experienced pain (88.17%), and 57 (35.85%) had neuropathic pain. The most common site of pain were the lower extremities (68.42%). Neuropathic pain was associated with length of time the patient had been on hemodialysis [4.35 (±3.20)], however this did not reach statistical significance (P = 0.006). It was found to be more common among older patients (53.4, P < 0.001), with diabetes (78%) with very low estimated GFR (<4 mL/min) and without residual renal function (RRF) (77.19%). The quality of life of these patients was found to be lower 69.49 (±13.91) (P < 0.001).

CONCLUSION

PainDETECT questionnaire could be a useful and simple bedside tool to determine the presence of peripheral neuropathy among hemodialysis patients. This study showed that presence of peripheral neuropathy was significantly associated with older age, diabetes, very low eGFR, absent residual renal function and thus, it indeed affected their quality of life. With the use of this tool, early detection and intervention can be done to aid clinicians, with the hope of improving the quality of life of these hemodialysis patients.