bluuebunny/crossref_metadata_2025 huggingface dataset:
#2380 A multicenter and randomized study of a VLPD supplemented with ketoanalogues in patients with advanced CKD in Spain. Adherence study
Authors: Montesa María , Guillen Marta Arias , Barril Guillermina , Loza Emma Huarte , Durbà Alba , Romano Barbara , Nogueira Ángel , Oliva Juan Carlos Gonzalez , Carrero Juan-Jesus , Molina Pablo
Published: May 2024

Background and Aims

Clinical guidelines recommend a very low-protein diet (VLPD) supplemented with ketoanalogues (KAs) for patients with advanced chronic kidney disease (CKD) to reduce progression (evidence 1A) and improve the quality of life (evidence 1C). However, there is no prior experience with this nutritional intervention in Spain.

Method

A multicenter, randomized, and controlled study that evaluated adherence to a VLPD supplemented with KAs (Ernamin®) in non-dialysis dependent CKD patients, estimated using the Morisky scale. Secondary objectives included assessing the effect of VLPD + KAs on kidney function, urine protein, albumin levels and other metabolic and nutritional parameters, including changes in body composition stores, at months 0, 1, 3, 6, and 9.

Results

Preliminary data from 33 patients (67% men; mean age 68 ± 10; GFR 16.7 ± 3.9 ml/min/1.73 m2), randomized into 2 groups, are presented.

The VLPD group showed good acceptance and tolerance of the diet and supplement, with medium or high adherence in 80% of patients from the first month, maintained throughout the study (Figure).

The use of VLPD was associated with a decrease in phosphorus levels (−0.4 mg/dl VLPD vs. 0.09 mg/dl LPD, P = 0.027) and C-reactive protein (CRP) levels (−2 mg/dl VLPD vs. 0.33 mg/dl LPD), an increase in calcium levels (0.3 mg/dl VLPD vs. −0.2 mg/dl LPD, P = 0.015), and an increase in muscle mass (LTM) measured by bioimpedance (3.7 kg VLPD vs. −0.6 kg LPD, P = 0.03). Stability in weight, fat mass, extracellular volume, albumin levels, and MIS scale was observed during the follow-up. Estimated glomerular filtration rate, and urine protein remained unchanged in both groups.

Conclusion

Protein restriction associated with KAs shows good short-term tolerance and acceptance. This study confirms several effects associated with VLPD supplemented with KAs, including an anti-inflammatory effect, the preservation of nutritional status, and a better control of phosphate levels. These data suggest safe protein intake restriction with stabilization of protein stores.
#1868 Dapagliflozin reduces urinary kidney injury biomarkers in chronic kidney disease irrespective of albuminuria level
Authors: Park Kootae , Kwon Soon Hyo
Published: May 2024

Background and Aims

The beneficial effects of Sodium-Glucose Cotransporter 2(SGLT2) inhibitor in patients with chronic kidney disease (CKD) with low albuminuria levels have not been established. In this study, we aimed to compare the effects of dapagliflozin on kidney injury biomarkers in patients with CKD stratified by albuminuria level.

Method

We prospectively enrolled healthy volunteers (HVs) (n = 20) and patients with CKD (n = 54) with and without diabetes mellitus (DM). Patients with CKD were divided into two subgroups by age- and sex-matched according to urinary albumin-creatinine ratio (uACR) levels (<300 mg/g and ≥300 mg/g). The CKD group received dapagliflozin 10 mg per day. Urine samples were collected before treatment and after 3 months and 6 months of dapagliflozin. Urinary kidney injury molecule-1 (KIM-1), interleukin-1β (IL-1β), and mitochondrial DNA nicotinamide adenine dinucleotide dehydrogenase subunit-1 (mtND1) copy number were measured.

Results

The estimated glomerular filtration rate (eGFR) of patients with CKD was lower than that of HVs (p < 0.001). During the study period, eGFR decreased and uACR did not change in the CKD group. Kidney injury markers were significantly elevated in patients with CKD compared with those in HVs. Dapagliflozin reduced urinary KIM-1, IL-1β and mtDNA copy number in patients with CKD after 6 months of treatment. In further, the levels of urinary KIM-1 and IL-1β, patients with CKD decreased after 6 months of dapagliflozin treatment regardless of albuminuria level.

Conclusion

In this study, dapagliflozin reduced urinary kidney injury biomarkers in patients with CKD, regardless of albuminuria level. These findings suggest that SGLT2i may also attenuate the progression of low albuminuric CKD.
#1036 Studying the quality of life in patients with CKD during the short physical rehabilitation program
Authors: Saipova Durdona , Egamberdieva Dano , Ruzmetova Iroda
Published: May 2024

Background and Aims

The purpose of the study was to study the quality of life in patients with stages 2-3 CKD during a short physical rehabilitation program.

Method

The study included 130 patients with stage 2-3 CKD at the age of 45 - 65 years (average age - 58.7 ± 0.73 years).

Patients included in the study were divided into 2 groups – main group and control group, depending on adherence to non-drug treatment: 1st - CG group (control) – patients receiving standard therapy (n = 30); 2nd - MG group (main) - patients who, in addition to medication treatment, received a course of physical training for 12 weeks 2-3 times a week (n = 100). Laboratory data were analyzed in patients urea, creatinine, electrolytes, albumin, total protein, blood hemoglobin.

Results

During the study of patients with CKD at pre-dialysis stages, patients in the main group rated their quality of life more positively. The total quality of life indicator in the main group during 12 weeks of regular physical training increased by 15.5% (p < 0.05). In the control group, after 12 weeks of physical training quality of life parameters remained at the same level, but there was a tendency to decrease. Patients in the study group reported significant improvements in physical quality of life measures compared with control group measures, including role limitations (physical) (mean change = −8.9 in the control group compared with mean change + 19.0 in study group P < 0.001), physical functioning (mean change = −0.7 in the control group compared with a mean change of +11.1 in the study group; P ˂ 0.005), Patients in the study group also reported a significant improvement in pain scores.

Conclusion

Thus, when studying the quality of life, a group of patients who received physical training with standard therapy noted an improvement in both physical and mental functioning.
#1530 Studying parenteral nutrition in patients with dialysis stage chronic kidney disease
Authors: Raimkulova Narina , Rasulev Yorkin , Ruzmetova Iroda , Khudoiberdieva Gulnoza
Published: May 2024

Background and Aims

Hemodialysis is associated with high rates of morbidity and mortality, as well as poor quality of life. Changes in nutritional status and loss of protein and energy are important indicators of these risks. Maintaining optimal nutritional status in hemodialysis patients is an important but sometimes overlooked aspect of treatment. In some cases, intradialytic parenteral nutrition is possible, but lack of knowledge about the practical aspects of administration is rarely discussed.

The purpose of our study was to study the age-related characteristics of the nutritional status in patients with CKD of the dialysis stages who are on parenteral nutrition.

Method

The study included 40 patients with stage C5 CKD. Glomerular filtration rate (eGFR) was estimated using the CKD-EPI formula (2011) [11]. Anthropometric data were studied: height, weight, body mass index (BMI), mid-thigh circumference and mid-upper arm circumference, as well as laboratory data: urea, creatinine, electrolytes, albumin, total protein, hemoglobin. All patients underwent instrumental research methods: ECG, EchoCG.

The patients were divided into 2 groups – with and without PEM. Statistical data processing was carried out according to standard methods using a computer program package.

Results

Total body water (TBW) (P = 0.026) and triceps skinfold thickness (P < 0.05) were higher in the hemodialysis group. BMI and other anthropometric parameters showed no significant differences between the two groups. Total caloric intake (P < 0.05) and total cholesterol (P < 0.05) were higher in patients with PEM. Intake of other nutrients, including proteins, lipids, microelements and vitamins, did not show significant differences between the two groups. Only 24% of patients were malnourished. Triglyceride levels were higher in non-malnourished patients, but HDL levels were higher in malnourished patients. Some anthropometric indicators were significantly higher in patients not suffering from PEM. It is worth noting that malnourished patients consumed more calories and nutrients, including proteins, plant lipids, animal lipids and carbohydrates.

Conclusion

Compared with malnutrition patients and non-malnutrition patients, several anthropometric parameters, including subiliac skinfold thickness and MAC, were significantly lower in the malnutrition group. These values can be measured using simple methods and are used as a useful method for assessing malnutrition. Interestingly, patients with malnutrition and lower BMI albumin actually consumed more calories and nutrients from food. This means that malnutrition in dialysis patients is not simply caused by low food intake.
#1048 Why are felids at such a high risk of chronic kidney disease?
Authors: Painer-Gigler Johanna , Rauch-Schmücking Hanna , Bohner Julia , Kalogeropoulu Szilvia , Stalder Gabrielle , Shiels Paul , Johnson Richard J , Stenvinkel Peter
Published: May 2024

Background and Aims

Felids are obligatory hyper-carnivorous mammals, representing the utmost manifestation of a carnivorous dietary adaptation. Chronic kidney disease (CKD) could be characterized as an epidemic amongst domestic and captive wild felids, affecting up to 87%. However, its aetiology remains yet unknown. The aim of the study was to assess how various diets influence the development of CKD in felids.

Method

Ninety adult, captive non-domestic felids (tigers, leopards, cheetahs, and lions) from zoological parks were examined under anaesthesia. Their examination and sampling were part of planned annual health evaluations, not related to experiments. Husbandry and dietary information, as well as medical history were collected through a questionnaire. Blood serum and urine were taken. For the staging of CKD, symmetric dimethylarginine (SDMA), the level of azotaemia (serum creatinine) and the level of proteinuria with the urinary protein creatinine ratio were evaluated and correlated to dietary, biological and management factors.

Results

Sixty percent of the felids were diagnosed with CKD. The risk for developing CKD was much higher in animals fed primarily with skeletal muscle meat only compared to animals being fed with meat containing bones or whole pray carcasses. Furthermore, the incorporation of fasting days was significantly linked to a lower CKD prevalence. In addition, feeding a combination of white and red meat showed a lesser association with CKD presence compared to exclusively feeding red meat.

Conclusion

Non-domestic felids in captivity are exposed to different feeding practices. Diets closer to natural, wild diets resulted in lower risks of developing CKD. Feeding strategies such as whole-body prey, the inclusion of white meat and the implementation of fasting days were associated to significantly lower risks of developing CKD in captive wild felids. Future studies on investigating the benefits of dietary supplements, the impact of the Calcium:Phosphorus ratio, the composition of meat and the structure of fasting days is needed. In addition, the role of chronic low-grade inflammation (inflammatory biomarker analysis) as well as the impact of various dietary regimes on the microbiota composition should be explored further.
#1306 Online medical education advances physicians’ understanding of the clinical benefits of SGLT 2 inhibition in chronic kidney disease management
Authors: Trier Joachim , Da Silva Rita Moreira
Published: May 2024

Background and Aims

Patients with chronic kidney disease (CKD) have a substantially impaired cardio-renal health prognosis and a reduced life expectancy. Several recent cardio-renal outcomes trials have demonstrated the clinical benefits conveyed by Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors with respect to improved cardiovascular (CV) risk and reduced decline in kidney function.

The goal of this online medical education activity was for learners to be better able to detect CKD early in clinical practice and integrate reno-protective therapies, such as SGLT2 inhibitors, into their management of suitable patients with CKD.

Method

Five nephrology experts participated in a 30-min online video program with synchronized slides and written transcript. Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 multiple choice questions assessed knowledge/competence, 1 question rated on a Likert-type scale assessed confidence. A paired samples t-test was conducted on overall average number of correct responses and for confidence rating, a McNemar's test was conducted at the question level (5% significance level). Cohen's d with correction for paired samples estimated the effect size of the education on number of correct responses.

Data collection from 28 December 2022 to 1 March 2023.

Results

Conclusion

Participation of PCP in an online video expert program improved their understanding of the close association between metabolic, renal, and cardiovascular diseases, the latest results of CKD outcome trials with SGLT2 inhibition in CKD management, as well as their competence in the practical use of these reno-protective medications in suitable patients with CKD.
#346 Oxylanthanum carbonate for hyperphosphatemia in ESKD: tolerability trial in progress
Authors: Pergola Pablo , Mourya Sanjay , Hasal Steve , Reddy Guru , Gupta Shalabh
Published: May 2024

Background and Aims

Despite current therapies, more than 43% of patients undergoing dialysis in the USA have hyperphosphatemia, defined as serum phosphate values >5.5 mg/dL and is commonly associated with an increased risk of death. Most currently available phosphate binders are known to cause gastrointestinal (GI) adverse events (AEs) that can negatively impact the patient experience. Common GI AEs include abdominal pain, nausea, and bloating. Phosphate binders are usually formulated as large tablets, and some must be chewed before ingestion. Commonly a high number of pills are needed per day to achieve goal serum phosphate levels. Oxylanthanum carbonate (OLC) is a new lanthanum-based nanotechnology product in development with a high in vitro binding capacity as compared to other phosphate binders. OLC is formulated as a small pill that is swallowed whole instead of being chewed before swallowing as is the case for lanthanum carbonate. The safety of OLC has been studied in >100 healthy subjects. The most common treatment-related AE (>5%) in an OLC bioequivalence (BE) study was nausea. This study aims to evaluate the tolerability of clinically effective (serum phosphate ≤5.5 mg/dL) doses of OLC in patients on hemodialysis.

Method

This open-label, single-arm, multicenter, multidose study will enroll up to 90 patients on hemodialysis who require phosphate binder therapy and have mean historical serum phosphate levels between ≥4.0 and ≤7.0 mg/dL for ≥8 weeks. The primary endpoint of the study is tolerability as assessed by the incidence of discontinuations due to treatment-related AEs. Additionally, the incidence of AEs related to OLC will be collected. Participants will undergo up to 3 weeks of phosphate binder washout until their serum phosphate levels reach >5.5 and ≤10.0 mg/dL (Fig. 1). During the 6-week Titration Period, all patients will receive 1500 mg/day OLC (500 mg TID with meals/snacks) for the initial 2 weeks, with subsequent titration every 2 weeks until achieving a target serum phosphate level (≤5.5 mg/dL) or to a maximum OLC dose of 3000 mg/day. After titration, patients will enter a 4-week Maintenance Period at the effective OLC dose.

Results

We intend to present results elucidating tolerability of clinically effective doses of OLC in patients on dialysis.

Conclusion

The tolerability of OLC at doses effective in achieving a serum phosphate ≤5.5 mg/dL in patients on hemodialysis will be evaluated in this study.
#2916 Interdialytic weight gain and low-salt diet in patients on chronic hemodialysis: a systematic review and meta-analysis
Authors: Mariani Ilaria , Bossola Maurizio , DI Stasio Enrico
Published: May 2024

Background and Aims

Interdialytic weight gain (IDWG) is one of the most important indicators of the patient status in chronic hemodialysis: it is correlated with fluid and/or food intake and it is assessed at the beginning of the dialysis session being an easily measurable parameter. High IDWG is associated with risk of all-causes mortality and hospitalization; furthermore, high IDWG leads to supplementary dialysis sessions with consequent reduction of the quality of life and increase of the costs. Numerous barriers have been shown to determine failure to adherence to diet and fluid restrictions such as lack of self-assessment. The present systematic review and meta-analysis tries to determine the differences in the IDGW between low salt diet and normal/high salt diet, and between nutritional counseling aimed at reducing salt intake and no nutritional counseling in patients on chronic hemodialysis.

Method

Medline, PubMed, Web of Science, and the Cochrane Library were searched for studies comparing subjects who experienced educational or psychological interventions to untreated control patients. Outcome of interest was IDWG.

Results

Eight articles (783 patients) were fully assessed for eligibility and included in the investigation. The meta-analysis showed patients that after dialysis increased their weight more than 2.5 Kg over total enrolled subjects for each group (control and experimental). As no significant heterogeneity was observed (I2 =8%; p=0.36), the pooled analysis was performed using a fixed-effect model. Funnel plot was generated and no obvious asymmetry was observed, which indicates no clear evidence of publication bias. The Overall Odds Ratio to get an event in the experimental group, in respect to controls, is 0.57 (0.33-0.97) (p=0.04] with single studies OR ranging between 0.11 to 1.08, the last derived by a peculiar result reported in the Sevick's manuscript referring an identical IDGW of 1.1 Kg for both groups and an extremely narrow IQ range (1.0-1.2); therefore, in this case, the estimated number of events (patients with IDGW > 2.5 Kg) was rounded up to 1.

Conclusion

The present systematic review and meta-analysis suggest that the use of a low salt diet and/or a nutritional counseling aimed at reducing salt intake are associated with a statistically significant reduction of the IDWG in patients on chronic hemodialysis.
#705 Survival of expanded hemodialysis and high-flux hemodialysis patients in Colombia: a cohort's 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

Survival is a core outcome of hemodialysis (HD) therapy. Progressive improvement in the permeability and biocompatibility of membranes for HD, dialysis techniques and clinical processes around these therapies have been developed. Recently, expanded hemodialysis (HDx) enabled by the medium cut-off membrane Theranova® has demonstrated encouraging efficacy outcomes in terms of better clearance of medium molecules and better outcomes reported by patients when compared to high-flux hemodialysis membranes (HF HD). The objective of the present study is to compare survival in an HDx cohort versus an HF HD cohort at a 48-month follow-up.

Method

Cohort study, one group with expanded haemodialysis (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. The sociodemographic and clinical characteristics of all patients were summarized descriptively. A Fine-Gray regression model was performed to evaluate the factors associated with time to death from causes other than COVID-19, death attributable to COVID-19 cause is a competing risk. A sensitivity analysis was performed using different statistical methods, such as extended Cox regression and Cox regression, after adjusting for imbalance between the cohorts with the inverse probability of treatment weighting (IPTW) method.

Results

We evaluated 1092 patients, 533 in HF-HD vs 559 in HDx; the mean age 61 years; 42% had diabetes, and 19% had cardiovascular disease. All patients' sociodemographic and clinical characteristics are summarized descriptively by cohort arm (Table 1).

A multivariate analysis was performed to evaluate the effect of demographic, clinical, and laboratory variables on the risk of death, adjusting for the competing risk of death from COVID-19 during four years of follow-up. Our results indicate that the Theranova dialyzer has a protective effect on mortality risk when controlling for confounding variables SHR = 0.75 [95% CI: 0.58 to 0.95, p-value = 0.019] (Table 2). The different sensitivity analyses report a statistically significant beneficial effect of Theranova versus HF dialyzer. See Table 3. Fig. 1 shows a difference in the survival functions according to the type of dialyzer.

Conclusion

HDx enabled by Theranova dialyzer was associated with an approximately 25% reduction in mortality risk compared to HF HD patients followed for up to 4 years; this effect was consistently observed using different survival analysis methods.
#1906 Lung ultrasound as a valid tool for fluid assessment in dialysis patients: a systematic review
Authors: Petersen Nanna Aagaard , Falster Casper , Schultz Anders Ørsted , Kampmann Jan
Published: May 2024

Background and Aims

The evaluation of hydration status in dialysis patients is a crucial aspect of their care. Focused lung ultrasound has garnered attention as a cost-effective and accessible tool for assessing hydration status, particularly through the detection of B-lines. Despite its potential, there is a lack of comprehensive systematic reviews addressing the clinical utility of lung ultrasound in fluid assessment for dialysis patients.

Method

A systematic search was conducted on PubMed, MEDLINE, EMBASE, Cochrane, and Web of Science. Two independent reviewers screened titles, abstracts, and full texts, with a third reviewer consulted in cases of discrepancy. Inclusion criteria encompassed papers utilizing lung ultrasound to evaluate fluid status in dialysis patients. Exclusion criteria were: abstracts or posters and papers not investigating at least one of the following endpoints: B-type natriuretic peptide, cardiovascular events, inferior vena cava, preload, NYHA classification, ultrafiltration/weight reduction, blood pressure, total body water/bioimpedance, hospitalization, mortality, and clinical evaluations. A modified QUADAS2-score was employed for assessment of risk of bias and applicability by two independent investigators. The protocol was registered at Prospero (CRD42022334147).

Results

A total of 2543 papers were identified of which 156 underwent full-text screening. Of these, 49 papers were included in the review, comprising seven randomised controlled trials and 41 observational studies. The most common study aim was impact assessment of ultrafiltration on the quantity of B-lines. However, numerous studies investigated the correlation between lung ultrasound and various endpoints such as bioimpedance, chest x-ray, and clinical examination.

Overall, the included papers were characterized by noteworthy heterogeneity in terms of ultrasound protocol, encompassing differences in number of scanning zone (8-28), B-lines cut-off points, and definitions of endpoint. The QUADAS assessment revealed risk of bias in the included studies, most commonly related to a lack of blinding and, consequently, an impact on the interpretation of index test results. Only n=24 studies (49%) scored “low” risk of bias. Regarding patient selection, the numbers were even lower with only n=17 studies (34%) scoring “low” on risk of bias.

Conclusion

The collective evidence on clinical utility of lung ultrasound for fluid assessment of dialysis patients is characterised by notable heterogeneity and risk of bias, precluding meta-analysis. Well-designed large scale studies are still warranted to determine the optimal ultrasound protocol.

Future studies should establish guidelines for scanned zones and consensus cut-offs to enhance homogeneity.
#1573 Effects of haemodialysis coupled with hemadsorption on uremic toxins removal, oxidative stress and cellular death.
Authors: Marcello Matteo , Virzi Grazia Maria , Cantaluppi Vincenzo , Marengo Marita , Brendolan Alessandra , Ronco Claudio , Zanella Monica
Published: May 2024

Background and Aims

The retention of middle-molecules and Protein Bound Uraemic Toxins (PBUT) in dialysis patients are directly linked to specific clinical complications such as anaemia, inflammation and cardiovascular disease leading to increased mortality. These toxins, not adequately cleared by current dialysis techniques, could be removed by adsorption as demonstrated in numerous studies on dialysis patients. Furthermore, in dialysis patients there's an increased inflammation and oxidative stress only partially attenuated by biocompatibility of newly developed membraned. This pathologic inflammatory response lead to tissue damage and cellular death. A particular form of programmed cellular death involving red blood cells is called Eryptosis and is detectable as changes in the morphology and in the shape of human erythrocytes. The aim of this study was to assess the safety of dialysis coupled with hemadsorption (HA+HD) in terms of biocompatibility and efficacy in terms of removal of middle-molecules and PBUTs.

Method

This was a preliminary analysis of a multicentre observational study that evaluated 4 dialysis session focusing on 7 chronic dialysis patients of our dialysis centre. Patients were treated with HA+HD with HA130 cartridge (Jafron) only in the early-week dialysis session and then returned to their usual prescription. Blood samples were taken before and after dialysis session in order to measure Eryptosis as a marker of biocompatibility and few uremic toxins to assess the efficacy of the treatment by using Removal Ratio. Eryptototic RBCs were identified by FS (cell volume dimension) and FITC_AnnexinV-binding (Beckman Coulter, Brea, CA, USA) using Navios Flow Cytometer (Beckman Coulter, Brea, CA, USA). A minimum 100.000 events were collected on each sample. Statistical analysis was performed using the SPSS Software package. A p-value of <0.05 was considered statistically significant.

Results

This study was carried out on 7 patients (4 women) with a mean age of 65.7 ± 11.5 years and a median dialysis vintage of 33 months (IQR 28-51). All patients had AVF with Qb of 330 ml/min. Dialysis length was 210 minutes. We didn't find any differences between Eryptosis values measured before and after dialysis (Table 1), and between different timepoints. We found significant reduction of PTH (pre: 391.5 ng/L, IQR 206.5-602.8 vs post: 162.0 ng/L, IQR 95.0-363.3; p=0.005) and β2-microglobulin (pre: 23.10 mg/L, IQR 22.1-24.1 vs post: 6.72 mg/L, IQR 6.2-8.3; p>0.005) throughout the dialysis session coupled with hemadsorption (Fig. 1).

Conclusion

In this preliminary analysis, we found that the association of Dialysis with Hemadsorption allows a great removal of middle molecular-weight uremic toxins without compromise biocompatibility and thus represent a better treatment option in patients with high retention of these toxins.
#885 Combination of medium cut-off dialyzer membrane and diet modification to reduce serum concentrations of p-cresyl sulfate and indoxyl sulfate
Authors: Herič Tjaša , Bogataj Špela , Pajek Jernej
Published: May 2024

Background and Aims

Online hemodiafiltration (ol-HDF) may be considered currently as the best choice for chronic hemodialysis (HD) treatment, but medium cut-off (MCO) membranes may provide similar efficiency for larger and protein-bound toxin removal. P-cresyl sulfate (PCS) and indoxyl-sulfate (IS) concentration depends mainly on residual renal function and diet. Increased dietary fiber intake and short-chain fatty acid (SCFA) supplementation were associated with decreased production of PCS and IS. The aim of this study was to pragmatically combine MCO use with diet modification in an attempt to reduce serum concentration of PCS and IS and compare this strategy to online HDF use.

Method

We report preliminary results from a subset of a study sample with 42 chronic prevalent HD patients in a prospective randomized controlled interventional study. Two weeks after standard bicarbonate HD (BHD), patients were randomized to hemodialysis with MCO membrane (EXP group) or ol-HDF with a standard "high-flux" (HF) dialyzer membrane (CON group). After 4 weeks, both groups were supplemented by a change in the diet with increase of the daily intake of dietary fiber to 30g and addition of a SCFA propionate in the dose of 1g daily for 8 weeks. Two main outcomes were serum concentrations of PCS and IS. Measurements were taken at baseline (after 2 week wash-in period), after 4 weeks of the first intervention phase (MCO vs. ol-HDF; T1), after 8 weeks of the second intervention phase (fiber and SCFA supplementation; T2) and finally, after 4 weeks of wash-out period with BHD (T3).

Results

From 42 participants, 38 completed the study (63.2% men, 66.4±10.9 years, Charlson comorbidity index 5.7±2.3). In the CON group, serum concentrations of PCS (in μg/ml) were 36.8±19.6 (baseline), 36.9±20.8 (T1), 32.4±17.4 (T2) and 38.6±22.1 (T3). Serum concentrations of IS (in μg/ml) were 31.8±13.0 (baseline), 32.9±14.7 (T1), 29.5±9.1 (T2) and 35.5±16.8 (T3). In the EXP group, serum concentrations of PCS were 33.5± 16.6 (baseline), 35.9±17.8 (T1), 34.0±16.1 (T2) and 37.4±21.5 (T3). Serum concentrations for IS were 39.6±12.6 (baseline), 37.3±12.9 (T1), 42.3±13.5 (T2) and 41.0±12.8 (T3). Repeated measures ANOVA revealed no significant time*group interaction for PCS (F(1,33)=0.479, p=0.698, ŋ2=0.014) and IS (F(1,33)=2.392, p=0.073, ŋ2=0.068). There was a significant within-group increase in serum IS concentration between T2 and T3 in CON group (p=0.042). There was a trend towards a decrease in PCS concentration between T1 and T2 and increase between T2 and T3 in CON group.

Conclusion

The results of the study suggest both hemodialysis methods are equivalent in eliminating PCS and IS. Additional fiber and SCFA propionate supplementation did not decrease serum PCS and IS concentrations significantly, although there was a trend towards lower serums concentration of PCS after diet modification in CON group.
#2266 Removal of middle size molecules: effects on the modifications of subgroups of white cell types
Authors: Viggiano Davide , Corte Michele Della , Evangelista Ciriana , Credendino Olga
Published: May 2024

Background and Aims

In both classical hemodialysis (HD) and its high convective version, the hemodiafiltration (HDF), the unavoidable contact of blood cells with the filters (e.g. polysulfone), may cause the formation of microaggregates and the release of Inflammatory cytokines. Reducing inflammation and thrombus formation is essential, as these may change the cardiovascular risk of patients undergoing chronic HD. To overcome this problem, removing plasma proteins with greater molecular weight, thereby modifying the protein network around blood cells, might be helpful.

Method

Synthetic dialyzers (FX 80 CorDiax [Fresenius Medical Care], medium-cutoff filter Theranova 400 [Baxter], Elisio 17-H [Nipro], and BG-U 1.6 [Toray]) have been compared regarding their effects on white blood cell types. We designed a retrospective, dual-center clinical study on patients in ESRD needing substitutive therapy. Groups comparable for age, blood pressure, and body weight have been compared. Changes in albumin, Hb, neutrophils, eosinophils, basophils, monocytes, and platelets have been analysed one month after the treatment.

Results

The Theranova treatment decreased lymphocytes but was also observed to increase neutrophils and MCV.

Platelet count was highest with Elisio-H filters, whereas they were comparable among the other groups. Correlation analysis showed a significant association between platelet counts, neutrophils, and monocytes in all groups. Conversely, the correlation between eosinophils and lymphocytes was significant for all groups except for the Theranova filters.

Furthermore, the dialyzers inulin (5.2kDa) clearance was negatively linearly correlated to the lymphocyte counts.

Conclusion

The recent introduction of MCO filters offers the clinician an adjunctive possibility to modify blood composition in terms of plasma composition and different white blood cells. Further studies may use these unique characteristics in new clinical settings.
#3132 The effect of the number of transfusions received and hemodialysis centers attended on the prevalence of hepatitis B and C in hemodialysis patients
Authors: Lafrid Maria , Aatif Taoufiq , Bahadi Abdelaali , Labioui Narjiss , Laasli Hajar
Published: May 2024

Background and Aims

Hepatitis B (HBV) and hepatitis C (HCV) viral infections significantly contribute to morbidity and mortality among hemodialysis patients, posing substantial challenges in the management of these individuals. These infections present a critical global public health concern. This study aims to describe the serological profile of hepatitis B and C among hemodialysis patients at the Military Hospital of Instruction Mohamed V in Rabat. Additionally, the research aims to investigate the associated risk factors, including the potential influence of blood transfusion and frequenting multiple hemodialysis centers as risk factors.

Method

We conducted a cross-sectional study involving 38 hemodialysis patients during the period from January 2022 to September 2022. Hepatitis B and C serological markers were analyzed using a chemiluminescent assay, while genome detection was carried out using a quantitative real-time PCR test.

Results

A total of 36 hemodialysis patients participated in the study, with 44.7% being male and 55.3% female. The age range varied from 26 to 82 years, with a median hemodialysis duration of 102 months. On average, patients attended 1.89 +/- 1.24 dialysis centers (minimum: 1, maximum: 5). Of the participants, 39.5% had a history of blood transfusion, and 13.2% were immunodeficients.

Approximately 63.2% of the patients tested positive for Hbs antibodies; however, only 42.1% demonstrated immunity to hepatitis B with antibody levels exceeding 100 UI/L. Among these patients, 31.6% had a history of vaccination, while 31.6% had previously contracted the disease. Notably, PCR results for HBV were negative in all patients. HCV antibodies were positive in 5.3% of the participants, with no viral RNA detected. Our study did not find any statistically significant risk factors.

We found no association between the prevalence of hepatitis B or C and a history of transfusion or the number of hemodialysis centers attended.

Conclusion

Our results affirm the decreasing prevalence of hepatitis B and C infections among Moroccan hemodialysis patients, attributable to the implementation of anti-HBV vaccination and other protective measures. However, the limited number of patients in our study renders the sample non-representative.
#1827 Myeloma cast nephropathy: is high cut-off hemodialysis effective?
Authors: Martín María Fernández , Gallardo José Manuel Urbizu , Garay Raquel Pérez , De Juan Oihane Abaunza , Mendia Iñigo Yañez , Arroyo Sonia Delgado , Davis Mónica Paola Rodríguez , Etxarri Neike Murua , de Hilla Nerea Ormaetxe Ruiz , Larrondo Sofia Zarraga
Published: May 2024

Background and Aims

Light-chain cast nephropathy is the result of intra-tubular precipitation of light-chains produced by a multiple myeloma. Treatment often includes high cut-off filters hemodialysis (HCO) with the purpose of purifying these chains until the chemotherapy response is achieved. The main goal of this study is to analyze our experience and determine if there is a correlation between the amount of chain purified and the conservation of renal function.

Method

We conducted a retrospective study that includes all patients suffering from myeloma cast nephropathy treated with hemodialysis in our hospital between 2008 and 2023. HCO filters were used in all of the cases and the diagnosis was established by clinical criteria. In the early stages of the study, only those patients who required kidney replacement therapy underwent dialysis. However, in recent years some cases which did not meet the renal replacement criteria were included.

Results

27 patients received the treatment, 59,3% were male and the average age was 68,7+/-8 years. Even though the average of glomerular filtration rate (GFR) previous to the myeloma was 72,65+/-20ml/min, it should be underlined that 8 of them suffered from 3-4 stage chronic kidney disease. The mean follow-up was 55 months, after which 16 had passed away. 59,3% were kappa gammapathy and 75% of them had bone disease. Chemotherapy schemes were variable (85% included Bortezomib).

The average of dialysis sessions was 8+/-3,8. 7 patients continued undergoing conventional hemodialysis during the hospital stay but only one of them remained in chronic dialysis. The average GFR at the beginning was 12,2+/-7ml/min. Despite the improvement of the renal function, when compared to the previous GFR, a statistically significant reduction in both hospital discharge (43,67ml/min) and after 1- and 2-year periods (51,94 and 39,91ml/min) was observed.

No differences in renal function between patients who started dialysis prematurely (GFR>10ml/min) and those who did not were noticed.

The light-chain reduction ratio in each dialysis was examined; it was remarkably variable (2-87%). In order to establish a connection between the amount of chain purified and the preservation of renal function, we conducted a correlation analysis between the intra-dialysis reduction of chains and the GFR at hospital discharge and after 1-year, but not statistically interrelations were observed (p=0,376 and 0,633 respectively). Lastly, no connection between the intra-dialysis light-chain reduction and the loss of GFR was detected.

Conclusion

In patients with myeloma cast nephropathy, a higher purification of light-chains in HCO hemodialysis is not associated with a better preservation of renal function.
#2192 Aging dialysis population and late referral: two factors influencing the choice of vascular access
Authors: Lomeo Elettra , Maria D'ascenzo Francesca , Sturniolo Antonio , Mangiacapra Roberto , Aureli Fabio , Pesce Francesco , Grandaliano Giuseppe
Published: May 2024

Background and Aims

The decision on the type of vascular access for hemodialysis is based on several factors including the timing of renal replacement therapy initiation and certain patients’ clinical and demographic features. We hypothesized that the increasing age of patients on hemodialysis and the issue of "late referral" can be relevant in this context and favor the use of central venous catheter (CVC) over arteriovenous fistula (AVF), with a surge in catheter-related complications.

Method

We carried out a retrospective observational study of vascular access procedures (AVF creation and long-term CVCs placement) performed at the Nephrology Unit of the “Fondazione Policlinico Universitario Agostino Gemelli” between January 2020 and December 2023.

Results

A total of 415 procedures for AVF creation (median age 63.5, IQR 55.5 - 71.5 years), of which 59 (14,2%) in “late referral” patients (median age 61, IQR 47.5 - 72.5 years), were performed.

During the same period, 343 CVCs were placed, of which 151 (44%) in patients with planned admission as previously evaluated by a nephrologist (median age 69, IQR 60 - 79 years). The remaining 192 CVC placements (56%) involved patients after an emergency admission (median age 69, IQR 57 - 80 years).

In 56 (29%) of these patients an AVF was created concurrently or within 60 days from the emergency procedure. Such patients were significantly younger (median age 66, IQR 57 - 73 years) than those who underwent a CVC placement after a planned admission (p=0.01) or others with emergency admission (p=0.03).

In a multivariate analysis (logistic regression) the use of CVC over AVF was significantly and independently correlated with both late referral and age.

Conclusion

These data suggest that the increasing use of CVCs in hemodialysis may be due to the age of incident patients and remark the importance of early evaluation in order to choose the most appropriate vascular access.
#2833 Charlson comorbidity index predicts early failure and overall survival of vascular access among diabetic dialysis patients.
Authors: Sánchez Christian Israel Alfaro , Franco Antonio José Marín , Sorribes Mª Paz , Martínez-Vaquera Shaira
Published: May 2024

Background and Aims

Vascular access (VA) survival is a determinant factor in the morbidity and mortality of haemodialysis patients, directly influencing their quality of life. Some studies have described the influence of diabetes on the reduced survival of arteriovenous fistulas as an independent factor; however, the correlation between other comorbidities in diabetic patients with vascular access survival has been less well documented. Therefore, our aim is to describe the relationship between comorbidities in diabetic haemodialysis patients and arteriovenous fistula (AVF) patency.

Method

Descriptive, observational and retrospective study in prevalent patients included in a haemodialysis programme by consulting electronic records over a period of 35 months. Demographic variables; related to vascular access and primary and secondary patency of all accesses were included. The Charlson Comorbidity Index was used to categorise diabetic patients according to comorbidities. Kaplan Meyer survival curves were used to contrast the impact of comorbidities on the different patency.

Results

22 patients, mean age 68.36 ± 10.9 years, 68.18% male, 31.82% female, Charlson index with a median of 6.5 (5 - 8), 95.45% had a native fistula, with humero-cephalic location being more frequent (72.72%) and predominance of the left upper arm (68.18%). The time required to reach an event in both primary patency and secondary patency in diabetic patients was longer in patients with a Charlson index less than or equal to 7, this being statistically significant (Log Rank Test (Mantel-Cox): primary patency p=0.022 and secondary patency p=0.032).

Conclusion

The Charlson Comorbidity Index in our population is a significant factor in arteriovenous fistula survival.
#1703 Role of early AV fistula creation among elderly and its impact on estimated decline in GFR among pre dialysis patients
Authors: Bhat Dr Sanjay , Chandra Abhilash , Rai Priyanka , Srivastava Rohit , Srivastava Alok
Published: May 2024

Background and Aims

Recent evidence suggests that AVF creation may slow estimated glomerular filtration rate (eGFR) decline. The aim of the present study was to assess the impact of the pre dialysis AVF creation on eGFR decline and the need for dialysis, after controlling for key confounding factors among elderly population with advanced renal failure .

Method

A retrospective cohort study among patients attending Nephrology, Urology and General Surgery OPD between Jan 2019-Jan 2022 in Tertiary care hospital, Lucknow for AV fistula creation and assessed their stage of CKD and trajectory of fall in eGFR within a year's time and the time to initiation of dialysis from AV fistula creation was assessed.

Results

34 men and 23 females (> 65 years ) of age who at time of AV fistula creation had an median eGFR at time of AVF creation of 15.5 (10.3–16.9) mL/min/1.73m2. The factors like frailty, diabetes, psychosocial issues were matched between the two genders . Males were more in age with better BMI .Baseline eGFRs were 14.4± 2.0 mL/min/1.73m2 in men and 13.8.0 ± 1.2 mL/min/1.73m2 in women. The crude annual eGFR decline rates were − 3.20 ± 2.50 mL/min/1.73 m2 pre- and − 2.45 ± 2.16 mL/min/1.73 m2 post-AVF.

In a mixed effect linear regression model, monthly eGFR decline was − 0.43 mL/min/1.73m2/month.. The period after AVF creation was associated with a relatively higher eGFR . There was a significant association between follow-up time and the period pre/post AVF such that eGFR decline was more attenuated each month after AVF creation. There was better preservation of GFR from the pre AV fistula creation .

Conclusion

In this cohort, AVF creation was associated with a significant reduction of eGFR decline among elderly population . Further prospective studies are needed to confirm this association
#1899 Transitional care clinic for incident hemodialysis patients : the Singapore experience
Authors: Baikunje Shashidhar , Chawla Mayank , Ekanayaka Mahesh , Guo Ww
Published: May 2024

Background and Aims

The period of transition from chronic kidney disease (CKD) to End stage kidney disease (ESKD) presents significant morbidity and mortality risk to the patients. This higher mortality risk is largely contributed by cardiovascular factors and infection.

The last 2 decades have seen a remarkable succession of programs to improve outcome in incident dialysis patients. One such initiative is the use of ‘fistula first’ policy. In Singapore, pre-emptive access creation among ESKD patients continues to be low, with up to 80% of incident dialysis patients being commenced on hemodialysis (HD) via a dialysis catheter. Ensuring that incident dialysis patients have definitive vascular access, early referral to transplantation and adequate psychosocial support, amongst other factors, is an important consideration in their journey towards improved health outcomes. In order to achieve this, meticulous care coordination and a multifaceted approach is required. This realization is what led to the inception of our transition care clinic (TCC) in 2019.

Conducted bi-monthly by a multidisciplinary team of nephrologists and renal coordinators, with inputs from pharmacists and medical social workers as needed, the TCC engages patients within 4-6 weeks post-hospital discharge. Its focus includes vascular access, dietary and fluid compliance, blood pressure control, HD adherence, transplantation referral, and medication reconciliation.

Method

A retrospective analysis of 314 ESKD patients who initiated HD between September 2019 and September 2022 compared outcomes between TCC attendees (n=164) and non-attendees

Results

TCC attendees exhibited a lower 1- year mortality rate (p=0.002) and higher rates for vascular access creation within first 6 months (p=0.001) as compared to non-attendees. However, no statistical differences were observed in hospitalization rates in the first year (p=0.760) and kidney transplantation referrals (p=0.20) between the two groups.

Conclusion

While notable improvements were observed in mortality rates and vascular access creation, there was no significant difference in hospitalization rates or kidney transplantation referrals between the two groups. In spite of the limitations due to its retrospective nature, this study clearly demonstrates the effectiveness of TCC in enhancing patient outcomes during the critical initial phase of hemodialysis. The study highlights the importance of setting up, refinement and expansion of such services in improving the outcome of this vulnerable patient group.