bluuebunny/crossref_metadata_2025 huggingface dataset:
MO750THE COMBINED PROGNOSTIC SIGNIFICANCE OF ALKALINE PHOSPHATASE AND INTRA-CRANIAL ARTERIAL CALCIFICATIONS IN HEMODIALYSIS PATIENTS
Authors: Cohen Hagai Keren , Erez Daniel , Zitman-Gal Tali , Fanadka Feda , Einbinder Yael , Benchetrit Sydney
Published: May 2021

Background and Aims

Intra-cranial arterial calcification (ICAC) in hemodialysis (HD) patients has a prevalence of about 90%, and its severity is correlated with age, hemodialysis vintage and mineral bone disease. Elevated concentrations of calcium and phosphorus are not sufficient to induce medial calcification because of inhibition by pyrophosphate. Alkaline Phosphatase (ALP) promotes vascular calcification by hydrolyzing pyrophosphate. Epigenetic mechanisms regulation by Apabetalone downregulates pathways involved in vascular calcification.

This study assessed the combined impact of ICAC and elevated serum ALP on mortality among chronic HD patients.

Method

vascular calcifications represented by ICAC were measured simultaneous with mineral bone disease parameters including serum ALP of chronic HD patients who underwent non-contrast brain computerized tomography (CT) from 2015 to 2018 in our institution.

Results

This retrospective study included 153 hemodialysis patients (mean age 71.3±12.1 years, 60.1% male). Of the total cohort, 12(7.8%) had no brain calcifications and 69 (45.1%) had multiple intracranial calcifications. Considering the patients with normal ALP and no calcification as the reference group yielded adjusted odds ratios for all-cause mortality of 4.6 (95%CI 1.7-12.7) among patients with brain calcifications and normal ALP, p=0.003, and odds ratios for all-cause mortality of 6.1 (95%CI 2.1-17.7) among patients with brain calcifications and increased ALP.

Conclusion

We founded an independent association between ICAC and the risk of death among hemodialysis patients. The combined effect of ICAC and increased ALP was significantly associated with higher odds-ratio for all-cause mortality in chronic HD patients and may contribute to the risk stratification of these patients.
MO751OXIDATIVE STRESS IN PATIENTS WITH CHRONIC RENAL FAILURE AND CARDIOVASCULAR COMPLICATIONS
Authors: Azouaou toualbi Leila , Toualbi Chahine , Abderrezak Khelfi , Arab Medina , Ballouti Wafa , Chader Henni , Benoui Abdelghani , Seba Atmane
Published: May 2021

Background and Aims

The atherosclerosis process is highly accelerated in patients with chronic kidney disease (CKD). Oxidative stress is considered as one of the pro-atherogenic factors involved in accelerating the atherosclerosis process of the carotid artery. The aim of the present study was to determine the relationship between oxidative stress markers and the progression of carotid atherosclerosis in CKD patients.

Method

The study was conducted on 220 patients with CKD and 40 controls, and the disease stage was scored between 2 and 5D. Blood samples were taken and myeloperoxidases, malondialdehyde, nitric oxide, glutathione, and oxidised low-density lipoprotein were measured. Furthermore, we studied the correlations between these biomarkers and clinical and para-clinical cardiovascular complications.

Results

The average age of patients was 60.5 years. The oxidative stress markers average ± SD levels in CKD groups compared to the control were as follows: myeloperoxidase (49.89 ±1.98 vs. 38.45 ±1.98 UI/ml), malondialdehyde (5.2 ±0.12 vs. 3.26 ±0.03 µmol/l), nitric oxide (56.82 ±1.06 vs. 42.19 ±2.1 µmol/l), glutathione (42.21 ±1.3 vs. 79.4 ±2.6 IU/ml), and oxLDL (15.57 ±1.07 vs. 1.72 ±0.82 µmol/l). While the glutathione level decreased significantly in advanced CKD stage (p < 0.05), the concentrations of all the other biomarkers increased significantly in accordance with CKD score (p < 0.05). Patients with high IMD (> 1 mm) had higher values of the prooxidant markers (NO, oxLDL, MDA, MPO) but lower antioxidant marker values (glutathione), compared to other patients with lower IMD

Conclusion

Cardiovascular diseases, mainly atherosclerosis, can be diagnosed indirectly by measuring oxidative stress markers. Furthermore, theses markers can be used to predict the progression of CKD, for better management of the disease.
MO752EVALUATION AND ANALYSIS OF CHRONIC PAIN IN HEMODIALYSIS PATIENTS
Authors: Ezzaki Sanae , Failal Imane , Elafifi Rania , Elkhayat Salma siham , Medkouri Ghizlane , Ramdani Benyounes
Published: May 2021

Background and Aims

Despite progress these recent years in support the hemodialysis, chronic pain remains a problem concern that ultimately affect the quality of life and psycho-emotional state, even among dialysis patients already psychologically fragile. However, it is often overlooked and its characteristics in chronic hemodialysis (HDC) are poorly understood. The purpose of this study was to evaluate the prevalence, features, impact and treatment of pain in our population of chronic hemodialysis patients and to determine the factors associated with it.

Method

cross-sectional study conducted in January 2020 including 71 chronic hemodialysis patients from the nephrology department of the CHU ibn rochd CASABLANCA. They were subjected to a questionnaire on socio-demographic characteristics, the characteristics of the pain, its impact on daily life, the various treatments performed. The pain is chronic if it persists for more than 3 months. The intensity was assessed using a visual analog scale.

Results

Of the 71 patients, 64.4% report chronic pain, the average age of our patients was 46.5 years, ranging from 16 to 93 years, with a sex ratio M/F 1.1, seniority hemodialysis was 17.3 years.

The pain is continuous, frequent, intermittent and rare in respectively 55.5%, 27.5%, 13.7%, 3.44% of cases, it is a weak, moderate, severe, very severe in respectively: 13.7%, 58.6%, 17.24%, 10.3%, causing musculoskeletal was predominant in 75.8% of cases, the most common sites are: shoulders (47,23%), knees (34.5%), the head (41.2%) and the back (19.65%). It resounded on the patient's daily activity in 55.17%, and sleep in 41.3%, the treatment was essentially based analgesics in 58.6% of cases, these analgesics were level 1 in 47.1% cases and level 2 in 52.9% of cases. This is taken daily in 28.5% of patients, common in 42.8% and 28.5% rare among of them, the disappearance of pain was achieved in 65.51% of cases. In perdialyse, the intensity of the pain does not change in 79.4% of patients.

Pain was favored by advanced age and age dialysis (advanced age (p = 0.043) and age dialysis (p = 0.01).)

Conclusion

Chronic pain is a major problem in hemodialysis by its high prevalence, its significant intensity and its impact on life daily patient. However its management remains inadequate. Regular assessment of pain using a well-codified questionnaire is necessary to improve the care of dialysis patients.
MO754THE INTERRELATIONSHIP BETWEEN FLUID OVERLOAD AND VASCULAR STIFFNESS IN HEMODIALYSIS PATIENTS: A SCOPING REVIEW
Authors: Lafta Aya , Bello Aminu , Davison Sara , Thompson Stephanie , Braam Branko
Published: May 2021

Background and Aims

Fluid overload and vascular stiffness are two independent predictors of cardiovascular events in hemodialysis (HD) patients. To date, observational and interventional studies that investigated the effect of inter- and intradialytic fluid overload changes on vascular stiffness in HD patients are very limited. We performed a scoping review to explore existing reports about effects of fluid overload on vascular stiffness in adults receiving HD treatment and to identify knowledge gaps for future research.

Method

We followed the framework originally developed by Arksey and O’Malley. We searched Medline, Embase, CINAHL, and Cochrane Database of systematic reviews from inception to October 29, 2019. References of review papers were screened for relevant studies not identified from the initial search until saturation is achieved.

Results

Of 666 eligible studies, nineteen studies met the inclusion criteria. These included clinical observational studies (n=16) and randomized controlled trials (n=3). In general, most of the identified studies had small sample size and short term of follow up. Studies use different definitions of fluid overload and vascular stiffness. Measures of relative fluid overload like the ratio of extracellular fluid/intracellular fluid, fluid overload/extracellular fluid, and/or extracellular fluid/total body fluid were used as a representative of fluid status. Pulse wave velocity and augmentation index were used interchangeably as vascular stiffness measures. The accumulated findings were inconsistent and inconclusive. There was no consensus whether intradialytic fluid volume changes affected vascular stiffness. In the majority of the observational studies, a decrease in pulse wave velocity or augmentation index correlated with a decrease in blood pressure after fluid correction by HD treatment. The randomized clinical trials used different methods and technologies for the correction of fluid overload, thereby, results were conflicting.

Conclusion

Current literature is insufficient to justify whether fluid overload changes have a direct effect on vascular stiffness in HD patients. The findings were conflicting which limits the comparisons of studies and generalization of findings. These knowledge gaps urge the need for further clinical studies to enhance the understanding and to improve the quality of research in this topic. This includes standardized definitions and methodologies as well as longer term of follow up.
MO755SPONTANEOUS SOFT TISSUE HEMATOMAS IN ESRD PATIENTS WITH SYMPTOMATIC SARS-CO-V2 INFECTION – THE EXPERIENCE OF AN EMERGENCY NEPHROLOGY AND DIALYSIS DEPARTMENT
Authors: Ileana Adela Vacaroiu , David Cristiana , Razvan Ion Florin Dragomirescu , Turcu Flavia Liliana , Cristina Dumitraciuc , Cristina Calinoiu , Daniela Radulescu
Published: May 2021

Background and Aims

While actual proofs plead for an increased thrombotic risk in SARS-Co-V2 infection and need for anticoagulant therapy in severe cases, we report suspicious occurrence of hemorrhagic events in a series of ESRD patients.

Method

59 patients with stage 5 CKD were hospitalized in a two months interval, since our hospital was designated for the admission of mild-severe SARS-Co-V2 patients exclusive. 8 patients were admitted for RRT initiation and 51 were maintenance dialysis patients admitted with SARS-Co-V2-associated complications. Beside hemodialysis and treatment of chronic complications of ESRD, all patients were treated, according to the stage and gravity of SARS-Co-V2 infection and under continuous supervision of an infectious disease physician, with antivirals, antibiotics, anticoagulants and IL-antagonists. Daily or at 2 days laboratory monitoring was performed and consisted in evaluation of inflammatory markers, clotting tests, complete hemogram, D-dimer testing, IL-1 and IL-6 serum levels, serum urea, creatinine and albumin.

Results

In 6 cases spontaneous soft tissue hematomas were noted, totalizing a number of 9 hematomas documented through ultrasound and CT-scan. In order of frequency, the locations were: 4 rectus abdominalis hematoma, 2 in the external oblique, 2 in gluteus maximus muscle, and one in the right psoas muscle. The source of the bleeding could not be identified in any patient. The occurrence of spontaneous hematomas was correlated with the D-dimer values (p=0.02), prolonged anticoagulation (over 7 days), albumin levels (p=0.01), platelets count (p=0.05). We found no correlation with the serum urea, creatinine, hemoglobin, INR, or with the dialysis age. In all these cases cough was severe. A conservative approach was instituted, with daily US monitoring, withdrawal of anticoagulants and antiplatelet medication, and blood transfusions. 2 patients necessitated surgical procedures and two deaths were recorded.

Conclusion

In this brief report, we observed that in chronic hemodialysis patients infected with SARS-Co-V2, risk of hemorrhagic manifestations may overcome the benefits of anticoagulant routine therapy. There is a need to explore further this risk in the future; until then, a careful individualized assessment of the safety and indications for anticoagulant therapy regimens is mandatory for ESRD patients with symptomatic new Coronavirus infection.
MO756MANAGEMENT OF CHRONIC HIPERKALAEMIA IN CLINICAL PRACTICE IN HAEMODIALYSIS
Authors: Esteve Simó Vicent , Tapia González Irati , Vadillo Ursula , Guzman Claudia , Fulquet Nicolás Miquel , Moreno Guzmán Fátima , Duarte Gallego Verónica , Pou Potau Mónica , Saurina Solé Anna , Oleas Diana , Ramírez de Arellano Serna Manel
Published: May 2021

Background and Aims

Patients with chronic kidney disease (CKD) on haemodialysis (HD) have an increased risk of hyperkalaemia, a serious and potentially fatal electrolyte disorder. New effective strategies for managing hyperkalaemia have recently become available. However, as yet, there is insufficient experience in routine clinical practice in HD.

The aim of our study was to report the prevalence of chronic hyperkalaemia and analyse the effects of different treatment strategies on potassium management, ratio of adherence and gastrointestinal symptoms in our HD population.

Method

A 12-week, prospective, single-centre study in HD patients with chronic hyperkalaemia (>5.5 mmol/l). Three study phases were established: Phase 1 — dietary advice (DA); Phase 2 — calcium polystyrene sulfonate resins (CPSRs); and Phase 3 — patiromer. In each phase, we analysed sociodemographic data, related biochemical data, treatment adherence and compliance (Simplified Medication Adherence Questionnaire [SMAQ]), gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale [GSRS]), HD characteristics and usual medical treatment.

Results

29.2% hyperkalaemia (46% mild); 13 patients (61.5% female); mean age 63.8 ± 14.1 years and 46.4 ± 41.6 months on HD. Serum K values decreased significantly (*p <0.05) only in phase 3 (–0.75 mmol/l), with a higher percentage of patients reaching optimal K range. Compared with CPSRs, patiromer yielded significantly better overall GSRS scores: abdominal pain (3.7 versus 2.5), constipation (7.1 versus 5.3), indigestion (6.2 versus 5.6); and also better treatment compliance. No significant changes were found in any other biocbhemical data, HD characteristics or usual medication over the course of the study.

Conclusion

Chronic hyperkalaemia is a highly prevalent disorder on our HD unit. Compared to dietary advice and traditional potassium binders; patiromer was effective in managing chronic hyperkalaemia, leading to improvement in gastrointestinal symptoms and treatment adherence with no associated severe adverse effects. Thus, considering our results, we shall consider patiromer a first-line treatment for chronic hyperkalaemia in our patients with HD.
MO757COMPARISON OF ANTI-COAGULATION AND NO ANTI-COAGULATION IN DIALYSIS PATIENTS WITH ATRIAL FIBRILLATION: A SINGLE CENTER RETROSPECTIVE STUDY
Authors: Lee Jun Young , Yang Jae Won , Kim Jae Seok , Choi Seong Ok , Han Byoung Geun
Published: May 2021

Background and Aims

Atrial fibrillation (AF) is common arrhythmia in end stage renal disease patients. Although, the need of anticoagulation to prevent stroke and thromboembolism is increasing, the efficacy of anticoagulation is not proven in most of study. We retrospectively analyzed the risk and benefit of anticoagulation in dialysis patients with AF.

Method

By using medical record, we retrospectively analyzed all data of 99 patients who received dialysis therapy and diagnosed AF.

Results

Among 99 patients who diagnosed AF with dialysis 36 patients received anticoagulation (17 coumadin, 19 apixaban 2.5mg bid), 63 patients received no anticoagulation. There was no significant difference of baseline characteristics between anticoagulation, and no anticoagulation patients. Although no anticoagulation group experienced more all-cause (39.7% vs 32.4%, p=0.572) and cardiovascular mortality (17.6% vs 10.8%, p=0.197) than anticoagulation group it was not statistically significant. Compared to apixaban 2.5mg bid patients, coumadin anticoagulation patients experienced more frequent mfig

ajor adverse cardiovascular events (35.3% vs 15.8%, p=0.109) but it was not statistically significant in multi variate Cox regression analysis (Hazard ratio 1.143, 95% Confidence Interval 0.503-2.597).

Conclusion

Apixaban 2.5mg bid was not inferior than coumadin considering risk and benefit of anticoagulation in dialysis patients.
MO758DIAGNOSTIC ACCURACY OF ELECTROCARDIOGRAPHIC METHODS OF ESTIMATION OF LEFT VENTRICULAR HYPERTROPHY IN A HAEMODIALYSIS POPULATION
Authors: Skampardoni Sofia , Kalra Philip A , Green Darren
Published: May 2021

Background and Aims

Left ventricular hypertrophy is common in end stage renal disease (ESRD) and haemodialysis. Its association with cardiovascular outcomes has been demonstrated. In this study we evaluated the diagnostic accuracy of electrocardiographic methods of calculating LVH compared to Real Time 3- Dimensional Echocardiogram (RT3DE) which we used as a surrogate gold standard test.

Method

This study was performed as a post-hoc analysis of a sub-group of patients enrolled into the Salford Kidney Study (SKS). Patients included into this analysis are from the sub-group of SKS previously known as the CRISIS-HD cohort. All adult haemodialysis patients at Salford Royal NHS Foundation Trust, UK or one of its satellite units are considered for inclusion.

In this study we examined the sensitivity, specificity, positive predictive value and negative predictive value of Sokolow – Lyon and Romhilt –Estes methods in comparison to RT3DE.

Results

The final sample comprised 44 patients. The vast majority were Caucasian (39 patients). The mean age of the patients was 62 ± 13 years and mean time on dialysis 5.1 ± 2.9 years. The sensitivity of both ECG methods for diagnosis of LVH was very low. This was the case for the whole sample and also for individual groups. Romhilt – Estes was marginally better than Sokolow – Lyon and that was especially the case for male patients.

Conclusion

Our study shows that ECG methods for assessment of LVH that rely on voltage criteria have very low sensitivity and unreliable specificity compared to RT3DE and also conventional M –Mode echocardiography. As a result, they could not be reliably used as a quick and inexpensive method of LVH estimation in clinical practice in the case of haemodialysis patients.
MO725DAPT ALLEVIATES CKD-RELATED CAC BY MODULATING PTH-INDUCED ENDOTHELIAL-TO-OSTEOBLAST TRANSITION VIA NOTCH1 PATHWAY ACTIVATION
Authors: Wang Liting , Zhang Yuxia , Tang Rining
Published: May 2021

Background and Aims

Coronary artery calcification (CAC)-induced myocardial infarction (MI) is an important cause of death in patients with chronic kidney disease (CKD). However, effective treatment for CAC is lacked at present. Previous studies have shown that endothelial cells (ECs) participated in vascular calcification through endothelial-to-osteoblast transition. DAPT, N-[N-(3,5-difluorophenacetyl)-l-alanyl]- S-phenylglycine t-butyl ester, could inhibit the activity of γ-secretase and block the activation of the Notch1 pathway. In this study, we investigated the function of DAPT in alleviating the CAC process by blocking endothelial-to-osteoblast transition via inhibition of the Notch1 pathway.

Method

We administered 5/6 subtotal nephrectomy and a 10-week high-phosphate diet (P, 2.0%) to construct a rat model of CKD. DAPT and AAV-129-5p was administered orally and injected abdominally to rats respectively in the treatment groups at the beginning of the high-phosphate diet. In vivo, it was performed to detect the expression levels of EndMT and Notch1 pathway markers in the coronary arteries. In vitro, the effect of high PTH levels on the endothelial-to-osteoblast transition and the role of the miR-129-5p/Notch1 signaling pathway were studied in human coronary artery endothelial cells (HCAECs).

Results

In vivo, endothelial-to-osteoblast transition accompanied with the Notch1 pathway activation was found in HCAECs upon stimulation of PTH, characteristic with up-regulated endothelial markers (CD31, CD34) and down-regulated mesenchymal markers (CD44, CD10, α-SMA, FSP1) and ostoblast markers (Runx2, Osterix). miR-129-5p was responsible for regulating Notch1; γ-secretase was time-dependently and concentration-dependently activated by PTH, which further affected the transcription of downstream regulators (HES1, HEY1). DAPT arrested HCAECs migration through decreasing γ-secretase activity, thus inhibiting endothelial-to-osteoblast transition. In vivo data showed that serum γ-secretase activity decreased in rats intraperitoneally injected with DAPT (10mg/kg) once a week after 5/6 nephrectomy. DAPT intervention or overexpression of mir-129-5p inhibited coronary endothelial-to-osteoblast transition by blocking the activation of the Notch1 pathway. Notably, DAPT retarded CAC and MI without obvious negative effects on rats heart function.

Conclusion

DAPT is a promising agent for protecting against PTH-induced endothelial-to-osteoblast transition via inhibiting the Notch1 pathway in HCAECs, thus alleviating CAC.
MO809DOES LISTENING TO LIVE MUSIC DURING HEMODIALYSIS SESIONS AFFECT THE QUALITY OF LIFE?*
Authors: Serrano Miriam , Garcia-Testal Alicia , Rico-Salvador Inmaculada , Carrrascosa López Conrado , Ortiz Ramón Rafael , Villalón Coca Javier , Royo-Maicas Pilar , Garcia-Maset Rafael
Published: May 2021

Background and Aims

Patients with chronic kidney disease on hemodialysis (HD) treatment have a health-related quality of life (HRQoL) lower than the reference values of the Spanish population.

Previous studies have shown through music therapy reduce levels of pain, anxiety and depression in chronic kidney disease patients on hemodialysis.

This study presents an intervention with classical music performed live during HD sessions. It is the first time to study the effect of classical music heard live on HRQL.

Method

Randomized clinical trial by groups. 90 patients agreed to participate. They were randomized into an intervention group (IG) and a control group (CG). The IG listened to 30/45 minutes of live classical music in two of the three weekly HD sessions for 1 month. The CG followed his usual treatment.

Different individual scales of the quality of life test in kidney diseases (KDQOL-SF) were analyzed, in two times, baseline (Start) and after (End) the musical intervention in both groups.

The analysis was performed using a mixed linear regression model for repeated measures with independent variables (age, sex, months in HD, Kt/v, Hemoglobin (Hb)) and dependent variables (individual KDQOL-SF scale scores).

Results

The CG sample included 43 patients with a mean age of 75.8 years; 22 women (51%); mean Kt/v 1.53; mean Hb 11.5 and mean time on HD 60.46 months.

The GI sample included 47 patients with a mean age of 73.53 years; 18 women (38%); mean Kt/v 1.47; mean Hb 11.3 and mean time on HD 63.34 months.

The results show that after the intervention, IG vs CG increased the mean score (pm) in all the scales significantly.

The End time and GI interaction showed a mean score increase of 15.78 (p <0.001) for the Symptoms/problems scale; 14.96 (p <0.001) scale Effects of kidney disease; 16.36 (p <0.001) on the Kidney disease burden scale; 14.78 (p <0.001) on the Sleep scale; 25.46 (p <0.001) on the Vitality scale; 29.57 (p <0.001) on the Emotional well-being scale; 41.92 (p <0.001) on the Pain scale and 23.39 (p <0.001) on the General Health scale.

Conclusion

Live classical music intervention during hemodialysis sessions improves self-perceived HRQL in patients with chronic kidney disease on HD
MO818SURVIVAL ON DIALYSIS: SWITZERLAND IN COMPARISON WITH OTHER COUNTRIES – A FOLLOW UP
Authors: Winzeler Rebecca , Ambühl Patrice Max
Published: May 2021

Background and Aims

Survival in dialysis patients is substantially reduced compared to the general population. The aim of the present analysis was to compare the survival of dialysis patients in Switzerland with other countries with an additional year of follow up and a higher number of patients.

Method

Incident dialysis patients (hemo- or peritoneal dialysis; N=5'406) from the Swiss dialysis registry were followed up from 2014 to December 31, 2019 (median follow up days=658). Deaths occurring during this time (N=1'353) were recorded and survival was examined using the Kaplan Meier method, censored for transplantation.

Results

Characteristics of the dialysis population stratified according to survival status are provided in Table 1.

Dialysis patients in Switzerland have an approximately 8% higher survival in the first and second year and about 10% higher 5 years after start of dialysis, compared to other European countries (Annual ERA-EDTA Report 2017).

In the first two years, the proportion in survival rates between genders is similar in Switzerland, as well as in Europe. After 5 years, however, a difference in survival rates between genders becomes apparent, with women having a 5-year survival probability of 56.6%, compared to a lower 5-year survival probability of 49.7% in men.

Conclusion

The markedly better survival in dialysis patients in Switzerland compared to other European countries could be confirmed with an additional year of follow up and more patients. Also, causes of death vary widely among European countries. 5-year survival was calculated for the first time, with Switzerland showing almost 10% better survival rates than other European countries.
MO820INTRACELLULAR WATER BEFORE HEMODIALYSIS PREDICTS ALL-CAUSE MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Ekart Robert , Keber Gasper , Vodošek Hojs Nina , Jakopin Eva , Piko Nejc , Bevc Sebastjan , Hojs Radovan
Published: May 2021

Background and Aims

Several factors may be responsible for the increased mortality in dialysis patients, but volume overload is considered among the main mechanisms of this association. Volume status is usually estimated using clinical criteria, i.e., patien's signs and symptoms, peridialytic blood pressure measurements, and intradialytic hemodynamic instability. Bioimpedance analysis (BIA) is another way to measure volume status in dialysis patients. BIA can measure overhydration (OH), extracellular water (ECW), intracellular water (ICW) and ECW/ICW ratio.

The aim of our study was to analyze the role of BIA parameters before and after hemodialysis (HD) on all-cause mortality.

Method

Eighty-three patients (mean age 64.2 years; 51 men) on maintenance HD were included. BIA was performed and blood pressure was measured before and after the HD session. Patients were followed for assigned time, until transplantation or death. The mean follow-up time was 1181±564 days.

Results

Descriptive statistics of our patients are shown in Table 1. During the follow-up period, 6 (7.2%) patients were transplanted and 39 (47%) patients died. Univariate Cox regression analysis showed that only ICW before HD was a significant predictor of all-cause mortality (HR=1.089; 95%CI: 1.01-1.17, p=0.018). OH, ECW, ECW/ICW ratio before and after HD and ICW after HD were not associated with survival. In multivariate Cox regression analysis including ICW before dialysis, age, dialysis vintage, pulse pressure before HD, hemoglobin, CRP and serum albumin, ICW before dialysis was an independent predictor of all-cause mortality (HR=1.102; 95%CI: 1.01-1.20, p=0.029) (Table 2).

Conclusion

ICW before HD predicts all-cause mortality in HD patients.
MO821OXYGEN EXTRACTION RATIO AND MORTALITY RISK IN HAEMODIALYSIS PATIENT: A MULTICENTRE STUDY
Authors: Rotondi Silverio , Tartaglione Lida , Muci Maria Luisa , Panocchia Nicola , Gesuete Antonio , Papalia Teresa , Solmi Luigi , Mazzaferro Sandro
Published: May 2021

Background and Aims

Patients on haemodialysis (HD) suffer a very high rate of cardiovascular mortality with some evidence suggesting a possible association with decreasing blood oxygen saturation (SO2) during sessions. The ratio between arterial SO2 (SaO2) and central venous SO2 (ScvO2) or Oxygen Extraction Ratio (OER), which represents an estimate of the amount of oxygen claimed by peripheral tissues and of the haemodialysis related hypoxic stress, might represent a new prognostic factor.

Method

We evaluate the relationship between OER values and mortality risks in HD patients in a prospective multicentre observational study. We enrolled chronic HD patients with permanent central venous catheter (CVC) and no fistula, in whom ScvO2 measurement is at hand and SaO2 is available with a peripheral oxymeter. OER ([(SaO2−ScvO2)/SaO2]×100) was measured before and after HD at enrolment (HD OER sessions) in each patients, and a one-year follow-up was planned to record the number of deaths.

Results

In 101 patients (age 71.5 ± 14 years on dialysis for 47 ± 38 months), during 9 ± 6 months of follow up, we recorded 35 deaths. Patients were then divided into two groups, above or below the median value of pre-HD OER, which was 30%. In these groups, the average incidence of deaths was 12% (24 deaths) and 5,5% (11 deaths) respectively (p<0.05), with significantly different survival curves (Kaplan-Meier log rank test = 0.04, fig). No difference in mortality was evident if we divided patients according to the median intradialytic change in OER value.

Conclusion

Patients with pre-HD OER > 30% have a higher mortality risk, most probably secondary to reduced capability to respond to HD related oxygen requirements. OER is novel biomarker to identify patients at greatest clinical risk.
MO828INTENSIFIED TREATMENT FOR PREGNANCY IN HEMODIALYSIS PATIENTS, ANALYSIS OF 13 CASES: IS THERE A GENDER ADVANTAGE?
Authors: Marcelli Daniele , Rybakova Olga , Shilo Valery , Wohn Luisa , Barth Claudia
Published: May 2021

Background and Aims

Pregnancy in dialysis patients is rare but challenging for nephrologists and obstetricians, because pregnancy has a significant maternal and fetal risk in these patients. Although intensified hemodialysis is effective to achieve favorable clinical outcomes, the evidence concerning reliable parameters for the optimal dialysis prescription is scarce. Herein, we report the management on hemodialysis and outcome of pregnancies occurring in the B. Braun dialysis network in Russia.

Method

We performed retrospective analysis of all pregnancy cases in B. Braun dialysis chain in Russia from 2013 to 2020. Cases were reported by the involved Renal Care Centers by a common questionnaire. All patients were treated with B. Braun Dialog+, AV set Dialog +, SolCart bicarbonate cartridge and Xevonta dialyzers.

Results

13 pregnancies were reported, all achieved without infertility treatment: 1 was interrupted by voluntary termination of pregnancy, 9 resulted with living birth (6 females and 3 males) after a mean of 24 gestational weeks (7 cesarean and 2 vaginal deliveries), 2 with stillbirth and 1 with spontaneous abortion after 8 gestational weeks. Mothers with positive pregnancy outcome were significantly younger (27.9±5.1 vs. 36.3±5.6 years), without differences in dialysis vintage, previous successful or unsuccessful pregnancies and during follow-up blood pressure was well controlled. Females newborns had borderline significant greater body weight (1.9±0.6 vs. 1.1±0.1 kg, p=0.076). 5 newborns had respiratory distress syndrome, 1 jaundice.

Conclusion

Prompt increase of treatment frequency and time on high-flux/HDF dialysis were associated with successful pregnancy outcome. Considering that cardiovascular system and endogenous metabolism dynamically alter during pregnancy, various clinical parameters, i.e. body weight and blood pressure, should be closely monitored to modify dialysis settings accordingly. Female gender of the newborn seems to be associated with a better outcome. This study shows the safety of high-flux hemodialysis and hemodiafiltration treatments in pregnancy and the benefit of enhanced prescription in dialysis time and frequency.

Acknowledgement

The authors express their gratitude to the entire medical multidisciplinary team from B. Braun Russia Renal Care Centers and other local medical institutions directly and indirectly involved in the treatment of each case described.
MO829INSTITUTIONAL TRANSPORT AS RISK FACTOR FOR COVID-19 IN HEMODIALYSIS PATIENTS
Authors: Heylen Line , Van Kerrebroeck Margaretha , Oris Els , Hendrickx Liesbet , Macken Eline , Metalidis Christoph , Peeters Jacques , Van Mieghem Ann , Steensels Deborah
Published: May 2021

Background and Aims

Hemodialysis patients face an exceptional risk in the current COVID19 pandemic, both for infection/transmission as well as for mortality. All efforts to reduce potential risk factors are needed to protect this vulnerable group. We aimed to evaluate risk factors for SARS-CoV-2 infection and transmission during the first COVID19 wave, in order to tackle these factors in the second.

Method

We included all hemodialysis patients who were dialyzed at our central institution on March 19, 2020 (date of first COVID19 diagnosis). External low care and home hemodialysis patients were excluded. Our central hemodialysis center has 5 dialysis shifts in 6 units located next to each other, with a separate seventh dialysis unit dedicated for COVID19 isolation. COVID19 infections were diagnosed with nasopharyngeal swab PCR at the discretion of the treating nephrologist. On May 18 and 19, after the first wave, all hemodialysis patients were evaluated for presence of SARS-CoV-2 antibodies using ELISA to screen for previous asymptomatic infections. Chi square and logistic regression were used for statistical analyses.

Results

216 hemodialysis patients were included in this study, with a mean age of 72 years old (IQR 65-83). COVID19 was diagnosed in 17 patients during the first wave: in 15 symptomatic cases through nasopharyngeal swab PCR and in two additional asymptomatic cases through SARS-CoV-2 IgG positivity. Interestingly, we observed that 58.8% of COVID19 patients were transported by the same transport company, while this company transports only 20.4% of hemodialysis patients (p=0.005) (Figure A). As such, 22.7% of patients transported by this company became infected (OR 6.93, 95% CI 2.49-20.34, p=0.0002).

Conclusion

Institutional transport was the most significant risk factor for SARS-CoV-2 infection among hemodialysis patients at our center. After stringent prevention measures we were able to prevent transmission during transport in the second wave of the COVID19 pandemic.
MO830COVID-19 INFECTION IN HEMODIALYSIS POPULATION
Authors: AlSahow Ali , AlQallaf Ahmed , Bahbahani Hamad , Alyousef Anas , Bahbahani Yousif , Alhelal Bassam , AlRajab Heba , Almuhaiteeb Abdullah , Shalaby Heba , Elabbadi Mohamed , Elsebaei Mohammad , Abdallah Emad , Ayoub Medhat , Abou Trabeh Aissar , AlSarraji Mariam , AlAwadhi Abdullah
Published: May 2021

Background and Aims

A third novel coronavirus leading to severe respiratory infection (coronavirus disease 2019, COVID-19) was first identified in Wuhan, China in December 2019; 1 as of January 2021, more than 90 million person infected and more than 2,000,000 died worldwide. 2 Hemodialysis (HD) patients are at risk of COVID-19 infection but reported infection rates are variable. 1 We report results of prospectively collected data on HD patients who contracted COVID-19 infection in Kuwait.

Method

Demographics, comorbidities, and mortality data for HD patients who got infected with COVID-19 in Kuwait from 1/March/2020 to 31/July/2020 were collected and analyzed.

Results

Kuwait population during that same period was 4,600,000 (63% Males and 37%Females). 3 Total number of HD patients was 2000 (representing only 0.04% of the total population with 52% Males and 48% Females). Total number of COVID-19 cases confirmed by PCR from nasopharyngeal swab was 66,957. Total number of infected HD patients was 141 (representing 7% of the total HD population and 0.2% of the total number of people infected with COVID-19 in Kuwait). All COVID-19 positive cases were treated for free in ministry of health hospitals

Mean age for HD patients with COVID-19 was 57 (54 for males and 62 for males). DM was present in 70%, HTN in 95%, CV disease in 61%, respiratory illness in 20.5%, and ICU admission was required for 31 patients (22%), with 80% requiring intubation and assisted ventilation. Conventional HD was switched to CRRT in 61 patients (43%). Steroids were used for 23%, convalescent plasma in 1 patient, lopinavir/ritonavir in 7 patients, tocilizumab in 3 patients.

Total number of mortality due to covid-19 infection in Kuwait was 447 (0.7% of the total cases). 4 Total mortality in HD population during that period for any reason was 100 (5% of the total HD population), however, total mortality due to COVID-19 infection was 30% of the total mortality in the HD population (and 7% of the total COVID-19 related mortality in the country). Patients who died were older with mean age of 63 vs 56 for survivors and had respiratory illness more frequently (27% vs 18%) and 60% were males. Of those who were switched to CRRT, 21 of 61 (34%) died. Of the 31 HD patients admitted to ICU, 19 (61%) died.

Conclusion

Despite the fact the HD population represents only a small fraction of the total population, they represent a sizable proportion of the total COVID-19 positive cases and a significant percentage of the total COVID-19 related mortality. This study highlights the increased susceptibility of HD population to COVID-19 infection, which is associated with high rate of mortality, although lower than mortality rates reported in Europe and the united states. 5,6
MO831PROGNOSIS OF HEPATOCELLULAR CARCINOMA IN HEMODIALYSIS PATIENTS
Authors: Ogura Yoshiyasu , Ohki Takamasa , Sato Kenta , Aihara Hideaki , Yabushita Sayaka , Tsukada Hiroyuki , Furuse Satoshi , Toda Nobuo , Mise Naobumi
Published: May 2021

Background and Aims

The aim of this study was to compare the prognosis of hepatocellular carcinoma (HCC) between dialysis and non-dialysis patients.

Method

In this retrospective observational study, we examined consecutive patients with naïve localized HCC, who were treated with radiofrequency ablation (RFA) between February 2000 and December 2017. The patients were categorized into two subgroups based on whether they were on maintenance dialysis (Dialysis Group, n=458) or not (Non-dialysis Group, n=13), and were followed until December 2019. The primary endpoint was overall survival using Kaplan-Meier analysis. As for propensity score matching, we matched 13 pairs of cases by using age, sex, Child-Pugh score, tumor size, number of tumors and HCV positivity. We also compared causes of death between the 2 groups.

Results

The study cohort were aged 69.9±9.1 years and included 328 male patients (70%). Hepatitis B was positive in 37 patients (7.9%), C in 322 (68.4%) and co-infection of HBV and HCV was detected in 3 (0.6%). Ninety-five (20.2%) were heavy alcohol drinkers. In Dialysis Group, patients were younger (p=0.004), total bilirubin, AST, ALT levels were significantly lower and PT level was significantly higher. In the entire cohort, overall survival was comparable between Dialysis Group and Non-dialysis Group (5-year survival rate 55.2% vs 52.7%, respectively; p =0.144). In the propensity score matching analysis, however, Dialysis Group showed significantly worse overall survival than Non-dialysis Group (5-year survival rate 52.7% vs 92.3%, respectively; p =0.018). During the observational period, 255 (54%) patients died. As for causes of death, liver-related death occurred in 44% in Dialysis Group and 67% in Non-dialysis Group, whereas cardiovascular death was 22% in Dialysis Group and 5% in Non-dialysis Group. Procedure-related major complication in the first RFA session of each patient was 0% in Dialysis Group.

Conclusion

Prognosis of hepatocellular carcinoma was poorer in dialysis patients compared to non-dialysis ones, which may be explained by a higher rate of non-liver-related death in dialysis population. Since RFA, per se, has been safely preformed in dialysis patients, prognostic improvement may be expected by treating HCC in dialysis patients as aggressively as in non-dialysis cases.
MO834LOWER POST DIALYSIS POTASSIUM AND HIGHER ULTRAFILTRATION RATE ARE INDEPENDENT PREDICTORS OF ALL-CAUSE MORTALITY IN DIALYSIS PATIENTS
Authors: Rista Elvana , Cadri Vilma , Akshija Ilir , Harja Endri
Published: May 2021

Background and Aims

Dialysis is a life-saving procedure for the end-stage kidney disease, but mortality in this category of patients is still high. The survival of these patients is much lower compared to the general population. Factors affecting this survival has been studied for years and still continue to be an important part of current studies. While ultrafiltration rate is known to be associated with mortality in prevalent dialysis patients an important predictor of survival is the control of potassium profile.

The aim of our study was to assess the hemodynamic and biochemical data, and to identify any significant association between post-dialysis potassium and all-cause mortality.

Method

This is a prospective study of 308 patients on maintenance dialysis, followed for seven years, ending 2019. All patients are dialysis dependent for ESKD and getting treatment in a single-center.

Hypokalemia was defined as a serum potassium level < 3.5 mEq/L and high ultrafiltration rate (UFR) > 13 ml/kg/h. Other hemodynamic and metabolic data were also evaluated

The survival rate was analysed by Kaplan-Meier curves and Cox regression analysis.

Results

A total of 308 patients were enrolled in this study. Mean age was 52 ± 15.6 years; 62.3% of pts were male; BMI 24.7±4.2. Of these, 55 patients (17.9%) died during the follow-up period. Our data showed the presence left ventricular hypertrophy (p=0.010), peripheral artery disease (p<0.0001), diastolic disfunction (p<0.01) and ultrafiltration rate during dialysis >13ml/kg/h (p=0.002) were the most important predictors of mortality. Metabolic abnormalities, low albumin (p<0.0005), hyperphosphatemia (p=0.011), post-dialysis potassium (p=0.037) were significantly associated with higher mortality.

Logistic regression analysis of the metabolic data identified post-dialysis potassium (OR 0.242, 95% CI 0.074 – 0.793, p=0.019), and logistic regression analysis of the hemodynamic data identified ultrafiltration ratio (OR 0.149, CI 0.033 – 0.673, p=0.013) as independent predictors of all-cause mortality.

Conclusion

Lower post dialysis potassium levels and higher ultrafiltration rate are independently associated with higher all-cause and CV mortality in prevalent hemodialysis patients. Therefore the potassium profile and the UFR of the dialysis patients needs close monitoring and optimal control. The individualization of the dialysis prescription is recommended for each patient and it has an important role in preventing the occurrence of complication with immediate and long term effects. Management of dialysis patients should focus especially on reducing the risk of hypokalemia, not only that of hyperkalemia.
MO837IMPACT OF DOWNTIME ON CLINICAL OUTCOMES IN CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY: A RETROSPECTIVE STUDY USING PROPENSITY SCORE-MATCHED ANALYSIS
Authors: Shin Jungho , Song Hyun Chul , Hwang Jin Ho , Kim Su Hyun
Published: May 2021

Background and Aims

Continuous renal replacement therapy (CRRT) is essential in treating critically ill patients with acute kidney injury, and circuit downtime is considered a quality indicator. However, it remains uncertain whether CRRT downtime affects outcomes such as mortality and renal recovery. This study investigated the impact of downtime on various clinical outcomes in critically ill patients undergoing CRRT.

Method

A total of 216 patients who underwent CRRT were retrospectively recruited. Downtime was calculated over 4 days from CRRT initiation, and patients were classified as downtime <20% or ≥20% of potential operative time. Patients with ≥20% downtime were matched to those with <20% downtime using 1:2 propensity score matching, adjusting for age, sex, comorbidity index, and severity score.

Results

There were 88 patients with <20% downtime and 44 patients with ≥20% downtime. The cumulative volume and median flow rate of effluent in patients with ≥20% downtime were lower than those in patients with <20% downtime (P<0.001 and 0.062, respectively). Daily fluid balance differed on days 2 and 3 (P=0.046 and 0.031, respectively), and the difference in levels of urea and creatinine widened over time (P=0.004 and <0.001, day 4). The levels of total carbon dioxide were lower in those with ≥20% downtime (P=0.038 and 0.020 at days 2 and 3). Based on our results, ≥20% downtime was not associated with increased 28-day mortality (P=0.944). On the other hand, a subgroup analysis showed the interaction between downtime and daily fluid balance on mortality (P=0.004). In this study, downtime was not related to renal recovery.

Conclusion

Increased downtime could impair fluid and uremic control and acidosis management in patients undergoing CRRT. Moreover, the adverse effect of downtime on fluid control may increase mortality rate. Further studies are needed to verify the value of downtime as a quality indicator and its impact on outcomes in critically ill patients requiring CRRT.
MO811HEALTHY LIFESTYLE SCORE AND MORTALITY IN PATIENTS ON HEMODIALYSIS: AN ANALYSIS OF THE DIET-HD STUDY
Authors: Su Guobin , Saglimbene Valeria , Wong Germaine , Ruospo Marinella , Natale Patrizia , Craig Jonathan , Hegbrant Jörgen , Carrero Juan Jesus , Strippoli Giovanni
Published: May 2021

Background and Aims

A healthy lifestyle promotes cardiovascular health and reduces cardiac-related mortality in the general population, but its benefits in patients treated with hemodialysis are uncertain. The aim of this study was to evaluate the association of a modified American Heart Association (AHA) healthy lifestyle score, and its individual components, with all-cause and cardiovascular mortality in a large multinational cohort of patients treated with long-term hemodialysis.

Method

Based on the AHA’s recommendations for cardiovascular prevention, a modified healthy lifestyle score was derived from non-smoking, being physically active, higher body mass index (BMI, obesity paradox of higher BMI being protective of death in dialysis patients), healthy diet, and well-controlled systolic blood pressure for participants in the DIET-HD study, a multinational cohort study of adults on hemodialysis. Hazard ratios (aHR) were estimated to evaluate the association between the healthy lifestyle score [low (0 -3 points) as the referent, medium (4-6), and high (7-10)] and cardiovascular and all-cause mortality by using cox model.

Results

5483 out of 9757 (56%) patients with complete lifestyle data were followed for a median of 3.8 years (17450.9 person-years). There were 2,163 deaths, of which 826 cardiovascular-related. Compared with patients with a low lifestyle score (963, 18%), the aHRs (95%CI) for all-cause mortality among those with medium (3,621, 66%) and high (899, 16%) were 0.70 (0.63-0.78) and 0.57 (0.49-0.66), respectively. Cardiovascular death was 17% [aHR, 0.83 (0.68-0.99] and 30% (0.70, 0.55-0.90) lower in patients with medium and high lifestyle score, respectively. Results were consistent in stratified or complete-case analyses, and after excluding early deaths. Risk reductions were largely driven by being a non-smoker, physically active and having a higher BMI. 20% of deaths were attributed to a medium/low lifestyle score (population attributable fraction; 95% CI 12-28%).

Conclusion

A healthier lifestyle, especially non-smoking, regular physical activity, and a higher BMI, is dose-dependently associated with lower all-cause and cardiovascular mortality in hemodialysis patients.