bluuebunny/crossref_metadata_2025 huggingface dataset:
MO809: Sucroferric Oxyhydroxide for the Management of Hyperphosphataemia in Peritoneal Dialysis Patients
Authors: Emilio Sanchez-Alvarez J , Astudillo Cortés Elena , Paraíso Vicente , Auxiliadora Bajo Rubio María , Millán Beatriz , Janet Chang Macchiu Pamela , Carlos Quevedo Reina Juan , Rama Inés , González Tabares Lourdes , González Peña Olga , Burguera Victor , Barbosa Francesc
Published: May 2022

BACKGROUND AND AIMS

Bone and mineral metabolism disorders are very common in chronic kidney disease (CKD) patients. The increase in phosphorus levels leads to bone disease, risk of calcification and higher mortality, so any strategy aimed at reducing it should be welcomed. The latest drug added to the therapeutic arsenal to treat hyperphosphataemia in CKD is sucroferric oxyhydroxide (SO).

Our objective was to analyse the efficacy and safety of SO in patients with CKD on peritoneal dialysis (PD), followed for 6 months.

METHOD

Observational, multicentre, prospective, clinical practice study. Patients who had been on PD for >6 months and who had been prescribed SO as a treatment for hyperphosphataemia were included; they should also meet any of the following conditions: serum phosphate >4.5 mg/dL, serum phosphate ≤4.5 mg/dL but receiving a high number of tablets or using another phosphate binder with adverse effects or intolerance. Clinical and epidemiological variables were analysed; also parameters related to bone and mineral metabolism disorders and anaemia. Variations in stool consistency and the need for laxatives were also taken into account.

RESULTS

A total of 92 patients (62 ± 14 years, 66% male, 23% diabetic), from 11 centres, were included in the study. In 66 patients (72%), SO was the first phosphate binder; in the other 26, a previous binder was replaced by SO due to lack of tolerance or efficacy. The initial dose of SO was 942 ± 516 mg/day. Globally, serum phosphate levels decrease at 3 (10.7%, P < .001) and at 6 months of treatment (18.3%, P < .001). After 6 months of treatment, 63% of the patients achieved a phosphataemia of <5 mg/dL and 41% <4.5 mg/dL. The decrease in serum phosphate levels correlated with baseline phosphate level (r = 0.367; P = .039), age (r = .338; P = .033) and time on dialysis (r = 0.578; P = 0.001). There were no differences in the efficacy of the drug when comparing the different populations analysed. Serum levels of calcium, iPTH, ferritin, transferrin saturation index and haemoglobin did not change throughout the study. Stool consistency was reduced, and the need for laxatives decreased by 18%. The mean dose of SO increased over time to 1167 ± 381 mg/day. The drug was well tolerated.

CONCLUSION

SO is an effective option for the treatment of hyperphosphataemia in PD patients. Age, basal phosphate levels and time in the technique are factors associated with a greater decrease in serum phosphate levels. Stool consistency became softer (which may improve dialysis efficiency) with less need for laxatives.
MO813: The Validity of Combined Urea and Phosphate Kinetic Modelling in Estimation of Daily Protein and Phosphate Intake in Haemodialysis Patients
Authors: Nagah Mohamed , Elsaid Ghada , Samaan Emad
Published: May 2022

BACKGROUND AND AIMS

The interpretation of patient dietary records, laboratory results in haemodialysis units to manage their phosphate and nutritional status is time and effort consuming and needs strictly compliant patients. This justifies the need of estimates of these parameters with accepted validity and applicability.

METHOD

In 100 haemodialysis patients [50 with residual kidney function (RKF) and 50 anuric patients], Daugirdas [1, 2] supposed urea and phosphate kinetic models’ estimates were extracted and correlated with the actual dietary records, phosphate binder dosage and dialysis prescription parameters. The estimates of interest were, daily ingested phosphorus (DIP), estimated phosphorus removed, intradialytic time averaged phosphate level, normalized protein catabolic ratio (nPCR) and dialysis estimated kt/v.

RESULTS

Modeled DIP is significantly correlated to calculated phosphate intake from average 3-day dietary records in both anuric and RKF patients (r = 0.89 and r = 91, respectively; P < .001). Also, the nPCR is significantly correlated with daily protein intake/kg in both study groups (r = 0.85 in anuric, r = 0.78 in RKF; P < .001). Estimated phosphorus removed is positively correlated to dialysis kt/v in both study groups (r = 0.51 in anuric, r = 0.52 in RKF; P < .001). Patients with RKF had significantly lower pre-dialysis serum phosphate (5.78 ± 1.05 versus 4.39 ± 0.78; P < .001), calcium-based phosphate binders’ dosage (2616.28 ± 390.93 mg/day versus 1937.5 ± 395.29 mg/day;  P < .001), estimated phosphate removed in haemodialysis (1271.86 ± 274.5 mg/day versus 1016.82 ± 198.42 mg/day;  P < .001) and intradialytic average phosphate levels (4.052 ± 0.87 mg/dL versus 3.26 ± 0.61 mg/dL;  P < 0.001) than the anuric group.

CONCLUSION

Modeled DIP and nPCR can be used as estimates for phosphate and protein intake in haemodialysis patients with or without RKF. RKF has a positive impact on the phosphate measures and decreases the need for phosphate binders.

For each patient is shown the mean result after CC treatment and after SO treatment. The red bold line represents mean values. (A) Bone turnover estimated from whole-body 18F-NaF PET/CT as Ki at lumbar vertebrae 1–5 in 20 participants. (B) Bone volume estimated as CT-derived HU at lumbar vertebrae 1–5 in 21 participants. * Significance level < 0.05.
MO814: Sucroferric Oxyhydroxide versus Calcium Carbonate in the Treatment Bone Metabolism in Patients with Ckd3–5 Evaluated by 18F-NA Fluoride PET/CT and Biomarkers: A Randomized Crossover Study
Authors: Vrist Marie , Mai Hindkjær Østergaard Ann , Mose Frank , Lauridsen Thomas G , Theil Jørn , Fynbo Claire , Langdahl Bente L , Nørgaard Bech Jesper
Published: May 2022

BACKGROUND AND AIMS

Non-invasive methods for assessing bone metabolism have been lacking in chronic kidney disease (CKD), and the effects of different treatments on bone metabolism are mostly unknown. However, fluorine-18 labeled sodium fluoride (18F-NaF) PET/CT scanning can assess bone turnover as skeletal plasma clearance of tracer (Ki) and bone volume/tissue volume (BV/TV) in CKD. In a randomized crossover study, we aimed to compare the 8-week treatment effects of a non-calcium-based phosphate binder, sucroferric oxyhydroxide (SO), with 8 weeks of treatment with a calcium-based phosphate binder, calcium carbonate (CC), on bone turnover and BV/TV.

METHOD

Whole body 18F-NaF PET/CT scans were performed at the end of the CC and SO treatment periods in each participant. Ki was determined by the single-point Patlak method with semi-population input functions. A recently established CKD-MDB population residual curve was applied. Estimation of BV/TV was made by CT-derived Hounsfield units (HU) in specified volumes of interest. Paired t-tests were used or non-parametric tests (Wilcoxon signed-ranks test) when data were not normally distributed. Statistical analyses were performed using SPSS 20.

RESULTS

Ki assessed by the 18F-NaF scan was not significantly different at the lumbar spine (CC: 0.030 ± 0.014 mL min–1 mL–1; SO: 0.031 ± 0.014 mL min–1 mL–1; P = .75) or any other site after short-term treatment with SO or CC. However, HU was significantly higher after CC treatment.

CONCLUSION

18F-NaF PET/CT is a practical tool with which to evaluate bone metabolism in CKD. Short-term SO treatment did not affect Ki (turnover) differently than CC treatment, but BV/TV (volume) was significantly lower after SO treatment than after CC treatment.
MO817: New Scenarios in Use of Calcimimetics: Could Etelcalcetide Improve Anaemia?
Authors: Leonardi Giuseppe , Spinelli Alessandra , Covella Patrizia , Montanaro Alessio , De Giorgi Annarita , Schiavone Palmira , Flores Antonio , Balestra Cosima , DI Renzo Brigida , Mariotti Amalia , Figlia Irma , Patella Gemma , Grazia Arcidiacono Maria , Coppolino Giuseppe , Vernaglione Luigi
Published: May 2022

BACKGROUND AND AIMS

Alterations of mineral metabolism in patients with chronic renal failure (MBD-CKD) are frequently found and appear in the earliest stages of the disease. If not accurately diagnosed and treated, they could lead to serious clinical complications. With the same safety and better tolerability compared with cinacalcet, etelcalcetide demonstrated greater efficacy in the control of parathyroid hormone (iPTH) with an improvement in patients' compliance.

Several reports in the literature document the effect of elevated levels of iPTH on anaemia. In vitro experiments showed that elevated concentrations of PTH (comparable to those found in the blood of uraemic patients with secondary hyperparathyroidism) exert a significant inhibition on erythroid progenitors, decreasing the number of erythropoietin receptors on erythroid progenitors and making these cells insensitive to erythropoietin.

High levels of iPTH could have, furthermore, a haemolytic effect on the peripheral RBCs causing disturbed calcium metabolism, increased cytosolic calcium and enhanced osmotic fragility of the cells.

Aim of this study was to verify in a dialysis cohort if etelcalcetide could not only improve iPTH levels but also haemoglobin levels with a reduction in weekly doses of erythropoiesis-stimulating agents (ESA).

METHOD

We analysed data from 130 haemodialysis adult patients over 2 years from three different centres. A total of 24 patients treated with etelcalcetide (Image 1) were enrolled and followed at different time points (1–3–6–12–24 months). Patients were on stable doses of ferric carboxymaltose, active vitamin D analogues, phosphorus binders, supplement of oral calcium and calcium concentration in dialysate (1.25–1.50 mmol/L).

RESULTS

Data analysed after 24 months of treatment with etelcalcetide (Image 2) demonstrated not only a drastic improvement in iPTH values (772.53 ± 452.6 pg/mL versus 308.7 ± 207 pg/mL–60.05%) but also a statistically significant improvement of haemoglobin values ( 10.35 ± 1.45 g/dL versus 11.57 ± 0.97 g/dL;  P < .05) in addition to a reduction in the weekly ESAs units required (193.39 ± 148 UI/kg/week versus 142.71 ± 118 UI/kg/week; P < .05). This effect was achieved by maintaining constant ferritin and TSAT levels and without substantial changes in iron carboxymaltose therapy. No side effects were recorded for the entire duration of the treatment.

CONCLUSIONS

Considering the well-known direct and indirect inhibition of parathyroid hormone on erythropoiesis, reduction of iPTH levels achieved with etelcalcetide could improve haemoglobin levels and reduce required weekly ESA units, with obvious clinical and economic advantages. Further studies, on large populations and over longer periods of time, are required.
MO818: PTH Levels and Mortality in Incident Haemodialysis Patients
Authors: Roldão Marisa , Figueiredo Cátia , Escoli Rachele , Sofia Flora , Lopes Karina , Vila Lobos Ana
Published: May 2022

BACKGROUND AND AIMS

Serum intact parathyroid hormone (iPTH) is associated with the prognosis of haemodialysis (HD) patients; however, its optimal range for reducing mortality remains unknown. The aim of this study was to assess the association between different serum iPTH levels and mortality in incident HD patients.

METHOD

We conducted a retrospective single-centre study of incident HD patients between January 2013 and 2020. According to the iPTH level measured at baseline, patients were categorized into four groups: <150 pg/mL, 150–300 pg/mL, 301–600 pg/mL and >600 pg/mL. Clinical, analytical and demographic data were compared among groups. All-cause mortality over a mean follow-up of 3.2 years was assessed using standard survival methods. Statistical analysis was performed using SPSS (Version 23 for Mac OSX).

RESULTS

The mean age of 149 patients was 74.14 ± 14.17 years, 95 (63.8%) were male, 75 (50.3%) were diabetic, 85 (57%) had congestive heart failure (CHF) and 110 (73.9%) had hypertension. A total of 46 patients (30.9%) were treated with vitamin D analogues, 2 (1.3%) with calcimimetics and 25 (16.8%) with oral phosphate binders. A total of 57 (38.3%) patients had iPTH < 150 pg/mL, 44 (29.5%) 150–300 pg/mL, 35 (23.5%) 301–600 pg/mL and 13 (8.7%) > 600 pg/mL. There were no age, gender, comorbidity or HD modality differences among groups. Patients with iPTH < 150 pg/mL had higher c-reactive protein (CRP) (P = .042), higher serum bicarbonate (P = .020), lower albumin (P = .001), lower serum phosphate (P = .009) and lower bone-specific alkaline phosphatase (BAP) (P = .008). During the study follow-up period, 82 patients (55%) died. Multivariate Cox regression showed that patients with iPTH < 150 pg/mL had an increased risk of all-cause mortality when compared with those with iPTH 301–600 pg/mL {HR: 0.59, [95% confidence interval (95% CI) 0.36–0.96]; P = .035} and iPTH > 600 pg/mL [HR: 0.36, 95% CI 0.19–0.70; P = .02] in both unadjusted and adjusted models for age, albumin, diabetes, CHF and hypertension. No significant difference was found between iPTH < 150 pg/mL and iPTH 150–300 pg/mL groups. When the reference was changed to iPTH > 600 pg/mL, patients in this group had a decreased mortality risk when compared with those with iPTH < 150 pg/mL (HR: 2.75, 95% CI 1.43–5.29; P = .02) and iPTH 150–300 pg/mL (HR: 2.23, 95% CI 1.14–4.36; P = .02), but not iPTH 300–600 pg/mL.

CONCLUSION

In our study, the baseline iPTH level was associated with all-cause mortality in incident HD patients. Our results suggest that the optimal serum iPTH level conferring the lowest mortality risk is > 300 pg/mL in this group of patients.
MO821: Quality of Life and Depression in Hemodialysis Patients
Authors: Denden Ghada , Ben Mahmoud Nouha , Letaief Ahmed , Hammouda Mouna , Ben Salah Manel , Ben Salem Meriem , Sabra Aloui , Skhiri Habib
Published: May 2022

BACKGROUND AND AIMS

End-stage renal disease (ESRD) has certainly an impact on patients’ health-related quality of life (HRQoL). Depression is, also, highly prevalent in hemodialysis patients. This study aimed to evaluate HRQoL, the prevalence of depression, its associated factors, and its impact on quality of life in our population.

METHOD

This was a cross-sectional study including 70 hemodialysis patients in Monastir, Tunisia. Depression was evaluated using the Beck Depression Inventory (BDI). Quality of life was assessed with the Short-Form 36. Data were also collected on sociodemographic, laboratory (albumin, parathormone, hemoglobin and phosphorus) and dialysis (dialysis vintage, vascular access and hemodialysis adequacy) characteristics. The analysis was performed with descriptive and analytical statistics.

RESULTS

Among 70 patients, 64.3% were men. The mean age was 49 ± 15.7 years old. High blood pressure, diabetes and dyslipidemia were the most common comorbidities. Low drug adherence was frequent. The global average score according to the SF-36 was 38.2. The QOL was impaired in 64.2% of the cases. We have identified five variables correlated with impaired QOL: lack of autonomy, a dialysis rhythm of 3 times a week, an age >60 years, low social economic level and living in rural areas. Depression was present in 14.2% of the sample. Depressed patients presented poor quality of life, lower serum albumin and higher parathormone levels.

CONCLUSION

Our study highlights the high frequency of QOL impairment in patients on hemodialysis. Actions aimed at changing some factors associated with reduced QOL can promote well-being.
MO828: The Humoral Response of SARS-COV-2 Vaccine in Haemodialysis
Authors: Chalkia Aglaia , Alexakou Zoi , Kourniotis Dimitrios , Mpora Margarita , Aggelis George , Petras Dimitrios
Published: May 2022

BACKGROUND AND AIMS

Although vaccination against COVID-19 infection in dialysis patients is an urgent issue of worldwide concern, literature data regarding the antibody level and their kinetics over time and the efficacy towards complete COVID-19 vaccination and booster dose in these patients is inconclusive.

METHOD

We retrospectively assessed the response to COVID-19 vaccination, after the completion of vaccine series and after a booster dose in haemodialysis (HD) patients. IgG antibodies to the spike protein S1 subunit of SARS-CoV-2 were measured using ELISA at least 15 days after completion of a vaccination series, 1 month and finally 15–30 days after the booster dose.

RESULTS

Among the 28 vaccinated HD patients (mean age = 59.8 years, 100% male) with two doses of mRNA vaccine, a seroconversion was documented in all the patients (100%) with a median antibody titre of 3270.6 U/mL (IQR: 94–40.000). We recorded 9 out of 28 early responders (peak level at 2 weeks) and 19/28 late responders (peak level at 1 month). The early responders were younger (56.25 years versus 61.63; P = 0.07), without cardiovascular history (88% versus 44%; P = 0.042) or diabetes (100% versus 63%; P = 0.042), compared with late responders. On multivariate analysis, combined haemoperfusion and haemodialysis (HR = 0.167, 95% confidence interval: 0.034–0.826; P = 0.028) was an independent prognostic factor for early responders. After 6 months, all the patients received a booster mRNA dose. The patients presented median antibody levels of 33.939 U/mL (IQR: 1112–181.223), much higher titre than the first peak. Finally, four patients, all from the late responders group, presented COVID-19 infection during the vaccination period (two patients in the early period <1 month and two patients in the late period >5 months).

CONCLUSION

HD patients develop a substantial humoral response against SARS-CoV2 and the booster dose much higher response. The early responders presented more rapidly and more efficacious antibody levels, while the combined haemoperfusion and haemodialysis emerged as a positive predictor factor.
MO837: Antibody Response to Mrna Covid-19 Vaccination in Haemodialysis Patients—A 7-Month Follow-Up
Authors: Chiras Theodoros , Velentza Aikaterinh , Kalamaris Athanasios , Skarakis Jacob , Biblaki Dimitra , Dagkounaki Paraskevi , Barbatsi Aggeliki , Martsoukou Maria , Sonikian Makrouhi
Published: May 2022

BACKGROUND AND AIMS

Haemodialysis (HD) patients have a great risk of severe infection from coronovirus 2(SARS-CoV-2). However, chronic kidney disease is often associated with immunodeficiency and other existing vaccines have reduced efficacy in HD patients [1]. Humoral immune response to SARS-CoV-2 vaccination in chronic HD patients was investigated during a period of 7 months.

METHOD

A total of 39 patients, M/F = 34/5, aged 71 (47–90) years, dialyzed for 55(18–286) months, vaccinated with mRNA Comirnaty vaccine (BNT 162b2; BioNTech & Pfizer) were studied. Patients received two initial vaccine doses in March and April 2021, respectively, and 24 out of 39 patients received a third dose in October 2021. We analyzed the antibody response to the spike (S) antigen of SARS-CoV-2 at 0, 1, 4 and 7 months (November) after second vaccine dose in all patients. We also compared serum antibody titers at time-point 7 between the 24/39 patients and 20 healthy age-matched individuals, also vaccinated with three doses at the same months.

RESULTS

At time-point 0, titers of S protein-targeting antibodies(S-Abs) were 5 ± 1 AU/mL. At 1 month S-Abs were < 50 AU/mL in 2 patients (5.15%), between 51 and 100 AU/mL in 2/39 patients (5.15%), between 101 and 1000(528 ± 292) AU/mL in 19/39 patients (48.7%) and between 1001 and 10 000 (4486 ± 2547) AU/mL in 13/39 patients(33.3%). S-Abs were higher than 10 000(14 516 ± 3062) AU/mL in 3/39 patients (7.7%) after previous infection. In the 36/39 patients not infected, at 4 months there was a significant titer decrease compared with values at 1 month: from 3108 ± 4361 to 1442 ± 4357 AU/mL; P < 0.001. At 7 months, the 24/39 patients vaccinated with the third dose showed increased titers in comparison with values at 1 and 4 months, respectively (9285 ± 11 202 versus 1957 ± 2763 AU/mL; P < 0.001 and versus 584 ± 669 AU/mL; P < 0.001, respectively). Among 15/39 patients who did not receive the third dose, 4/15 with an average titer of 739 AU/mL died from other causes, 3/15 with an average titer of 25 468 AU/mL were hospitalized for COVID-19 and discharged and 8/15 showed further titer decrease (2117 ± 4887 to 950 ± 1855 AU/mL; P = 0.031). After the third dose higher S-Abs were observed in healthy controls compared with HD patients (18 050 ± 15 374 versus 9285 ± 11 202 AU/mL; P = 0.032).

CONCLUSION

Healthy controls showed a better humoral immune response compared with patients. Two doses of mRNA BNT162b2 vaccine induced an initial satisfactory humoral response in HD patients but S-Abs significantly declined subsequently [2]. Humoral response was significantly better after the third dose and booster immunization seems necessary [3].
MO840: A Survey on the Impact of Pruritus Associated With Chronic Kidney Disease (CKD-AP) In the Quality of Life of Patients Undergoing Haemodialysis in Spain
Authors: Reyes Victor , Caro Johanna , Pais Beatriz , Buades F Juan M , De Sequera Ortiz Patricia , Espín Jaime , Tombás Antonio , Moreno Marta , Carlos Julián Mauro Juan
Published: May 2022

BACKGROUND AND AIMS

Chronic kidney disease (CKD) patients can be affected by pruritus. In Spain, CKD associated pruritus (CKD-aP) affects 60% of CKD patients on haemodialysis (HD). CKD-aP severely impacts in physical and mental health of patients, resulting in sleep disturbance, depressed mood, increased risk of infection and a low quality of life [1]. In Spain, there is a lack of data regarding CKD-aP patient's quality of life (QoL). The aim of the study is to determine how CKD-aP affects the HD patients’ QoL in Spain.

METHOD

The study was structured in two phases: The first phase involved the design and the validation (by a multidisciplinary panel of 9 experts) of a survey to assess CDK-aP patient's QoL. The second phase consisted in sending the survey to CKD patients and subsequent results analysis.

RESULTS

The survey was structured in 10 domains with 25 questions that collected relevant aspects of the CKD-aP patients’ QoL.

A total of 189 HD patients answered the survey, 97 (51%) of whom had CKD-aP. The main results are showed in Table 1.

CKD-aP HD patients reported a health status significantly lower than HD patients without pruritus (mean = 46 versus 53 out of 100, respectively, P-value = 0.02). Moreover, the health status worsened when increasing severity of pruritus (mild = 51/100; moderate = 48/100; severe = 32/100). Out of 10, 6 CKD-aP patients suffer from it always or sometimes a day. A total of 30% of patients reported pruritus throughout the day, while 29% suffer from it at night. 39% of CKD-aP patients, of which 39% have severe pruritus and 62% moderate, reported having difficulty falling asleep sometimes a week or more. A total of 44% of patients experienced irritability once a week or more, 32% frustration, 21% distress, 11% depression and 7% embarrassment. In addition, pruritus limits patients’ daily and social activities (12% patients were limited once a week or more), preventing them from doing sports, housework, going to restaurants and/or engaging in cultural activities. It also alters patients’ cognitive function, leading to a lack of concentration and/or confusion (22% patients had an altered cognitive function once a week or more). 10% of patients had infections or fistula damage due to scratching. 62% of CKD-aP patients were not treated for pruritus, and of those treated, 47% were dissatisfied with their treatment.

CONCLUSION

This study shows that CKD-aP is a distressing condition with a huge impact in CKD HD patients’ QoL in Spain. However, there is an unmet need in terms of treatment, meaning that new treatments for CKD-aP are necessary to improve patients’ QoL.
MO841: Anxiety and Depression in Maintenance Hemodialysis Patients: Prevalence and Their Effects on Health-Related Quality of Life
Authors: Nagy Eman , Tharwat Samar , Mohammed Elsayed Abdelrahman , Shabaka Shimaa , Kamal Nassar Mohammed
Published: May 2022

BACKGROUND AND AIMS

End-stage renal disease and hemodialysis (HD) can afflict psychological status of patients causing various mood disorders including anxiety and depression. These mood disorders can negatively affect quality of life (QOL) of those patients. The aims of the study are to assess prevalence of anxiety and depression, to explore their associated factors, and to discover impact of these disorders on QOL in maintenance hemodialysis (MHD) patients.

METHOD

This cross-sectional multi-centric study involved 298 patients, who were maintained on HD for >3 months, in 3 different HD centers in Delta, Egypt from January 2021 to May 2021. Sociodemographic and clinical data of patients were obtained from their records. Anxiety and depression of the patients were evaluated by the usage of the hospital anxiety and depression scale (HADS). This scale divides patients to normal, borderline cases and abnormal cases. Assessment of QOL of the patients was carried out by using Kidney Disease Quality of Life (KDQOLTM-36), which yields symptom/problem list, effect of kidney disease, burden of kidney disease, physical health composite (PHC) and mental health composite (MHC). Comparison between abnormal cases, borderline cases and normal subgroups of anxiety and depression was performed regards various collected data of the patients in addition to 5 component of QOL.

RESULTS

The present study was conducted on 298 MHD patients (male 176, 59.1%) with median age of 49 years and median duration of HD of 5 years. Anxiety cases and borderline cases were identified in 49.7%, 26.1% of the patients, respectively, while depression cases and borderline cases were recognized in 55% and 28.2% of the patients, respectively. Percentage of females was increased significantly in cases with anxiety (26.4%, 41% and 49%, respectively), which did not occur with depression cases. However, there was no statistically significant differences between 3 groups of depression and anxiety regarding age, educational level, comorbidities and socioeconomic status. Abnormal cases of depression and anxiety had significantly longer duration of HD than other two groups (P = 0.001 and 0.013, respectively). All five components of QOL showed statistically significant differences between 3 groups of anxiety and depression (Table 1).

CONCLUSION

Both anxiety and depression are prevalent among MHD patients. These disorders can afflict different components of QOL of those patients.
MO849: Consistency of the Predicted Target Weights and ECW/TBW Using Bia After Hemodialysis in Patients Between Standing and Lying-Down Positions
Authors: Choi Gwangho , Jin Song Young , Kim Hyunsuk
Published: May 2022

BACKGROUND AND AIMS

As hemodialysis is administered with the patient lying down, the distribution of body fluid is stable in the lying position, which is why this position is recommended for bioimpedance analysis (BIA). Although the InBody S10 is widely used for hemodialysis patients in the lying position, clinicians must make the measurements in person. In contrast, patients can use the InBody 770 to obtain measurements by themselves in the standing position, which may be more convenient. Therefore, this study compared the measurements of hemodialysis patients’ estimated target weight and ECW/TBW obtained lying down using the S10 to those obtained in the standing position using the 770.

METHOD

This study was conducted among maintenance hemodialysis patients at Chuncheon Sacred Heart Hospital in October 2020. Measurements from 56 patients before and after hemodialysis were obtained using the 2 machines. Each (S10 or 770) estimated target weight, both pre- and post-hemodialysis, was considered ideal when the ECW/TBW ratio was 0.380. R2 was calculated and the Bland–Altman test was performed.

RESULTS

The patients’ median age was 64 years old, and 51% were men. The actual ultrafiltration was 2 kg, and the mean TBW change measured using the InBody devices was 1.5 L (R2 = 0.718) for the S10 and 1.7 L (R2 = 0.616) for the 770. The estimated target weight at pre- and post-hemodialysis showed a remarkably high correlation with the patients’ actual pre- and post-hemodialysis weight (R2 >0.095). The correlation between these measurements (lying versus standing) before and after hemodialysis was also very close (R2 = 1.0000). In addition, ECW/TBW had a good correlation (R2 ≥ 0.970) The Bland–Altman test of dry weight and ECW/TBW yielded similar results.

CONCLUSION

This study showed that patients’ estimated target weights in the lying position using the InBody S10 device and in the standing position using the InBody 770 device were consistent in both pre- and post-hemodialysis states.
MO851: Impact of COVID-19 on Dialysis Patients: Reported Experience in Qatar
Authors: Fouda Tarek , Yasin Fadumo , Aly Sahar , Ravinder Singh Poonam , Ezzat Hussain Mohammed Mohammed , Elesnawi Mohamed , Hamad Abdullah , Almalki Hassan
Published: May 2022

BACKGROUND AND AIMS

Patient-centred care is a concept focussing on meeting the specific health needs of patients as expressed by them. There is increasing evidence to show that patient centred care can help to achieve higher rates of patient satisfaction, clinical outcomes and overall better experience, particularly for patients with chronic disease. Patients Reported Experience Measures (PREM) is another concept associated with patient-cantered care. PREM surveys capture information about the healthcare experience as perceived by patients. Its importance lies in the incorporation of patient feedback into the clinical decisions and service evolution. Dialysis patients play an important role in their treatment and their voice matters to provide proper care. PREM was first conducted in 2019 in our dialysis unit including 200 patients. In 2020, COVID-19 impacted the dialysis services and resulted in many challenges including staff shortage and deployment.

METHOD

We used a validated questionnaire from the National Health Service in United Kingedm. It consisted of 7 questions covering demographics, dialysis options, patient portal, patient's relationship with the staff, teamwork and travelling abroad. The survey involved 317 randomly selected patients who have been at least 1 year on dialysis. We performed a comparison of the 2019 and 2020 results using Chi-squared test.

RESULTS

257 patients on hemodialysis and 60 on peritoneal dialysis participated in the survey. Majority of the surveyed patients (65%) were on dialysis from 1–5 years and 32% with more than 5 years’ survival on dialysis. Sixty five % of patients responded that they were on follow up in nephrology or low clearance clinic before starting dialysis. Access to dialysis team, nurses and doctors from home declined in 2020 due to the shortage of staff in the dialysis services and deployment of many staff to COVID-19 facilities, 62% of surveyed patients were able to contact their care givers from home compared with 87% in 2019 (P < 0.0001). Regarding education, 78% of the patients responded that they received education before starting dialysis and it was in an understandable manner while patients' response to the same question was 85% in 2019 (P = 0.047). 44% received education on side effects, which is remarkably less compared with 74% in 2019 (P = 0.0001).

CONCLUSION

Patient reported experience helps in the evaluation of health services. Exploring patient experience in dialysis patients in Qatar, we found negative impact of COVID-19 from patients’ perspectives. Our PREM survey showed significant decline in many parameters likely attributed to COVID-19 consequences including the shortage of staff.
MO860: Dialysis Department Patients’ Mortality During Covid-19 Pandemic—A Single Centre Experience
Authors: Karapandžić Marija , Jemcov Tamara , Kusic Milicevic Jovana , Djurkovic Veselinka , Markovic Rodoljub , Indjic Djordje , Momcilovic-Zivkovic Danijela , Jordanova Elena , Zec Gnjidic Nadezda , Komadina Ljiljana , Apostolovic Branislav , Stajcic Mina , Dodić Jelena
Published: May 2022

BACKGROUND AND AIMS

An epidemic of coronavirus (COVID-19) has been reported in Serbia since March 2020. Patients requiring chronic haemodialysis (HD) are considered particularly vulnerable due to altered immune response. However, severe form of COVID-19 infection has also been associated with multiple organ disfunction that, in some patients, may lead to acute kidney injury (AKI) or acutisation of previously known chronic kidney disease (aCKD). This study aimed to evaluate mortality rates in dialysis dependent patients hospitalized due to COVID-19.

METHOD

This retrospective study included 189 patients hospitalized in Clinical Hospital Centre Zemun between March 2020 and March 2021 due to COVID-19. All patients underwent haemodialysis during hospitalization and have been distributed in three groups depending on their renal status: AKI, HD and aCKD. Clinical presentation of the COVID-19 was defined as asymptomatic, mild, moderate, severe or critical. Demographic data and laboratory analyses were derived from the patients’ electronic record. Statistical analysis of the acquired data was performed in SPSS program.

RESULTS

Out of 189 patients, majority (75.1%) were receiving chronic haemodialysis, while 14.8% had AKI and 10.1% aCKD. The oldest patients were in AKI group, with average age of 70 ± 15 years, although difference did not reach statistical significance. Bilateral pneumonia was a predominant radiography finding in all patients, independently of study group (P = 0.168). Clinical presentation was mostly defined as mild in CHD group, whereas critical in AKI and aCKD group. Regarding complications, AKI group of patients had significantly higher sepsis rate (21.4%, P = 0.027) and respiratory insufficiency (78.5%, P = 0.000) than other groups. Mortality rate among overall population was high, precisely occurred in 64 (34.6%) patients. Statistically significant difference was observed between study groups regarding outcomes (P = 0.000). The worst survival rate was observed in AKI, while the lowest in HD group of patients, 82.1% and 21.9%, respectively.

CONCLUSION

Among COVID-19 positive population, patients who develop AKI have higher mortality rate compared with patients with previously acknowledged CKD, irrespectively of pre-hospital initiation of dialysis.
MO866: Evaluating Psychosocial Contributions to Musculoskeletal Disorders in Hemodialysis Patients: A Single Center Experience From Egypt
Authors: Kamal Nassar Mohammed , Abdel-Gawad Sara M , Elrefaey Rabab , A. Elsawi Alaa , Mohammed Elsayed Abdelrahman , Nagy Eman , Shabaka Shimaa , Tharwat Samar
Published: May 2022

BACKGROUND AND AIMS

Patients with end-stage kidney disease (ESKD) on regular hemodialysis (HD) suffer from a high burden of comorbidities. Musculoskeletal disorders (MSDs) are frequently encountered in those patients. The factors linked to MSDs in HD patients are incompletely defined, therefore this study was done to figure out how often musculoskeletal symptoms are in those patients and identify their association with many psychosocial aspects including quality of sleep, social support and fatigue.

METHOD

This cross-sectional study was carried out in the HD unit at Mansoura University Hospital, Egypt in the period from August to December 2021. The sample included 94 ESRD patients on regular HD for more than 3 months. Sociodemographic characteristics, clinical and therapeutic data were collected. The Nordic Musculoskeletal Questionnaire (NMQ-E) was used to determine the prevalence and patterns of MSDs in various parts of the body areas. Moreover, the modified Edmonton Symptom Assessment System, multidimensional Fatigue Inventory (MFI-20), Pittsburgh Sleep Quality Index (PSQI), Perceived Social Support from Family Scales were completed by the patients. MSDs predictors were evaluated by univariate regression analysis.

RESULTS

The mean age of the studied patients was 49.73 years and more than half of them (59.6%) were males. MSDs affected nearly three quarters (72.3%) of patients. The most frequently encountered MSD domains were knee pain (48.9%), low back pain (43.6%), shoulder pain (41.6%), hip/thigh pain (35.1%) and neck pain (35.1%) (Figure 1).

Regarding Pain and symptom burden, patients with MSDs had significantly higher scores of pain (P < 0.001), fatigue (P = 0.01), depression (P = 0.015) and anxiety (P = 0.003). Regarding MFI scale, patients with MSDs experienced reduced activity (P = 0.02). Subjective sleep quality, daytime dysfunction domains and global PSQI score were worse among patients with MSDs (P = 0.02, 0.031 and 0.036, respectively). Patients with MSDs perceived less social support (P = 0.029). Female gender (P = 0.013), higher scores of fatigue (P = 0.012), depression (P = 0.014), anxiety (P = 0.004), reduced activity (P = 0.029) domains and PSQI score (0.027) were the significant predictors of MSDs in the studied HD patients (Table 1).

CONCLUSION

MSDs appears to frequently occur in HD patients. Female gender, fatigue, depression, anxiety, reduced activity and poor sleep quality can predict the occurrence of MSDs in HD patients.
MO873: County-Level Characteristics Associated With Variation in End-Stage Kidney Disease Mortality in the United States, 2010–8
Authors: Snow Kylie , Patzer Rachel , Patel Shivani , Harding Jessica
Published: May 2022

BACKGROUND AND AIMS

Geographic and neighborhood-level factors such as poverty and education have been associated with an increased risk for incident end-stage kidney disease (ESKD), likelihood of receiving pre-ESKD care, and likelihood of receiving a transplant. However, few studies have examined whether these same factors are associated with ESKD mortality. In this study, we examined county-level variation in ESKD mortality and identified county-level characteristics associated with this variation.

METHOD

We identified 1 516 507 individuals (aged 18–84) initiating renal replacement therapy (dialysis or transplant) between 2010 and 2018 using the United States Renal Data System. Among 2807 counties, we estimated county-level all-cause age-standardized mortality rates (ASMR) among patients with ESKD. We then identified county-level demographic (e.g. percentage of female), socioeconomic (e.g. percentage of unemployed), health care (e.g. percentage of without health insurance) and health behavior (e.g. percentage of current smokers) characteristics associated with ASMR using multivariable hierarchical linear mixed models and quantified the percentage of ASMR variation explained by county-level characteristics.

RESULTS

County-level ESKD ASMR ranged from 45 to 1022/1000 person-years (PY) (mean, 119/1000 PY). ASMRs were highest in counties located in the Tennessee Valley and Appalachia regions, and lowest in counties located in New England, Pacific Northwest and southern California (Figure 1). In fully adjusted models, county-level characteristics significantly associated with higher ESKD mortality included a lower percentage of Black residents (−5.67/1000 PY), lower median income (−5.53/1000 PY), lower number of dialysis facilities/population (−2.25/1000 PY) and higher health care expenditures (5.36/1000 PY). Overall, county-level characteristics explained 16.9% of variation in ESKD mortality.

CONCLUSION

Counties with high ESKD-related mortality may benefit from targeted and multi-level interventions that combine knowledge from a growing evidence base on the interplay between individual and community-level factors associated with ESKD mortality.
MO885: Anxiety Burden in Haemodialysis and Peritoneal Dialysis Patients
Authors: Trbojevic-Stankovic Jasna , Milošević Saša , Nikic Petar , Andrić Branislav
Published: May 2022

BACKGROUND AND AIMS

The growing number of people undergoing dialysis therapy on a global scale is becoming a universal concern. Their mental health is substantially associated with quality of life and outcomes. The prevalence of anxiety for people on dialysis is not well known, but appears much higher than in the general population. Nevertheless, it remains under-recognised and under-managed. We aimed to assess the prevalence of anxiety in adult patients on chronic haemodialysis (HD) and continuous automated peritoneal dialysis (CAPD).

METHOD

This single-centre cross-sectional study enrolled 123 patients (61 on HD and 62 on CAPD) in stable clinical condition and able to understand and fill-in the self-administered Beck Anxiety Inventory questionnaire (BAI). The patients’ self-rated health was assessed by an EQ Visual Analogue Scale (EQ-VAS). Standard laboratory parameters and Kt/V were measured in all patients. Other relevant demographic and clinical data were obtained from patients’ medical records. The results were analyzed with independent sample T-test and χ2 statistic.

RESULTS

The HD and CAPD groups did not differ significantly with regard to sex (59% versus 48% men; P = 0.237), age (60.83 ± 12.98 versus 60.37 ± 13.10 years; P = 0.845), level of education (44% versus 52% with only primary school; P = 0.593) and dialysis vintage (35.14 ± 26.77 versus 30.31 ± 26.11 months; P = 0.312). The average BAI was 19.40 ± 15.64 in HD and 11.52 ± 9.69 in CAPD patients (P < 0.01). Among HD patients 17% had mild (BAI = 8–15) and 53% severe (BAI >15) anxiety, while among CAPD patients 37% had mild and 26% severe anxiety (P = 0.013). No statistically significant difference was noted within the HD and CAPD groups related to the presence of anxiety and sex, age, level of education, dialysis vintage, dialysis adequacy and laboratory measurements. HD patients with BAI ≥ 8 had significantly lower EQ-VAS than those with BAI < 8 (48.89 ± 21.98 versus 66.92 ± 26.70;  P = 0.032). However, no such observation was obtained in the CAPD group.

CONCLUSION

Anxiety is a common symptom among patients undergoing dialysis. In HD patients, it appears to be related to an overall worse health status. Early detection and treatment of anxiety may have a positive impact on patient outcomes. Thus, the high prevalence of anxiety in the current study supports the need to adopt effective strategies to adopt and improve screening strategies.
MO890: Modifiable and Non-Modifiable Factors Associated With Increased COVID-19 Related Mortality Among Dialysis Patients
Authors: Carioni Paola , Kooman Jeroen , Stuard Stefano , Kotanko Peter , Usvyat Len A , Kovarova Vratislava , Arkossy Otto , Bellocchio Francesco , Tupputi Antonio , Winter Anke , Zhang Yan , Zhang Hanjie , Larkin John , Neri Luca
Published: May 2022

BACKGROUND AND AIMS

Patients with end-stage kidney disease (ESKD) face higher risk for severe outcomes from COVID-19 infection. Moreover, it is not well known to which extent potentially modifiable risk factors contribute to mortality risk. In this study, we investigated the incidence and risk factors for 30-day case-fatality of COVID-19 in haemodialysis patients treated in the European Fresenius Medical Care (FMC) Nephrocare network.

METHOD

In this historical cohort study, we included unvaccinated adult dialysis patients with a first documented SARS-CoV-2 infection between 1 February 2020 and 31 March 2021 (study period) registered in the European Clinical Database (EuCliD®). The first SARS-CoV-2 suspicion date for all documented infections was considered the index date for the analysis. Patients were followed for up to 30 days. Follow-up time was defined from the index date until the date of death, end of follow-up period or lost to follow-up, whichever occurred first. We ascertained patients’ characteristics in the 6-month period prior to index date. We used logistic regression and XGBoost to assess risk factors for 30-day mortality.

RESULTS

We included 9211 patients meeting the inclusion criteria for the study (Table 1). Age was 65.4 ± 13.7 years, dialysis vintage was 4.2 ± 3.7 years. In the follow up period, 1912 patients died within 30 days (20.8%, 95% confidence interval: 19.9%–21.6%). Correlates of COVID-19 related mortality are summarized in Table 2. Several potentially modifiable factors were associated with increased risk of death: patients on HD compared with online haemodiafiltration had shorter survival after presentation with COVID-19 as well as those who did not achieve the therapeutic targets for serum albumin, erythropoietin resistance index, protein catabolic rate, haemodynamic status, C-reactive protein, single-pool Kt/V, hydration status and serum sodium in the months before infection. The discrimination accuracy of prediction models developed with XGBoost was similar to that observed for main-effect logistic regression (AUC 0.69 and 0.71, respectively) suggesting that no major cross-interaction and non-linear effect could improve prediction accuracy.

CONCLUSION

We observed high 30-day COVID-19 related mortality among unvaccinated dialysis patients. Older patients, men and those with greater comorbidities had higher risk of death after COVID-19 infection. Derangement in potentially modifiable factors in the 6 months prior to COVID-19 infection was independently associated with increased mortality. Whether achievement of clinical therapeutic targets is associated with improved survival after COVID-19 infection is a matter of further research.
MO897: Diabetic Retinopathy and Risk of Macrovascular Complications in Patients Undergoing Hemodialysis: A National Population-Based Cohort Study
Authors: Lin Ting-Yun , Hung Szu-Chun
Published: May 2022

BACKGROUND AND AIMS

The association of diabetic retinopathy (DR) with macrovascular complications in patients with end-stage kidney disease undergoing hemodialysis is unclear.

METHOD

We conducted a nationwide cohort study of 44 514 incident hemodialysis patients who were enrolled in Taiwan's national health insurance research database between 1 January 2010 and 31 December 2014 and had follow-up data until 31 December 2015. Patients with and without DR were matched by propensity score in a 1:1 ratio. The primary outcomes were acute coronary syndrome (ACS), acute ischemic stroke and hospitalizations for peripheral artery disease (PAD).

RESULTS

Of the 27 286 patients with type 2 diabetes, 10 537 (38.1%) had DR at baseline. We matched 9164 patients without DR (mean age, 63.7 years; 44.0% women) by propensity score to 9164 patients with DR (mean age, 63.5 years; 43.8% women). Over a median follow-up of 2.8 years, 2781 patients (15.2%) experienced ACS. Stroke occurred in 1613 patients (8.8%), and 1938 patients (10.6%) were hospitalized for PAD. In a multivariable Cox model accounting for the competing risk of death, the presence of DR was associated with an increased risk of stroke {subdistribution hazard ratio (sHR) 1.30 [95% confidence interval (95% CI) 1.17–1.44]; P < 0.0001} and PAD (sHR 1.17, 95% CI 1.08–1.29; P = 0.0006) but not ACS (sHR 0.99, 95% CI 0.91–1.07; P = 0.9168). The observations were consistent across patient subgroups.

CONCLUSION

Our findings support early identification and close monitoring and management of hemodialysis patients with DR to prevent the development of stroke and PAD.