bluuebunny/crossref_metadata_2025 huggingface dataset:
MO483: Validation of The Kidney Failure Risk Equation in a Portuguese Cohort
Authors: Marques Da Silva Bernardo , Charreu José , Duarte Inês , Outerelo Cristina , António Lopes José , Gameiro Joana
Published: May 2022

BACKGROUND AND AIMS

In chronic kidney disease (CKD) patients, the risk of kidney replacement therapy (KRT) is highly variable. In 2011, Tangri et al. developed the kidney failure risk equations (KFRE) to predict the 2- and 5-year probability of requiring kidney replacement therapy (KRT). The KFRE is an easily calculated 4-variable equation that has been extensively validated in multiple cohorts. The aim of this study was to validate this risk score in a Portuguese cohort.

METHOD

We conducted a retrospective analysis of CKD patients stage 3–5 referred for nephrology consult at Centro Hospitalar Universitário Lisboa Norte during the first 6 months of 2018. Age, gender, estimated glomerular filtration rate (eGFR) and albuminuria were assessed. The four-variable Kidney Failure Risk Equation (KFRE) calibrated for a non-North American population was calculated. Requirement for KRT was assessed in a 2-year follow-up. We assessed the Cox logistic regression method of the KFRE to predict KRT requirement, and the discriminatory ability was determined using the receiver operating characteristic (ROC) curve. A cut-off value was defined as that with the highest validity.

RESULTS

A total of 360 patients were included, and 54.4% were male. The mean age was 74.9 ± 12.2 years, serum creatinine was 1.97 ± 0.84 mg/dL, eGFR was 33.4 ± 12.13 mL/min/1.73 m2 and albuminuria was 571.1 ± 848.3 mg/g. The mean calculated risk score was 6.2 ± 11.2%. A total of 23 patients required KRT (6.4%) in the 2-year follow-up. The hazard ratio was 1.1 [95% confidence interval (95% CI) 1.06–1.12; P < .001] for the 2-year risk of KRT. The KFRE predicted progression to KRT requirement with an auROC of 0.903, (95% CI 0.86–0.95; P < 0.001), with a sensitivity of 91.3% and specificity of 71.8%. The optimal KFRE cut-off was >4.5% for 2-year nephrologist referral, with a hazard ratio of HR 26.7 [95% CI 6.15–116.3; P < .001] for 2-year risk of KRT. requirement.

CONCLUSION

We have independently externally validated the 2-year KFRE and shown that it has excellent discrimination. The KFRE should be incorporated into the clinical care of patients with CKD to improve patient-clinician dialogue and provide guidance on the timing of referral for nephrology evaluation and planning for dialysis access.
MO494: The Prospective Roles of Urinary Dickkopf-3 for Detecting Renal Function Deterioration and Monitoring Chronic Kidney Disease Progression: Systematic Review of Cohort Studies
Authors: Pratama Putra Boby , Nugraha Putra Felix
Published: May 2022

BACKGROUND AND AIMS

Chronic kidney disease (CKD) is a worldwide health problem whose incremental prevalence. Early detection and proper monitoring of renal dysfunction can decrease morbidity and mortality among CKD patients. Estimated glomerular filtration rate (eGFR) and albuminuria have been used for monitoring CKD progression. Unfortunately, substantial CKD patients’ proportion might undergo CKD progression through non-proteinuric pathways. Dickkopf-3 (DKK3), stress-induced renal tubular epithelial-derived glycoprotein, is a key driver of tubulointerstitial fibrosis through the canonical Wnt/β-catenin signaling pathway. This study aims to evaluate the role of DKK3 in detecting and monitoring renal dysfunction and CKD progression.

METHOD

Comprehensive literature searching was performed through the online databases of PubMed, EMBASE, ScienceDirect and The Cochrane Library. This study followed the PRISMA guidelines. The inclusion criteria are all cohort studies that assess the correlation and clinical implications of increased urinary DKK3 with CKD progression. The quality of included studies was accessed by using the Newcastle–Ottawa Scale.

RESULTS

Six cohort studies matched the inclusion criteria. Urinary DKK3-to-creatinine >4000 pg/mg was independently associated with annual eGFR decline among early CKD stages. A multivariate analysis study suggested that 24-h urinary DKK3 was independently associated with the annual Kt/V decline among peritoneal dialysis patients. Increased urinary DKK3 was associated with a significant eGFR decline in 6 months among IgA nephropathy patients. A cohort study suggested that populations with microalbuminuria were significantly susceptible to prevalent cardiovascular diseases, prevalent CKD, and new-onset CKD risks. Urinary DKK3 was associated with significant incremental risks for declining eGFR and proteinuria as well as CKD progression risks in chronic obstructive pulmonary disease (COPD) patients. In a study, involving CKD patients who underwent coronary angiography, the baseline urinary DKK3-to-creatinine ratio was superior to serum cystatin-C and serum and urinary neutrophil gelatinase-associated lipocalin (NGAL), predicting both acute kidney injury (AKI) and persistent renal dysfunction. A cardiac surgery study showed that high urinary DKK3-to-creatinine ratio >471 pg/mg was significantly associated with AKI, persistent renal dysfunction and dialysis dependency.

CONCLUSION

Dickkopf-3 shows promising prospective roles for detecting early renal dysfunction and monitoring CKD progression. Nevertheless, further studies are warranted to confirm its promising prospective role.
MO497: Upper Tract Urothelial Cancer and Balkan Endemic Nephropathy: 65 Years of Follow UP
Authors: Glogovac Stevan , Tasic Danijela , Dimitrijevic Zorica , Apostolovic Branislav , Bašić Dragoslav , Mitic Branka , Prokopovic Miomir , Pertovic Milan , Stojanovic Miomir , Paunovic Karolina , Ljubenovic Stanimir
Published: May 2022

BACKGROUND AND AIMS

All researchers dealing with Balkan endemic nephropathy (BEN) talk about the association of BEN with malignant tumours of the upper urothelium (UTUC). Long-term research of UTUC obtained various results depending on the period and region of observation, depending on the stage of renal failure, degree of malignancy, surgical or autopsy treatment. The aim of this paper is to monitor UTUC in certain parts of the Republic of Serbia in a long period of time and what is the frequency of tumours in relation to the observed endemic and non-endemic built-up areas for BEN.

METHOD

Occurrence of UTUC was analyzed for the period 1953–2017 on the basis of operational protocols of the Institute of Urology and Nephrology KCS Belgrade, Clinic of Urology Nis, Department of Urology and Haemodialysis Leskovac. The categorization of built-up areas into (A) endemic, (B) hypoendemic, (C) non-endemic rural and (D) non-endemic urban built-up areas was used. For practical reasons, the groups of built-up areas (A) and (B) united in the group of endemic and (C) and (D) in the group of non-endemic built-up areas. The average annual incidence rate (AAIR) is calculated/100 000 inhabitants.

RESULTS

In his summary series of UTUC, which included a large number of urological centres in Serbia, Petkovic found in a period of 20 years (1953–1973) that the frequency of tumours is 100 times higher in an endemic than in a non-endemic built-up area. In a 40-year study (1978–2017), Glogovac found that the incidence of tumours in Jablanica district was 14.24 times higher in endemic (AAIR-11.82) than in non-endemic built-up areas (AAIR-0.83) in the last 20 years (1998–2017). The frequency is 4.14 times higher.

The linear trend of UTUC in the Jablanica district in the endemic built-up area for BEN in the observed 40-year period was in a statistically weak decline (y = –0.0276x + 55.691; r2 = 0.1718) while for BEN it was in a statistically significant decline (y = –0.2127x + 6.6966; r2 = 0.8529).

CONCLUSION

The high frequency of UTUC in regions with BEN may indicate a common nephropathogenic and carcinogenic etiological factor and confirms the existence of a positive correlation between BEN and UTUC. The reason for the decline in the frequency of UTUC in the observed built-up area in the observed period should be sought in the drastic decline in BEN, which is explained by changes in the course of the disease, better screening, water supply, health education, lower toxicity, micromigration and possibly misdiagnosis.
MO498: Incident Chronic Kidney Disease in Older Adults With Diabetes
Authors: Lim Cynthia , Mong Bee Yong , Ang Andrew , Abdul Kadir Hanis , Liang Kwek Jia , Choo Jason , Chuan Tan Ngiap
Published: May 2022

BACKGROUND AND AIMS

Chronic kidney disease (CKD) is a growing global public health burden among aging populations and is associated with increased risks of cardiovascular disease, kidney failure and death. Early identification and treatment can amelioriate these risks. We aimed to evaluate incident CKD and risk factors among older adults with diabetes in Singapore.

METHOD

Retrospective cohort study of 13 028 older adults ≥65 years with diabetes mellitus who were free of CKD (eGFR ≥60 mL/min/1.73 m2) at baseline and had kidney function tested 3 years later at Singapore's largest healthcare cluster that includes the Singapore General Hospital and SingHealth Polyclinics. Demographic, clinical and laboratory data were retrieved from electronic medical records and the SingHealth Diabetes Registry. Incident CKD was present if eGFR was <60 mL/min/1.73 m2 at follow up. Binary logistic regression analysis was used to obtain the odds ratio (OR) and 95% confidence interval (CI) for pre-selected factors.

RESULTS

In this multi-ethnic cohort (Chinese 91%, Indian 8%, Malay 8% and other ethnicities 3%), the mean age was 72.1 ± 5.6 years and the eGFR was 84.2 ± 11.1 mL/min/1.73 m2. The majority were on glucose and blood pressure lowering medications and achieved glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 7.1% ± 1.1, 133 ± 16 mmHg and 68 ± 9 mmHg, respectively.

Cumulative incident CKD among older adults with diabetes was 19.4% >38.5 ± 4.7 months. In the fully adjusted model, considering age, gender, ethnicity, comorbidities (hypertension, cardiovascular disease, cancer, statin use), SBP, DBP, BMI and laboratory results (eGFR, albuminuria, glucose, HbA1c, LDL- and HDL-cholesterol). Female gender {adjusted OR: 1.54, [95% confidence interval (95% CI) 1.36–1.76]}, Malay ethnicity (adjusted OR: 1.24, 95% CI 1.01–1.53), hypertension (adjusted OR: 1.40, 95% CI 1.02–1.93), albuminuria (adjusted OR: 1.49, 95% CI 1.31–1.69) and higher HbA1c (adjusted OR: 1.11, 95% CI 1.04–1.18/unit increase) were independently associated with incident CKD, while higher eGFR (adjusted OR: 0.88, 95% CI 0.87–0.88/unit increase) and statin use (adjusted OR: 0.79, 95% CI 0.64– 0.99) were associated with decreased incident CKD.

CONCLUSION

Incident of CKD was frequent among older adults with diabetes. The presence of risk factors for incident CKD can aid clinicians to identify those who may benefit from close surveillance and interventions.
MO514: Cardiorenal Outcomes Associated With Oral Anticoagulant Use in Patients With Atrial Fibrillation
Authors: Mazhar Faizan , Trevisan Marco , Hjemdahl Paul , M. Clase Catherine , De Jong Y , Evans Marie , Bellocco Rino , Fu Edouard , Jesus Carrero Juan
Published: May 2022

BACKGROUND AND AIMS

Novel oral anticoagulants (NOAC) are currently the first-line choice for stroke prevention in patients with atrial fibrillation (AF), as they have a better risk/benefit profile compared with vitamin K antagonists (VKA). Secondary analyses of trials suggest that NOAC also reduces kidney outcomes, but this has been less explored.

METHOD

Observational study from the SCREAM project comparing clinical outcomes of all persons with AF and eGFR ≥15 mL/min/1.73 m2 that initiated NOAC or VKA in Stockholm, Sweden, during 2011–18. The primary outcomes were acute kidney injury (AKI, by diagnosis or sudden creatinine elevation) and the composite of kidney failure and >30% eGFR decline. Secondary outcomes were major bleeding and the composite of hospital admission with stroke or systemic embolism. Inverse probability of treatment weighting (IPTW) was used to balance 51 baseline confounders. Sensitivity analyses included falsification endpoints (pneumonia and cataract surgery), subgroups and evaluation of per-protocol effects.

RESULTS

A total of 32 699 patients initiated oral anticoagulants (median age, 75 years, 45% women, median eGFR 73 mL/min/1.73 m2), of which 18 323 (56%) used NOAC. Compared with VKA, initiation of NOAC was associated with a 13% lower relative risk of experiencing the composite kidney outcome (HR: 0.87; 95% CI 0.78–0.98) and a 12% relative risk reduction on AKI occurrence (HR: 0.88; 95% CI 0.80–0.97). Compared with VKA, NOAC use was associated with a lower risk of major bleeding (HR 0.77; 95% CI 0.67–0.89), but a similar risk of stroke/systemic embolism (HR: 0.93; 95% CI 0.78–1.11). Results were similar across subgroups, including patients with chronic kidney disease (eGFR <60 mL/min/1.73 m2) and when censoring patients at treatment discontinuation or switch.

CONCLUSION

Compared with VKA, and regardless of baseline kidney function, initiation of NOAC was associated with a lower risk of CKD progression, AKI and major bleeding, but a similar risk of the composite of stroke and systemic embolism.
MO518: Chronic Kidney Disease in Primary Care and the Risk of Cardiovascular Comorbidity and Mortality
Authors: Borg Rikke , Kriegbaum Margit , Klinten Grand Mia , Struer Lind Bent , Lykkegaard Andersen Christen , Persson Frederik
Published: May 2022

BACKGROUND AND AIMS

The prevalence of chronic kidney disease (CKD) is increasing globally. Often, the condition develops silently over time, with no or only a few symptoms in earlier stages. Therefore, early recognition in primary care may have an important role in ensuring diagnosis and proper intervention. We aimed to determine the prevalence and outcome of CKD in a large primary care cohort in Denmark.

METHOD

We performed an observational cohort study using data from individuals above age 40 followed in primary care in the greater Copenhagen area between 2000 and 2015 and linked them to Danish health registries. A run-in period of 3 months was included to ensure stable conditions and rule out acute changes in eGFR at baseline. The date of the second measurement of eGFR during the study period was considered the subject's index date (baseline). Outcomes were relevant diagnoses such as stroke, myocardial infarction (MI), hospitalisations for heart failure (HHF) and peripheral artery disease (PAD) (last update 2018), all-cause mortality and cardiovascular mortality. Kidney function (eGFR) was estimated by the CKD-EPI formula based on serum creatinine and expressed in mL/min/1.73 m2. Conventional CKD groups are used with CKD 1 and 2 (normal—eGFR > 60 mL/min/1.73 m2) as reference groups for the hazard ratio estimates. Outcomes were presented as the number of events/100 person-years (PY). We conducted survival (all-cause mortality outcome) and competing risk (rest of the outcomes) analyses using the Cox proportional hazards model to calculate the (cause-specific) hazard ratios for the outcomes according to CKD group. We further explored the continuous associations between kidney function and the outcomes examined by using eGFR as a continuous variable with penalised splines. All models were adjusted for known risk factors (age, gender, diabetes, hypertension, existing CVD, heart failure, LDL cholesterol, use of antihypertensive treatment).

RESULTS

We included a population of 171 133 individuals. As expected, the majority (n = 157002) was in CKD 1 or 2 at the index date, and only a small proportion (0.05%) was in CKD stage 5. In general, event rates were low in CKD stages 1 and 2 and rose with higher stages of CKD. In the adjusted analyses, we observed a stepwise increase in hazard rates for every outcome with every increment in CKD stage (Fig. 1). This was confirmed by the continuous analysis. Compared with CKD stage 1 + 2,  individuals in CKD stage 4 had approximately double the hazard rate of PAD, MI, cardiovascular and all-cause mortality.

CONCLUSION

Our data from a large primary care cohort demonstrate an early increase in risk for adverse outcomes already at CKD stage 3. This provides the basis and underlines the importance of studying early intervention in primary care.
MO580: Healthy Plant-Based Diet for Patients With Chronic Kidney Disease (CKD) Through Use of Sodium Zirconium Cyclosilicate (SZC): A Feasibility Study (Helpful)
Authors: Avesani Carla , Heimbürger Olof , Lindberg Anneli , Rubin Charlotta , Faxen Irving Gerd , Rashid Tony Qureshi Abdul , Lindholm Bengt , Stenvinkel Peter
Published: May 2022

BACKGROUND AND AIMS

Healthy plant-based diets (HealthyPB diet) may offer metabolic and cardiovascular benefits to patients with CKD. However, the higher potassium (K+) content of these diets is a concern when prescribed to CKD patients with hyperkalemia (HK). Potassium-lowering medication, such as SZC, can be a treatment option to allow better control of plasma K + for those ingesting a HealthyPB diet. We investigated whether patients with CKD stage 4–5 and HK can be safely prescribed a HealthyPB diet with increased K + content by concomitant use of SZC.

METHOD

This is an ongoing open label feasibility clinical trial that will include 36 patients with CKD stage 4–5 not on dialysis with HK (plasma K+ ≥ 5.1 mmol/L). Patients with plasma K+ > 6.5 mmol/L are excluded. Intervention: Patients are followed for 6 weeks. In the first 3 weeks (stabilization phase), SZC is prescribed according to the drug label to normalize plasma K + while ingesting a low protein diet (0.6–0.8 g/kg/day) with low content of K+ (2.3 g/day) as counselled by a dietitian. After 3 weeks, patients initiate and follow for 3 additional weeks, the HealthyPB diet containing unchanged low amount of protein and K + content of 3.7–4 g/day. In order to increase diet adherence, a food basket (containing fruits, vegetables, whole grains, nuts, whole cereals, white meat, fish or eggs in amounts adequate for the patient and the family) is delivered to patient's home once per week. Serum K is closely monitored and the dose of SZC is adjusted according to the drug label to maintain serum K between 3.5 and 5.0 mmol/L. Adherence to the diet is assessed by 24-h urinary K + excretion, 24-h food record, and a semi-quantitative short food questionnaire at the beginning and end of the stabilization phase and again at the beginning and end of the HealthyPB diet phase. The protocol is registered at www.clinicaltrials.gov (identifier NCT04207203).

RESULTS

Among 14 patients included so far, 12 completed the study protocol and 2 are being followed. Results in the patients (n = 12; age 56.5 ± 10 years; 66.7% men; eGFR: 16.4 ± 4.6 mL/min/1.73 m2) who completed the follow-up are described in the Table 1. Mean ± SD or median and interquartile range; NA: not assessed.

At the end of follow-up three (25%) patients had plasma K + between 5.1 and 5.3 mmol/L.

CONCLUSION

These preliminary results indicate that patients adhered to the low protein HealthyPB diet with an increase in the intake of fruits, vegetables, whole cereals and nuts. The mean plasma K + was well controlled with SZC and within the normal range after the start of the HealthyPB diet.
MO644: Comparative Analysis of Survival and Morbidity in Home and Hospital Haemodialysis
Authors: Todorov Sakic Verica , Djuric Petar , Jankovic Aleksandar , Bulatovic Ana , Bjedov Jelena , Djuric Zivka , Pešić Snezana , Dimkovic Nada , Naumovic Radomir
Published: May 2022

BACKGROUND AND AIMS

Many studies have shown that home haemodialysis (HOHD) provides fewer complications and better outcomes as compared with hospital haemodialysis (HHD). The aim of this study was to compare morbidity and survival in patients on HOHD and HHD.

METHOD

We analysed 26 prevalent HOHD patients who were matched with 52 HHD patients according to sex, age and Davies Comorbidity Index (DCI). DCI is based on seven groups of comorbidities: ischaemic heart disease (IHD), left ventricular dysfunction (LVD), peripheral vascular disease (PVD), malignancy, diabetes mellitus (DM), systemic collagen vascular disease and other significant pathology. Grade 0 had patients without any of these comorbidities, grade 1 those with 1–2 and those with 3 or more comorbidities had grade 2. Patients were followed from January 2011 to January 2020. We analysed an overall number of hospitalizations during the study period, a number of hospitalizations per year (annual hospital admission rate) and longevity of in-hospital stay (days). We categorized each hospitalization into 1 of 4 causes: cardiovascular disease (CVD), infection, vascular access dysfunction, or other cause.

RESULTS

Median age for HOHD and HHD patients was 55.7 and 56 years respectively and 77% of patients in both groups were men. Majority of the patients in both groups had DCI 1 (65%), 31% had DCI 0 and only 4% had DCI 2. The most common comorbidity for both HOHD and HHD patients was IHD (35% and 29% respectively), followed by HCV infection (35% and 17% respectively) and PVD (11.5% and 15% respectively). There was no difference between HOHD and HHD patients in an overall number of hospitalization (3.7 ± 3.3 versus 3.9 ± 2.8;  P = .47), nor in annual admission rate for all-cause morbidity (0.5 ± 0.4 versus 0.6 ± 0.4;  P = .28), but HHD patients had longer in-hospital stay (7.4 ± 9.8 days versus 9.3 ± 8.7 days; P = .05). Cause-specific morbidity showed that HHD patients had a more frequent annual admission rate for CVD (0.2 ± 0.1 versus 0.4 ± 0.3;  P = .05), while there were no differences for infections (0.3 ± 0.2 versus 0.3 ± 0.3;  P = .9) nor vascular access complications (0.3 ± 0.3 versus 0.4 ± 0.3;  P = .3). Also, annual in-hospital stays for CVD (3.0 ± 3.1 versus 4.0 ± 4.5 days; P = .5), infection (6.4 ± 7.5 versus 5.7 ± 7.6 days; P = .6) and vascular access complications (6.0 ± 7.0 versus 7.7 ± 7.8 days; P = .5) did not differ between HOHD and HHD group. Kaplan–Meier curve revealed that survival in HOHD and HHD patients were 92.3% versus 90.4% at 3 years, 84.6% versus 70.2% at 5 years and 55.7% versus 50% at 9 years (log-rank test P = .5).

CONCLUSION

Our study has shown that HOHD and HHD patients had similar hospitalization rates, but patients on HOHD had better rehabilitation and shorter hospitalizations for all-cause morbidity. Despite this, HHD and HOHD patients had similar survival rates.
MO654: Automatic KUF Max Determination as a Tool to Prescribe a Personalized Convection Flow in Post-Dilution Haemodiafiltration by Predicting the Transmembrane Pressure to Which the System will be Subjected
Authors: Ficheux Alain , Laget Jonas , Duranton Flore , Gayrard Nathalie , Vetromille Fernando , Szwarc Ilan , Servel Marie-Françoise , Argiles Ciscart Angel
Published: May 2022

BACKGROUND AND AIM

Post-dilutional haemodiafiltration (HDF) with high convection volumes are suggested to improve survival. However, a large increase in convection flow (QUF) is associated with high transmembrane pressure (TMP) which, when exceeding limits advised by guidelines, acts as a limiting factor and prevents achieving the prescription. Our aim is to predict the TMP needed to reach any given convection flow for a patient and dialysis session.

METHOD

The TMP necessary to obtain a desired convection was predicted from the automatic determination of the maximum ultrafiltration coefficient (KUF max, HDF machine Dialog iQ, BBraun, Melsungen, Germany) and compared to the actual value for 16 patients and 29 dialysis sessions. KUF max was determined at the start of the session and the coefficients of the quadratic regression of the ultrafiltration coefficient (KUF) on convection flow (KUF = a*(QUF)² + b* QUF + c) were obtained and used to predict the TMP needed to obtain a convection of 30% of QB (QUF max), knowing that TMP = QUF/KUF. Then, infusion rate was set at QUF max and the observed TMP was recorded after 8 minutes stabilization. Dialyses were performed with the patient's usual dialyzer (Diacap pro for 28 sessions, Nephral 400 for 1 session) and blood flow [363 ± 30 mL/min (300–400 mL/min)]. Observed and estimated TMPs were compared.

RESULTS

There was a high correlation between both TMPs (Pearson's R = 0.98; P < .01). The Bland and Altman analysis showed an average difference (systematic bias) of 3.3% with 95% limits of agreement of −9 and +15% and a maximal difference of 12%, indicating a slight overestimation.

CONCLUSION

KUF max determination allows estimating TMP at any QUF prescription with an acceptable error (3%). Therefore, the KUF on QUF parabolic curve may be of help in the clinical setting to prescribe the most suitable convection in post-dilutional HDF by predicting the TMP the filtrating system will be submitted to. Based on this principle, automatic systems to aid personalized convection flow prescriptions can be developed.
MO658: Effect of a Time-Dependent Dialysate Bicarbonate Concentration on Intradialytic and Postdialytic Blood Bicarbonate Kinetics
Authors: Wieliczko Monika , Twardowska-Kawalec Malgorzata , Debowska Malgorzata , Mauro Pietribiasi , Waniewski Jacek , (Ken) Leypoldt John , Malyszko Jolanta
Published: May 2022

BACKGROUND AND AIMS

Use of a high dialysate bicarbonate (HCO3) concentration during haemodialysis (HD) is associated with higher patient mortality, potentially due to post-dialytic metabolic alkalosis [1]; it remains unclear how to optimize dialysate HCO3 concentration ([HCO3]) to both neutralize interdialytic acid generation and minimize post-dialytic alkalosis. We compared the effects of an intradialytic increasing or decreasing dialysate [HCO3] during HD on blood bicarbonate kinetics.

METHOD

Blood [HCO3] was measured in 11 chronic, thrice-weekly HD patients (5 male, 6 female) during 4-h treatments with i) constant dialysate [HCO3] of 35 mEq/L; ii) dialysate [HCO3] of 35 mEq/L for the first 2-h and 30 mEq/L for the second 2-h; and iii) dialysate [HCO3] of 30 mEq/L for the first 2-h and 35 mEq/L for the second 2-h. Treatment interventions were fixed during a given week, and arterial blood samples were obtained at the start of treatment, every hour during the treatment and 1-h after the treatment during the second and third treatments of the week; a total of 66 HD treatments were monitored. Blood acid-base composition was determined using a blood gas analyzer; [HCO3] was calculated from measured pH and partial pressure of carbon dioxide using the Henderson–Hasselbalch equation. Blood [HCO3] for each patient was averaged over the second and third treatment of the week. HCO3 transfer from dialysate to blood was calculated by numerical integration of the time-dependence of the blood bicarbonate profile assuming a constant dialyzer dialysate of 198 mL/min. Blood flow rates were 250–350 mL/min and were relatively constant for each patient; dialysate flow rates were always 500 mL/min.

RESULTS

Pre- and post-dialytic body weights were 71.1 ± 12.6 kg and 69.5 ± 12.1 kg [mean ± standard deviation (SD)], respectively, during the first study treatment. Mean values of blood [HCO3] are shown in the Figure; certain statistics are tabulated.

Blood pH at the start of treatment was not different (P = 0.12) between Treatments A and B (7.41 versus 7.40, respectively) but was lower (P < .001) at end of treatment during Treatment B than A (7.47 versus 7.51). HCO3 transfer from the dialysate to blood during A, B and C treatments were 140 ± 58, 97 ± 47 and 120 ± 47 mEq, respectively. HCO3 transfer trended lower (P = .09) during treatment B than A.

CONCLUSION

HD treatments with a dialysate [HCO3] of 35 mEq/L for only the first 2-h led to a reduction in HCO3 transfer to the patient and lower post-dialytic blood [HCO3] and pH. Lowering dialysate [HCO3] after 2-h of a 4-h HD treatment can reduce post-dialytic metabolic alkalosis. Further, long-term studies with such a strategy are needed to evaluate its effect on patient outcomes.
MO659: First Experience of Bamlanivimab for Covid-19 Positive Haemodialysis Patients: A Case-Control Study
Authors: Djuric Petar , Bogicevic Jovana , Pešić Snezana , Davidovic Zeljko , Naumovic Radomir
Published: May 2022

BACKGROUND AND AIMS

The previous study showed a higher prevalence of coronavirus (COVID-19) in end-stage renal disease (ESRD) patients than in the general population (3.1% versus 0.1%). The presence of COVID-19 infection significantly increased the mortality rate of patients on dialysis compared to non-COVID patients (20.2% versus 0.2%). To date, no clear guidelines exist for the management of COVID-19 in renal patients. Bamlanivimab is a potent neutralizing monoclonal antibody that blocks severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attachment and entry into human cells, which could potentially lead to therapeutic benefit. To our knowledge, this is the first study to use bamlanivimab in COVID-19+ haemodialysis (HD) patients with the aim to determine the effect of bamlanivimab on the mortality of these patients.

METHOD

We conducted a retrospective case-control study across a single HD centre of non-hospitalized HD patients, with documented positive SARS-CoV-2 testing. We analysed the period from October 1 to November 14 2021, in which COVID-19+ patients were dialyzed in our institution. Cases were defined as HD patients who received bamlanivimab and controls were patients who did not receive bamlanivimab. Descriptive statistics, including chi-squared and Mann–Whitney U test, were performed. We used multinomial logistic regression to find the independent relationship between bamlanivimab use, disease severity, coronary artery disease (CAD), heart failure and 1-month mortality risk.

RESULTS

Patients who received bamlanivimab frequently had the chronic obstructive pulmonary disease (COPD) than those in the control group. There were no significant differences between groups in any of the other parameters assessed (Table 1). Besides higher baseline ferritin levels in the control group, no other significant differences in biochemical markers were found between examined groups (Table 2). Over a 1-month follow-up, one patient (7.7%) died in the bamlinivimab group, while 8 patients (44.4%) died in the control group. Multinomial logistic regression revealed that no bamlanivimab treatment was given. CAD and disease severity increased the risks of mortality 39.1 times (P = 0.12), 81.7 times (P = 0.08) and 99.9 times (P = 0.04), respectively.

CONCLUSION

In COVID-19+ HD patients, bamlanivimab has been a safe and effective treatment method, lowering mortality although not statistically significant. We also discovered that having a more severe clinical presentation at baseline, as well as having a CAD, was related to a greater risk of mortality. Our findings imply that larger, more conclusive clinical studies of bamlanivimab in HD patients with COVID 19 should be conducted.
MO661: Elimination of Middle and Large Uraemic Toxins in Short Daily Home Haemodialysis with Low Dialysate Volume: A Randomized Crossover Clinical Trial
Authors: González Moya Mercedes , Molina Pablo , Molina Mariola D , García-Valdelvira María , Vizcaíno Belén , Montesa Marín María , Ventura Josep , Pérez-Zafra Erika , Calatayud Emma , Valero Alejandro , Beltrán Sandra , Estañ Nuria , Asuncion Sancho Calabuig Maria
Published: May 2022

BACKGROUND AND AIMS

Portable haemodialysis (HD) systems with a low dialysate flow rate in a short frequent schedule have become an attractive option for patients on home HD (HHD). Although these systems have been demonstrated to be effective for removing low weight molecular uraemic toxins, there are few data on their removal ability of higher molecular weight toxins. This study assessed the uraemic toxin removal ability of the portable Physidia S3 Monitor in a short, frequent, 5 days/week, low-dialysate flux HHD versus 3 days/week, in centre online haemodiafiltration (OL-HDF).

METHOD

In an open, randomized, cross-over, single-centre, controlled, prospective study, 40 adult chronic HD patients were treated by a 2.5-h low flux dialysate HD session or a 4-h post-dilution OL-HDF. All other dialysis parameters including dialyzer (polysulfone high-flux dialyzer NS 1.8, Toray®) were kept constant in both the study arms. The weekly reduction rate (RR) and the weekly eliminated mass into dialysate (EM) of urea, creatinine, phosphate, β2-microglobulin, kappa (κFLC) and lambda (λFLC) free light chains and albumin, were intra-individually compared for the two dialysis types with linear mixed models.

RESULTS

There were no significant differences in the RR for urea, phosphate, κFLC and albumin, whereas the weekly RRs for creatinine and β2-microglobulin were significantly higher with the Physidia S3 system than those obtained with OL-HDF (Table). Only the λFLC RR was significantly higher with OL-HDF. Similar results were observed when weekly EMs were compared (data not shown).

CONCLUSION

This study demonstrates that treating patients with low flow dialysate HHD in a short frequent schedule with Physidia S3 system, instead of 3 days/week, in-centre OL-HDF, significantly increases the weekly elimination of β2-microglobulin, enabling an adequate clearance of small and large uraemic toxins.
MO663: No Translocation of Intact Intestinal Bacteria During Intermittent Dialysis Therapies
Authors: Rootjes Paul A , Budding Andries E , de Roij van Zuijdewijn Camiel , Bontkes Hetty J , Van Ittersum Frans J , Nubé Menso J , Wijngaarden Gertrude , Grooteman Muriel
Published: May 2022

BACKGROUND AND AIMS

Accumulating evidence shows that online post-dilution haemodiafiltration (HDF), especially when a high convection volume is achieved, is associated with a lower mortality risk than haemodialysis (HD) [1]. The mechanism behind this effect, however, is unclear. In this respect, a superior intradialytic organ perfusion and hence, less intestinal tissue damage, permitting the transfer of bacteria from the gut to the blood, might play an important role. Therefore, we assessed whether differences exist in the intradialytic translocation of intact bacteria between four dialysis modalities.

METHOD

A randomized cross-over trial was performed (NCT03249532, ClinicalTrials.gov) in 11 prevalent dialysis patients, who were exposed to four dialysis strategies: HD with standard dialysate temperature (Td) 36.5°C and cool (Td 35.5°C) dialysate, and HDF with a high (≥23 L/1.73 m2/session) and low (15 L/1.73 m2/session) convection volume. Microbial DNA (mDNA), soluble CD14, high-sensitivity CRP and IL-6 receptor were measured during each modality, as secondary endpoints of this study. Quantitative assessment of mDNA was performed by 16S-23S interspace profiling after DNA isolation [2, 3]. In the current analysis, the quantitative difference in circulating mDNA between modalities was investigated. In addition, differences in the acute phase reaction (APR), as measured by soluble CD14, high-sensitivity CRP and IL-6 receptor and potential relations between mDNA and the APR were analysed.

RESULTS

DNA of intact bacteria could not be demonstrated in blood samples of the patients in any dialysis strategy. Yet, in all modalities a similar increase in IL-6 receptor, high-sensitivity CRP and soluble CD14 was observed (pre- versus post-dialysis: P-values <.05) (Figures 1A-B).

CONCLUSION

i) The appearance of DNA from intact bacteria in the blood of dialysis patients could not be demonstrated, despite the use of a sensitive state-of-the-art technique, which is free from contamination by human DNA; ii) during all modalities a comparable and significant APR was observed; iii) hence, the intradialytic APR does not seem to result from translocated intact bacteria.
MO664: Assisted Peritoneal Dialysis (APD): Is it Only for the Old?
Authors: Haridian Sosa Barrios R. , Burguera Vion Víctor , Campillo Trapero Cristina , Viera Ramírez Elizabeth , Martin Irene , Mínguez Toral Irene , Fernandez Lucas Milagros , Rivera Maite
Published: May 2022

BACKGROUND AND AIMS

Patients with end-stage kidney disease (ESKD) are becoming older and more comorbid. We define assisted peritoneal dialysis (aPD) as any PD treatment that needs the help of another person regardless of the age of the patient and the duration of such help. Our aim was to analyse our aPD experience.

METHOD

RESULTS

CONCLUSION

aPD should be considered not only in the elder or fragile, but also in cases of variable disability regardless of patient age. It does not imply a higher complication rate or a technique failure, and careful caregiver support should be provided to avoid exhaustion and PD abandonment.
MO667: Creating a New Cardiorenal Unit: 3-Year Study Results
Authors: Pérez Martínez Juan , Javier Centellas Pérez Francisco , Fuentes Manso Raquel , Gómez Pérez Alberto , Gallego Sánchez Gonzalo , Ortega Cerrato Agustin
Published: May 2022

BACKGROUND AND AIMS

Cardiorenal syndrome is a clinical manifestation of the bidirectional interaction between the heart and kidney diseases, so creating specific units between cardiologists and nephrologists is necessary for better treatment of these patients.

In our hospital we have recently formed a workgroup for better organization of patients who need peritoneal dialysis (PD) and day-hospital assistant.

The aim of this study is to analyse the evolution of the patients in our PD program since the creation of a new cardiorenal unit in our center.

METHOD

This study includes patients beginning PD due to cardiorenal syndrome since the creation of our cardiorenal unit, between 15 June 2018 and 14 June 2021. We have registered the date of PD initiation and also the date of exclusion of the technique. Also we performed a pre–post observational study comparing the number of hospitalizations/emergency visits in the year before PD starts and its evolution for the next year. Statistical study was analysed with SPSS software, for a P-value <0.05.

RESULTS

Twelve patients (9 men and 3 women) have been included in this study. The mean age was 66.50 years (range 50–82). PD survival was 34.43 months (range 7–70). The number of hospitalizations/emergency visits was 8.04 in the year before PD started, and 0.44 the next year (P < 0.05). Nine of 12 patients had zero hospitalizations in the 12 months after initiating PD.

CONCLUSION

PD is an interesting treatment option for patients with cardiorenal diseases, which allows a significant reduction in hospitalization and decompensation rates. Creating new cardiorenal units is a good option for the integral management of these patients.
MO669: Predictive Parameters of Automated PD Cycler Software for Diagnosis of Catheter Dysfunction
Authors: Arianna Oviedo Flores Krystell , Kaltenegger Lukas , Eibensteiner Fabian , Unterwurzacher Markus , Kratochwill Klaus , Aufricht Christoph , König Franz , Vychytil Andreas
Published: May 2022

BACKGROUND AND AIMS

An adequately functioning catheter is of vital importance for successful long-term treatment and technique survival to peritoneal dialysis (PD) patients. According to the 2021 International Society of Peritoneal Dialysis guidelines on membrane function, catheter drainage problems should be suspected first in patients with low ultrafiltration (UF) capacity. Catheter dysfunction and the consequent decrease in UF are frequent complications in PD patients associated with significant negative clinical outcomes.

METHOD

We introduce the use of a combination of parameters obtained from daily measurements of the cycler software PD Link (Baxter) for predicting catheter dysfunction in automated peritoneal dialysis (APD) patients. Out of 117 APD patients treated at the Medical University of Vienna from 2015 to 2021, we identified all patients with verified catheter malposition and dysfunction (n = 14, cases) and compared them to controls without clinical evidence of mechanical problems and a recent X-ray confirming position of the PD catheter tip in the recto-vesical/recto-uterine space (n = 19). We retrieved cycler data for 7 days each and tested parameters predictive capability of catheter dysfunction.

RESULTS

Total number of alarms/week >7 as single predictive parameter of catheter dislocation identified 85.7% (sensitivity) of patients with dislocated catheter and 31.6% (1—specificity) of control patients. A combination of two out of three parameters (number of alarms/week >7,  drain time >22 min,  UF of last fill <150 mL) identified the same proportion of patients with catheter dislocation, but was more accurate in identifying controls (21% false positive).

CONCLUSION

We confirmed our clinical impression that number of alarms, total drain time at the end of cycler session and UF of last fill are good predictors for mechanical drainage problems. In contrast to yearly peritoneal equilibration test measurements, these data provide valuable information for clinical management of PD patients on a daily base and will be easily available in new APD cyclers with devices connected to remote monitoring platforms.
MO671: Should We Undergo Peritoneal Dialysis in Malnourished Chronic Kidney Disease Patients?
Authors: Donato Beatriz , Mateus Catarina , Adragao Teresa , Matias Patricia , Branco Patricia
Published: May 2022

BACKGROUND AND AIMS

The implementation of peritoneal dialysis (PD) in end-stage renal disease has been associated with various long-term pathophysiologic changes, which result in adverse consequences, such as malnutrition, occurring in 30–50% of patients. Specific factors to PD might be associated with poor oral intake as continuous absorption of glucose from PD solutions and abdominal fullness induced by the dialysate can suppress appetite.

There are several accepted strategies for stratifying malnutrition in PD, such as laboratory markers [serum albumin and normalized protein catabolic ratio (nPCR)] and the recent use of bioimpedance spectroscopy (BIS) (with low lean tissue index).

We aimed to evaluate if PD patients with a poor nutritional status at the beginning of the technique had worse outcomes (peritonitis, PD failure, hospitalizations, and death).

METHOD

We studied a cohort of incident patients from a single PD unit between 1 July 2011 and 31 August 2021, who had one BIS measurement and a peritoneal equilibration test in the first 3 months after the start of PD. We also collect laboratory data within 6 months from the BIS evaluation (serum albumin). Besides demographic parameters, we evaluated established endpoints (peritonitis, PD failure, hospitalizations and death).

RESULTS

There were included 91 PD patients. The mean age of patients was 65.40 $ \pm $ 13.88 years with a median dialysis vintage of 24 (IQR 14–31.61) months; 59.3% were male and 28% had diabetes. During the follow-up period, 5.5% of the cohort died, 56% were hospitalized and 47.3% had at least one episode of peritonitis. Furthermore, the transfer to hemodialysis occurred in 18 cases (19.8%) and 15 (16.5%) received a renal transplant.

There was no difference in nutritional markers median in patients that had clinical endpoints versus those who had not (Table 1). In a multivariable analysis, neither nPCR, nor albumin nor lean tissue index were predictors of peritonitis, PD failure or hospital admissions.

CONCLUSION

In this study, we found that malnourished patients, prevalent in PD, did not have worse clinical endpoints (higher rate of infections, hospital admissions and PD failure). Although adequate nutrition has been deemed vital to the success of PD, this modality of renal replacement therapy did not result in worse outcomes, despite the malnutrition markers at the beginning of PD. Further studies are warranted to evaluate the positive impact of PD in nutrition status.
MO677: Prevalence and Characteristics of Chronic Kidney Disease-Associated Pruritus in Home Hemodialysis Patients Compared to Dialysis Peritoneal and in-Center Hemodialysis
Authors: Montesa Marín María , Molina Pablo , Vizcaíno Belén , Gandía Paula , Parra Manuel , González Moya Mercedes , Valero Alejandro , Quilis Aina , Osma July , Sancho Asunción
Published: May 2022

BACKGROUND AND AIMS

Chronic kidney disease-associated pruritus (CKD-aP) is a very common symptom in dialysis patients and can significantly limit their quality of life and survival. While the prevalence of CKD-aP in peritoneal dialysis (PD) and in-center hemodialysis (HD) patients has been studied, little data are known for home HD (HHD) patients. The objective of this study was to analyse the prevalence of pruritus in HHD patients, and the factors associated with its presentation, as compared to PD and in-center HD patients.

METHOD

Cross-sectional, single-center study that included all patients on chronic dialysis treated at our center in November 2021. The patients were divided into three groups according to the dialysis modality (HHD, PD and in-center HD). All the patients answered a validated questionnaire on CKD-aP that evaluated the presence of itching, its intensity, frequency and location; the moment of appearance; the effect on quality of life, emotional state, cognitive function, sexual activity and quality of sleep. Likewise, it was assessed whether they had previously been diagnosed and treated for CKD-aP. The visual analogue scale (VAS) was used to define the intensity of itching as absent (VAS = 0), mild (VAS = 1–2), moderate (VAS = 3–6) or severe (VAS = 7–10). Clinical and analytical variables were compared between the groups, and the factors associated with the presence of pruritus were analysed using binary logistic regression.

RESULTS

Nighty-nine patients (41% women) were included, with a mean age of 64 ± 15 years and a median stay on dialysis of 57 (IQR: 17–159) months. The proportion of patients on HHD, PD and in-center HD was 20%, 41% and 39%, respectively. A total of 36% of the patients had some degree of pruritus, being mild, moderate, and severe in 8%, 13%, and 13% of the patients, respectively. The prevalence of pruritus and its intensity was similar in all the dialysis modalities (Figure 1). In the logistic regression analysis, the dialysis modality was not associated with presence of CKD-aP.

CONCLUSION

In our experience, the prevalence and intensity of pruritus was similar in HHD, PD and in-center HD patients. These data suggest that the type of dialysis techniques does not influence CKD-aP prevalence.