bluuebunny/crossref_metadata_2025 huggingface dataset:
#2338 Potassium-competitive acid blocker use is associated with a lower risk of renal function deterioration compared to proton pump inhibitor use
Authors: Jang Minyoung , Jeong Seoin , Kim Jeongyun , Gu Juyeon , Kim Minji , Jeon Junseok , Jang Hye Ryoun , Lee Jung Eun , Huh Wooseong , Lee Kyungho
Published: May 2024

Background and Aims

Proton pump inhibitors (PPI) are commonly used drugs worldwide and have been linked to worsening renal function and incident chronic kidney disease. Recently, potassium-competitive acid blockers (P-CAB) have emerged as alternative gastric acid-reducing agents with a comparable effect as PPIs. However, little is known about the renal safety of P-CAB. We aimed to compare the renal outcomes of patients treated with P-CAB and those treated with PPI.

Method

We retrospectively identified all patients who were prescribed P-CAB (tegoprazan) or PPI (esomeprazole) for 30 days or more in outpatient clinics of a tertiary care center between 2019 and 2023. Longitudinal serum creatinine data and various demographic and clinical variables were collected. Renal outcomes were defined as creatinine doubling or decline in estimated glomerular filtration rate (eGFR) of 30%. Patients with baseline eGFR < 15 mL/min/1.73 m2 and those who do not have sufficient creatinine measures to assess renal outcomes were excluded. Cox proportional hazard analyses were performed for renal outcomes with adjustment of multiple clinical covariates.

Results

Among 8 436 patients with a mean followup of 21 months, 2 214 and 6 222 patients were treated with P-CAB and PPI, respectively, for esophageal and gastric diseases. P-CAB group showed lower rates of creatinine doubling (Log-rank P = 0.001) and decline of eGFR (Log-rank P = 0.001) compared to PPI group. P-CAB use was associated with a 0.50-fold (95% confidence interval [CI] 0.33–0.75) lower risk for creatinine doubling and 0.58-fold (95% CI 0.42–0.81) lower risk for eGFR decline in unadjusted analysis. After adjusting multiple covariates including baseline eGFR, prescription days, major comorbidities, and concomitant use of other medications, hazard ratios for creatinine doubling and eGFR decline were 0.64 (95% CI 0.42–0.98) and 0.73 (95% CI 0.53–1.02), respectively.

Conclusion

Use of P-CAB is associated with a lower risk for renal function deterioration compared to PPI. Given the renal safety concerns of PPIs, using P-CAB could be a relatively safer strategy for preserving kidney function in patients who need long-term gastric acid suppression. Further studies with a larger cohort incorporating other P-CABs are required to validate this finding.
#2744 Analysis of bacteremia and mortality in patients with tunneled catheter for hemodialysis: a 14-years observational study
Authors: Almenara-Tejederas Marina , Moreno Fernando Bertomeu , Rodriguez-Baño Jesus , De Cueto-López Marina , Lazo Mercedes Salguiera
Published: May 2024

Background and Aims

Infections are a leading cause of morbidity and mortality in hemodialysis patients. Tunneled catheters (TC) have been associated with increased risk of infection and death, but mortality rates are not widely reported. Our study aimed to analyse catheter infection-free survival and mortality of patients with this vascular access.

Method

This is a retrospective study of all TC inserted during the period of 1 January 2005 to 31 December 2019. The TC were inserted by nephrologists, following a preimplantation protocol agreed with the Infectious Diseases Service. Patients were followed up from the tunneled catheter insertion until the study end date (December 31, 2020), TC related bacteremia or died.

Results

In the 14-year period under study, 406 TC were implanted in 325 patients. A total of 85 tunneled catheter related bacteremia were diagnosed, resulting in an incidence of 0.40 per 1000 catheter days (81.1% after 6 months of implantation). The predominant microorganisms isolated were Gram-positive organisms: Staphylococcus epidermidis (48.4%); Staphylococcus aureus (28.0%). During the study, a total of 145 patients had the TC removed or exchanged due different causes. The main reasons for catheter removal were the adequate development and use of the arteriovenous fistula (48, 33.1%) and discharge from hemodialysis due to recovery of renal function, transfer to peritoneal dialysis or renal transplantation (47, 32.4%). Only in 26 (17.9%) patients, the TC was removed due to bacteremia at a median of 4.8 (1.0-8.0) days from the bacteremia. The median time to catheter removal for non-infection-related reasons was 448 (185-910) days, without significant differences with the TC related bacteremia group [430 (116-695)] (p=0.83). The 30-day mortality rate from the first TC related bacteremia was 8.7%. During the study period, a total of 168 (51.7%) patients died for different causes.

Conclusion

The incidence of bacteremia in our study was low and did not seem to have a relevant impact on catheter survival. The global mortality rate was similar to that reported in European registries for patients on renal replacement therapy. An implantation and management protocol, strict in prophylactic measures, could reduce the incidence of bacteremia and reduce its morbidity and mortality.
#2826 The Charlson Comorbidity Index in Registry-Based Research for Survival of Vascular Access
Authors: Franco Antonio José Marín , Sánchez Christian Israel Alfaro , Useche Gustavo , Sorribes Mª Paz , Martínez-Vaquera Shaira
Published: May 2024

Background and Aims

Several studies have reported higher haemodialysis survival in women; however, the influence of gender on arteriovenous fistula survival has not been extensively studied. For this reason, our aim is to estimate the prevalence of arteriovenous fistulae according to gender, adjusted by the Charlson comorbidity index.

Method

Retrospective study in patients on haemodialysis programme, by consulting electronic records over a period of 35 months. Demographic variables, primary and secondary patency events were included. The population was categorised on the basis of the Charlson Index and gender. Statistical analysis was performed using Kaplan Meyer survival curves to contrast the impact of comorbidities on the different patency events.

Results

52 patients were evaluated, with a mean age of 70.7 ± 1.57 years, 69.2% men, 30.8% women, 42.3% diabetic, Charlson with a median of 7 (6.5 - 7.73), 98.1% had a native fistula, being more frequent the location in the humeral head (63.5%) and predominantly in the left upper limb (65.4% ). 21.2% of patients required some intervention on their AVF. The time required to achieve an event in both primary patency and secondary patency was longer in patients with a Charlson Index less than or equal to 7, and this was statistically significant (Log Rank Test (Mantel-Cox): primary patency p=0.003 and secondary patency p=0.002). In the group of women with a Charlson comorbidity index less than or equal to 7, mean survival for primary and secondary patency was even higher than in all patients, with statistical significance (Log Rank Test (Mantel-Cox ): primary patency p=0.005 and secondary patency p=0.008), a situation not repeated in men where no significant differences in survival were found when analysed according to the Charlson index.

Conclusion

The Charlson index in our population is a significant factor in the survival of AVFs in women.
#460 Digital twin in hemodialysis model, with machine learning algorithms. Data from the Andalusian Hemodialysis Registry. SICATA
Authors: Marcos Sergio Garcia , Sánchez Manuel Benítez , Bayo Magdalena Palomares , Dominguez Clara María Moriana , de Mota Elvira Maria Esquivias , Ojeda Raquel , Morales Ana , Novillo Carolina Lancho , Sacaluga Luis Gil
Published: May 2024

Background and Aims

Orthodoxly, a digital twin is a computer simulation of an individual, “in silico”, and in real time. A digital twin can also be created with BIG DATA. The Objective It is the development of a survival digital twin model using Machine Learning algorithms using data from the Andalusian SICATA registry.

Method

The database was composed of 29,189 records at the time of analysis and contains variables in the areas of comorbidity, anemia, efficacy of renal replacement therapy (RRT), and renal bone disease.

The algorithms used were: - XG Boost, AdaBoost, Cat boost. KNN, Random Forest, Decision Trees, Logistic Regression. A survival model was developed with each Machine Learning (ML) algorithm . The metrics of the models were taken into account: precision, calibration, accuracy. The software used was Orange based on Python and Rattle based on R. An explanation of the “black box” type models was carried out using SHAP (Shapley values) based on game theory.

Results

The characteristics that the digital twin that we have modeled with the greatest survival would have are: 1. Age equal to or less than 45 years, 2. Being included in the kidney transplant waiting list. 3. Longer duration of the hemodialysis session. 4. Low doses of Erythropoietin. 5. Normal or high serum albumin levels. 6. BMI > 21.The sample was stratified according to the Ultrafiltration (UF) ratio during the Hemodialysis session in ml/kg/hour. Group1: UF <4 ml/kg/hour. Group2: UF 5-9 ml/kg/hour. Group3: UF>9 ml/kg/hour. And a mortality study was carried out using multivariate Logistic Regression. We found that the OR for mortality in groups 2 and 3 was 17% and 24% in relation to group 1, which had the lowest mortality.

Conclusion

ML has revealed that the UF ratio (ml/kg/hour) is an important predictor variable of mortality. In our studio a UF ratio<4 ml/kg/hour is safe ML has found an answer to a question that we had not asked ourselves when beginning the study: What is the optimal UF rate in the hemodialysis session?
#616 Effectiveness of regdanvimab on clinical outcomes in COVID-19 infected patients on hemodialysis
Authors: Lee Young-Ki , Kee Youn Kyung , Park Hayne Cho , Cho Ajin , Kim Do Hyoung , Yoon Jong-Woo
Published: May 2024

Background and Aims

Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (COVID-19), there are lack of effective and proven treatments for the COVID-19 patients with end-stage kidney disease (ESKD). The present study aims to evaluate the effectiveness of regdanvimab on clinical outcomes in COVID-19-infected patients on hemodialysis (HD).

Method

We conducted a retrospective study of 230 HD patients hospitalized with COVID-19 infection between December 1, 2020 and November 30, 2021. Of these, 77 (33.5%) were treated with regdanvimab alone or in combination with dexamethasone or remdesivir during hospitalization (regdanvimab group), and 153 (66.5%) did not treat with regdanvimab (non-regdanvimab group). We compared in-hospital mortality rate according to the use of regdanvimab and investigated the factors associated with mortality.

Results

The mean age of the patients was 67.9 ± 12.1 years, with 214 (93%) patients aged 50 years or older. There were no significant differences in demographics and comorbidity between the regdanvimab and non-regdanvimab groups. Fifty-nine deaths occurred during hospitalization, 49 (32%) in the non-regdanvimab group and 10 (13%) in the regdanvimab group, and mortality rate was significantly higher in the non-regdanvimab group than that in the regdanvimab group (P=0.001, Fig.). Multivariate Cox regression analysis showed that malignancy (P=0.001), low oxygen saturation<95% at admission (P=0.003), and administration of antibiotics and regdanvimab (P=0.007 and P=0.002, respectively) were significantly associated factors with mortality.

Conclusion

Regdanvimab administration is beneficial in improving prognosis in hospitalized COVID-19 patients on HD. Considering the vulnerability of ESKD patients to infection, regdanvimab may be considered as a therapeutic option in COVID-19 patients on HD.
#3034 Therapeutic compliance: another challenge for patients on chronic hemodialysis
Authors: Ayed Amel , Jaballah Lazhar , Brahim Mayssa Hadj , Elhadhri Asma , Elati Zohra
Published: May 2024

Background and Aims

Therapeutic compliance corresponds to the degree of concordance between the patient's behavior and the recommendations of his doctor. Non-adherence to treatment predispose to high risk of mortality and increases health costs.

The objective of our study was to assess the level of compliance in chronic hemodialysis patients and to identify the predictive factors of poor compliance.

Method

A cross-sectional study was conducted in the hemodialysis center at Taher Sfar Hospital in Mahdia. Medication adherence was assessed using a “compliance assessment test” quiz comprising six questions to which the patient must answer yes or no.

Results

Sixty-one patients were enrolled. The mean age was 50 ± 13 years (26 - 79 years) with a sex ratio M/F of 1.27. The patients have diabetes mellitus and hypertension in 35% and 68% of cases. They were dialyzed for a long duration (37 ± 15 months) that reaches a maximum of 280 months. The main initial nephropathies were diabetic nephropathy (35.5%) and chronic interstitial nephropathy (23.5%). Adherence was poor in 16.9 % of patients, average in 55.9% of patients while 27.1% were good adherents. Polymedication and missing of treatment were the leading causes of non-adherence. In univariate analyses, the socio-economic level affected significantly the compliance in elderly group as well as high comorbidity score (Charlson) (p<0.04) and diabetes status (p=0.04). No significant difference was found between elderly and young group in term of compliance to treatment.

Conclusion

Compliance is a dynamic behavior that is difficult to predict and requires constant monitoring. In our hemodialysis center it turned out to be good; we must insist on the therapeutic education of patients and minimize the list to the necessary.
#670 Clinical characteristics of sarcopenic obesity in hemodialysis patients
Authors: Ito Minoru
Published: May 2024

Background and Aims

Sarcopenia is associated with all-cause mortality in older dialysis patients. Although obesity is a risk factor for a variety of diseases in the general population, obese hemodialysis patients have a survival advantage over lean patients. Some hemodialysis patients are obese but have reduced muscle mass, a condition known as sarcopenic obesity. The characteristics and diagnostic criteria for sarcopenic obesity in dialysis patients remain unclear. This study aims to determine the prevalence and clinical characteristics of patients at risk for sarcopenia or sarcopenic obesity.

Method

The dialysis centers involved in this study were four dialysis centers belonging to Seiei-kai Medical Corporation. Hemodialysis patients attending these facilities were included. Obesity was defined as a BMI of 25 kg/m2 or higher, and sarcopenia risk was described as a SARC-F questionnaire score of 4 or higher and a sit-to-stand test (SS-5) of 12 seconds or longer. Patients were classified as sarcopenic obese if they met both criteria. Patients classified as obese (OB) or sarcopenic obesity (SO) were compared for the following factors: age, history of dialysis, sex ratio, presence of diabetes, blood biochemical tests, Kt/V, nPCR, %CGR, number of falls in the past year, and symptoms using the Patients Reported Outcomes Measure (PROM).

Results

We analyzed the cross-sectional data of 622 patients attending our four dialysis centers. The prevalence of SO among all patients was 6% (34 patients), and OB was 26% (164 patients); Hb (10.9 ± 1.5 vs. 11.4 ± 1.2 g/dl; p=0.03), albumin (3.40 ± 0.3 vs. 3.63 ± 0.3 mg/dl; p<0.01) and nPCR (0.82 ± 0.16 vs. 0.91 ± 0.13 g/kg/day; p=0.01) were significantly lower in the SO group than in the OB group. Age (72.4 ± 9.2 vs. 32.9 ± 12.7 years; p<0.01) was higher in the SO group, and patients with a history of falls were significantly more likely to be in the SO group (59% vs. 29%; p<0.01). Symptom severity as measured by the PROM was also higher in the SO group.

Conclusion

This study showed that patients in the SO group were more likely to fall and had inadequate protein intake. In addition, patients in the SO group are older and have more severe PROM symptoms. Interventions to increase muscle strength and improve physical function should be considered for patients with SO. Nutritional support, treatment of individual symptoms, and exercise therapy will be necessary, and these interventions may be complex and challenging. We will design an observational study on the prognostic impact of sarcopenic obesity. A limitation of this study is that we used the SARC-F questionnaire and SS-5 rather than the AWGS criteria to assess sarcopenia, which may not have captured true sarcopenia.
#743 Clinical outcomes of patients hospitalized with the diagnosis of COVID-19 infection and undergoing hemodialysis: a single center experience
Authors: Savsar Mehmet Gürdal , Oguz Ebru Gok , Kayhan Sanem , Okyay Gulay Ulusal , Sahin Hatice , Ayli Mehmet Deniz , Atilgan Kadir Gokhan , Ebinc Fatma Ayerden
Published: May 2024

Background and Aims

The main purpose of this study is to determine the effect of dialysis on the prognosis (admission to intensive care unit, intubation requirement, length of hospitalization, mortality) of patients with COVID-19 receiving hemodialysis treatment in our clinics. Another aim of this study is to examine the effect of the need for hemodialysis on COVID-19 prognosis in order to contribute to the data of our country.

Method

Cross-sectional study of 104 patients with hemodialysis and were diagnosed COVID-19 were conducted. In this study, patients were divided into three groups: (i) those with chronic renal failure (CRF) and receiving routine hemodialysis; (ii) those with chronic kidney disease (CKD) but needing urgent hemodialysis; and (iii) those who did not have a known kidney disease but needed urgent hemodialysis because of acute kidney injury (AKI) . The study was performed in accordance with the Declaration of Helsinki. The local ethical committee approved the study design (date: 21.03.2022; reference number: 133/13).

Results

When we evaluated the demographic, clinical and laboratory factors in our study, it was found that the factors affecting mortality were lymphopenia, emergency HD treatment under the presence of CKD, an increase in AST more than 2 times, the need for mechanical ventilation and high d-dimer (Table 1).

Conclusion

This case demonstrates that AKI associated with cytokine storm and developing multi-organ dysfunction situation is directly linked to mortality, particularly in patients with severe clinical condition. When the biochemical data of the patients were analysed, it was discovered that AST increase, lymphopenia, and d-dimer rise were directly found associated with increase mortality. In light of these observations, the above-mentioned biochemical laboratory values of the patients can be closely monitored, as can the clinical course of COVID-19 and renal-related mortality.
#1807 Use of teriparatide to prevent severe hypocalcemia after parathyroidectomy in dialysis-dependent patients: a feasibility study
Authors: Parshina Ekaterina , Novokshonov Konstantin , Chernikov Roman , Tolkach Alexey
Published: May 2024

Background and Aims

Hungry bone syndrome is a common postoperative complication after parathyroidectomy (PTx) for severe secondary hyperparathyroidism (SHPT). We aimed to conduct a feasibility study to assess the potential impact of teriparatide on the course of postoperative hypocalcemia after PTx in dialysis-dependent patients.

Method

We performed a randomized controlled pilot study in 20 dialysis-dependent patients with severe SHPT undergoing total parathyroidectomy with autotransplantation of parathyroid tissue. Patients were randomized to receive either 20 mcg teriparatide (Forsteo) subcutaneously on day 1 after surgery in addition to standard postoperative care (n=11) or standard postoperative care alone (n=9). Severe postoperative hypocalcemia was defined as an ionized serum calcium level of less than 0.8 mmol/l during the first 3 days after surgery.

Results

Patients in the two groups did not differ in terms of pre- and postoperative laboratory data, including PTH, corrected total calcium, ionized calcium and alkaline phosphatase levels – Table 1.

Severe hypocalcemia was observed in 6 patients in the teriparatide group (55%) and in 4 patients (44%) in the control group (p=0.99). The proportion of patients with symptoms of hypocalcemia was higher in patients not receiving teriparatide (67% vs 27%, p=0.17), although these differences did not reach statistical significance.

All post-PTx patients received standard supplementation according to local protocol, including calcium carbonate 20 gr/day, active vitamin D 2 mcg/day per os, and intravenous calcium gluconate supplementation on demand for symptoms of hypocalcemia (e.g. numbness, tingling, or cramps).

Total elemental calcium requirement after surgery (which may serve as a surrogate for the severity of hungry bone syndrome) was higher in patients receiving standard treatment alone (41 [Q1-Q3: 33; 49] grams per hospitalization vs 33 [Q1-Q3: 25; 40] grams in the teriparatide group, p=0.0375) – Fig. 1.

The total length of hospital stay was 4 ± 1 days in teriparatide group and 5 ± 2 in control group, p=0.36.

Conclusion

In dialysis-dependent patients after PTx, we observed a trend towards an alleviation of postoperative hypocalcemia after single injection of teriparatide in addition to routine care. Further studies with larger sample sizes are needed to confirm these preliminary results.
#1112 A simplified lung ultrasound guided management protocol of pulmonary congestion in hemodialysis
Authors: Saleh Kaysi , Hamad Abdulla , Boulgheraif Abdullah , Bonkain Florence , Libertalis Mark , Baz Mahmoud , Farah Ibrahim , Ibrahim Rania , Ateya Heba , Mathew Mincy , Almalki Hassan , Nortier Joelle
Published: May 2024

Background and Aims

Pulmonary congestion PC is frequent in Hemodialysis HD and holds a negative prognostic value. Lung ultrasound LUS is accurate in detecting and quantification PC, however, there are many methods to use LUS to evaluate PC. Here we validate a simplified LUS guided pulmonary congestion management protocol in HD patients that can be easily integrated in clinical practice, while studying at the same time the impact of such method on blood pressure control.

Methods

A prospective randomized multi-centric trial including stable HD patients in 3 countries.

Patients were randomized into two groups: active and control group.

All patients had a bedside LUS at the end of their mid-week session every two weeks according to the following time-line: Day 1, 15, 30, 45, 60.

Lung ultrasound was performed according to the 8-zone method, and a B line score BLS was obtained. A global BLS of more than 6 was considered reflecting a significant PC level.

The dry weight was adapted according to the standard of care in the control group. In the active group, in addition to the standard of care, if BLS was more than 6 at day 1 then the dry weight was reduced by 500 g. The same procedure was repeated at Day 15. (The maximum global dry weight modification per patient was 1 kg) (Fig. 1).

Home blood pressure monitoring HBPM was also obtained weekly all through the study period.

Results

28 stable HD patients (21 males) were enrolled in the study up until now. Mean age was 66.4 years, 14 were diabetics, 4 with stable ischemic heart disease, 1 heart failure and 27 were suffering from hypertension. Mean dialysis vintage was 35.8 months, and mean residual urine volume was 548 ml/24H. Mean session time was 4 hours. Main study population characteristics are described in Table 1.

In the active group, mean BLS at day 1 (13.5) was significantly reduced, and reached (7.57) at day 60. (P < 0.001, ES:1.55) (Fig. 2). This was in parallel with a little but significant reduction in the dry weight (P: 0.03, ES: 0.6) but without a statistically greater UF values (P: 0.23) (Table 2).

A significant reduction in home blood pressure was also observed by the HBPM readings, especially in the diastolic BP (P: 0.004).

In the control group, the mean BLS at day 1 was (12.1). This level did not change all through the study time line, as it was (12.1) at day 60. No significant difference was observed in the dry weight, or ultrafiltration rate UF or home blood pressure values (Table 3).

Conclusion

Our simplified LUS guided management protocol was able to safely reduce the pulmonary congestion in HD patients in addition to better controlling their blood pressure. This protocol can be applied easily in every HD unit, and may be added to the standard of care to better estimate the dry weight in HD patients.
#492 Ten-year experience treating osteoporosis with bisphosphonate in hemodialysis patients
Authors: Sakai Kentaro , Saidou Akiharu , Hayashi Saho , Satou Yoshiki , Yada Tomotaka , Matsui Rei , Higashi Harumichi
Published: May 2024

Background and Aims

The treatment of osteoporosis in patients undergoing hemodialysis (HD) has not been established, as there is insufficient evidence regarding the treatment of osteoporosis. The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 guidelines suggest that determining the bone marrow density (BMD) of HD patients is useful. In 2011, we began treating HD patients' osteoporosis with alendronate. Herein, we describe the effects of the treatment based on our 10-year experience.

Method

This was a single-center prospective observational study of 85 HD patients (age 67.8 ± 11.0 yrs; 47 females, 38 males) treated for osteoporosis with alendronate at our hospital during the 10 years 2011–2021. The average observational period was 3.9 ± 2.9 years. The patients' BMD values including those at the lumbar spine, femoral neck, and total hip were determined by dual-energy X-ray absorptiometry. The patients whose first T-score was ≤ −2.5 were treated with alendronate. We evaluated the patients' yearly BMD measurements and their yearly values of bone metabolism markers, i.e., parathyroid hormone (PTH), bone alkaline phosphatase (BAP), and tartrate-resistant acid phosphatase 5b (TRACP-5b).

Results

We compared the data before and after the start of alendronate treatment by dividing the patients into a responder group (the patients whose T-score had improved at 1 year after treatment started; n=44) and a non-responder group (the patients whose T-score had not improved; n=32). The mean observational period of the responder group was significantly longer than that of the non-responder group (p<0.01). In a multiple regression analysis, a longer observational period was significantly associated with the improvement of T-scores (p=0.02). Only the mean T-score of the lumbar spine gradually improved during the study period; those of the femoral neck and total hip did not.

Conclusion

A long-term use of alendronate for the treatment of osteoporosis may be effective in hemodialysis patients, especially for the lumbar spine. Decisions regarding the effect of alendronate treatment for osteoporosis patients undergoing HD should not be made within only a year after the treatment initiation; rather, a longer observation period is necessary.
#665 Comparison of outcomes between kidney transplant-naïve and post-transplant graft failure peritoneal dialysis patients
Authors: Chen Yi-Ting
Published: May 2024

Background and Aims

Despite progress in kidney transplant medicine, there are still patients experiencing graft failure and returning to dialysis therapy. Data regarding the prognosis of these patients remain conflicting. This study was conducted to compare clinical outcomes between transplant-naïve peritoneal dialysis (PD) patients and those returning to PD after a failed allograft.

Method

In this retrospective cohort study during 2006 and 2016, we included a total of 786 patients on chronic PD. Of them 679 were transplant-naïve, 76 patients underwent a successful transplantation, and 32 patients returned to PD after a failed kidney allograft. Baseline demographics and clinical characteristics were analyzed in relation to the outcomes of all-cause mortality and peritonitis rate. We employed the Kaplan-Meier method and Cox proportional hazards model to evaluate survival, while Poisson regression was utilized to estimate rate ratios for peritonitis.

Results

During a median follow-up of 6.37 years, 56.68 % death and 146.62 episodes of peritonitis/patient-year were observed. Compared with patients who received a kidney graft, transplant-naïve patients were older, more with diabetes and having higher mortality (58.6 ± 15.8, 40.5% and 57.73%, p < 0.0001). After accounting for age, gender, and comorbidities, the adjusted hazards ratios were 0.26 (95% CI 0.13-0.53) in patients with a functioning graft and 1.12 (95% CI 0.61-2.06) in patients returning to PD after graft failure, compared respectively with concurrent PD patients without kidney transplant. The adjusted relative risk of peritonitis in patients resuming PD after graft failure was comparable to those without kidney transplant (95% CI 0.22-1.14).

Conclusion

Successful kidney transplant reduced the risk of overall mortality among patients on long-term PD. Patients returning to PD after graft loss showed outcomes similar to transplant-naïve counterparts. These data support reactivation of PD as a viable option for patients with a failed kidney transplant.
#365 Dialysis centers performance: socioeconomic and environmental determinants
Authors: Gorji Hassan , Ye Xiaoling (Janice)
Published: May 2024

Background and Aims

Healthcare outcomes in hemodialysis centers are intricately shaped by a myriad of factors extending beyond clinical realms. This study explores the interplay of socioeconomic and environmental determinants on the performance of 7638 hemodialysis centers in the United States during 2022. Leveraging data from the Centers for Medicare & Medicaid Services, the United States Census Bureau, and the National Center for Environmental Information, our analysis encompasses outcomes like mortality, hospitalization, readmission rates, and emergency department visit rates.

Method

A dataset comprising information from 7638 US hemodialysis centers, spanning January to December 2022, was obtained through the Centers for Medicare & Medicaid Services, US Census Bureau and environmental data, and from the National Center for Environmental Information. The study assessed mortality, hospitalization, readmission, and emergency department visits within one-month post-hospitalization. Independent variables included dialysis center characteristics, state-specific socioeconomic and environmental data, analysed through descriptive statistics and a linear regression model.

Results

Results reveal a significant correlation between racial composition and outcomes, with states having higher Latino populations exhibiting lower ED visit rates, contrasting with elevated mortality rates in states with higher African American populations. Socioeconomic factors, such as education and insurance status, influence ED visit rates. Environmental determinants, specifically average yearly state temperature, impact mortality and hospitalization rates. Operational characteristics matter: for-profit centres and those providing higher number of hemodialysis bed correlate with decreased mortality rates, while centres offering peritoneal dialysis or late-shift services demonstrate lower emergency department visit rates.

Conclusion

Our study unveils a nuanced interplay of factors influencing outcomes in hemodialysis centers. Disparities rooted in race and socioeconomic status underscore the need for targeted interventions. Environmental considerations further contribute to the complexity, while operational characteristics reveal intriguing trends, challenging conventional expectations. This analysis provides a foundation for tailored strategies to enhance the performance and equity of hemodialysis centers.
#2231 The efficacy of anti-viral therapies for hepatitis B in kidney transplant recipients
Authors: Coban Harun , Demirsoy Asli Karsli , Atas Dilek Barutcu , Tugcu Murat , Asicioglu Ebru , Arikan Izzet Hakki , Tuglular Z Serhan , Velioglu Arzu
Published: May 2024

Background and Aims

The efficacy and long-term outcomes of anti-viral therapies used for hepatitis B treatment or prevention continue to be a challenging area in kidney transplantation practice. This study aimed to determine the effectiveness of anti-viral treatment in a hepatitis B kidney transplant cohort and its effect on long-term graft and overall survival.

Method

We reviewed the data of 589 patients who were followed up on at our clinic between January 1, 2002, and December 31, 2023. Recipients who were AntiHbc IgG positive and received Rituximab and HbsAg negative recipients whose donor was HbsAg positive were included in the prophylaxis group, and recipients who were HbsAg positive were included in the treatment group. Age- and gender-matched recipients who did not use anti-viral treatment constituted the control group. HBV-DNA positivity in the prophylaxis group and an increase in HBV-DNA titers in the treatment group were indicators of treatment ineffectiveness. Anti-viral treatment-related side effects were noted. Graft functions, graft, and overall survival rates were examined at the beginning of treatment and at the last visit.

Results

A total of 30 patients receiving anti-viral therapy (prophylaxis n = 15, treatment n = 15) were included and compared with 32 control patients. The median age of the prophylaxis group was 49 (13–60) years, the median age of the treatment group was 46 (15–63) years, and the median age of the control group was 44 (22–71) years (p = 0.846). No difference was detected between the groups in terms of gender distribution. Entecavir was used in 17 patients, tenofovir in 7, and lamivudine in 6 patients. Hepatitis B activation was not observed in any patient in the prophylaxis group. An increase in HBV-DNA level was observed in 2 of 5 patients (40%) in the treatment group, followed by lamivudine. No treatment unresponsiveness was observed with other agents. No anti-viral drug-related side effects were reported in any patient. While there was no graft loss in the anti-viral treatment groups during follow-up, overall survival was determined as 100% in the prophylaxis group, 80% in the treatment group, and 90.6% in the control group (log rank p = 0.404). No hepatitis B-related mortality was reported. The findings are summarized in Tables 1 and 2.

Conclusion

Kidney transplant recipients using anti-viral medications for Hepatitis B, either for treatment or prophylaxis, showed similar graft and patient survival compared to the control group. Entecavir is the most commonly used anti-viral agent. Our findings support that it is advisable to consider alternative anti-viral medications instead of lamivudine, as there is a potential risk of non-response.
#2696 The effect of laxatives on reducing serum phosphate levels of probiotics in hemodialysis patients: a subanalysis of RCT
Authors: Ogawa Tetsuya , Hirasawa Eriko , Nishizawa Youko , Nagano Nobuo
Published: May 2024

Background and Aims

Dysbiosis of the intestinal microbiota in chronic kidney disease increases uremic toxin, which damage the epithelial tight junctions and increase the permeability of the intestinal wall via endotoxemia and systemic inflammation. Some articles reported that probiotics reduced the uremic toxin and decreased inflammation biomarkers in CKD patients. Meanwhile, we have already reported that oral administration of Bifidobacterium longum in a gastro-resistant seamless capsule decreases serum phosphate levels in patients receiving hemodialysis (Clin Kidney J, 5:373-374, 2012). In addition, in this congress, we reported that three-combination probiotics decreased serum phosphate levels. Meanwhile, some articles reported the relationship hypophosphatemia and laxative abuse. The aim of this subanalysis study is to evaluate the efficacy of laxatives on reducing serum phosphate levels of three-combination probiotic in patients receiving hemodialysis.

Method

A 6-month prospective, randomized, double-blind, placebo-controlled study was conducted at three hemodialysis centers. As probiotic therapy, of three-combination probiotics (Bio-Three) tablets, each containing 2 mg of lactomin (Streptococcus faecalis T-110), 10 mg of Clostridium butyricum TO-A, and 10 mg of Bacillus mesentericus TO-A, were used. The patients receiving hemodialysis were randomly assigned to the Bio-Three group (n = 37) and the placebo group (n = 36). In both the Bio-Three group and the placebo group, patients orally received 6 tablets 3 times daily. We evaluated the effect of probiotic on serum phosphate level and gut microbiome before and 6 months after the start of treatment. The gut microbiome composition was analyzed by a 16s rRNA gene-based sequencing protocol. In addition, in patients with laxative (n = 24), we evaluate the effect of probiotic on serum phosphate levels and gut microbiome.

Results

The serum phosphate levels in the Bio-Three group significantly decreased after 6-month treatment, while did not change in the placebo group. Furthermore, the serum phosphate level in patients with Bio-Three and laxative additionally decreased. In a 16s rRNA gene-based sequencing protocol analysis, serum phosphate levels were positively correlated with the occupancy ratio of Erysipelotrichaceae, Lachnospiraceae, Oscillospiraceae, Ruminococcaceae, and Sutterellaceae and were negatively correlated with the occupancy ratio of Leuconostocaceae and Lachnospiraceae in patients with Bio-Three and laxatives.

Conclusion

In this subanalysis study, the effect of reducing serum phosphate levels on three-combination probiotic might be augmented by laxatives and the specific bacteria in the gut microbiome might contribute to the decrease of serum phosphate levels.
#1391 Evaluating effect on frailty of a home-based training program developed for kidney transplant recipients (HOMETRAIN-KTR)
Authors: Aronsen Tommy , Heldal Kristian , Lønning Kjersti , Hellwege Emilie , Andersen Marit Helen
Published: May 2024

Background and Aims

Frailty and impaired physical function are prevalent among patients undergoing kidney transplantation (KTx), and is an independent risk factor for poor outcome after transplantation. Limited number of studies have prospectively investigated the efficacy of exercise training for KTx-recipients with low pre-transplant physical function. Our aim is to evaluate the effect of a structured 12 week home-based physical training program delivered to recipients with low pre transplant physical function, on physical function and frailty at 1-year post transplant.

Method

HOMETRAIN-KTR is a 2-arm unblinded Norwegian clinical trial with RCT design (Fig. 1). Patients will be recruited at admission for KTx at Oslo University Hospital, Rikshospitalet. Patients who score below 60 at 36-Item Short Form Survey (SF-36) will be included and tested with 6-minute walking test (6MWT), Clinical Frailty Scale (CFS), hand-grip strength, 30 seconds Sit-to-Stand test, and questionnaire about physical activity and psychological distress. Included patients are randomized to either training group or control group (standard of care). The training group will, under supervision by a physiotherapist, start a 12-week structured home-based training program from week 4 post-KTx. The training program consist of a combination of strength training, cardio training and optional activities. During the intervention period, the intervention group will are receive regular follow-up by phone. The training sessions will be documented via patients logs and heart rate monitor (Fitbit). At one year post-KTx, all patients will undergo the same tests as at inclusion.

Results

Inclusion of patients will start in January 2024, and continue for the next 2-3 years. We aim to include 200 patients, 100 in each arm. The study will evaluate physical function, frailty, graft function, patient survival, HRQoL and physiological distress during the time-span of the study.

Conclusion

The HOMETRAIN-KTR study is supposed to bring new knowledge about the effect of a physical training program on frail KTx-recipients. Such information is highly relevant to improve KTx outcomes and to optimize the utilization of the limited source of donor organs.
#2536 Bisphosphonates as a tacrolimus-sparing strategy in kidney transplantation: insights from a retrospective analysis
Authors: Koh Hee Byung , Kim Beom Seok
Published: May 2024

Background and Aims

The chronic toxicity of tacrolimus makes its sparing a crucial consideration for kidney transplant recipients (KTRs). Previous research has indicated a positive association between bisphosphonate use and favorable graft outcomes in KTRs. Therefore, our study aimed to investigate whether bisphosphonate use impacts the relationship between tacrolimus trough levels (TTLs) and graft outcomes in KTRs.

Method

We conducted a retrospective study encompassing 1,657 KTRs who were administered tacrolimus-based immunosuppressive therapy. The primary exposure was characterized by a time-dependent cross-product of TTLs (low TTLs vs. normal-high TTLs with a reference of 6 ng/mL) and the use of bisphosphonate. The study had two primary outcomes: (1) overall graft loss, defined as either the occurrence of patient death or conversion to kidney replacement therapy, and (2) reaching an estimated glomerular filtration rate (eGFR) of less than 30 ml/min/1.73 m².

Results

Over a cumulative total of 11,211.8 person-years, overall graft loss were observed in 183 patients, equating to 11.0% of the cohort. In multivariable Cox regression analysis, it was noted that normal to high TTLs, in the absence of bisphosphonate use, were associated with a reduced risk of overall graft loss (HR, 0.61; 95% CI, 0.43-0.87) compared to low TTLs without bisphosphonate use. The use of bisphosphonate in conjunction with normal to high TTLs correlated with an even further diminished risk of overall graft loss (HR, 0.36; 95% CI, 0.16-0.83) in comparison to low TTLs without bisphosphonate use. In low TTLs, the administration of bisphosphonates was associated with a reduced risk of overall graft loss than bisphosphonate non-use (HR, 0.26; 95% CI, 0.14-0.49). Similarly, this trend was observed in cases where the eGFR was below 30 ml/min/1.73 m².

Conclusion

The use of bisphosphonate was associated with favorable graft outcomes, even with a low TTLs. Incorporating bisphosphonate to a conventional immunosuppressant regimen Could potentially reduce tacrolimus requirement.
#1650 Synergistic effects of mineral bone disorder (MBD) markers and iron metabolism markers on QT prolongation in maintenance haemodialysis patients
Authors: Sasaki Sho , Fujisaki Kiichiro , Joki Nobuhiko
Published: May 2024

Background and Aims

Prolonged QT interval is known to be common in maintenance haemodialysis (HD) patients, and QT prolongation is a risk for the development of fatal arrhythmias and cardiovascular complications. Previously, we showed that low Ca and low or high P before dialysis were associated with QT prolongation in HD patients. In this study, we aimed to investigate the effect of abnormalities in MBD markers such as Ca and P on QT time when added to abnormalities in markers of iron metabolism, a known cardiac prognostic factor due to abnormal energy metabolism in the myocardium.

Method

A cross-sectional study was conducted on adult maintenance HD patients enrolled in the 2020 Japanese Society for Dialysis Therapy Annual Survey. Patients with dialysis frequency less than 3 times per week and patients with absent serum Ca, serum P, transferrin saturation (TSAT), serum ferritin, and QTc were excluded. After describing patient characteristics, an analytical-epidemiological study was conducted with serum Ca, P, TSAT, and serum ferritin as exposure and QTc >500 msec as outcome. Exposure was defined as cut off values for Ca, P, TSAT, and serum ferritin of 8.4/10, 3.5/6, 20/40, and 100/300, respectively according to JSDT guideline. Adjusted variables in the multivariate analysis were age, gender, history of dialysis, BMI, and presence or absence of diabetes, previous cardiovascular disease, P adsorption medication, vitamin D analogue use, calcimimetics use. Missing values were addressed using Multiple Imputation by Chained Equations. All analyses were performed using STATA 18.0. The significance level was set at 5%.

Results

169 705 patients were analysed. Among all subjects, 65.6% were male, mean age was 69.7 years (standard deviation (SD) 12.4), 50.6% had comorbid diabetes, 24.1% had previous cardiovascular disease, and mean serum Ca and P levels were 8.6 mg/dL (SD 0.7) and 5.2 mg/dL (SD 35.8), respectively. The mean QTc was 452 msec (SD 37.9). In multivariate analysis, the increased risk of QT prolongation in the low Ca, low P, and high P categories was further increased with low TSAT and cancelled with high TSAT (Table). In contrast, no such effect was appeared for ferritin.

Conclusion

The present study suggests that the association between lower serum Ca and lower and higher serum P levels and QTc prolongation in maintenance haemodialysis patients may be enhanced at low TSAT levels and weakened at normal and high TSAT levels.
#2082 Effectiveness of a surveillance protocol and early mTORi conversion according to Urine BK viral load in Thai kidney transplant recipients
Authors: Larpparisuth Nuttasith , Panyathammarat Pattaranun , Ratchawang Nartsiri , Skulratanasak Peenida , Premasathian Nalinee , Vongwiwatana Attapong
Published: May 2024

Background and Aims

BK viral nephropathy (BKVN) is a crucial cause of early kidney allograft failure. Early detection and prompt treatment in the case of a high urine viral load might be more advantageous than waiting until BK viremia occurs. Data regarding outcome of BK infection based on adjustments of immunosuppression according to urine viral load is limited.

Method

A prospective cohort study of kidney transplant (KT) recipients at Siriraj Hospital, conducted between January 2015 and June 2020, involved monitoring urine BK viral load (RT-PCR) at 1, 2, 3, 6, 12, 18, and 24 months after KT. Determination of BK viremia and adjustments to immunosuppression were performed in patients with urine BK viral loads exceeding 1,000,000 copies/ml or demonstrating progressive increments in BK viruria. Initially, mycophenolate (MPA) dosage was reduced, and subsequently, conversion to mTOR inhibitors was considered for non-responsive cases. Data on the overall incidence and risk factors of BK viremia and/or BKVN were collected.

Results

Out of a total of 339 enrolled patients, 234 (69%) underwent deceased KT, and 49 (14.5%) received induction therapy with anti-thymocyte globulin. The incidence of BK viruria, viremia, and BKVN were 38.6% (131 patients), 9.7% (33 patients), and 4.1% (14 patients), respectively. The median time of occurrence for BK viruria and BKVN was 3 (IQR 1-12) and 4.5 (IQR 3–18) months after KT, respectively. Most BKVN cases (71.4%) developed within the first six months post KT. We did not find any significant risk factors associated with the occurrence of BK viremia or BKVN. Regarding the adjustment of immunosuppression, the initial reduction of MPA dosage was effective in 48 out of 92 patients (52.17%). In cases with an extremely high urine BK viral load or no response to MPA reduction, 46 patients received a change from MPA to everolimus, which was successful in 38 patients (82.6%). No graft loss due to BKVN was observed throughout the study.

Conclusion

The incidence of BK infection after KT in Thai recipients is high, comparable to western population. A surveillance protocol with urine BK viral load and early mTORi conversion is effective for prevention of allograft loss from BKVN.