bluuebunny/crossref_metadata_2025 huggingface dataset:
#2147 Enoxaparin dosing in advanced chronic kidney disease: importance of monitoring with anti-Xa levels
Authors: Corona Clara Maria Cases , Melero Eva López , Triska Eugenia Landaluce , León Mariana , Roldán Deborah , Gruss Enrique , Shabaka Amir
Published: May 2024

Background and Aims

Enoxaparin is a low-molecular-weight heparin (LMWH) that is commonly used in the prevention of deep venous thrombosis (DVT) and the treatment of acute thomboembolic diseases. Current literature indicates that in advanced chronic kidney disease (CKD), there is a reduced clearance and increased half-life of LMWH and therefore, a dose adjustment is recommended. The prescription label recommends a dose adjustment of enoxaparin to 0.5 mg/kg/day for prophylaxis of DVT and 1 mg/kg/day for therapeutic anticoagulation when eGFR <30 ml/min. The aim of this study was to examine the accuracy of this dosing strategy to achieve the desired target of anticoagulation in advanced CKD.

Method

We conducted a prospective study in patients admitted from May 2019 to April 2023 in the Nephrology ward at our centre, who started anticoagulant treatment with enoxaparin during their in-hospital stay for prophylactic or therapeutic indications. We excluded patients with eGFR >30 ml/min at the onset of anticoagulation with enoxaparin. The dosing strategy was 0.5 mg/kg/day for prophylaxis of DVT and 1 mg/kg/day for therapeutic anticoagulation in all patients. Blood samples were drawn 4 hours after the third dose of enoxaparin to monitor anti-Xa levels in all cases.

Results

The study included 153 patients; 70 patients with stage 4-5 CKD and 83 patients on renal replacement therapy. 132 patients (86.3%) received enoxaparin for a therapeutic indication, while 21 patients (13.7%) received it as prophylaxis of DVT.

In patients receiving enoxaparin for a therapeutic indication, 73 patients (55.3%) reached the therapeutic target anti-Xa levels (0.6-1), while 32.6% of patients had peak anti-Xa levels below the therapeutic target (<0.6) and 12.1% were over-anticoagulated (>1). There was an inverse relationship between the proportion of patients who were adequately anticoagulated and CKD stage; 66.7%, 58.6% and 48.6% of patients reached the target peak anti-Xa levels in CKD stage 4, 5 and 5D respectively. There was no significant association between anti-Xa levels and obesity or liver disease.

In patients receiving enoxaparin for prophylaxis of DVT, 42.9% reached the target anti-Xa levels for prophylaxis (0.3-0.6), while 38.1% had anti-Xa levels below this range and 19% were over-anticoagulated.

Conclusion

The enoxaparin dosing recommendations indicated by its label entails a high proportion of patients with advanced CKD who do not achieve the target therapeutic levels of antiXa, especially in patients on renal replacement therapy.

To ensure adequate anticoagulation in these patients, we recommend using individualized dosing adjustments based on monitoring of anti-Xa levels for the prevention of thromboembolic events and reducing the risk of hemorrhagic events.
#1429 Daily urinary potassium excretion is not a fixed percentage of daily potassium intake
Authors: van Vliet Anne Myrthe , Rauh Manfred , Vogt Liffert , Titze Jens , Engberink Rik Olde
Published: May 2024

Background and Aims

High potassium intake is associated with a lower blood pressure and lower incidence of chronic kidney disease. Since a significant amount of potassium is lost via stool, the World Health Organization advices to multiply 24-hour renal potassium excretion by 1.3 for estimation of dietary intake. We analyzed whether this 1.3 factor for potassium intake varies in healthy volunteers and evaluated whether factors associated with tissue cation storage, namely sodium intake, aldosterone, cortisol and urine volume, affect the renal potassium excretion.

Method

We performed a post-hoc analysis of the long-term sodium balance studies Mars105 and Mars520. Ten healthy male participants consumed a fixed amount of salt (6, 9 and 12 grams/day for >29 days) and potassium (4 grams/day) for 105 (n = 4) and 205 days (n = 6). During the entire study period all urine was collected in 24-hour aliquots. We calculated the percentage of potassium intake that was excreted in the corresponding 24-hour urine collection during steady-state. We assessed whether this percentage was associated with sodium intake, potassium intake, urinary aldosterone, urinary cortisol and urine volume using a multivariable mixed-effects model.

Results

Overall, the median renal potassium excretion was 80% of potassium intake (IQR 65-97%; range 24-304%). This corresponds to a conversion factor of 1.25 (IQR 1.03-1.54). Within individual subjects we also observed a marked day-to-day variation in the percentage of renal potassium excretion: the average intraperson width of the IQR was 25%.

A higher sodium intake was associated with an increased percentage of renal potassium excretion, whereas a higher potassium intake was associated with a decreased percentage of renal potassium excretion. A significant positive interaction between the effects of sodium and potassium intake was present (P < .001; Fig. A). Furthermore, urinary aldosterone (Fig. B), urinary cortisol (Fig. C) and urine volume (Fig. D) were positively associated with the percentage of renal potassium excretion.

Conclusion

The percentage of consumed potassium that is excreted via urine shows considerable intra- and inter-subject variability. During steady-state this percentage is independently affected by sodium intake, potassium intake, urinary aldosterone, urinary cortisol, and urine volume. Our results suggest that the WHO's fixed 1.3 conversion factor may lead to inaccurate estimations of potassium intake.
#951 Structural and functional indicators of the left heart in the aspect of contrast-induced nephropathy
Authors: Daminova L T , Kadirovich Muminov Davron , Muminova Sitora
Published: May 2024

Background and Aims

To study the structural and functional features of the left heart in patients with coronary artery disease depending on the development of contrast-induced nephropathy (CIN) against the background of radiopaque endovascular procedures (REP).

Method

The study included 303 patients with stable forms of coronary artery disease who underwent X-ray endovascular procedures (REP). Patients with eGFR, determined by serum creatinine concentration, less than 60 ml/minute were not included in the study. 20 healthy volunteers were examined as a control group. All patients were divided into 2 groups - patients with an uncomplicated postoperative period of REP (CIN- group, 206 patients, 67.99%) and patients who developed contrast-induced nephropathy (CIN+ group, 97 patients, 32.01%). Subsequently, the CIN+ and CIN- groups were retrospectively compared based on baseline echocardiographic parameters.

Results

The present study demonstrated that EchoCG predictors of CIN in patients with stable forms of coronary artery disease are dilatation of the left ventricular (LV) cavity more than 136 ml (relative risk 1.65, p < 0.01), an increase in the index of impaired regional contractility of the LV to 1.2 points or higher (relative risk 1.77, p < 0.01) and a decrease in the e/a ratio of tissue Dopplerogram of the lateral edge of the mitral annulus to 0.7 relative units or less (relative risk 1.59, p < 0.01).

Conclusion

In patients with coronary artery disease after REP, despite the improvement in the index of impaired regional contractility and the index of LV sphericity, in the CIN+ group there is a more significant deterioration in the structural and functional properties of the LV myocardium, which manifested itself in an increase in systolic myocardial stress, a decrease in ejection fraction and an increase in the degree of diastolic dysfunction, which indicates a toxic effect of the radiocontrast drug not only on the kidneys, but also on the myocardium.
#2775 ERCOS multicenter Spanish study: clinical profile of patients with chronic kidney disease G3a-G5D and osteoporosis
Authors: Jiménez Elisabeth Masso , Sanjuan Jordi Bover , Casado Enrique , García Minerva Rodríguez , Lloret Maria Jesus , Alonso Cristina Castro , Henriquez Fernando , Gifre Laia , Calvo José Antonio Herrero , Teruel Jose Luis Górriz , Gómez Carlos , Navarro-González Juan F
Published: May 2024

Background and Aims

Fracture risk evaluation has recently been integrated into the 2017 KDIGO CKD-MBD (Chronic Kidney Disease- Mineral and Bone Disorder) guideline and its 2021 Spanish endorsement. It is now suggested to test bone mineral density (BMD) to assess fracture risk “if results will impact treatment decisions”. In fact, multiple new prospective studies have now documented that lower BMD predicts incident fractures in patients with CKD G3a–G5D. However, we scarcely know current real clinical practice in this population. Thus, the aim of the ERCOS (“Enfermedad Renal Crónica OSteoporosis”) study was to describe the clinical profile of patients with CKD who had been diagnosed of osteoporosis in outpatient Nephrology and Rheumatology clinics in Spain.

Method

ERCOS is a descriptive, observational, and multicenter Spanish study. Patients were recruited by consecutive sampling from 15 different Spanish hospitals. Osteoporosis characteristics (history of fragility fracture, BMD and other fracture risk factors), associated comorbidities, biochemical parameters and treatment were analyzed.

Results

A total of 163 patients (median age 77 years old) were included. Most were women (71.2%) and 98.3% of them were postmenopausal. Hypertension was the most frequent comorbidity (87.1%) and “attributed” cause of CKD (43.2%). Diabetes mellitus and cardiovascular disease were present in 35.6% and 29.4% of patients, respectively. Median estimated glomerular filtration rate was 36 ml/min/1.73 m2 [creatinine 1.48 mg/dl (95% CI 1,2-2)]. 38% of patients were G5D CKD patients (95.2% undergoing hemodialysis). 37.7% of patients had had a fragility fracture after the diagnosis of CKD (vertebral 52.5%, hip 24.6%, wrist 21.3%, humerus 16.4%, among others). Importantly, despite the diagnosis of osteoporosis, only 60.1% of the patients received specific treatment (mainly bisphosphonates or denosumab). Moreover, antiosteoporotic treatment was much more frequently prescribed by rheumatologists (46.9%), internal medicine physicians (23.5%), and only 13.3% was prescribed by nephrologists. 19.4% of patients suffered from fragility fractures even after initiating specific treatment.

Conclusion

Most patients with moderate and severe CKD with osteoporosis were old postmenopausal women with a high prevalence of diabetes or cardiovascular disease. Although about 40% had even suffered a fragility fracture, there is a high treatment gap, especially relevant among nephrologists. A call to action and to avoid existing therapeutic nihilism seems necessary, expanding the knowledge of the new more proactive guidelines and homogenizing the care and therapeutic approach in these patients.
#1051 Association between anemia/iron deficiency and health-related quality of life in patients with advanced CKD: the Reach-J CKD cohort study
Authors: Okubo Reiko , Ohigashi Tomohiro , Kondo Masahide , Tsunoda Ryoya , Kai Hirayasu , Saito Chie , Okada Hirokazu , Narita Ichiei , Hoshino Junichi , Maruyama Shoichi , Wada Takashi , Yamagata Kunihiro
Published: May 2024

Background and Aims

Low Hb and low TSAT levels are associated with worse health-related quality of life (HRQOL) in patients from Brazil, France and USA in the CKD outcomes and Practice Patterns Study (CKDopps). However, there is little evidence for those in Asian countries. We aimed to evaluate the association between anemia/iron deficiency and HRQOL in Japan.

Method

We conducted a nationwide cohort study of Japanese patients with advanced CKD. We recruited 2249 patients with stage G3b-5 CKD receiving nephrologist care from 31 representative facilities throughout Japan, randomly selected with stratification by region and facility size, aligned with the CKDopps. The association between Hb and TSAT levels at enrolment and HRQOL derived from KDQOL-36 was evaluated.

Results

Mean age was 69.1 ± 12.6 years; 35.2% were female; mean body mass index was 23.6 ± 4.8 kg/m, mean eGFR was 23.2 ± 10.5 mL/min/1.73 m2. Mean Hb was 11.7 g/dL, mean TSAT was 31.4% and ferritin was 147.4 ng/mL. The mean physical component summary (PCS) scores, mental component summary (MCS) scores and scores on the three KDQOL subscales were worse with Hb <10, compared to ≥10 g/dL. Few differences in PCS and MCS scores were seen between the TSAT levels.

Conclusion

In Japanese patients with CKD, HRQOL was worse with Hb <10 g/dL and not associated with TSAT levels. These data will provide important information for international comparisons and the clinical practice of Asian patients with CKD.
#708 Retrospective analysis of the real-world experience of desidustat in the treatment of chronic kidney disease induced anemia
Authors: Pahari Dilip
Published: May 2024

Background and Aims

Chronic kidney disease (CKD) is commonly associated with an increased risk of anemia, which significantly impacts patients' quality of life and increases morbidity and mortality. Current treatment options for anemia in CKD, such as injectable erythropoiesis-stimulating agents (ESAs) have limitations and safety concerns. Desidustat, a novel oral hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) has shown promise in stimulating endogenous erythropoiesis and addressing anemia in CKD. Therefore, the present study assesses the real-world clinical efficacy and safety of the desidustat treatment for a short duration of 6 months (24 weeks) in CKD patients with anemia.

Method

This is a retrospective analysis of 140 patients at our center who received Desidustat as a treatment for CKD anemia. Desidustat was initiated in all patients at 100 mg three times a week. Dose adjustment was done every 4 weeks as per the Hb level of the patient. The duration of the study was 6 months. The primary endpoint of the present study was a change in Hb from baseline with desidustat therapy and the secondary endpoint was safety of the treatment.

Results

The majority of the patients were Pre-dialysis 74.28% (n = 104) and 25.72% (n = 36) were dialysis-dependent patients. Of 36 dialysis-dependent patients; 75% (n = 27) were on dialysis three times a week, rest were on twice-a-week dialysis. In the current study, the majority of patients had Hypertension (95.7%) and diabetes (68.57%) as co-morbidities. All the patients in the current study were maintained with 100 mg Desidustat, however, 9.2% (n = 13) required dose reduction, and 11.42% (n = 16) required an increased dose of desidustat on the follow-up visit. In both Pre-Dialysis and dialysis-dependent patients, there was a sustainable rise in the mean Hb levels at the end of 24 weeks from baseline (1.05 g/dL; p < 0.05) All the patients tolerated desidustat well. In the present study, we didn't observe significant side effects related to the therapy apart from 2.41% (n = 3) cases of Diarrhoea and Vomiting.

Conclusion

Desidustat is effective in increasing Hb in CKD Anemia patients in the short run. However, Long-term studies are required to establish the efficacy and safety of this novel therapy.
#1452 Halting the progression of chronic kidney disease; an audit of the use of renin-angiotensin-aldosterone blockers and SGLT-2 inhibitors
Authors: Teh Jia Wei , Harris Luke , Corcoran Niamh , Lappin David
Published: May 2024

Background and Aims

Sodium-glucose cotransporters-2 inhibitors (SGLT2i) were initially developed for the treatment of type 2 diabetes. Multiple studies have demonstrated the renoprotective effect of SGLT2i, with the capacity to slow diabetic kidney disease and non-diabetic proteinuric chronic kidney disease progression. More recently, the EMPA-KIDNEY trial demonstrated a benefit in patients with chronic kidney disease with a wider range of albuminuria and glomerular filtration rate. We aim to identify the proportion of patients on renin-angiotensin aldosterone system blockade (RAASb) such as angiotensin converting enzyme inhibitor (ACEi), and angiotensin II receptor blocker (ARB), and sodium-glucose transporter-2 inhibitor (SGLT2i) in our Nephrology outpatients clinic. We also aim to encourage awareness and prescribing of RAASb and SGLT2i in eligible patients with CKD.

Method

A prospective audit was performed in Galway University Hospital (GUH) from September 2023 to October 2023. The audit questionnaire was completed by doctors reviewing patients in OPD. The use of ACEi/ARB/SGLT2i was recorded during the consultation.

Results

165 patients were included in the audit with a mean (±SD) age of 62.1 ± 18.6 years. The 3 most common primary renal diagnoses were diabetic kidney disease; 20/165 (12.1%), hypertensive renal disease; 18/165 (10.9%) and IgA nephropathy; 15/165 (9.1%). The mean estimated glomerular filtration rate (eGFR) was 46.8 ± 24.5 ml/min/1.73 m². At baseline, 94/165 (57%) were already on RAASb, none on dual RAASb agents. 20/165 (12.1%) were already on SGLT2i, amongst these, 15/20 (75%) were also on RAASb at the time of the OPD consultation. 13/165 (7.9%) patients were maximised on RAASb and 4/165 (2.4%) commenced an SGLT2i at the clinic visit. Guideline directed medical therapy according to the EMPA-Kidney and UK Kidney Association Clinical Practice Guidelines would suggest missed opportunity on therapeutic optimisation with RAASb and SGLT2i in 66/83 (79.5%) patients; 26/66 (39.4%) were neither on RAASb or SGLT2i, 34/66 (51.5%) were on RAASb but not on SGLT2i, 3/66 (4.5%) were on SGLT2i but not on RAASb, and 3/66 (4.5%) were on sub-maximal RAASb with an SGLT2i.

Conclusion

There is new evidence to support the use of SGLT2i, in those with chronic kidney disease with a wide range of albuminuria. SGLT2i use is underutilised in our clinic. Ideally, these patients should be initiated on an SGLT2i after being established on a RAASb early in their diagnosis to ensure the optimal renoprotective effects of SGLT2i.
#178 Patient survey reveals insights into patient perceptions and understanding of polycystic kidney disease
Authors: Larkin Amy
Published: May 2024

Background and Aims

This patient survey examines patient knowledge of polycystic kidney disease (PKD) and provides insights into their preferences, and communication received from healthcare teams.

Method

A 20-question, online, patient-facing survey was deployed on WebMD.com. Respondent confidentiality was maintained, and responses were de-identified and aggregated prior to analyses. No personally identifiable information was collected for the respondents in this study. The activity launched in April 2023 and data were collected through August 2023.

Results

In total, 331 people participated in the survey. Key clinical takeaways include:

Conclusion

Patient experiences across several aspects of PKD were assessed in this survey to provide clinical insights into education for patients and clinicians. This educational research study uncovered valuable insights into the patient/caregiver experience as it relates to PKD. The findings and trends in healthcare utilization identified in the survey help to provide insight for future education for both clinicians and patients/care partners.
#876 Albuminuria and the risk of dementia and different dementia subtypes: the Stockholm Creatinine Measurements (SCREAM) project
Authors: Luo L I , Gansevoort Ronald , Kieneker Lyanne , Yang Yuanhang , Bosi Alessandro , de Boer Rudolf , Franssen Casper F M , Eriksdotter Maria , Carrero Juan-Jesus , Xu Hong
Published: May 2024

Background and Aims

Studies investigating the association of chronic kidney disease and dementia predominantly focused on estimated glomerular filtration rate (eGFR) rather than albuminuria. The few studies focusing on albuminuria reported conflicting results, probably due to a lack of power, not taking into account the different dementia subtypes, not adjusting for eGFR, and the use of different albuminuria measurement techniques. This study therefore investigated the eGFR-independent risk of all-cause and type-specific dementia associated with albuminuria, quantified as urine albumin-creatinine ratio (ACR) and by dipstick, in a large population.

Method

We included subjects from the Stockholm Creatinine Measurements (SCREAM) project without a history of dementia and with age ≥65 years. The main analyses involved 138 688 subjects with at least one ACR test, and for sensitivity analyses, we involved 170 572 subjects with at least one dipstick proteinuria test. Albuminuria was quantified as KDIGO albuminuria A1-A3 stages. The primary outcome was incidence of all-cause dementia, and the key secondary outcomes were incidence of type-specific dementia. Dementia incidence was ascertained by record linkage with the national dementia registry (SveDem). ICD-10 coding was also used to classify subtypes only when there were no available dementia records in SveDem. Multivariable Cox regression models were used to calculate hazard ratios (HRs, 95% CIs) crude, and adjusted for confounders including baseline eGFR.

Results

During a median follow-up of 3.9 (IQR, 1.8-7.2) years, 9 970 subjects developed de novo dementia. After multivariable adjustment including baseline eGFR, subjects with an ACR of 30-299 mg/g or ≥300 mg/g had a 26% (HR, 1.26; 95% CI, 1.20-1.32) and 36% (HR, 1.36; 95% CI, 1.24-1.50) higher risk of developing all-cause dementia, respectively, when compared to subjects with an ACR <30 mg/g. Subjects with an ACR of 30-299 mg/g also presented a higher risk of developing several type-specific dementia, including Alzheimer's dementia (HR, 1.09, 95% CI, 1.01-1.17), vascular dementia (HR, 1.35, 95% CI, 1.22-1.48), and unspecified dementia (HR, 1.54, 95% CI, 1.41-1.69). No significant associations between albuminuria and the incidence of Lewy body dementia and Parkinson's Disease with dementia, frontotemporal dementia, as well as other types of dementia were observed. These results were generally robust in several sensitivity analyses, including replicating our main analyses in subjects with a dipstick proteinuria test instead of an ACR.

Conclusion

Increased albuminuria is associated with a higher risk of all-cause, Alzheimer's, and vascular dementia, independent of baseline eGFR and different albuminuria measurement techniques.
#1024 Lung ultrasound in 28 versus 8 places and volume status in chronic hemodialysis patients
Authors: Varda Luka , Petreski Tadej , Jensen Sophie Fromholt , Chamkar Ikram , Bilici Bilge Nur , Ekart Robert
Published: May 2024

Background and Aims

Overhydration is considered a significant risk factor for cardiovascular and all-cause mortality in end-stage kidney disease patients. Measurement of total and extracellular water with bioelectrical impedance analysis (BIA), inferior vena cava diameter (IVCd) measurement, and circulating pro-B-type natriuretic peptide (proBNP) levels have previously been tested as possible indicators of volume status in hemodialysis (HD) patients, with BIA showing the most potential. Recently, it has been shown that lung ultrasound (LUS)-guided volume depletion is an effective strategy for relieving lung congestion in chronic HD patients. The aim of our study was to determine whether performing LUS on only 8 places was comparable to the regular 28 places.

Method

LUS was performed on 29 randomly selected patients before their regular HD procedure in 28 regular places and correlated with 8 places (4 on each side). In addition, BIA with a body composition monitor (BCM) was performed, IVCd was measured using ultrasound and serum NT-proBNP value was determined. Statistical analysis was performed using a commercially available SPSS® for Windows® (version 29.0; Chicago, IL, USA). Spearman's non-parametric test was used to determine a correlation between variables. P-values less than 0.05 were considered statistically significant.

Results

We included 29 chronic HD patients, 15 male (51.7 %), with a mean age of 66.3 ± 12.5 years and a median dialysis vintage of 53.0 (95% CI (40.9, 100.6)) months. Most patients (96.6 %) had a functional arteriovenous fistula, whereas only one patient (3.4 %) was dialysed using a Hickman catheter. A very strong, directly proportional correlation was found between performing LUS in 28 and 8 places (ρ=0.909; p<0.001). A significant moderate correlation was also found between both LUS in 28 and 8 places and systolic blood pressure (ρ=0.503; p=0.005 and ρ=0.467; p=0.011, respectively) (Table 1). Neither of the LUS methods statistically correlated with other tested volume markers – overhydration, intracellular and extracellular volume measured with BIA, IVCd in inspiration and expiration and IVC index, or serum NT-proBNP levels.

Conclusion

In our study, we found a very strong, positive, and significant correlation between performing LUS in 28 regular places and 8 places. Both also moderately correlated with systolic blood pressure. However, we did not find a statistically significant correlation between LUS and other tested volume markers.
#2778 The Charlson Index can be used prospectively to identify patients who will need a close follow up of surveillance for the vascular access
Authors: Franco Antonio José Marín , Sánchez Christian Israel Alfaro , Pizarro Jose Luis , Sorribes Mª Paz , Martínez-Vaquera Shaira
Published: May 2024

Background and Aims

The primary screening methods for monitoring vascular access in haemodialysis involve measuring access blood flow and dialysis venous pressure. However, challenges are present in both aspects, potentially hindering the attainment of desired results. Research in this field is crucial to identify the optimal combination of intensive clinical monitoring and supplementary surveillance for effective outcomes.

For this reason, we aim to describe the impact of comorbidities and patency of native arteriovenous fistulae (nAVF).

Method

Descriptive study of prevalent patients on haemodialysis, carried out by consulting electronic medical records over a period of 35 months. Demographic and vascular access-related variables were included. Primary and secondary patency was calculated for all accesses. Patients with upper limb AVF were classified according to distal and proximal access location; and the Charlson Index was used to categorise patients according to comorbidities. Kaplan Meyer survival curves were used to contrast the impact of comorbidities on the different patency.

Results

52 patients, age 70.7 ± 1.57 years, 69.2% male, 42.3% diabetic, Charlson index with a median of 7 (6.5 - 7.73), 98.1% with a native fistula, the most frequent nAVF location in our population was humerocephalic (63.5%) and a predominance of the left upper extremity (65.4%). According to the location of the access, adjusted by the Charlson index, it is evident that in proximal accesses (humerocephalic and basilic humerus nAVF), with a Charlson Index less than or equal to 7, the time required to reach an event was statistically significantly longer (Log Rank Test (Mantel-Cox): primary patency p=0.057 and secondary patency p=0.069). This comparison was not significant in distal fistulas.

Conclusion

Using the Charlson comorbidity index information, we transformed it into an accessible and valuable tool for maintaining vascular access patency. Close follow-up in patients with proximal nAVF and high Charlson comorbidity index could be beneficial.
#2885 Thrombosis complicating the first native arteriovenous fistula: what are the risk factors?
Authors: Smii Amani , Ikram Mami , Hiba Ghabi , Syrine Tlili , Lamia Rais , Fatma Lilia Ben , Zouaghi Karim
Published: May 2024

Background and Aims

The native arteriovenous fistula is considered the best vascular access for hemodialysis, whose ultimate complication is thrombosis. The risk factors for this complication are multiple. The aim of our work is to determine the risk factors for thrombosis of the first created native AVF.

Method

This is a retrospective descriptive study of 65 patients over 18 years of age and hemodialyzed in our department who benefited of the confection of a native arteriovenous fistula at the same hospital.

Results

Arteriovenous fistula thrombosis occurred in 41.53% of patients with an average age of 49.4 years and a sex ratio M/F=3.5.

59.2% of arteriovenous fistulae were distal versus 40.7% proximal, divided into humerocephalic (29.6%) and humerobasilic (11.1%).

AVF thrombosis occurred after a mean duration of 3.19 years after its confection [01 months, 13 years].

25.9% of arteriovenous fistulae had not yet been punctured.

63% of patients were smokers, 55.6% were diabetics, 74.1% were hypertensive and 66.7% were cardiac with predomination of ischemic etiology in 29.6%.

44.4% of patients had obliterative arteriopathy of the lower limbs, 25.9% of whom were amputees.

Patients had been on dialysis for an average of 4.4 years [01 months, 13 years], with diabetic nephropathy predominating at 51.9%.

All patients were on antiplatelet therapy and 7.4% on anticoagulation.

11.1% had perdialytic hypotension.

Multivariate statistical analysis revealed a significant correlation between anemia, diabetes and the occurrence of thrombosis (respectively p = 0.03; p = 0.024).

Conclusion

Patients with arteriovenous fistula thrombosis have multiple cardiovascular risk factors. Diabetes and anemia remain the main predictive factors for thrombosis.
#865 Autologous cephalic vein transposition in the placement of forearm arteriovenous fistulas
Authors: Lomonte Carlo , Corciulo Simone , Libutti Pasquale , Bagagli Francesca , Robles Sara , Montinaro Vincenzo
Published: May 2024

Background and Aims

The autologous vein transposition was commonly used for hemodialysis vascular access (VA) in selected patient. The saphenous vein was used as a vascular graft; while, the contralateral cephalic vein was used as a bridge. We describe a new technique of autologous cephalic vein transposition to create a native AVF in hemodialysis patients.

Method

Patients referred to our hospital for a vascular access placement. US vascular mapping of upper extremities revealed small arteries, but adequate forearm veins in all patients. Specifically, the radial artery luminal diameter was < 1.4 mm and < 1.6 mm, respectively at wrist and at middle-arm. While, at bend of the elbow, the ulnar artery diameter (>2.5 mm) in one case, and the brachial artery diameter (>3.5 mm) in two cases, were deemed adequate as feeding arteries of a possible AVFs. Furthermore, the diameter of the forearm cephalic vein ranged from 2.0 to 2.4 mm; in the upper arm the veins were obstructed or stenotic in one of the two arms. The basilic vein was patent in both arms of the patients; the internal diameter varied from 2.5 to 2.7 mm. Due to difficulty to create a traditional fistula, and higher risk of primary failure, it was decided to transpose the cephalic vein, from the forearm not suitable for the AVF, to the contralateral arm chosen for the AVF placement.

Results

With local anesthesia, an approximately 10-cm stretch of cephalic vein was harvested from the arm contralateral to the site chosen for AVF. Then, the transposed veins, reversed in their cranio-caudal position, were tunneled subcutaneously and anastomosed, in an end-to-end fashion, with cephalic vein at wrist region, and subsequently in a side-artery to end-vein at the elbow crease. The transposed AVFs were created in three patients with ESKD (2M/1F), mean age 47± 3.6 years, (two in the non-dominant arm), without complications. After 4 weeks, all the AVF were patent and the access flow was 660±120 ml/min. All the three AVF was deemed mature and usable for hemodialysis.

Conclusion

In selected cases, autologous transposition of the cephalic vein can be used to create an AVF, providing a long segment for cannulation. This type of AVF can be an alternative to prosthetic fistula, sparing the central venous catheter.
#831 Associations of quality of life with hospitalization for infection and subsequent death in hemodialysis patients: Osaka Dialysis Complication Study
Authors: Nagata Yuki , Shoji Tetsuo , Nakatani Shinya , Mori Katsuhito , Morioka Tomoaki , Emoto Masanori
Published: May 2024

Background and Aims

Health-related quality of life (HRQOL) as self-reported health status is known to predict mortality in hemodialysis (HD) patients. Infection is one of the major causes for death in those patients, although limited studies have examined possible associations of HRQOL with infection-related outcomes. In the present study, we examined the associations of HRQOL scores with all-cause mortality, hospitalization for infection, and subsequent death in HD patients.

Method

Patients for this study were selected from the Osaka Dialysis Complication Study (ODCS) which is a prospective cohort study from 2012 to 2017 including a total of 1696 HD patients. HRQOL was assessed by Medical Outcomes Study short form 36 (SF-36) questionnaire to determine scores of the physical component summary (PCS) and the mental component summary (MCS) at baseline, and patients were divided into tertiles of them. The key outcomes were all-cause mortality, hospitalization for infection, and subsequent death after infection. Association was analyzed with Cox proportional hazards models or Fine-Gray models to estimate hazard ratios (HRs) with the highest tertile of PCS or MCS (T3) as referent. Models were unadjusted and adjusted for potential confounders including major demographic factors, traditional cardiovascular risk factors, and the factors related to chronic kidney disease-mineral and bone disorder (CKD-MBD), protein energy wasting and inflammation, and renal anemia.

Results

We analyzed data from 1464 patients, and we identified 384 all-cause deaths, 321 hospitalizations for infections, and 143 subsequent deaths following infection. Risk of all-cause death was the highest in the lowest PCS tertile in unadjusted model, and this association remained significant in multivariable-adjusted models. In addition, a lower PCS was significantly predictive of a higher risk of both hospitalization for infection in models unadjusted and adjusted for demographic variables, but not significant in a model adjusted for all confounders. However, risk of death after hospitalization for infection was significantly higher in the lowest PCS tertile in unadjusted and in multivariable-adjusted models, compared with the highest PCS tertile. In contrast, MCS was not associated with all-cause mortality, hospitalization for infection, or death following hospitalization for infection.

Conclusion

A low PCS was associated with both hospitalization for infection and subsequent death after infection in HD patients, but it was more closely associated with the latter. This study revealed that HRQOL, particularly its physical component, is an independent predictor of infection-related outcomes in this population.
#2377 Association of uremic toxins with morbidity and mortality in patients on hemodialysis
Authors: Tourountzis Theodoros , Lioulios Georgios , Van Laecke Steven , Stai Stamatia , Christodoulou Michalis , Moysidou Eleni , Fylaktou Asimina , Glorieux Griet , Stangou Maria
Published: May 2024

Background and Aims

Morbidity and mortality are increased in patients on hemodialysis (HD), and the possible impact of protein bound uremic toxins (PBUT) is of great interest. We assessed the association between PBUT serum levels and clinical events including cardiovascular (CVE), severe infections (hospitalization due to infection, respiratory infection) and all-cause mortality.

Method

In this prospective observational study, PBUT plasma levels [hippuric acid (HA), indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glycuronide (pCG), indole-3-acetic acid (IAA), 3-carboxy-4-methyl-5-propyl-2-furanpropionate (CMPF)] were quantified by ultra-performance liquid chromatography in 54 patients on HD (Age 51.3±16.91 years) and the association with future clinical events (CVE, hospitalization due to severe infection, respiratory infection and all-cause mortality) during 24 months follow up (FU), was assessed.

Results

In patients who died during FU (n=6), increased levels of total HA 6.42 (4.54) vs 2.75 (3.03)mg/dl (p=0.007), free HA 4.79 (3.93) vs 1.363 (1.85)mg/dl (p=0.004); free IxS 0.29 (0.29) vs 0.13 (0.17)mg/dl (p=0.045); total pCG 0.36 (0.5) vs 0.19 (0.28)mg/dl (p=0.045), free pCG 0.33 (0.43) vs 0.18 (0.26)mg/dl (p=0.042) were found. Moreover, in patients who experienced a CVE (n=11), a higher concentration of CMPF [0.39 (0.67) vs 0.15 (0.19)mg/dl (p=0.015)] was observed. No significant correlations were found between pCS and IAA levels with morbidity and mortality in this study.

A logistic regression model, describing the effect of each PBUT on death probability could explain 44% (Nagelkerke R2) of the variance in death and correctly classified 90.7% of cases. Patients with increased levels of free IxS, total and free HA were more likely to die within a 2-year FU period (p=0.047, p=0.013, p=0.003, respectively).

PBUT levels were not different among HD patients with and without severe infections.

Conclusion

Increased levels of PBUT (HA and free IxS) in patients on HD, associate with increased risk of death and CMPF with cardiovascular events.
#2973 COVID-19 increased hemodialysis patients’ mortality, relation with inflammation and telomere attrition
Authors: Kovačević Tamara , Pešić Snežana , Kotur-Stevuljevic Jelena , Naumovic Radomir
Published: May 2024

Background and Aims

An increased risk of mortality and hospitalization has been consistently demonstrated in patients with CKD who are additionally affected by corona virus disease 19 (COVID-19). In this study, we tried to identify predictive factors of mortality and hospitalizations, especially the ratio of neutrophils to lymphocytes (NLR), lactate dehydrogenase (LDH), c-reactive protein (CRP), disease status of COVID-19, telomere length in peripheral blood cells (TL) and 2-year risk score.

Method

A total of 130 chronic hemodialysis patients, were enrolled in the present study and followed up for 18 months. Routine laboratory parameters including LDH, were determined by standard automated methods, redox status parameters SOD and O2. - Using spectrophotometric methods.TL was determined using the modified Cawthon method and was calculated as the T/S ratio. Kaplan-Meier analysis was used to test survival predictors.

Results

Patients in deceased group (30%) were significantly older (p <0.001), with higher body mass index (BMI), (p < 0.01) than survived patients. Also, patients in the deceased group had higher levels of LDH, NLR index, CRP compared to survivors. Lower lymphocytes and shortened TL were characteristic of these patient groups, but the deceased group had the lowest lymphocytes (p < 0.005) and telomeres (p<0.002), and had the highest NLR (0.004). The difference in 2-years risk score also was significant (p < 0.001), with higher scores in the deceased group. Kaplan-Meier survival analysis showed six parameters were significant predictors in the following order of significance: COVID-19 status, 2-years risk score, NLR, TL, CRP, LDH. Using binary logistic regression analysis Summary risk score, a combination of these six parameters revealed as the best predictor of patients’ survival in this group of parameters (Log rank=25.4, P < 0.001).

Conclusion

Independent predictors of mortality in chronic haemodialysis patients are higher NLR, CRP, LDH, Lower lymphocytes and shortened TL, and COVID -19 made the situation even worse by significantly arising these patients’ mortality rate.
#2824 Use of proton pump inhibitors is not associated with post-dialysis fatigue and time of recovery after dialysis in patients on chronic hemodialysis
Authors: Mariani Ilaria , Bossola Maurizio , DI Stasio Enrico
Published: May 2024

Background and Aims

Chronic hemodialysis is often associated with post-dialysis fatigue (PDF), a condition characterized by extreme tiredness and lack of energy. PDF is a debilitating symptom that significantly impairs quality of life of hemodialysis patients. Furthermore, PDF is independently associated with the time to recover after dialysis (TIRD), which can be used as an indirect measure of PDF. Recent studies have shown that the use of proton pump inhibitors (PPI) is independently associated with the prevalence and severity of fatigue in kidney transplant recipients. The aim of this study is to determine whether the use of PPIs in patients undergoing chronic hemodialysis is associated with PDF prevalence and characteristics, as well as the TIRD.

Method

For this retrospective study, we recruited patients undergoing chronic hemodialysis and asked open-ended questions about their post-dialysis fatigue and time of recovery. Each patient was asked to rate the intensity, duration and frequency of their PDF on a scale of 1 to 5. We defined whether patients used a PPI (no PPI use or PPI use), the type of PPI used, the dose of PPI used, and the duration of the PPI use (<1 year or ≥1year).

Results

The study analysed 346 patients, of whom 259 used PPIs (55 used omeprazole, 63 esomeprazole, 54 pantoprazole, 87 lansoprazole, and 7 rabeprazole) and 87 did not. Among the patients, 232 reported suffering from PDF, while 114 did not. The median [min-max] TIRD was 210 minutes [0-1440]. The prevalence of PDF in PPI users and non-users was 67% and 68%, respectively (p= 0.878). There was no significant difference in the median [min-max] TIRD between PPI users and non-users (180 [0-1440] and 240 [0-1440], respectively; p=0.871). Additionally, there was no significant difference in the median PDF intensity, duration, frequency, and severity PPI users and non-users. The prevalence of PDF was similar among the different types of PPI used and did not differ with respect to PPI non-users. Duration of PPI exposure was <1 year in 42 patients and ≥1 year in 224 patients. There was no difference in prevalence of PDF between the two exposures. The correlation matrix showed no statistical significance between PPI equivalent dose, treatment duration, PDF frequency, PDF characteristics, and TIRD.

Conclusion

There is no association between the use of PPIs and PDF or time of recovery after dialysis in patients on chronic hemodialysis.
#1624 The association between serum beclin 1 level and the presence of aortic valve calcification among individuals on hemodialysis
Authors: Ahmed Fatma Abdelrahman , Hebah Hayam Ahmed , Kamel Hadeer , Bastawy Islam
Published: May 2024

Background and Aims

The autophagy pathway, a crucial regulator of cellular health and metabolism, plays a fundamental role in maintaining healthy blood vessel function. Studies have established its critical involvement in endothelial cell stability, vascular smooth muscle cell (VSMC) phenotype control, and VSMC calcium balance. Recent evidence, further, underlines autophagy's direct protective role against vascular calcification. It has been shown that autophagy can modulate different cardiovascular pathologies, including valvular calcification. We aimed to explore the potential link between the protein beclin 1 and heart valve calcification in dialysis patients.

Method

We compared two groups of 51 haemodialysis patients each, defined by the presence (Group 1) or absence of valve calcification (Group 2) on echocardiograms. Both groups underwent beclin 1 level measurements and other assessments (lipid profile). Cardiac valve calcification was diagnosed through echocardiography by identifying dense echoes exceeding 1 millimeter in thickness on one or more aortic valve cusps. The severity of calcification was then classified into three stages:

Mild: Calcification thickness ranged from 1 to 3 millimeters and involved less than 50% of the valve leaflet.

Moderate: Calcification thickness exceeded 3 millimeters but still affected less than half of the valve leaflet.

Severe: Calcification thickness surpassed 3 millimeters and encompassed more than 50% of the valve leaflet.

Results

Our analysis demonstrated a statistically significant increase in beclin 1 levels in Group 2 compared to Group 1 (p<0.001), a striking relationship between lower beclin 1 levels and more severe valve calcification. Interestingly, a specific beclin 1 cutoff below 35.5 ng/ml offered the highest accuracy (98% sensitivity and 92% specificity) in predicting valve calcification. Notably, significant differences were found in lipid profiles (Analysis of the lipid profile revealed a striking trend in Group I, with significant elevations in cholesterol, triglycerides, and LDL. Conversely, HDL levels were significantly higher in Group II). and prevalence of heart disease between the groups. Analysis of IHD prevalence across the two groups yielded a striking result. Group 1 displayed a significantly higher proportion of individuals with IHD (17 cases) compared to group 2 (3 cases), with a statistically significant difference (p<0.001).

Conclusion

Based on these results, it appears promising to integrate serum Beclin 1 measurements into a risk assessment model for the development of heart valve calcification in dialysis patients.
#52 Pulmonary hypertension in hemodialysis patients: prevalence and risk factors: a single center study
Authors: Khedhiri Azza , Ami Drajalha , Boudawara Mohamed , Guermazi Ines
Published: May 2024

Background and Aims

Pulmonary hypertension (PH) is an underestimated cardiovascular trouble in patients on hemodialysis (HD). Therefore, we studied its prevalence, risk factors, association with inflammation, and cardiac changes in HD patients.

Method

This was a single-center cross-sectional observational study conducted at Sfax CNSS polyclinic hemodialysis center during October 2023. Patients on hemodialysis for at least three months were included and divided into those with and without PH; patients with secondary causes for PH were excluded. Clinical characteristics, HD-related factors, lab parameters, and echocardiography details were compared. PH was defined as a mean pulmonary artery pressure (PAP) of > 25 mmHg at rest, and it was further divided as mild (26–39 mmHg), moderate (40–60mmHg), and severe (> 60 mmHg). Mean levels of PAP were compared in different groups according to the main clinical parameters.

Results

Of 30 patients, 21 patients had PH (mild:15, moderate:4, and two had severe PH) with a prevalence of 70%, and a mean age of 58 years old. No difference was found in clinical characteristics, dialysis-related factors, and biochemical parameters. Inflammation seemed to be more important in the PH group but the difference was not statistically significant (mean C-reactive protein in the PH group vs. 5,69 in the non-PH group; p=0,34). Otherwise, according to echocardiography findings, PAP was significantly higher in patients with left ventricular failure(HF) (mean PAP in HF group vs. 31,12 in the non-HF group; p=0,011), in patients with right ventricular dilation(RVD)(mean PAP in RVD patients=47,83mmHg vs 28,88mmHg in the non-RVD group; p=0,05) and in patients with mitral regurgitation(MR) (mean PAP in MR group=40,18mmHg Vs 28,32mmHg in the non-MR group; p=0,04).

Conclusion

Haemodialysis patients have a high prevalence of PH, especially in patients with heart failure and ventricular dilation. PH was significantly associated with the presence of mitral regurgitation on echocardiography. Inflammation was slightly higher in PH but our study did not find significant differences in traditional risk factors, and HD-related factors between the groups with and without PH.